The impact of a disaster is not over once a disaster has passed and/or an individual has an opportunity to reflect and adjust. A disaster can be seen as a “trauma with a capital T,” to distinguish it from smaller-scale traumatic events one may encounter in life such as life or job changes, relationship breakdowns or financial stress. The Substance Abuse and Mental Health Services Administration (SAMHSA) states that trauma “has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.’”
“Two years later [after the flood], residents were finally beginning to express the trauma they had undergone and their needs for mental health services.”
~ Karla Twedt-Ball, Senior Vice President, Programs and Community Investment, Greater Cedar Rapids Community Foundation
We know from the descriptions of researchers such as David Abramson at New York University, that people and communities who have experienced a weather-related disaster event go through a series of reactions to the event over the long arc of recovery. These reactions may be more or less complicated due to pre-existing physical and mental health conditions; social networks that bring attention and security; political power that gives communities a seat at the table for determining their own recovery; economic capital such as income, stable housing and insurance; and access to mental and behavioral diagnostic and treatment care.
Disaster-related trauma is similar to other types of serious emergencies, especially those that result in death or profound personal loss. As the image above shows, the emotional highs and lows continue long after the disaster event itself. Many of the trigger events that cause serious mental health issues or depression often occur a year or more later.
People are usually caught up in preparation for a disaster that comes with a warning, such as a hurricane. If they have been through a past disaster, they are likely to experience flashbacks or anxiety. But in the immediate aftermath, stories of heroism and the sheer act of survival usually help stabilize and, in many cases even elevate, their mood. But as they take inventory of their losses and encounter difficulties to rebuild or regain normalcy, disillusionment sets in. They struggle, especially as the anniversary gets closer. Eventually, as their lives gain some stability, they will begin to work through their grief. Although setbacks occur, the intensity and frequency of these periods decrease, as indicated in the image above.
Yet, we also know that mental health responders or other professionals don’t typically identify many survivors who need care for various reasons. Survivors also don’t usually present themselves for assessment until long after the precipitating event, the media attention and the financial support have gone.
Pre-existing conditions, cultural awareness and understanding of mental health, access to health and mental health services, and the extent of the disaster are also factors that come into play in understanding the impact of a disaster on someone. Since each person has a unique starting point and different social and community safety nets, the same disaster will affect each person differently. For someone who was already dealing with mental health issues, a disaster may be the final straw that puts them over the edge and makes it impossible for them to cope with their current circumstances.
During CDP’s COVID-19: Support for Mental Health, Bereavement and Griefwebinar, Lisa Furst, vice president for policy, advocacy and education at Vibrant, said: “Funders are often focused on meeting the immediate needs that occur in the recovery phase. … However, I think there is a real opportunity for funders to focus their efforts into longer-term recovery phases following disasters because that is when mental health issues often emerge for people. Either because they stabilized enough materially to be able to address a mental health need, or because other short-term mental health and other supports have been withdrawn.”
With the vast footprint of the COVID-19 pandemic, we entered into new territory in assessing risk, evaluating impact and supporting interventions in mental and behavioral health. The timeline of the pandemic is unknown and has stretched over many months and potentially years. And for the first time in modern history, people around the country and the world are facing a disaster simultaneously. The COVID-19 quarantines, shutdowns and fears of becoming ill have impacted almost everyone, even those without any previous experiences with mental illness or poor mental health. Domestic violence and abuse hotlines report increased online communication and are preparing for an influx of calls once quarantines are lifted. Suicide ideation is up, and mental health hotlines report a huge increase in call volume.
The large number of COVID-19 infections and deaths in the U.S. and around the world have brought global attention to the impact of disasters on mental health, grief and bereavement. Many have been touched by loss and know at least one individual who has been infected or died. The quarantines have meant estrangement from loved ones in their hour of greatest need, making death extraordinarily challenging for the dying individual and their family and friends. Extremely limited funerals have removed one of the key cornerstones of the grieving process: the ability to gather as a community to mourn and celebrate the life of an individual. This further increases the trauma individuals, families and communities are experiencing.
Not everyone is equally at risk during a disaster. Many people face disproportionate impacts and higher levels of systemic (e.g., social and economic) and physical vulnerabilities.
“…for the larger population the barriers to treatment remain persistent: homelessness, rural locations, isolation, concentrations of low-income households in urban areas, race, and predispositions to health crises such as diabetes and heart disease and food deserts. Disasters magnify these disparities.”
~ Dr. Teri Brister, National Director, Research and Quality Assurance, National Alliance on Mental Illness (NAMI)
There are a number of special populations who are at a higher risk than others post-disaster:
- School-aged children.
- Individuals living with chronic illness.
- Individuals with visual, hearing, and/or mobility-impairments.
- Individuals living with depression or other forms of mental illness.
- Individuals with limited access to health care.
- Parents/caregivers, especially female heads of households (because they often put the needs of everyone else in the family above their own).
- Individuals living at or below the poverty line.
- Immigrant populations and undocumented individuals.
- First responders, emergency services, fire and police department personnel.
People responding to a disaster need to pay attention to pre-existing vulnerabilities to help direct their resources – human and financial – appropriately.
Signs of Concern
In the aftermath of a natural disaster or human-made tragedy, people with pre-disaster mental health issues are not the only ones who will need support. Many members of the general public will also need mental health services.
Depression and depressive-like symptoms are the most prevalent mental health issues post-disaster, with sleep problems being the most commonly reported. Communities that have experienced serious trauma or major disasters often see an increase in PTSD symptoms and community mental health challenges 12 to 18 months post-disaster. Depressive-like symptoms can also be tied to domestic violence, substance abuse and suicide; all of these tend to increase after a disaster.
However, according to SAMHSA, there are a number of risk factors or warning signs related to post-disaster stress and trauma. These are the same issues that are reported to affect bereaved people as well:
- Eating or sleeping too much or too little.
- Pulling away from people and things.
- Having low or no energy.
- Having unexplained aches and pains, such as constant stomachaches or headaches.
- Feeling helpless or hopeless.
- Excessive smoking, drinking, or using drugs, including prescription medications.
- Worrying a lot of the time; feeling guilty but not sure why.
- Thinking of hurting or killing yourself or someone else.
- Having difficulty readjusting to home or work life.
Additionally, the anniversary of the event or certain sights, sounds and experiences may trigger emotional distress. Those who have lived through major hurricanes for example, often find severe rainstorms and hurricane season generally to be stress-inducing.
People often minimize their personal mental health needs. They are typically in denial about their anxiety and stress levels, or want to help others instead. Many people – especially those from Black, Indigenous or People of Color (BIPOC) communities – do not ask for help due to the stigmatization of mental health challenges. This minimization of need is also particularly true for frontline workers and first responders who believe that they should be strong. It is vital that programs and services address the needs of all communities in their outreach and informational materials.
Increasingly, in mental health circles, there is a focus on trauma-informed care. This kind of therapeutic intervention occurs when a program or organization recognizes the “widespread impact of trauma and understands potential paths for healing; recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; and responds by fully integrating knowledge about trauma into policies, procedures, and practices, and seeks to actively resist re-traumatization.”
“More than anything, survivors need to have their despair normalized and need to have basic coping tips to move forward.”
~ Nancy Beers, Founding Director of the Midwest Early Recovery Fund, Center for Disaster Philanthropy
Trauma-informed services work to meet clients “where they are” rather than engaging in processes that could re-traumatize them. For NGOs and philanthropy, this could include extensive outreach and coordinated intake to avoid having disaster survivors retell their stories repeatedly.
Governmental and nongovernmental policies and planning to address disaster mental health must continue to draw from academic research, programmatic responses, and innovations in diagnostic and therapeutic care. Legislators, care providers and disaster funders should take the long view in supporting mental health issues. Organizations need to prepare for delays in expressions of distress and financial need since those who experience mental health challenges often do not seek care until long after the precipitating event.