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How to prioritize behavioral health during disaster recovery

November 20, 2017

Hurricanes Harvey, Irma and Maria.

The mass shooting in Las Vegas and at the Texas church.

The northern and southern California wildfires.

The terrorist attack in New York City.

The mere mention of such recent disasters evokes an emotional response for many people. Yet for those who experienced these events first-hand, the emotional toll will likely continue for quite some time.

It serves as a reminder that while disaster recovery efforts must first focus on physical health and safety, it’s also imperative to prioritize behavioral health as a part of disaster recovery. Delivering innovative access to behavioral health services—especially weeks and months after a disaster—is critical to enabling not only physical, but emotional renewal. 

The impact

Natural disasters often affect large numbers of people. However, they typically have the benefit of early warning through technology and media alerts. Social media can provide an especially valuable tool for staying up-to-date. People can prepare, which offers a sense of control and the chance to build resiliency—both crucial factors in maintaining behavioral health. Unfortunately, there is little preparation possible—and few feelings of control—when faced with an unexpected crisis such as the Las Vegas or Pulse nightclub shootings.

Regardless the type of crisis event, social and mass media focus can be intense in the aftermath. The 24-hour news cycle can create constant reminders that feed post-traumatic stress disorder (PTSD), anxiety, depression, sleep disorders, substance use disorders (SUDs) and other behavioral health conditions. This is why it’s so important to ensure people have access to behavioral health services as they recover from a disaster.    

One solution is to offer problem-based supportive therapy to help build resiliency skills and help people regain their sense of control. This calls for behavioral healthcare professionals to understand the issues an individual is facing and provide practical support tools. If someone lost their home in the California wildfires, for example, a specialist might point the way toward immediate help obtaining shelter, food and clothing, as well as assistance navigating long-term physical and emotional recovery.  

Improve access to care

Ensuring physical safety is paramount during an acute crisis and in the immediate aftermath. While that’s happening, healthcare organizations should become familiar with all the public health resources dedicated to the crisis, and should begin mobilizing their own behavioral health resources. Although there may be a groundswell of short-term help, here are some ways healthcare organizations can ensure that supportive therapy remains available over the longer term too:

Broaden the reach of behavioral health services—Where possible, organizations may want to add new behavioral health providers to the area to provide services and rebuild infrastructure. Where that’s not possible, however, consider innovative access strategies such as:

  • Telemedicine programs designed to extend the availability of remote behavioral health expertise.
  • Computerized cognitive behavioral therapy (CCBT) services that can help patients manage issues such as anxiety disorders, depression and insomnia.
  • Collaborative care arrangements in which patients visit their primary care providers (PCPs), who are in turn supported by behavioral health professionals.
  • Group support models (as appropriate) in which one or two providers help larger groups of people at once.
  • Toll-free hotlines connecting patients to a designated support resource around the clock. 
  • Workplace employee assistance programs (EAPs) that can play a key role in navigating people into appropriate services.

Educate community providers—Survivors of traumatic events may have a difficult time communicating their experiences, so it’s incumbent on healthcare providers to know the signs of behavioral health conditions.  

For example, while someone may show signs of acute stress disorder immediately, PTSD symptoms tend to grow and fluctuate over time. Symptoms may include intrusive memories and dreams that make it feel as though the traumatic situation is reoccurring, along with physical symptoms such as a racing heart or nausea. Roughly 50% of PTSD cases occur in people with pre-existing mood disorders or SUDs. Other risk factors include being female, experiencing childhood trauma or interpersonal violence, and having less formal education.

Behavioral health specialists can help those in the community learn how to use digital “smart screening” tools to spot the signs of anxiety, depression, PTSD and other conditions. This is especially important since symptoms may not appear until weeks after an event—long after the initial wave of support resources has left.

Maximize existing staff resources—Be sure to match clinical resources to patient acuity levels to ensure everyone works top-of-license. Psychiatrists should help the most severely affected people, for example, while licensed clinical social workers (LCSWs) and other staff should work to the tops of their licenses as well.

Normalize the need for care

No two people experience a disaster the same way — even if it’s exactly the same event. Past experiences, risk factors, and support systems all affect how someone will respond. In the wake of a crisis, it’s important for healthcare providers and the community to understand this and to encourage behavioral health services through psychoeducation.

Those who live through disasters know they can get assistance for their physical health. To achieve full recovery, they need the same reassurance about their behavioral health.  

Barry M. Smith is chairman and chief executive officer of Magellan Health.

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