To address the mental health service gap for older adults in Puerto Rico and the USVI, International Medical Corps will collaborate with the Asociación de Salud Primaria de Puerto Rico (ASPPR), a network of community health centers serving low-income populations on the island, Frederiksted Health Care in the U.S. Virgin Islands, and with the National Association of Community Health Centers, to deliver trainings for approximately 255 health staff on mental health care for older adults. The organization will conduct initial assessments of health facilities and available services in Puerto Rico and the U.S. Virgin Islands, develop and implement a training package, and provide ongoing supervision, mentorship, and consultation to healthcare staff to ensure they can apply new skills. Trainings will be developed in line with evidence-based World Health Organization materials, Inter-agency Standing Committee guidelines, and the Government of Puerto Rico’s Economic and Disaster Recovery Plan, with topics including Psychological First Aid, recognizing signs of distress and disorder, providing appropriate referral to other services as needed, and principles of mental health and psychosocial support in emergency settings.
International Medical Corps’ selection of training locations will take into account the population density of older adults, the number of Medicare recipients in each geographical location, and the Centers for Disease Control’s Social Vulnerability Index, as well as the capacity of healthcare staff in the areas. The training sessions will reach 15 health centers across 15 communities, spreading the impact of support in Hurricane Maria-affected areas.
Following the trainings, International Medical Corps will work with health center staff and community members to organize community-based mental health promotion activities and events for an estimated 1,500 people. The activities will target vulnerable populations, especially older adults, and contain discussions about stress and positive coping mechanisms. Mental health and psychosocial support information dissemination and group sessions will promote exercise, health lifestyles, and social support networks. Ultimately, teams will enhance the capacity of healthcare staff to provide mental health and psychosocial support services, build community awareness of such services, and strengthen the referral system between mental health actors.
January – February 2019: Collaborate with local partners and government to map existing mental health and psychosocial support services in Puerto Rico and U.S. Virgin Islands
Actions to be taken:
Complete mental health and psychosocial support needs assessment and mapping of such existing services in Puerto Rico and U.S. Virgin Islands and identify 15 health centers to be served
February 2019 – August 2019: Enhance capacity of healthcare staff to provide mental health and psychosocial support services
Actions to be taken:
Develop and adopt mental health training package for healthcare staff, in line with internationally-accepted standards
Conduct training of at least 255 healthcare staff from clinics on mental health issues affecting vulnerable populations post disaster
August 2019 – October 2019: Improve community awareness of mental health and psychosocial support and strengthen referral pathways between existing local, regional and national mental health actors
Actions to be taken:
Conduct community-based mental health promotion activities
Provide technical guidance and supportive supervision to local partners on mental health and psychosocial support protocols to ensure news practices are integrated and adopted
In 2017, the United States and Caribbean endured a catastrophic hurricane season with Hurricanes Irma and Maria causing unprecedented destruction. The impact of the hurricanes on the Caribbean and southeastern United States was disastrous. Record wind speeds and storm surge caused massive damage to infrastructure and widespread flooding, breaking supply chains and leaving communities across the region without access to necessities such as clean water, healthcare, and shelter.
The hurricanes not only had a significant impact on affected populations’ daily lives, but also exposed pre-existing weaknesses within vital infrastructure and social services. When collaborating with health centers in Puerto Rico and the U.S. Virgin Islands, specifically, International Medical Corps found that local staff maintained limited training on how to provide mental health and psychosocial support to distressed populations, especially post-disaster. Meanwhile, months after the hurricanes, many individuals endured rises in depression, anxiety, panic attacks, and post-traumatic stress disorder (Artiga, Hall, Rudowitz, and Lyons, 2018).
As the Guardian reported in September 2018, mental healthcare was an issue in Puerto Rico before Hurricane Maria, due to the ongoing recession and significantly stressed health care system on the island. As younger populations have left, the population of elderly adults in Puerto Rico has grown to now nearly 20%; many of whom still faces challenges accessing the services that are available due to road closures, a lack of infrastructure and unreliable access to ongoing care. In addition, with the World Health Organization noting that approximately 15% of older adults (60+) suffer from a mental disorder (WHO, 2017), International Medical Corps is specifically emphasizing care for older populations.