Disaster Response, Mental Health, and Community Resilience

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The increase in repeated disasters and associated social stressors linked to global warming is likely to affect the mental wellbeing of billions of persons in the 21st century, increasing risk for depression, anxiety, PTSD, anger and violence, social disruption and displacement, and social conflict. This means that our current conceptual frame of disaster response will be too narrow to address the many problems created and exacerbated by climate change-disaster mental health no longer should remain the sole model guiding our preparation and response. We need an expanded view that encompasses diverse responses to match a greatly expanded set of threats.

The importance of strengthening disaster mental health response system

Disaster mental health response in the US commonly includes a stepped care system that includes community outreach and delivery of psychological first aid (PFA), crisis counseling, and, for those most greatly affected, formal treatment. The brief education and support included in PFA is offered to as much of the affected population as possible, with more intensive services made available for those at greatest risk for problems. Brief crisis counseling programs offer support and, increasingly, teach skillsets to improve coping (eg, problem-solving, relaxation, positive activity scheduling).

Most communities only develop the ability to implement these disaster response elements after they find themselves affected by a disaster. Prior to such emergent need, these services seem relatively optional and have not, to date, been able to compete with other political priorities. As a result, they do not attract significant organizational focus and allocation of resources. Moreover, after external funding goes away, the various organizational structures used to respond often disappear. If we are to improve our ability to respond to repeated events, an effort to transform acute response systems into enduring, sustainable programs is needed. Given the heightened awareness of disaster in the face of climate change, greater levels of preparation are needed for responding to mental health requirements as well as a way to sustain the capacities developed in response to specific disasters for ongoing use in future events.

The problems created by global warming (including recurrent disasters) are multifaceted. The all-hazard community-based resources and capabilities will enable more effective action in the face of climate-induced problems and will also spill over into the many challenges already troubling our communities (eg, family problems, work stress, drug addiction, suicide). In this sense, actions to increase climate change resilience tie in with other existing programs and services for social problems and life improvement.

Towards resilient communities: some components of a more adequate response

Improving disaster mental health programs will not be adequate to meet upcoming challenges. Rather, these programs will need to be supplemented by novel initiatives and combined into an integrated program of community support and resilience. They will require creativity and significant contributions from many quarters.

Coping skills training and support. Individuals who have effective coping and stress management skills, such as problem-solving, mindfulness, physical relaxation, and conflict resolution, will more successfully manage their experiences of disaster and exposure to climate-related stressors. Dissemination of these skills across larger populations in neighborhoods and regions is feasible and can include several strategies. Perhaps the most straightforward strategy is to develop, deploy, and maintain internet and mobile technologies for resilience. These technologies can include educational content and brief, interactive training materials that can serve as stand-alone resources or supplements to other support offered by mental health professionals and peers.

Findings from research suggest that internet-facilitated interventions can be effective in addressing a range of mental health problems especially when supplemented by human support.^1,2 Mental health apps such as Calm and PTSD Coach are widely used and can reach large numbers of individuals; similar approaches are being harnessed for disaster response. For example, the Sonoma County Wildfire Collaborative deployed MySonomaStrong, an internet-based self-management tool (MySonomaStrong.com) and a mental heath app (SonomaRises).

Another strategy for strengthening effective coping and spreading key skills is to expand training for health care professionals as well as lay community members on effective coping and and crisis counseling. Primary and acute care medical clinicians can provide disaster response and critical incident stress management.

In addition, trained laypersons can be deployed to support clinical caregivers in disaster response. However, the capacity to train laypersons and paraprofessionals in delivery of effective interventions to address such adversity must be developed. This involves identifying effective interventions and training mental health professionals who would then train a large cadre of lay community members in these interventions.

Capacity to supervise trainees and administer training programs also would need to be established. While there are many evidence-based treatments for mental health problems, there continues to be a large gap between routine care and best practices, because of limited availability of trained providers. Expansion of access to training would help spread coping skills among disaster- and climate-affected populations while also increasing access to effective treatments in many mental health and social service settings.

Beyond psychological coping: actions for climate solutions. While a focus on coping and emotional wellbeing is necessary, it is also critical that direct actions to address the realities of climate change and mitigate its effects are undertaken as part of community response. In fact, involvement in activities intended to reduce global warming and address proximal climate problems is likely to bring direct psychological benefits, in addition to creating a safer and sustainable local environment.

Cumulative exposure to media coverage of the impacts of climate change compound stress responses via increases in perceived threat to our environment and our wellbeing. Already observable are increases in “eco-anxiety” as we worry about the future for ourselves, our children, and future generations. Adoption of behavioral changes (eg, use of public transportation, development of green spaces, adoption of clean energy technologies), efforts to take on problems that exacerbate the effects of climate change (eg, poverty, inequality), and participation in political actions to address climate change can help reduce stress and anxiety associated with a climate change. Making such changes can build confidence in one’s ability to cope (self-efficacy) and help reduce distressing thoughts and beliefs.

Self-efficacy can be expected to increase when individuals take practical actions to address aspects of a problem (eg, develop family emergency plans, participate in activities of the climate change movement, practice energy-conserving personal behaviors). Some climate-related actions, such as increasing commuting via bicycle and walking, may help reduce stress by increasing cardiovascular health and reducing physical tension. Increasing recreation and work in green spaces might reduce personal stress levels while at the same time increasing positive social interactions. Increased use of public transportation might increase perceptions of community cohesion. If individuals increase their engagement in such activities, it will help transform the negative thinking associated with worry about environmental problems into effective action, building hope and resilience in place of anxiety and depression, fatigue and despair.

Community-based readiness and sense of community. Over time, global warming is likely to increase social relationship stress, substance abuse, interpersonal aggression, violent crime, and social instability, the combined effects of which are likely to decrease community cohesion and, potentially, divide the global community. While social cohesion and social capital are thought to protect communities against mental and physical health impacts of disasters, it is not clear how to rapidly or reliably build these. However, even in the face of limited knowledge, it seems prudent to invest in and expand community mental health infrastructures; take steps to reduce disparities in resources and increase supports for vulnerable subgroups; strengthen capabilities for public mental health communication related to disasters and emergency incidents along with capacities to harness social media in the service of wellbeing; develop and strengthen preparedness planning; and establish and develop online communities for mutual support.

In addition to these specialized community-wide mental health activities, some more general initiatives will improve the wellbeing of community members. One key step is to increase the availability and use of public transportation, which in turn can be expected to increase community cohesion, recreational activities, neighborhood walkability, and physical exercise, all of which are likely to reduce symptoms of depression and stress. A second step is to increase the availability of contact with nature. More time spent interacting with nature can improve health and lower stress via several mechanisms including exposure to better air quality, increased exercise, the calming effects of natural environments, and increased social cohesion. Increased exposure to nature might also help to create commitment to environmentally positive behaviors and actions to reduce global warming.

Collaboration and community: toward resilient communities

Critical to a comprehensive response to climate change is bringing together climate activists, health care organizations, local government, self-help groups, educational institutions, business groups, and technology providers, to create a sustainable focus on these issues. Such a “big tent” approach is needed to ensure community buy-in and enable the kind of multidisciplinary expertise required for the various tasks.

Existing institutional structures may create barriers to needed collaboration. The various scopes of practice of disaster response personnel may make it difficult to jump the corridors of professional identity. The institutions in which mental health professionals work might have difficulty in expanding their missions to encompass the broader sets of activities. In fact, it seems likely that the expanded threats associated with climate change call for new kinds of interprofessional and interdisciplinary collaboration within the context of new kinds of organizational structures and alliances. Different perspectives on the problems (eg, climate change versus disaster response, political versus professional, economic versus mental health, social justice versus governmental responsibility) will need to be combined to reach an alignment on common goals and processes. It this can be achieved, it will bring into being many facets of a more robust public health system.

The process of community building needed to accomplish the objectives outlined here represents a significant strengthening of resilience within the participating communities and constituent organizations. The challenge is to mobilize wide, sustained support when climate change, for many, continues to feel like something that will happen to others, in far off places, in some distant future.

Because so many of the primary effects of climate change will be on mental health and psychosocial functioning, our current set of responses must evolve with much greater involvement of health care organizations. Hospital environments represent major opportunities to increase readiness for the mental health aspects of disaster and expand delivery of evidence-based mental health interventions. Increased capacity to deliver these interventions after disasters will also result in improved behavioral medicine services and capacity to more effectively address the wide array of traumas routinely seen in hospitals.

Mental health professionals, with their disciplinary expertise, are needed to help make the link between mental health and climate. They are central to any attempt to improve the emotional regulation skills and problem-solving abilities of the citizenry, whether they deliver such training as part of post-disaster support efforts or, more proactively, before disaster strikes, in schools, workplaces, community centers, hospitals, and social service organizations. As mental health professionals, we must become more climate-literate and serve as community leaders for this relatively ignored aspect of climate change. We also must step beyond our professional identities and work-related roles to facilitate greater community collaboration and help innovate to develop more effective individual and community-wide interventions.

A particular challenge is to identify which organizations might take responsibility for leading efforts and undertake population-based mental health monitoring and intervention as part of a more adequate and comprehensive response to climate change. The fight against climate change and its incumbent disasters must include mental health and social service organizations, community and national public health entities, worksite wellness programs, school-based mental health education, climate change organizations that can incorporate new areas of work to include mitigation of mental health difficulties, technology companies interested in improving the wellbeing of their communities, and mental health professionals.

Disclosures:

Dr Ruzek is Co-Director Center for m2 Health, Palo Alto University and Adjunct Professor, Department of Psychiatry and Behavioral Sciences, Stanford University, CA. He reports no conflicts of interest concerning the subject matter of this article.

References:

1. Andrews G, Basu A, Cuijpers P, et al. Computer therapy for the anxiety and depression disorders is effective, acceptable and practical health care: an updated meta-analysis. J Anxiety Disord. 2018;55:70-78.

2. Kuester A, Niemeyer H, Knaevelsrud C. Internet-based interventions for posttraumatic stress: a meta-analysis of randomized controlled trials. Clin Psychol Rev. 2016;43:1-16.