Disaster Mental Health Community Planning

A Manual for Trauma-Informed Collaboration

Robert W. Schmidt, Sharon L. Cohen

• Publisher: Routledge
• Year: 2020
• ISBN:
  9781000038118
• Edition: 1
• Topic: Scienze sociali
• Subtopic: Studi sullo sviluppo globale

Disaster Mental Health Community Planning is a step-by-step guide to developing mental health disaster plans, assisting communities to act on long-term resilience and recovery.

As disasters continue to increase in severity and number, with 16% of survivors identified as potential PTSD victims ifthey don't promptlyreceive care, this book is a critical read. Chapters outline how to prepare, develop, and implement a trauma-informed collaborative process that prioritizes lasting emotional wellbeing along with survivors' short-term needs. The manual demonstrates how to form this partnership through effective communication, assess those individuals at greatest risk of distress, and deliver trauma-specific treatment. Readers will appreciate the book's practical, user-friendly approach, including case studies, checklists, and follow-up questions to better define goals. Cutting-edge treatment interventions are included along with basic information on trauma's impact on the brain and the types and effects of human-caused and natural disasters to help readers make sound planning decisions.

Accessible to mental-health providers, community leaders, organizations, and individuals alike, Disaster Mental Health Community Planning is a Road Map for anyone interested in delivering a trauma-informed mental health supplement to their community's medical disaster preparedness and response plan.

1

Introduction to Mental Health

Chapter 1 Preview
A. Increasing Extent of Disasters
B. Launch of Emergency Management
C. History of Disaster Mental Health
D. Statewide Disaster Mental Health
E. Parity of Disaster Mental Health Plans
F. Foundations of Community Psychology
G. Manual Overview

Events over the past several years have proved how both natural and human-caused disasters are on the rise, and American communities need to be prepared for potential calamites to come. That word, “preparation,” is the main purpose of this manual: Most American towns and cities have developed disaster response plans or a set of action steps fire departments, police, and hospitals must take for response, reduction, and recovery for any catastrophic event from biological exposure to a mass shooting to an earthquake. Until recently, the ultimate goal of these plans has been solely the “physical” wellbeing of citizens. Mental health has not been a consideration, with long-term stress, anxiety, and trauma either ignored or treated as afterthoughts. This needs to change. Disaster mental health preparedness can no longer be overlooked if communities truly care about the effective long-term recovery and resiliency of their residents.

Disaster mental health planning is also not a one-size-fits-all process because of all the inherent differences:

1. Not all disasters impact the mental health of populations in the same way. This is especially true of natural versus human-caused disasters, where the latter lead to more severe trauma;
2. Although human-caused disasters can occur anywhere in the U.S., each geographical area is more prone to experiencing one type of event over another. Hurricanes are most common along the East Coast, for example;
3. Municipalities do not share the same ability to respond to a catastrophic event. Rural or low-populated areas, small communities, and urban localities face different challenges;
4. The demographics of each community differ along with those residents who are the most vulnerable. The socioeconomic makeup of the town or city, for example, impacts response effectiveness; and
5. Certain states are better prepared to respond to disasters than others. Some states, for example, have already developed statewide and/or regional mental health/behavioral plans and response teams.

By following the steps in this manual, you can determine the disaster mental health plan best for your community’s unique parameters. Expect planning to be an ongoing learning process, in which improvements are made either post disaster and/or as information is acquired from other communities and newly published studies. Naturally, it is hoped your community will not need to implement your plan but only to keep it on hand to provide the best care possible whenever necessary.

A. Increasing Extent of Disasters

In the U.S. alone, by early October 2019, weather and climate disaster events, including storms, cyclones and flooding, had each led to losses exceeding $1 billion. In 2018, the U.S. was devastated by a multitude of extraordinary natural disasters, from the deadliest wildfires in California’s history that destroyed the entire town of Paradise to the worst hurricanes on the East Coast since the late 1960s. The price tag of disasters is also quickly mounting with increased severity. Total costs of $306 billion in 2017 far surpassed the $214.8 billion in 2005, according to the National Oceanic and Atmospheric Administration (www.noaa.gov). Disasters cause significant economic impact to communities and the entire country for an undetermined time. Louisiana will never be the same after Hurricane Katrina in 2005, and scores of residents still struggle with the financial impact of Superstorm Sandy in 2012.

Human-caused catastrophes also broke records these past several years. According to the Gun Violence Archive (www.gunviolencearchive.org), which keeps track of gun-related injuries and deaths, 2017 topped the all-time record for mass shootings with a total of 345. This violence included two of the deadliest such events in American history within just 35 days of each other. In October, 64-year-old Stephen Paddock opened fire on 22,000 concertgoers in Las Vegas, leaving 58 people dead and over 500 injured. After an extensive federal study, Paddock’s motive remains undetermined. Following this Las Vegas tragedy, one survivor of the 2016 Pulse nightclub shooting, which killed 49 and wounded 58 in Florida, said, “My heart is breaking all over again. … How much can we take?” (Santach, 2017).

Only a month after the Las Vegas shooting, 26-year-old Devin Patrick Kelly murdered 26 congregants during religious services at the First Baptist Church in Sutherland Springs, Texas. This catastrophe was even worse than the earlier Burnette Chapel Church of Christ shooting in Antioch, Tennessee, which killed one and injured seven. The number of mass shootings in 2018 was only a few lower than in 2017, but brutal all the same. These violent events included Marjory Stoneman Douglas High School in Parkland, Florida; the Tree of Life Synagogue in Pittsburgh, Pennsylvania; the Capital Gazette newspaper in Annapolis, Maryland; and the Borderline Bar and Grill in Thousand Oaks, California. As this book goes to press, continued shootings occur in schools and houses of worship.

In 2019, it seemed that every day brought a new shooting and that turned out to be true. There were more mass shootings than days in the calendar. It also appears that no location is safe, with gun violence in houses of worship, sports arenas, shopping malls, schools, theaters, and nightclubs. In addition, a new form of human-caused concern, cyberviolence, is growing steadily, and New Orleans was shut down after a cyberattack.

B. Launch of Emergency Management

Although disasters have battered the U.S. from its earliest history, the country reacted quite slowly in responding to the aftereffects. The first time the U.S. government took action on a local disaster was in 1803 when a congressional act provided financial assistance to Portsmouth, New Hampshire, which was destroyed by fire. Then, no great strides were made in emergency response until the 1930s, when the Reconstruction Finance Corporation and the Bureau of Public Roads authorized disaster loans for public facility reconstruction. Congress also passed the Flood Control Act in 1934, which gave the U.S. Army Corps of Engineers greater authority to design and build flood-control projects. In the Cold War 1950s, numerous civil defense programs arose across the country.

Source: FEMA

A decade later, many natural disasters rocked the country. An earthquake in Montana, Hurricane Donna in Florida, and Hurricane Carla in Texas caused record damage. The 1962 Ash Wednesday storm destroyed over 620 miles of East Coast shoreline; the 1964 Alaskan earthquake measured 9.2 on the Richter scale and generated tsunamis that killed 123 people; and Hurricanes Betsy and Camille at the end of the decade were fast and furious, killing and injuring hundreds of people and causing hundreds of millions of dollars in damage—a considerable amount for the time.

The government was still acting in an ad-hoc fashion for disaster relief, with over 100 federal agencies offering some type of support after each event. With such a fragmentation of funding and no unified federal emergency management system, the state governors’ frustration grew. They finally decided to act and launched the National Governors Association Subcommittee on Disaster Assistance (1979). Based on their concerns, President Jimmy Carter established a new Federal Emergency Management Agency (FEMA) in 1985 to make recommendations on how to prepare for and respond to national emergencies.

Now, most communities have developed emergency management plans to diminish the damage of disastrous events as well as Community Emergency Response Teams (CERTs) that are trained to immediately respond with medical, fire safety, and rescue efforts. FEMA (www.fema.gov) defines emergency preparedness as “pre-impact activities that establish a state of readiness to respond to extreme events that could affect the community.”

The vast majority of emergency plans are focused on the community’s environment, the physical wellbeing of the residents, and the effect on infrastructure. Information includes evacuation routes, emergency contacts, checklists, and critical operations. Preparedness is a step-by-step process, with an ongoing series of analyses, plan development, and education/training and skill development of participating individuals. Community emergency plans vary in their planning process; some have more formal and defined approaches, a specific planning budget, and clear outcomes, and others follow a more informal, less defined approach with a low budget or on a volunteer basis. The degree of formality of emergency plans often corresponds to community size and disaster history, such as a region regularly facing destruction by tornadoes.

Regardless of the type of emergency plan they develop, communities clearly recognize preparedness is essential in caring for the medical needs of their residents and the rebuilding of their homes and infrastructure. On the other hand, nearly all of these emergency plans lack a psychological component. Mental health typically takes a back seat in disaster response.

C. History of Disaster Mental Health

It was not until the late 1800s that psychologists Sigmund Freud and Pierre Janet began communicating about the impact of traumatic situations (Ringel & Brandell, 2012). Following World War I, and more so after World War II and the Vietnam War, studies depicted soldiers’ traumatic reactions to their battle experiences. Research was also conducted on the effect of interpersonal violence, such as spousal abuse. Formal studies on the relationship between calamity and trauma go back at least 75 years. After Boston’s Coconut Grove nightclub fire in 1944, Erich Lindemann (2006) published one of the first observations on the impact of disasters on mental health. For the first time, this study noted psychological upheaval, including symptoms of stress, anxiety, helplessness, and depression. After a year, these changes also led to an increase in mortality rates, a heightened frequency of physical ailments, and visits to physicians and hospitals. Social contacts were greatly reduced, and people were less satisfied with the quality of their lives and reported reduced participation in leisure activities.

Kai Erikson (1976) thoroughly covered the mental health impact of human-caused tragedies in his book about the deadly floods in Buffalo Creek, West Virginia. On February 26, 1972, 132 million gallons of muddy water broke through a temporary mining-company dam and immediately changed the town forever. Flood survivors, who had previously lived in a tightly knit community, were crowded into trailer homes with no concern for former neighborhoods. This disregard for living conditions resulted in a collective trauma, with tension and conflicts among the residents and a loss of personal connection, as well as disorientation, declining morality, a rise in crime, and outmigration.

In 1980, PTSD was added to the third edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-III), mostly due to the mental health concerns of returning Vietnam War veterans. This addition to the DSM led to increased research on the mental health impact of traumatic events, including disasters. At the same time, the International Society of Traumatic Stress Studies was established to enhance the development of disaster planning and response strategies. As defined by the DSM—Fourth Edition (DSM-IV; APA, 1994), “The person experienced, witnessed, or was confronted with an event or events that in...