How Social Workers Can Help Disaster Mental Health Preparedness

By Tonya Hansel, PhD, LMSW

With hurricane season approaching, we are seeing reminders and recommendations in the media about how individuals and organizations can prepare. In recent years, hurricane season has been starting earlier and this year is expected to be highly active (Belles & Erdman, 2021; Erdman, 2021).

As with most years, the recommendations are generally oriented around physical safety and financial readiness. Certainly both during and immediately following a disaster, physical health and safety are of the utmost urgency. But given the extraordinarily challenging year we have just been through and that we are still in the midst of a pandemic, it would be advantageous to consider a dimension that often gets neglected and underfunded when it comes to disaster preparedness: mental health.

The Challenge of Integrating Disaster Mental Health Services
The challenge is that disaster planning is an area in which mental and behavioral health traditionally receive less attention. Part of the reason is that mental health services are already an underserved and underutilized resource in day-to-day life. This only gets exacerbated in a disaster in which infrastructure becomes damaged and available resources are appropriated and used, understandably, for the most immediate basic needs, including food, water, shelter, and medical attention.

However, once some of the initial shock has subsided, a range of mental health concerns surface as a direct result of the disaster, all documented by a substantial body of research over the past several decades: PTSD, grief, depression, anxiety, substance use, and suicide ideation (Makwana, 2019).

This is not surprising. In large-scale disasters such as hurricanes and wildfires, people’s homes may be heavily damaged or destroyed, their loved ones may have been hurt or worse, and there is often much uncertainty about the future. Secondary trauma, or vicarious trauma, is also a concern during disasters, since people don’t need to have directly experienced the event to contract symptoms of distress. Simply being in proximity to a disaster—in terms of physical distance, media exposure, or past experiences (even from decades ago)—can lead to mental health symptoms (Kessler, 2012).

There are also challenges unique to disasters and collective trauma that are not as widely encountered with individual trauma. For example, social support is an important component of coping and resilience, and a local community is often the main or only source of assistance for disaster survivors until organized emergency response efforts are mobilized. But in the aftermath of a collective disaster, social support between and among survivors can deteriorate due to the strain that people in the affected community are under, potentially contributing to a downward spiral in which the very crisis that makes social support more crucial also undermines it, adding more burden to people who are already overburdened (Koichiro et al., 2020).

This brings us back to the importance of making mental health a more integral part of disaster preparedness. In the short-term it is vitally important that people have a roof over their heads, a bed to sleep in, food to eat, and clean water to drink. Resources, especially when limited, should by all means be focused on providing these necessities. However, disaster survivors are at significantly higher risk of severe mental health symptoms, and if their conditions are so severe that they are unable to function, a roof and a bed can only do so much (North & Pfefferbaum, 2013).

Previous disasters have taught us the importance of preparing for mental health needs, but 9/11 and Hurricane Katrina also taught us that even though there is a real need for mental health services, timing and methodology are key (Covell et al., 2006; Many et al., 2012). When people are in survival mode they are not as likely to seek out mental health services, which is OK so long as their ability to function isn’t impeded.

Since resources would likely be limited, services can be planned for and provided in such a way as to emphasize public health messaging for the majority of people who’ve been exposed and reserve more intensive services for those experiencing severe symptoms. Public health messaging, moreover, can train people to recognize when the symptoms they are experiencing are normal responses that can be managed via coping skills and when they should actively seek out help.

The Role of Social Workers
Social workers and social service agencies have a large and important role to play in disaster preparation with regard to mental health. One way is to vigorously advocate—at the local, state, and federal levels—for better funding and resources so that agencies can better apply what past large-scale disasters have taught us about mental and behavioral health needs. Since social workers often serve on the front lines of disaster response and see the need for mental health services firsthand, they are ideally positioned to advocate for these services to be integrated into more traditional disaster responses.

With more funding, public health messaging about mental health in relation to disaster preparedness can be widely implemented and play a helpful preventive role before, during, and after disasters. Messaging can serve as reminders to routinize healthy coping behaviors. When disasters strike, victims will be less likely to adopt unhealthy behaviors. When practiced early, healthy coping behaviors not only make it more likely that people will continue these behaviors during and after disasters but will also help to balance the negative effects of unhealthy coping behaviors. They also help reduce the allostatic load of stress by “reducing the temperature,” similar to when the lid on a pot of boiling water is lifted to prevent it from overflowing.

Since better funding is an objective that may take time and will be achieved unevenly across different regions, social workers can play a huge role in their daily interactions with clients. In addition to issuing healthy coping behavior reminders, social workers can help normalize nonsevere mental health symptoms for those who are affected by disaster—as many have done throughout the COVID-19 pandemic.

Remind people, especially those who are in survival mode and just trying to get by, that the feelings they are experiencing are a normal and expected reaction to a highly stressful event. It may be difficult to integrate healthy coping strategies in the short term, which, as long as they are able to function, is fine. Encourage them to do what they can, when they can. For example, if they find that yoga helps with stress but they can’t complete hour-long sessions, encourage them to squeeze in whatever they can, even if it’s only five or 10 minutes. These types of reassurances can be extremely helpful.

With an active hurricane season forecasted and the mental stress of the pandemic still fresh, this form of messaging is particularly important. As with the boiling water analogy, only so much pressure can build up before the water boils over. Therefore, now is the time to remind and encourage people to refill their coping reservoirs as much as reasonably possible, so that if and when disaster strikes, they will be better equipped to manage.

— Tonya Hansel, PhD, LMSW, is an associate professor and director of the Doctorate of Social Work at the Tulane University School of Social Work. She is a social worker with expertise in research, statistics, disaster mental health, trauma, and maximizing outcomes for social service agencies.

References
Belles, J., & Erdman, J. (2021, April 26). 2021 Atlantic hurricane season expected to be more active than normal, the Weather Company outlook says. The Weather Channel. https://weather.com/storms/hurricane/news/2021-04-13-atlantic-hurricane-season-outlooks-april-twc-csu.

Covell, N.H., Donahue, S.A., Allen, G., Foster, M.J., Felton, C.J., & Essock, S.M. (2006). Use of Project Liberty counseling services over time by individuals in various risk categories. Psychiatric Services, 57(9), 1268-1270. https://doi.org/10.1176/ps.2006.57.9.1268.

Erdman, J. (2021, April 19). Atlantic hurricane season is six weeks away, but it has started early 6 straight years. The Weather Channel. https://weather.com/storms/hurricane/news/2021-04-19-hurricane-season-early-start-2015-to-2020.

Kessler, R.C., McLaughlin, K.A., Koenen, K.C., Petukhova, M., & Hill, E.D. (2012). The importance of secondary trauma exposure for post-disaster mental disorder. Epidemiology and Psychiatric Services, 21(1), 35-45. doi:10.1017/S2045796011000758.

Koichiro, S., Yazawa, A., Kino, S., Kondo, K., Aida, J., & Kawachi, I. (2020). Depressive symptoms in the aftermath of major disaster: Empirical test of the social support deterioration model using natural experiment. Wellbeing, Space and Society, 1, 100006. https://doi.org/10.1016/j.wss.2020.100006.

Makwana, N. (2019). Disaster and its impact on mental health: A narrative review. Journal of Family Medicine and Primary Care, 8(10), 3090-3095. https://doi.org/10.4103/jfmpc.jfmpc_893_19.

Many, M., Hansel, T., Moore, M., Rosenburg, Z., & Osofsky, H. (2012). The function of avoidance in improving the understanding of disaster recovery. Journal of Human Behavior in the Social Environment, 22(4), 436-450. https://doi.org/10.1080/10911359.2012.664974.

North, C.S. & Pfefferbaum, B. (2013). Mental health response to community disasters: a systematic review. Journal of the American Medical Association, 310(5), 507-518. https://doi.org/10.1001/jama.2013.107799.