Why Natural Disaster Recovery Must Include Long-Term Mental Health Support

How long is mental health support needed after a natural disaster? A lot longer than it’s usually available, according to a new Centers for Disease Control and Prevention (CDC) report on the lingering mental health effects of Hurricane Irma, a Category 4 hurricane that struck the Florida Keys in September 2017.

Using data from a survey of survivors, it found that anxiety and depression worsened and the suicide rate climbed over the 20 months after the hurricane. What’s more, nearly 40% of the households who reported a need for mental health services were unable to get support, largely due to cost barriers. 

“Right now, the federal and state response in disaster response plans deploy mental health resources immediately after [a] disaster. Those resources are in [a] community for about six months, then they leave. They’re not really where they need to be,” said the report’s co-author, Summer Hartley, PhD, MPH, a nurse scientist and researcher at West Virginia University, in a press release.

Let’s take a closer look at why the long-term emotional impacts of a natural disaster can often be worse than in the immediate aftermath, and the critical need for ongoing mental health support for victims.

Emotional Toll of Natural Disasters

Natural disasters can take a serious toll on the mental health of individuals and their communities at large. There’s no doubt that seeing homes wiped away and city infrastructure in shambles right after a disaster would be devastating. But it’s at a year to 18 months after a natural disaster when “things really get bad,” said Hartley.

“Natural disasters don’t happen and then conclude; they are termed ‘disasters’ because they have far-ranging and long-standing impacts on people’s lives,” says Elisabeth Netherton, MD, a psychiatrist with MindPath Care Centers, a Community Psychiatry practice.

Surprisingly, the first few weeks after a natural disaster can be a time of emotional highs for a community. It includes a “heroic phase,” when people witness and perform rescues that inspire a sense of altruism. That’s followed by the “honeymoon phase,” during which an influx of assistance fosters optimism and bonding within a community.

“Immediately following a disaster, community support tends to be greatest,” says Gary W. Small, MD, chair of psychiatry at Hackensack University Medical Center and behavioral health physician-in-chief at Hackensack Meridian Health. “However, that support wanes over time due to limited resources and lack of recognition of the lingering mental health impact of a disaster.”

That’s when communities enter the “disillusionment phase,” a period of extreme emotional lows. Recovery workers have packed up and moved on, and people feel abandoned. Many community members become physically exhausted and substance use disorders surface during this period, which can last months or even years. And trigger events, like the anniversary of the disaster, can cause spikes of mental health problems.

“Anniversaries of disasters may create feelings of depression as community members reflect on the moment that their lives as they once knew them were upended,” explains Kristin Roelofson, MPH, MSW, LSW, resident in counseling at Thriveworks in Pittsburgh.

Finding Support During Disaster Recovery

Despite the increase of mental health problems, the disillusionment period of disaster recovery is often a time when support services are difficult to access. In some cases, the available mental health services may not be able to meet demand, especially after the crisis resources have dried up.

Plus, the ongoing disaster recovery comes with challenges for people in need of emotional support that make it difficult to access services.

“Natural disasters are disruptive to one’s state of normalcy, including daily routines, activities of daily living, employment, transportation, housing, and social relations,” explains Roelofson.

The costs of therapy can be prohibitively expensive for people in normal times. That obstacle can be exacerbated during disaster recovery, when people may be experiencing disruptions at work and trying to come up with money to repair damage or even find a new home.

“Folks’ immediate focus is often not on receiving care, even when they can afford to go. They are often more immediately consumed with re-establishing normalcy and safety,” says Dr. Netherton. “In late stages following a natural disaster there can be challenges with job stability and insurance, along with difficulties finding providers remaining in the area to see.”

Mobilizing Long-Term Mental Health Support

The study on the impact of Hurricane Irma indicates that emergency preparedness plans should find ways to extend mental health services throughout the long-term recovery phase. 

“Focusing on people with limited financial resources, increasing the visibility of mental health services during anticipated emotional lows, and suicide prevention strategies should be priorities,” said Dr. Small.

But the ongoing shortage of mental health professionals and combined with increasingly extreme weather events pose huge challenges to ramping up the long-term support disaster survivors need.

“Having mental health support available for the long-term after a natural disaster would require that we find solutions to the shortage of mental health clinicians and ensure that those clinicians are able to work and see folks in areas where they are most needed,” says Dr. Netherton. “We would also need to ensure that people affected by the disaster are able to afford the services provided or that funding was allocated for this purpose.”

In addition to increasing funding and providers, response teams may need to get creative to bring mental health services where and when they’re most needed.

Roelofson suggests “mobilizing community health workers, peer navigators, and even counselors and social workers in training to provide mental health services as part of their professional preparation.”

She continues: “This may provide a gateway for community members in need to receive services for free or for a low fee, which would be beneficial to people who are underserved and have limited financial and other resources.”

The CDC report also recommends offering telemedicine to allow people to get virtual mental health services. Assuming survivors are able to access a phone or computer, they could potentially connect with a therapist anywhere in the state or country.

Regardless of the strategy used, providing long-term mental health support is critical to helping disaster victims get back on their feet and heal from trauma. It’s a reminder that climate change isn’t just an environmental concern—it’s a mental health issue, as well.