The images of disaster are never far from our collective consciousness. The flooded neighborhoods of New Orleans after Hurricane Katrina. The ash-stained streets of New York City after 9/11. The red skies of California during the wildfires of 2020. The ICUs packed to capacity during the heights of the COVID pandemic.
While a disaster’s physical and economic toll can be quantified, its psychological impact is most noticeable in the moments that headlines can’t capture, from sleepless nights to anxiety to depression to lingering post-traumatic stress.
Disaster mental health services
Formerly, these issues may have gone unseen and unaddressed for months or years, if they were addressed at all. Positive change came in 1988 with the congressional mandate that authorized the provision of disaster mental health (DMH) services in the wake of a major disaster.
Given the unique nature of DMH, healthcare professionals, particularly behavioral health professionals, are best equipped to respond to disasters when they understand the ways in which DMH differs from traditional office-based interventions.
Though scope and impact may vary, a disaster is generally defined as an unexpected, catastrophic event that generates widespread damage, loss, or destruction. Disasters cause ecological and psychosocial disruptions that surpass a community’s ability to cope. They necessitate intervention and assistance from an outside source.
Disasters may be natural or human-made — i.e. a flood versus a terrorist attack. They may be on a large scale, like a global pandemic, or a smaller scale, like a school shooting. Regardless of scope or cause, most disasters occur in the following phases.
- Initial impact phase: This is the phase immediately following the disaster, when everyone is still reeling. It’s characterized by shock, fear, and anxiety.
- Heroic phase: This phase may last up to a week after the disastrous event. During this time, survivors often band together to prevent further loss of life and property.
- Honeymoon phase: Lasting from two weeks to two months after the event, this is the phase during which survivors are buoyed by an outpouring of support, services, and supplies. Various government and community relief agencies may make significant promises in the honeymoon phase, and community members are generally optimistic about the future.
- Disillusionment phase: When the honeymoon phase fades, disillusionment sets in. This phase may last anywhere from several months to a year or more, in which outside relief workers return home, promises remain unfulfilled, and the survivors realize that they’re on their own, with a great deal of work that remains unfinished.
- Reconstruction phase: Over the next several years, or even the next several decades, the community rebuilds and individuals come to terms with their personal and collective traumas.
Recommended for behavioral health professionals: Disaster Mental Health, 2nd Edition
As in any life-threatening situation, disasters trigger a response from the autonomic nervous system and hypothalamic-pituitary adrenal (HPA) axis. This can result in the following reactions after a disaster:
- Physical health problems and/or somatic concerns
- Poor sleep quality
- Acute stress disorder
- Increases in the use of alcohol and/or drugs
- Anxiety and depression
- Post-traumatic stress symptoms and/or disorder
- Dissociative responses
- Complicated grief, which presents as a combination of grief and post-traumatic stress disorder (PTSD) symptoms. This causes greater psychological distress and for a longer period of time than when death is due to natural causes.
- In children, depression, anxiety, and PTSD that may be manifested by emotional ability, problems falling asleep, frequent crying, fear, anniversary grief, and multiple medically unexplained somatic complaints.
Recommended for nurses: Crisis Resource Management for Healthcare Professionals
Post-disaster mental health competencies
Trauma reactions vary from person to person. Major risk factors include severity of exposure, ongoing stressors, deteriorating psychosocial resources, demographic, emotional, and cognitive factors, and a lack of community cohesion. Vulnerable groups, including children, older adults, minorities, and first responders, are at a high risk for more severe traumatic responses.
Disaster mental health is the collection of supportive and therapeutic services designed to help individuals and communities exposed to a disaster. It also helps identify those in vulnerable populations who may be at risk for later or long-term issues.
Counselors and behavioral health professionals already bring critical skills to the table: assessment, listening, empathy, etc. DMH, however, requires additional levels of flexibility, empathy, and the ability to work in a chaotic and unpredictable environment. DMH providers need to understand the different interventions appropriate in each post-disaster phase, know when to be directive and when to listen, and maintain appropriate boundaries to prevent burnout.
Self-care for disaster mental health providers
Depending on the nature of the disaster, DMH care can be intense, exhausting, and even dangerous. DMH providers are at an increased risk for developing acute stress reactions, depression, and even PTSD. Proper self-care is necessary in order to support survivors in their natural recovery process, identify at-risk individuals, and provide the most effective care for survivors.
Self-care strategies may include:
- Maintaining strong social support networks, including family, collegial, and supervisory relationships
- Focusing on positive emotions, including humor and acceptance
- Reinterpreting events in a positive light
- Pausing to clarify personal values and identify the ‘why’
- Controlled breathing exercises
- Well-balanced nutrition and healthy sleep habits
- Flexible use of coping strategies
Recommended for therapists: Understanding Posttraumatic Stress Disorder
A person-centered approach
Although the majority of those affected by disasters will make a full recovery, a substantial percentage of those exposed will experience acute distress in the immediate aftermath of the disaster. Of this, a significant number will eventually develop long-term disorders.
Triage and a person-centered approach should be integral components of any disaster behavioral health program. This is critical in order to select those who need interventions, monitor the course of recovery, and evaluate the program’s ultimate effectiveness.
This article is based on the 2-hour Social Work and Psychology and 3-hour Counseling CE course “Disaster Mental Health, 2nd Edition” written by Bradley E. Belsher, MSW, Jennifer Housley, MS, PhD, and Patricia Watson, PhD.