Mental Health and Trauma

According to mentalhealth.gov, “mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make choices. Mental health is important at every stage of life, from childhood and adolescence through adulthood.

Over the course of your life, if you experience mental health problems, your thinking, mood, and behavior could be affected. Many factors contribute to mental health problems, including:

• Biological factors, such as genes or brain chemistry
• Life experiences, such as trauma or abuse
• Family history of mental health problems.”

While the first and last factors may certainly be impacted or exacerbated by disasters, life experience is the usual connection between disasters and issues with mental health. 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.’”

Pre-existing conditions, cultural awareness and understanding of mental health, access to health and mental health services and the extent of the disaster are all factors that come into play in understanding the impact of a disaster on someone. Since each person has a different starting point and a different social and community safety net, the same disaster will affect each person differently. For someone who was already dealing with mental health issues, a disaster may be a final straw.

According to the SAMSHA there are a number of risk factors or warning signs related to post-disaster stress and trauma:

• “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 rain storms and hurricane season generally to be stress-inducing.

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.”

Trauma-informed services work to meet clients “where they are” rather than engaging in processes that could re-traumatize them. For nongovernmental organizations (NGOs) and philanthropy, this could include extensive outreach to disaster survivors and coordinated intake to avoid people having to retell their story repeatedly.

• Since its launch in February 2012, the Disaster Distress Helpline has received over 63,000 calls and text sessions. The “Disaster Distress Helpline, accessible by calling 1-800-985-5990 or texting TalkWithUs to 66746, is a 24/7, 365-day-a-year, national hotline dedicated to providing immediate crisis counseling for people who are experiencing emotional distress related to any natural or human-caused disaster. This toll-free, multilingual, and confidential crisis support service is available to all residents in the United States and its territories.”
• There is no health without mental health. Mental health issues can interfere with a person’s daily life, work, ability to learn, physical health and relationships with others, which in turn impacts social and economic development. In the context of humanitarian crises, mental health is critical to recovering from disasters and the ability to rebuild.
• A tremendous stigmatization remains with mental health. When stigmatized, those who need help are less likely to access care, less likely to stick to medication or therapy schedules, and less likely to receive support from loved ones.
• A general lack of understanding/awareness of mental health issues persists, particularly in nations in the Global South. Lack of knowledge of issues hinder community members from living active, productive lives.
• In the United States and many other countries, suicide rates increase after disasters. Suicide is the 10^th leading cause of death in the U.S. and the number two cause for young people aged 15-34. For every successfully, completed suicide there are approximately 30 attempts. In 2019, there were at least 47,511 completed suicides. Following disasters in the U.S., this increases sharply. For example, in Puerto Rico, following Hurricane Maria, there was an increase from 19 suicides per month in the eight months before Maria to 25 suicides per month in the first three months after Maria. In Japan, after the 2011 earthquake and tsunami, there was a decrease in the overall suicide rate (although female suicides went up) for the first two years and then there was an increase. This speaks to the need for long-term mental health supports.
• Pre-existing mental health issues are exacerbated by disasters. Worldwide, the World Health Organization (WHO) says that “the burden of mental disorders continues to grow with significant impacts on health and major social, human rights and economic consequences in all countries of the world.”
• Health systems, especially in the Global South, do not provide adequate mental health supports, even before a disaster strikes. WHO states that, “. . .the gap between the need for treatment and its provision is wide all over the world. In low- and middle-income countries, between 76% and 85% of people with mental disorders receive no treatment for their disorder. In high-income countries, between 35% and 50% of people with mental disorders are in the same situation. A further compounding problem is the poor quality of care for many of those who do receive treatment.”
• Psychosocial support should be integrated into primary healthcare efforts to ensure needs are met during periods of disaster. Healthcare providers in clinics, for example, can be trained in the basics of mental health symptoms and potential treatments for more holistic—and effective—care.
• Those with severe mental health issues prior to a crisis must be taken care of so they can better cope when that crisis occurs. The stronger the mental health reserves of the individual, the better able that person is to handle “normal” reactions of shock, grief, loss, insecurity, etc. 

• Fund activities and programming that are integrated into wider systems. These efforts will likely reach more people, be more sustainable and carry fewer stigmas. Consider activities and programming affiliated with community support mechanisms (school systems, general health services, general mental health services or social services). Stand-alone services—such as those that deal only with rape survivors or people with a particular diagnosis—may be less effective in reaching people who do not consider themselves to have mental health issues. All health services after disasters should include a mental health component.
• Fund child-friendly spaces. Child-friendly spaces provide children who are living through the stresses of conflict or post-conflict life—or those who have survived terrifying events like an earthquake or tsunami—with a safe, protected, carefree environment where they can learn, play and grow. A welcoming, stimulating atmosphere, regular routines and structured time all help children to regain a sense of normality and overcome some of their problems. Support child-centered spaces immediately after a disaster, both in shelters and in the community, and then for an extended period during recovery.
• Make compliance with the Inter-Agency Standing Committee (IASC) Guidelines on Mental Health and Psychosocial Support in Emergency Settings a criterion for supporting mental health and psychosocial projects. Composed of experts from more than 30 international agencies, the IASC Reference Group on Mental Health and Psychosocial Support in Emergency Settings produced these guidelines as minimum standards and a guide to best practices in emergency settings based upon extensive, ongoing reviews of evidence-based practice.
• Partner with local NGOs and healthcare providers to address severe mental health issues prior to disasters. Identify people in need and help them build relationships with a range of mental health providers who are community-based and culturally diverse. Ensure that necessary medications and other supplies will be available should disaster strike. It is important to begin planning for the development of a sustainable mental health system early in the recovery process so that all supports do not leave once the immediate crisis is resolved.
• Use the Sphere Handbook’s suggestion for key actions to address mental health to be taken in the days immediately after a catastrophic disaster. These include: coordinating mental health and psychosocial supports across sectors, basing programs on identified needs and resources, strengthening community self-help or support services and providing information for staff and volunteers on psychological first aid.
• Foster public awareness programs that can reduce the stigmas associated with mental health issues. Community support and understanding can help ensure those affected receive the help they need—as well as prevent unnecessary costs and complications.
• Invest in training for healthcare workers to better communicate, recognize and treat mental health issues in emergency settings. This can cut down on duplication of efforts and confusion.

• The Center for Disaster Philanthropy provided a $35,000 grant to University City Children’s Center in Missouri in 2016 to provide emotional and mental health support for children and their families post disaster through its Midwest Early Recovery Fund. The Hurricane Harvey Recovery Fund awarded Texas Children’s Hospital $779,917, to be spent over two years, for the expansion of the Trauma and Grief Center at Texas Children’s Hospital’s Mobile Unit program. The funding will increase access to best-practice care among traumatized and bereaved children affected by Hurricane Harvey.
• Chevron Corporation Contributions Program provided Save the Children a $750,000 grant in 2017 to provide mental health support to 50,000 children in the Houston region affected by Hurricane Harvey through the Journey of Hope.
• Foundation for Louisiana provided a $10,000 grant to the Bridge Center for Hope to create a trauma and resiliency conference after the Great Flood of 2016 in Baton Rouge and surrounding parishes.
• The Robert Wood Johnson Foundation provided a $199,821 grant to the Mental Health Association of Monmouth County in 2015 to fund relief and recovery efforts for New Jersey in the aftermath of Hurricane Sandy by sustaining and expanding mental health and related social services.
• Global Greengrants Fund Inc., provided a $2,696 urgent action grant in 2017 to Unypad-Ranao for psychosocial first aid and play therapy for affected children and parents in the Marawi siege. It included provision of trauma debriefing session and healing play therapy to children in the underserved areas in Marawi City and addressing post-trauma stress to enable affected parents to become more effective in securing their needs and concerns as internally displaced persons (IDPs).
• The Unitarian Universalist Service Committee provided Syria Bright Future two $21,500 grants for their work with Syrian refugees in Turkey. The 2016 grant was used to conduct three trainings based on the Mental Health Gap Action Program that will equip trainees with the skills necessary to support the mental health and psychosocial well-being of Syrian refugees in Turkey. The 2017 grant supported the implementation of three separate trainings: 1) training twelve Community Case Workers in identifying individual needs and making referrals; 2) training six mental health professionals on the particular mental health and psychosocial support services (MHPSS) needs of refugees; 3) training six primary care physicians on the essentials of MHPSS so as to be able to treat the most common mental health disorders found among refugees.

• World Health Organization – Mental Health Atlas
• SAMHSA – Coping Tips for Traumatic Events and Disasters
• The Lancet (2004): Severe Mental Disorders in Complex Emergencies
• IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings
• The Sphere Project: Humanitarian Charter and Minimum Standards in Humanitarian Response
• World Health Organization: Mental Health in Emergencies: Mental and Social Aspects of Health of Populations Exposed to Extreme Stressors
• World Health Organization: Mental Health and Psychosocial Well-being among Children in Severe Food Shortage Situations
• WHO/UNHCR/UNFPA: Clinical Management of Survivors of Rape: Developing Protocols for Use with Refugees and Internally Displaced Persons (revised edition)
• U.S. Department of Veterans Affairs – PTSD
• Mental Health and Psychosocial Support Network
• Anxiety and Depression Association of America

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