CMPH Journal

The reason for seeking Acolhe-Saúde was related to the fire at the nightclub in 89.4% (657) of the visits. Of these, 49.9% were relatives of victims or survivors of the tragedy, 19.4% were friends, 18.7% were survivors, 6.9% were involved in work directly related to the disaster (volunteers, rescuers, reconnaissance of bodies, undertaker), among others. The search for the service by the remaining 10.6% was due to psychological symptoms, family problems, loss of a family member, alcohol and other drugs.

Of those who sought psychosocial care for reasons related to the disaster, most were university students (93.9%) and people classified as having a declared occupation related to the nightclub (98.7%). The majority (89.8%) of patients with unrelated declared occupation were seen because they were affected by the incident, while 10.2% were seen for other reasons (p=0.09).

Distribution of demand for the first year of Acolhe Saúde, according to declared gender and use of other medications (nonpsychopharmaceuticals) (Table 3).

Table 3: Distribution of demand for the first year of Acolhe Saúde, according to declared gender and use of psychotropic drugs before the disaster.

As can be seen in Table 4, there was an increase of approximately 31% in the demand for psychotropic medications used by patients after the disaster.

Table 4: Comparative distribution of Acolhe Saúde, according to declared gender and use of psychotropic drugs before and after the disaster.

Discussion

Most of the services were carried out in the first two months, reaffirming the great demand for resources and activities, especially right after the event. Therefore, it is evident the need to enable the assessment and identification of damage and impacts on health to provide a quick response to the affected population through a ready protocol for assisting victims.

Knowing the epidemiological profile of those affected by the disaster provides information to identify patients at risk. In this study, the large number of university students and professionals who worked on the day of the disaster sought or were referred for psychosocial care.

After a year, 130 individuals were still receiving care at the service, reinforcing the need for constant monitoring of the health of victims and workers involved in the disaster. It should be noted that the affected population should not be inadequately medicated, as only a minority develops a psychiatric disorder. In Santa Maria’s psychosocial care service, priority was given to listening and welcoming individuals. Only in a few cases was the patient referred to a psychiatrist for a more specific assessment, in which the need for prescription of psychotropic drugs was considered. According to medical records or files, 30.9% of those assisted by the service took some type of psychotropic drug. The international humanitarian organization Doctors Without Borders, through the Municipal Secretary of Health, offered support in the areas of mental health to public health professionals and volunteers who assisted the families of the victims and survivors of the disaster.

In response to the earthquake that struck Haiti in 2010, a similar action was taken to “train the trainers” with the creation of an intervention called 5x5 that helped health professionals plan their clinical services. This model identifies five types of skills that a mental health service should practice: (1) understanding the victims’ context: local beliefs and their needs, (2) identifying priority patients with validated symptom screening scales specifically related to mental illnesses such as depression, (3) use specific tools that help decision making and screening rules, (4) use quality practices, (5) aim for the sustainability of the health service. To practice the five proposed skills in the chaotic environment that has settled in one of the poorest Western countries, health professionals used their cell phones to share and record data about patients and practices adopted in a coordinated way. As a result, 20,000 individual and collective mental health consultations were carried out, in which psychosocial services were able to offer longterm care based on the local Community [18,19].

Studies show that it is important to accurately monitor changes in the psychic state of victims and provide adequate treatment for those who need specialists. In Japan, after a major earthquake, the Ministry of Health, Labor and Welfare monitored teams to offer special care to victims who already had mental illnesses so that they would not decompensate. In addition, a system with a unified direction was very important for the organization of victims into groups (resistance, resilience, recovery, relapsing/remitting, dysfunctional and chronically dysfunctional) and for collecting data, which are important for epidemiological surveillance [20,21]. It was reported that prior to the disaster, mental health services were not available to all people in need. After the disaster, such services were severely disrupted, so priorities were established:

i) transferred pre-existing psychiatric patients to hospitals outside the affected area, ii) re-established and strengthened mental health services in the disaster área [22,23].

Psychosocial care after the disaster at the Kiss Nightclub was the responsibility of the municipality of Santa Maria and was developed in two main lines of work: direct psychosocial care for users and matrix support for health teams in the territory. Already in the early hours of January 28, 2013, less than 24 hours after the disaster, mental health care was implemented for the people involved in the fire through volunteers coordinated by a management group with the participation of the Municipal Health Secretariat. One of the precautions in the first moments of Reception for those who sought or were referred to the service was qualified listening, in order to also classify the risks with regard to Mental Health [24].

During the first two months, its headquarters were improvised next to the Caminhos do Sol Psychosocial Care Center for Alcohol and Drugs (CAPS). As of April 2013, a house was rented for Acolhe Saúde, with the purpose of vacating the CAPS space and facilitating user access to the new service. In addition, an emergency hiring of a multidisciplinary team of 32 workers was carried out to provide follow-up care. With this adjustment, the coordination of the service started to be carried out solely by SMS staff professionals.

In the first months, the operation was on a 24-hour basis every day. As a result of the decrease in demand, as of September 1, 2013, the opening hours were reduced to 7:00 am to 12:00 am, from Monday to Saturday. Later, as of November 1st, a new change was made, opening from 8:00 am to 8:00 pm, from Monday to Friday. All these changes were decided after a careful assessment of the needs and demands forwarded to the service and were agreed with representatives of the SMS and the Association of Relatives of Victims and Survivors of the Tragédia de Santa Maria. This adjustment process resulted in the progressive reduction of the team, so that at the end of 2013, the number of professionals was 16.

Due to the urgent nature of care, the registration of consultations through medical records only began to be carried out on February 1, 2013, a situation that left out a significant number of users who accessed the service in the first three days of operation. From that date until December 31, 2013, 891 people are in the Acolhe Saúde file.

In the present study, the epidemiological profile of the population impacted by the disaster that sought care or were referred to the Acolhe Saúde psychosocial care service was drawn. Thus, it was possible to know the needs of service users, to contribute to the mapping of the care network.

In the post-disaster period, interventions are carried out that prioritize the diagnosis and the consequent medicalization in the treatment of trauma. The Ministry of Health provides a list of medicines and medical materials organized in a kit that can be used in these situations. It is quite common for mental health services to trivialize psychopharmacological medicalization by prescribing them to the general population. However, the current guidelines of the National Mental Health Policy advocate psychosocial care according to the complexities and specificities of each individual in psychological distress, especially in disasters, when the aim is to prevent further damage to the mental health of victims.

One of the disadvantages found during the research is due to the fact that much information about the patients was not recorded in the files and medical records created by the service. Consequently, a lot of data (as a profession) was ignored. Furthermore, the way in which information on the psychotropic drugs used was collected did not allow us to analyze the most prescribed classes and the date of prescription. Based on these findings, further studies on the prescription and use of psychotropic drugs in disaster situations are suggested, in order to forecast the demand for medication.

By mapping the psychological care network, it is possible to know which people were affected, their profile and the care they received after the disaster. It facilitates the monitoring of these and the maintenance of the continuity of the psychological follow-up service.

To mitigate the psychosocial impacts caused by the disaster, the literature suggests holding events to celebrate the event, in which there is a reinforcement of the victories and growth achieved so far. The perception of visible progress can revive individual beliefs in oneself and in the community. The aim should be to fully restore the psychosocial balance, to address psychosocial needs in the medium and long term. For this, it is recommended that health professionals make an effort to maximize the resilience of the affected community by offering educational material, lectures, in which behaviors, thoughts and actions that promote adaptation are taught [25].

Final Considerations

This study quantified users and outlined the epidemiological profile of people who sought or were referred for psychosocial care in the public health network - Acolhe Saúde - in the municipality of Santa Maria after the fire. The study of this demand makes it possible to monitor the post-disaster crisis situation, assess the health of affected groups and identify problems, to understand the immediate and long-term impact from a psychological point of view, contributing to the planning of adequate care for users.

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