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Disaster Mental Health Preparedness and Community Collaboration


Although emergency medical plans have been developed and implemented in most United States’ communities, the majority of these towns and cities do not have formal mental health intervention procedures. Typically, the community asks a national group like the Red Cross, a state mental health response team, or FEMA to provide psychological support to survivors. Although this support can be helpful, it lowers the ability to offer the most expedient assistance to those in most need. These external groups are not familiar with the population’s vulnerability or the totality of economic, social, cultural, institutional, and psychological factors that form the resident’s capacity for resiliency and recovery. A community can self-replicate practices and networks of care that build community resilience, which we see so often in the mutual aid efforts that come to the fore during and after disasters. As an Irish proverb reads, “It is in the shelter of each other that the people live.”


1. Introduction

Although disasters have caused devastation throughout American history, even with the growing severity of natural events over the past decade, the majority of communities only have limited preparedness plans for the mental health impact (Schmidt & Cohen, 2020). Too frequently, responding national nonprofit and government organizations compete to provide services, duplicate services, under-estimate the need for support (Blowenkamp, 2012), and are unfamiliar with the populations’ psychosocial and cultural needs (Schmidt & Cohen, 2020; Abukhalaf & von Meding, 2020). This results in anywhere from 20% to 40% of direct survivors developing acute stress disorder and then post-traumatic stress disorder if not receiving necessary trauma-informed care within two months following the event (Alfonso, 2018).

There is thus a critical need to greatly increase the number of communities that will develop effective disaster mental health preparedness plans, which protect the residents’ psychological needs before, during, and following the catastrophic event (Varghese et al., 2021; Naser et al., 2020). Mental health responders must understand the disaster intervention structure, including the members of the response team and their responsibilities and how they team with local mental health support services. Such information must be regularly communicated, because of the quickly changing disaster environment and residents requiring are. To ensure efforts are not duplicated and all areas of need are covered, the collaboration must continually coordinate their efforts and practice procedures (Gard & Emory, 2006; Naser et al., 2021a).

Essential for responding successfully to the mental health impact following a disaster are strategies to 1) Understand the unique needs of the community’s populations through assessment of those at greatest risk (Cohen & Abukhalaf, 2021b; Schmidt & Cohen, 2020); 2) Remedy the shortage of disaster responders with appropriate mental health expertise to aid individual disaster survivors (McCabe et al., 2014) and 3) Stress the importance of involving the public in decisions before, during, and after calamitous events occur (Schmueli et al., 2021; Cohen & Abukhalaf, 2021a).


2. Literature review:

Exposure to traumatic events does not equate to mental health decline. Although there are factors that increase the risk of mental ill-health on an individual level (i.e., genetic, psychological, psychosocial, and personality components), risk factors are predictive - not deterministic - and can be ameliorated by protective factors at the individual, community, and societal levels. The acute stress response can enhance signaling in cortical regions that allow quick thinking and heightened memory (Popoli et al., 2011).

This short-term biological advantage is valuable post-disaster both individually and within communities when problem-solving solutions are required for rapidly changing needs. Conversely, chronic stress is damaging to the brain and, when coupled with adverse life events that reduce individuals' coping capacity, can cause an allostatic overload, thus adversely affecting physical and mental health (Guidi et al., 2021). These biological changes demonstrate the brain’s plasticity, whereby positive changes to mental health can also be made.

Disaster events (characterized by acute stress) provide an opportunity to change the status quo on a societal level. In the weeks following the COVID-19 outbreak, the US Government, with cooperation from insurance companies, made provisions for medical care, which allowed testing, treatment, and eventually, vaccinations even for uninsured individuals (Centers for Disease Control and Prevention, 2021). When access to health care is lost through unemployment during a pandemic, this is a necessary measure; however, given the far-reaching effects of stress on all aspects of physical and mental health, King (2020) calls for reflection on universal access to healthcare in all areas of need - a concept which finds support amongst 63% of Americans (Jones, 2020).

Due to their unexpected nature, prospective data is often unavailable for disaster research; however, Breslau et al. (2021) published a longitudinal study in a representative sample of US adults which compared reported psychological distress (PD) in the year before the outbreak to the months following, tracking within-person changes. They reported increased PD across all demographics, but those most affected had previous psychiatric conditions, for which targeted services are required. In contrast to global health statistics on depressive disorders, they reported that individuals over 60 years experienced lower PD than younger participants which may be due to increased economic stress faced by this group. The authors were unable to pinpoint the causal factors for variability in distress levels within groups, which highlights the difficulty in assessing conditions with layers of heterogeneity across a diverse sample.


The Pan American Health Organization (2020) details strategies such as establishing a daily routine, communicating emotional distress, and spending time with friends and family as common protective factors, many of which overlap with physical benefits such as mindfulness, regular exercise, adequate food, and water, and avoiding tobacco and alcohol. Lack of sleep and vitamin D can reduce immunity and increase inflammation which can negatively impact health on the whole (Berk et al., 2013; Naser et al., 2021b). Thus employing a holistic view of individuals' multi-dimensional needs and those of the wider community they inhabit is necessary for planning preventative and post-disaster responses.

Whereas medical needs should be met by professionals deployed by institutions at a societal level, communicating protective strategies and overcoming individual barriers to employing them requires care and knowing that only a community can provide. Psychological needs could be included and addressed through collaborative, community-led, horizontal planning (Spade, 2020). Bendau et al. (2021) highlighted the need for self-efficacy, maintaining social contacts, and knowing where to access medical care following pandemic lockdown. While institutional support may be provided in disaster relief, this service often runs out of funding or is deprioritized.


3. Discussion and recommendations

Schmidt and Cohen (2020) explain in order to develop a disaster mental health plan, collaboration needs to be formed based on community demographics. It will consist of stakeholders promoting mental health advocacy and decision-making, including mental health providers and organizations and government behavioral health department staff. Just as important is the inclusion of neighborhood leaders who understand the unique needs of their residents. Do these individuals have specific cultural and/or language needs since, for example, communication barriers can greatly increase anxiety at catastrophic times. This approach ensures that linguistically and culturally diverse populations are not misunderstood or overlooked (Abukhalaf & von Meding, 2021a; Chmutina et al., 2020) and receive appropriate services as needed (U.S. Dept of Health and Human Services, 2021).

Similarly, does the community have a predominance of elderly and frail residents and assisted living and nursing homes? How can these residents be quickly helped when disasters occur? (Parker et al., 2016). This collaboration will establish the step-by-step roadmap of actions to take for effective psychological intervention and the individuals responsible. It will be based on the population demographics and the history of disasters (e.g., tornado, hurricane, forest fire). Just as important, the collaboration will determine how this plan is communicated to town residents and their input and acceptance attained (Riddell et al., 2020).

Each stage of the mental health preparedness plan development should be communicated to the public through traditional and social media, as well as open meetings. The community needs to understand and respond to the plan’s objectives and goals. When the intervention roadmap is completed, it should be available through numerous online and community-based outlets for final acceptance. After a disaster occurs, the plan needs to be reviewed and the public contacted for critiques. The plan must be continually updated (SAMHSA, 2016; Abukhalaf & von Meding, 2021b).

In their book Disaster Mental Health Community Planning (2020), Schmidt and Cohen strongly recommended that communities develop these community collaborations to prepare for the worsening natural disasters to come. COVID-19 hit only a couple of months later, which has greatly exacerbated preparedness. Proactive planning for a future catastrophe becomes very difficult when in the midst of another one, especially as all-encompassing as this pandemic. Accomplishing this objective necessitates a two-prong approach, where the community collaboration responds to present mental health needs while planning for those to come. In both cases, however, many of the critical factors are the same: Which at-risk groups most need the care, what treatment do they require and how will they receive it, and how can resiliency be maximized.


4. Conclusion

In order to develop the most effective plan for psychological intervention immediately following a disaster and to build pre-disaster resiliency, communities need to form a collaborative of individuals, nonprofit organizations, and city/state agencies whose objectives are to 1) Define and assess the needs of the most vulnerable populations when disasters occur; 2) Include goals that reflect these specific needs; 3) Delineate the steps to take for mental health intervention when a disaster is declared and the individuals responsible for taking those steps; and 4) Establish ways to enhance disaster preparedness and resiliency prior to any event occurring.


5. References

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