1	Social Trauma and Media Solutions
2	Agenda Mental health need Time of trauma -Movie- Media violence Mind Media
3	Equity argument
4	Mental Health Need
5	Global Mental Health Need Neuropsychiatric disorders account for more than a quarter of the years of life lived with a disability (DALYs). Depression is the fourth most important cause of DALYs - and will be the second most important in the year 2020. Suicide is the tenth leading cause of death in the world.
6	Lifetime prevalence in the ICPE Surveys Any anxiety disorder 5.6-25% Any mood disorder 7.3-19.4% Any addictive disorder 9.6-28.2% Any ICPE disorder 12.2-48.6%
7	Issues driving global mental health need (dalys)
8	Cost-effective treatments available for:
9	Contextual relationships: schizophrenia
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11	Overcoming barriers to Global Mental Health
12	Decrement in sustainability of effective programs
13	Economic argument
14	Mental health stress related costs 120 Billion Dollars (1999 in economic loss in Europe and North America) 3-4% of Europe’s GNP spent on mental health problems Stress and mental health problems are most common cause of disability related pension in Europe and North America
15	Losses due to depression (ILO) US: 200 million workdays lost each year Germany: 7% premature retirement - 2.2 billion DM loss - 2 1/2 times longer incapacitated Finland: 50% of workforce has stress related disorders - 7% suffer incapacitating ‘burnout’ Poland: Depression slows development
16	Summary of workplace costs of depression -in billions of 1990 US $- Absenteeism $24.5 (74.3%) While at work $8.5 (25.7%) Total $33.0 (100%)
17	A TIME OF TRAUMA
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20	Psychological sequelae of the September 11 terrorist attacks in New York City
21	Disasters that result in serious psychological sequelae Damage to property Financial problems Cause human intent (terrorism) Associated with a high prevalence of trauma or loss of life
22	Prevalence of DSM-III-R disorders from the National Comorbidity Study ^Kessler et al. 1995 ^*DHHS 1999 ^†Kessler et al. 1994 ^‡Blazer et al. 1994
23	Assessments of psychological sequelae after disasters Most research focusing on persons directly affected, i.e., injured or victims of those who died Different diagnostic scales and timeframes of assessment Relatively few studies examining psychological consequences of disasters in general population
24	PTSD after disasters ^Carr et al. 1997 ^*Hanson et al. 1995 ^†North et al. 1999 ^‡Smith et al. 1990
25	Study Measures Main outcomes NWS PTSD module Modified SCID MD measure Exposures Stressors, traumas, and supports before September 11 Physical proximity to World Trade Center Peri-event emotional reactions Event experiences Study period: Oct. 16-Nov. 16, 2001
26	Study design Sampling frame: Manhattan residents living below 110^th St. Sampling scheme: Random digit dialing Survey dates: October 16 to November 15, 2001 Sample size: 1008; 988 analyzed Response rate: 64.3% Weighting: persons and telephones in household Demographically equal and representative of the population
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28	Event experiences (n=988)
29	Re-experiencing symptoms after September 11
30	Avoidance symptoms after September 11
31	Hyper-arousal symptoms after September 11
32	Mental health in NYC post- Sept. 11^th
33	Multivariable model predicting PTSD after the September 11 attacks
34	Multivariable model predicting MD after the Sept. 11 attacks
35	Summary High prevalence of exposure to September 11 attacks among general population of NYC 2 to 3-fold increase in PTSD and depression over baseline after events of September 11 Event experiences predictive of PTSD Stressors and supports predictive of MD
36	Implications Substantial burden of mental health problems in the general population after a human-made disaster Need to consider ways to facilitate rapid mental health data collection and system response
37	Implications Interventions in the acute post-disaster period Use of media and public programs
38	Potential long term impact of stigma & trauma on society Increase in second generation problem: Crime Alcohol/drug abuse Teenage pregnancies Street children Child prostitution violent behavior Severe depressions suicide
39	Long term impact
40	"Dr." Dr. Pamela Cantor
41	The Needs Assessment The Needs Assessment tells us: how children were affected, the disorders that have resulted, the levels of severity, the numbers of children affected, and the pre-existing conditions that increase vulnerability in children.
42	Key Findings 1 in 4 children in grades 4-12 meet criteria for one or more psychiatric disorders. 75,000 children have symptoms consistent with post-traumatic stress disorder. Of these affected children, two-thirds have not received any sort of help. 190,000 children (including those who have PTSD) have symptoms of one or more of the other measured psychiatric disorders. Mental health impacts were felt by children citywide, not just in the immediate ground zero area.
43	The Needs Assessment: What’s missing The specific effects of 9/11 on: children K-3rd grade private school children infants and preschool age children
44	The Needs Assessment: What’s missing Screening is essential to identify traumatized children All children should have access to necessary treatment Classroom interference
45	Public Education Primary Prevention Barriers to services Stigma hinders access to treatment Parents don’t want children labeled as having a disorder Don’t recognize symptoms as signs of illness Educate public on trauma and coping Anti-stigma print campaign Use of media
46	Education of Trauma Treatment Create knowledge base about effective practices with children Expand training of successful models of treatment to school-based and community-based professionals. Provide psycho-educational supports to children, staff, and parents Increase capacity for addressing trauma-related mental health problems.
47	Promoting Access to Community Health (PATCH) District leadership at the Superintendent and Principal level Provider Leadership Active Coordination and Collaboration Training that is directed at evidence based approaches for trauma related mental health problems in children and adults Public Education: mental health issue Alliance in media
48	Limiting Factors (1) Overwhelming need Limited capacity and overburdened staff Only the most severe cases get addressed Inability to assess children at risk Limited understanding of school mental health needs Inadequate funding
49	Limiting factors (2) Insurance caps Shortage of culturally sensitive services Absence of focus on primary prevention strategies Stigmatization of mental health
50	Public mental health solutions
51	CCPMH - Task areas
52	CCPMH model (1)
53	CCPMH model (2)
54	CCPMH model (3)
55	Media as a problem
56	Media violence Facts: 7.5 violent acts per hour on US prime time TV 8.6 violent acts per hour on German entertainment programs 5.8 for Dutch dramatic fiction 2.5 for UK prime time TV
57	Media Violence A US child watching 2-4 hours per day (the norm) will have witnessed 8.000 homicides and 100.000 other acts of violence by the age of 18 (From: WFMH)
58	Examples DeFilippo v. NBC (1982): Boy hangs himself after seeing stunt on TV. Warnings repeatedly given. Herceg v. Hustler (1983): Article on autoerotic asphyxiation alleged to cause death of 14-year old boy.
59	Examples ‘What would they do for some ‘dew’? Why, I’d ride my bike into the lake! Ad showed ‘lake jumping’ 14 year old copied act Broken neck Court ruled for PepsiCo Add encouraged people to drink Mountain Dew, not to ride bikes into the lake.
60	Infliction of emotional distress According to the Restatement of Torts, section 46: ‘One who by extreme and outrageous conduct intentionally or recklessly causes severe emotional distress to another is subject to liability for damages’
61	"Media solutions" Media solutions
62	Actions to reduce media violence Parents and caregivers Take charge of the media in your child’s life (tv, video games). Have a voice in local television programming
63	Actions to reduce media violence General society Promote violence tax Follow up on MTV’s spot ‘Silence the Violence’ Involve business and schools
64	Mind Media Group
65	Mind Media objectives
66	Mind Media objectives
67	Mind Trust Mission To build a fund and a center of excellence that offers sustained support for the development and dissemination of mental health media, learning tools and advisory services, focused on a defined global mental health need, linked closely to CCPMH
68	Development goals of Mind Media (1)
69	Development goals of Mind Media (2)
70	Interested parties Corporates - decreasing work stress -containing costs Consumer media - respond to expressed consumer interest Government/NGO Stakeholders -public education and professional capacity building
71	Mind Media Products & Services Media Broadcast (TV, Radio, Mobile] Events DVD Internet Print Editorial Agenda News TV Business TV Lifestyle TV Features Youth TV Video diaries
72	Mind Media education packages Training: -Graphic animations for children and schools -Cd-Rom, DVD, Video programs for professionals -Self help e-learning packages -Media assisted small group PBL -Mixed media for facilitating community discussions
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75	Endorsements “As knowledge grows of the causes and nature of mental health problems we become increasingly aware of how they are linked to the major illnesses of societies… partnerships between all groups… are an essential key to progress” Her Majesty Queen Elizabeth II “Improving mental health services is a key priority for my government.” Prime Minister, UK
76	Endorsements Continued… “Over the years, World Mental Health Day has served as an opportunity to educate many people about mental health issues and mental illness. Through this special occasion, we have forged new alliances with people from vastly different backgrounds, ethnic groups and cultures” Rosalynn Carter “We receive more feedback on The Infinite Mind than any other programme of its kind” Director of Programmes WUMB-FM on LCM’s weekly radio show
77	Mind Media Group Toward life style resilience and mental health throughout the life cycle
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