Psychologists
can have public health roles in disaster recovery
By Paula Hartman-Stein, Ph.D.

    Disasters, both natural ones such as hurricanes, floods, wildfires, earthquakes, or those that are human-generated, such as school shootings or chemical spills, have become commonplace in American society. 
    Stress-related behaviors and symptoms linked to post-traumatic stress disorder (PTSD) can be triggered in those who must evacuate their homes, sustain property damage, or lose loved ones following disasters. The emotional impact can be profound even for people whose homes and property are not directly destroyed. Proximity to disaster zones, seeing devastated neighborhoods, and hearing distressing accounts of loss can lead to secondary traumatization and survivor's guilt.  
     The psychological impact of disasters is often overlooked at first, as public health efforts concentrate on infrastructure, immediate assistance, and humanitarian aid. However, mental health issues can take longer to develop, may peak well after the incident, and can persist over time, leading to significant financial costs.

     According to Dr. Joshua Morganstein and Dr. James West, in their free 8-hour online course offered by the Department of Disaster and Preventive Psychiatry at the Uniformed Services University in Bethesda, Maryland, the estimated cost for screening and treating mental health disorders after Hurricanes Katrina and Rita was $12.5 billion. Psychologists can play a vital role in assisting communities with their emotional recovery following a disaster.
     The traditional role of mental health professionals is to treat individuals with pre-existing conditions exacerbated by the crisis. Through a public health lens, psychologists can have a greater and long-term impact on communities by offering interventions geared to the prevention of risky health behaviors, alcohol and substance abuse, depression, anxiety, and severe family conflicts.
     Psychologists may volunteer to consult with elected officials, provide critical incident debriefings for first responders, and lead psychoeducational support groups for community members.

Personal experience after Hurricane Helene
    In the fall of 2024 Hurricane Helene swept western North Carolina with a vengeance. The unexpected high winds and torrential rain caused forests to be ripped apart, with floods and 2,000 landslides changing the topography of the land, resulting in houses, businesses, and cars to literally wash away. Six months after the storm, the number of confirmed human fatalities is 106. The impact was so severe that it is considered the deadliest storm in North Carolina’s history. 
    I live in a small mountainous rural community in one of the hurricane-impacted areas. Fortunately, my family did not experience property damage or physical harm, but the devastation was all around. The communication desert with knocked out cell towers was a stressful outcome with no way to communicate with the outside world.
Additional common stressors included having inadequate cash to buy the limited groceries or gasoline with no access to bank accounts, needing to clear debris or fallen trees that blocked roads, and abiding by city-wide curfews. Two local news stations were able to broadcast updates twice a day to those lucky enough to have crank or battery-operated radios, or by listening to car radios. 
    Despite not suffering serious personal losses, about 10 days after the storm, I experienced stress-related reactions that were puzzling, such as crying easily, feeling irritable, startling easily, having difficulty sleeping, and feeling anxious at the first sign of rain. At that time, I had no knowledge of secondary trauma. Talking to a friend with similar symptoms helped me realize that these reactions are common. After the Wi-Fi was restored, I read the results of post-hurricane studies, which reassured me that my reactions were typical responses to non-human loss grief. 
    At the time of the hurricane, I was retired from clinical practice but served in a volunteer role as the city’s Age-Friendly task force coordinator following receipt of the designation as an AARP Age-Friendly city.
Immediately before the hurricane, I had been co-leading a six-session program to promote healthy behaviors of older adults in conjunction with a community nursing class. 
    The nursing instructor and I pivoted the focus of the program to a hurricane recovery support group to address the immediate needs of her students and the older adults in our community. 
    The group’s goals were to address shared experiences, focus on emotional support

for everyone present, increase social connections, normalize stress reactions, and teach

self-calming techniques. Among the topics discussed were overcoming survival guilt and

re-evaluating relationships with those who made no effort to stay in contact after

communication channels were restored. 

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Practitioner tips 
    1. The essential elements for effective recovery post-disaster for communities are safety

and stability, calming and stress reduction; social support and connectedness; self-efficacy;

and hope the program we designed was based on these widely accepted principles. 
    2. Professionals who have experienced the disaster can reach out to colleges, city officials,

or public health departments in the county to offer their services and lead groups on a pro bono basis.
    3. If a practitioner has no prior experience in disaster recovery efforts, I recommend taking online courses from sources such as Psychological First Aid, SBP-USA, the Uniformed Services University, or other university programs. Additionally, consulting with experienced peers can be very beneficial. 
    4. Clarifying at the beginning of each session the differences between psychotherapy groups and support groups is essential, with the recognition that privacy is recommended but cannot be guaranteed.
    5. Calming strategies vary; one-size offerings do not fit all. Introduce several different techniques such as diaphragmatic breathing, mindfulness exercises, progressive muscle relaxation, gratitude journaling, and therapeutic creative writing.  Disaster preparedness organizations recommend limiting the consumption of news and media coverage of the crisis.
    6. Normalization of stress-related reactions is key to a recovery program, as most people will experience them. However, practitioners need to be aware when participants describe more
severe reactions that warrant individual attention. Compiling a list of community mental health resources to offer individual interventions is imperative.
    7. Survival guilt, a deep and complex feeling, may be experienced by those who do not experience property damage or lose a friend while they were spared. Recognizing that this guilt is tied to grief and is a valid emotional reaction is vital in understanding this response. Using both cognitive re-framing, normalization of the feeling, and sharing suggestions for meaningful volunteer actions in the community may be helpful coping strategies. 
    8. Knowledge of sleep hygiene strategies is imperative, as disturbed sleep is common.
    9. Basic knowledge of leading groups is useful, such as gently urging people to share airtime, or if participants do not wish to say anything, acknowledge that attentive listening is perfectly acceptable.
    10. Expect that tears will flow; have a box of tissues handy. 
    11. Research done following Hurricane Sandy in New York suggests that the “young-old,” age 60 to 74, experience more stress-related and depressive symptoms compared to the more resilient “old-old,” or those over age 75, unless they have lost access to medical care. 
    12. To successfully reach older adults, hold support groups/listening circles in community centers or churches instead of behavioral health or medical clinics. Given the stigma that exists that limits mental health access, hold support groups/listening circles in locations where the older adult population and minority groups feel safe and are most comfortable. 
    13. Some people feel trauma-related growth post-disaster and meaning-making in their lives from the experience. This notion is a worthwhile topic for discussion in listening circles. 
    14. Anniversary reactions are common after a disaster. Reassuring community members that such reactions may occur and suggesting strategies to lessen their intensity are powerful public health disaster preparedness interventions.
Leading support groups in my community post-Hurricane Helene has been gratifying both personally and professionally. Evidence suggests that mental health professionals who have gone through the trauma first-hand are more readily accepted than experts from outside the area who offer services. 
    Psychologists who live or work in communities that have experienced disasters need not wait to be called upon to serve the public. By designing and leading public health interventions at the time of disasters, you use your skill sets in a timely, relevant way. An added benefit is the deepening of connections to one’s own community.

References available from author