The effects of flooding on mental health: Outcomes and recommendations from a review of the literature.

Introduction While most people who are involved in disasters recover with the support of their families, friends and colleagues, the effects on some people's health, relationships and welfare can be extensive and sustained. Flooding can pose substantial social and mental health problems that may continue over extended periods of time. Flooding can challenge the psychosocial resilience of the hardiest of people who are affected. Methods The Health Protection Agency (HPA) undertook a review of the literature published from 2004 to 2010. It is intended to: assess and appraise the epidemiological evidence on flooding and mental health; assess the existing guidance on emergency planning for the impacts of flooding on psychosocial and mental health needs; provide a detailed report for policymakers and services on practical methods to reduce the impacts of flooding on the mental health of affected people; and identify where research can support future evidence-based guidance. The HPA identified 48 papers which met its criteria. The team also reviewed and discussed relevant government and non-government guidance documents. This paper presents a summary of the outcomes and recommendations from this review of the literature. Results The review indicates that flooding affects people of all ages, can exacerbate or provoke mental health problems, and highlights the importance of secondary stressors in prolonging the psychosocial impacts of flooding. The distressing experiences that the majority of people experience transiently or for longer periods after disasters can be difficult to distinguish from symptoms of common mental disorders. This emphasises the need to reduce the impact of primary and secondary stressors on people affected by flooding and the importance of narrative approaches to differentiate distress from mental disorder. Much of the literature focuses on post-traumatic stress disorder; diagnosable depressive and anxiety disorders and substance misuse are under-represented in the published data. Most people's psychosocial needs are met through their close relationships with their families, friends and communities; smaller proportions of people are likely to require specialised mental healthcare. Finally, there are a number of methodological challenges that arise when conducting research and when analysing and comparing data on the psychosocial and mental health impacts of floods. Conclusions The HPA's findings showed that a multi-sector approach that involves communities as well as agencies is the best way to promote wellbeing and recovery. Agreeing and using internationally understood definitions of and the thresholds that separate distress, mental health and mental ill health would improve the process of assessing, analysing and comparing research findings. Further research is needed on the longitudinal effects of flooding on people's mental health, the effects of successive flooding on populations, and the effects of flooding on the mental health of children, young people and older people and people who respond to the needs of other persons in the aftermath of disasters. Corresponding author: Carla Stanke Address: Health Protection Agency 151 Buckingham Palace Road London SW1W 9SZ E-mail: carla.stanke@hpa.org.uk Fax: 020 7811 7759 Telephone: 020 7811 7161.

The impact of climate change on the expansion of Ixodes persulcatus habitat and the incidence of tick-borne encephalitis in the north of European Russia.

BACKGROUND: The increase in tick-borne encephalitis (TBE) incidence is observed in recent decades in a number of subarctic countries. The reasons of it are widely discussed in scientific publications. The objective of this study was to understand if the climate change in Arkhangelsk Oblast (AO) situated in the north of European subarctic zone of Russia has real impact on the northward expansion of Ixodid ticks and stipulates the increase in TBE incidence. METHODS: This study analyzes: TBE incidence in AO and throughout Russia, the results of Ixodid ticks collecting in a number of sites in AO, and TBE virus prevalence in those ticks, the data on tick bite incidence in AO, and meteorological data on AO mean annual air temperatures and precipitations. RESULTS: It is established that in recent years TBE incidence in AO tended to increase contrary to its apparent decrease nationwide. In last 10 years, there was nearly 50-fold rise in TBE incidence in AO when compared with 1980-1989. Probably, the increase both in mean annual air temperatures and temperatures during tick active season resulted in the northward expansion of Ixodes Persulcatus, main TBE virus vector. The Ixodid ticks expansion is confirmed both by the results of ticks flagging from the surface vegetation and by the tick bite incidence in the population of AO locations earlier free from ticks. Our mathematical (correlation and regression) analysis of available data revealed a distinct correlation between TBE incidence and the growth of mean annual air temperatures in AO in 1990-2009. CONCLUSION: Not ruling out other factors, we conclude that climate change contributed much to the TBE incidence increase in AO.

An ecological approach to promoting population mental health and well-being--a response to the challenge of climate change.

Climate change can be viewed as human-induced change to climate and depletion of natural systems. It potentially the biggest global health threat of the 21st century. It is predicted to have wide-ranging impacts upon human mental health and well-being, through changes and challenges to people's environment, socioeconomic structures and physical security. Even the most conservative estimates of the health impacts are extremely alarming. Increasingly, the causes of poor human health and environmental damage are related. This implies that there are common solutions. For example, there are co-benefits to human health and biodiversity from mitigating and adapting to climate change (e.g. promoting active transport and reducing car use reduces CO2 emissions, benefits our environment and reduces morbidity and mortality associated with a sedentary lifestyle). This article outlines how climate change impacts upon mental health and well-being. It introduces ecological concepts, applies these to public health and outlines their implications in transforming the way that we prioritize and deliver public health in order to promote both environmental and human health. Evidence, from psychology and neuroscience, suggests that the perception of being disconnected from our inner selves, from each other and from our environment has contributed to poor mental and physical health. We argue that we must transform the way we understand mental health and well-being and integrate it into action against climate change. We describe a Public Health Framework for Developing Well-Being, based on the principles of ecological public health.

A dynamic model for wellbeing.

OBJECTIVE: This paper presents a public health model of mental health which places wellbeing at its centre and illustrates how wellbeing is influenced by the inter-relationship between risk, protective and environmental factors. This model should encourage a more comprehensive approach to wellbeing promotion and will assist in developing appropriate mental health public health initiatives. METHODS: The model considers how different social and individual risk factors impact negatively upon mental health and how these risk factors can be addressed. It explores the need for active development of protective factors in order to increase an individual's resilience to deal with stresses of life and the additional input required to promote resilience in those with existing mental health problems. This approach to wellbeing balances addressing risk factors with promoting protective factors and uses a public mental health approach to wellbeing promotion within particular settings and the wider environment, supported by both local-level and regional policy. It also suggests that considerable economic savings could be achieved by implementing such integrated management programmes.

A framework for the delivery of public health: an ecological approach.

The "Framework for the Delivery of Public Health" presented in this paper provides a new structure that brings together the multiple components of public health, relates them to key influencing factors and provides greater clarity, balance and direction for the effective delivery of public health. The paper outlines the development of the framework and describes the significance behind the key constructs. The symbolisms within the picture and interactions between the varied components are compared with the dynamics of an ecosystem; this aims to emphasise that improving health occurs within a constantly changing and interactive environment. Finally, the applications of the framework are explored, including embedding public health within an organisation or setting, assisting in strategy development for specific topics and as a training and educational aid.

Influence of environmental factors on mental health within prisons: focus group study.

OBJECTIVE: To increase understanding of how the prison environment influences the mental health of prisoners and prison staff. DESIGN: Qualitative study with focus groups. SETTING: A local prison in southern England. PARTICIPANTS: Prisoners and prison staff. RESULTS: Prisoners reported that long periods of isolation with little mental stimulus contributed to poor mental health and led to intense feelings of anger, frustration, and anxiety. Prisoners said they misused drugs to relieve the long hours of tedium. Most focus groups identified negative relationships between staff and prisoners as an important issue affecting stress levels of staff and prisoners. Staff groups described a "circle of stress," whereby the prison culture, organisation, and staff shortages caused high staff stress levels, resulting in staff sickness, which in turn caused greater stress for remaining staff. Staff shortages also affected prisoners, who would be locked up for longer periods of time, the ensuing frustration would then be released on staff, aggravating the situation still further. Insufficient staff also affected control and monitoring of bullying and reduced the amount of time in which prisoners were able to maintain contact with their families. CONCLUSIONS: Greater consideration should be given to understanding the wider environmental and organisational factors that contribute to poor mental health in prisons. This information can be used to inform prison policy makers and managers, and the primary care trusts who are beginning to work in partnership with prisons to improve the mental health of prisoners.