top of page

Our Recent Posts

Archive

Tags

Mental Health and Disaster Preparedness


After the Federal Emergency Management Agency (FEMA) was established in 1979, most American communities developed emergency plans to provide survivors with medical care immediately following a disaster. Although calamities also emotionally traumatize about 20% of victims for long periods of time, few of these same communities have established preparedness plans for disaster mental health interventions. Psychological First Aid (PFA) and FEMA crisis counseling services (CCP) are becoming more prevalent for post-disaster mental healthcare, but they are intended only for short-term support. Many survivors will thus needlessly endure lengthy suffering from severe illnesses such as post-traumatic stress disorder (PTSD). The pandemic, one of the worst disasters possible, and climate change have exacerbated these mental health issues. To offer maximum wellbeing, communities need to effectively assess and respond to the mental health needs seriously arising from COVID-19, as well as develop psychological preparedness plans that will immediately address further long-term problems from worsening natural and human-caused events.


Introduction and Literature Review


Although disasters have battered the U.S. from its earliest history, the country responded quite slowly to the after-effects. Congress did not legislate financial assistance for extreme emergencies until fires nearly obliterated the city of Portsmouth, New Hampshire, in 1803 (Jones & Kovacich, 1803). Even then, no major changes occurred in national emergency response until the 1930s when Congress passed the Flood Control Act, extending the U.S. Army Corps of Engineering’s authority to design and build flood-control projects (Schmidt & Cohen, 2020). This does not mean that major calamities were not occurring across the country. Quite the opposite is true.


The 1930s brought devastating tornadoes and snowstorms as well as the Dust Bowl, which killed 7,000 and left 2 million homeless (Hurt, 2019). Several decades later, an earthquake in Montana, Hurricane Donna in Florida, and Hurricane Carla in Texas were followed by a winter storm that destroyed 620 miles of the East Coast shoreline. In addition, the Alaskan earthquake and Hurricanes Betsy and Camille (Rubin & Cutter, 2019) caused significant damage. The U.S. government responded to such calamities on an ad-hoc and scattered basis, with over 100 federal agencies offering some form of support (Schmidt & Cohen, 2020).


The states eventually determined they could no longer deal with this fragmented government response and lack of financing and launched the National Governors Association Subcommittee on Disaster Assistance (1979), which led to FEMA’s establishment. FEMA’s charter includes CCP, or short-term disaster mental health for survivors: “The scope of the Crisis Counseling Program is immediate, short-term, incident-specific, intervention-style crisis counseling services and support for emotional recovery to individuals adversely affected by major disasters” (FEMA, 1979). Some authorities attest that this support does not adequately respond to chronic mental health issues (Lake & Turner, 2017; Schmidt & Cohen, 2020). Left unresolved, severe reactions can lead to social isolation, suicidal behavior, and medical problems that often impede normal activities and develop into psychiatric maladies such as severe depression and anxiety, acute stress, PTSD, and dissociation.

The growing severity and frequency of natural weather events due to climate change and the increasing number of mass shootings in once-safe locations as places of worship, malls, and theaters, are expected to significantly worsen mental health problems. “Increasing ambient temperature is likely to increase rates of aggression and violent suicides, while prolonged droughts due to climate change can lead to more number of farmer suicides,” (Padhy et al., 2015). It is essential to build resilience to cope with such changes and help those individuals who are emotionally impacted when a disaster occurs. The current model of care must be altered to effectively tackle the multifaceted dimensions of mental health (Lake & Turner, 2017).


Discussion and recommendations


Even before COVID-19 and worsening natural and human-caused events, the U.S. was having difficulty responding to the rising prevalence of mental illness, especially with the most vulnerable populations. According to the American Psychiatric Association (2020), over half of the people with mental illness do not receive needed support, due to barriers such as cost, limited providers, appointment logistics, and stigma. If communities are already having difficulty responding to mental health issues, how will they be able to handle the more severe cases that arise with increasing challenges from the pandemic and other disasters?


Every time a disaster occurs in a similar location with many of the same people impacted such as Louisiana and California, the mental health ramifications multiply (Lowe et al., 2019; Abukhalaf & von Meding, 2020). Over the past two years, many clinics have closed and emergency departments have swelled with mental health cases (American Hospital Association, 2020). It is this historic combination of parameters that lead the American Psychological Association (2020) to state that the country is facing a mental health crisis that could yield serious health and social consequences for many years to come.


COVID-19 has greatly added to first-hand knowledge of what occurs in a long-term and far-reaching catastrophe. According to Schmidt & Cohen (2020), the emotional impact is even greater than what is normally expected from being involved in a disaster. A study by Vahratian et al. (2021) found that adult levels of anxiety, depression, and mental healthcare use from August 2020 to February 2021 increased from 36.4% to 41.5%; those reporting an unmet mental healthcare need grew from 9.2% to 11.7%. Research conducted by the Centers of Disease Control (CDC, Bryant-Genevier et al., 2021), which evaluated the mental health conditions of 26,174 healthcare workers from March to April of 2021, found that 53% reported one of the following symptoms in the previous two weeks: depression, anxiety, PTSD, and suicidal ideation.


Other vulnerable populations fared no better: People of color had significantly higher levels of depression (Chmutina et al., 2020; Abukhalaf & von Meding, 2021a; Saltzman, 2021). Further, the CDC reported that in June 2021, 1 in 4 of survey respondents ages 18 to 24 had considered suicide within the past month. Mental Health America (2021) found that children from 11 to 17 are more apt than other ages to have moderate to severe symptoms of anxiety and depression.

It is now four decades after FEMA was formed when communities developed their medical response plans. As always, mental healthcare lags slowly behind. It was not until the beginning of the 21st century that researchers began to hone in on the emotional impact of disasters (Abukhalaf & von Meding, 2021b). This was precipitated by multiple factors: the addition of the term PTSD to the third edition of the American Psychiatric Association’s Diagnosis and Statistical Manual of Mental Disorders (DSM-III, 1980), the concern about returning veterans who were plagued with trauma, and the September 11, 2001, terrorist attacks that led to an immediate rise of psychological disorders (Schmidt & Cohen, 2020). Since then, increasing numbers of studies have confirmed that approximately 20% of disaster survivors will be at considerable risk of long-term mental health issues; this is higher in vulnerable populations and first responders.

It is true that the most individuals at a disaster site are resilient and will have short- versus long-term mental health issues (Columbia University Irving Medical Center, 2021). It is also true that 20% of those acquiring stress-related illness, including the most vulnerable dealing with prior challenges, will not be cured without having the appropriate trauma-informed care (Schmidt & Cohen, 2020). Many of the residents of the home town of Schmidt and Cohen, where the Sandy Hook Elementary School shooting occurred nearly a decade ago, still face the mental health ramifications, as do cities such as New Orleans that are repeatedly hit by storms.


A country with a major mental health crisis not only contends with scores of people suffering from trauma but also faces increasing medical problems, employment instability and high sick leave numbers, potential for greater mass shootings, and political and social unrest. Communities need to plan and implement effective interventions before and after disasters to enhance adverse long-term effects. Resiliency needs to be stressed to empower those who are facing/will face future calamities. It is well past time that responding to medical and mental healthcare and wellbeing needs go hand-in-hand.


Declaration of interests:


This research did not receive funding from any agency in the commercial, public, or not-for-profit sectors, and no incentives were provided for the subjects to participate in the study. The authors also declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.





References


Comentários

bottom of page