Easing the Mental Health Toll of Disasters
ORLANDO, Fla.—In talking with survivors of Hurricane Katrina in New Orleans, Louisiana, Richard Weisler, MD, learned just how quickly tragedy struck.
“In areas like the Ninth Ward and others, the water came in so quickly that it literally was just a minute or 2 before your house filled up,” he shared with attendees during a session on disaster mental health at Psych Congress 2018. “People would float to the ceiling and have to pound their way through and pull themselves up into the attic. Sometimes family members were not able to do that because they weren’t as strong.”
“Some people we talked to had a relative or a friend wash out” into the floodwaters, Dr. Weisler said. “And then they would feel a lot of guilt and wonder ‘why not me?’ ”
Disasters are known to affect mental health and can increase the prevalence of post-traumatic stress disorder (PTSD), depression, anxiety, and substance abuse. After Hurricane Katrina, 11.3% of residents had serious mental illness and nearly 20% had mild to moderate mental illness, explained Dr. Weisler, an adjunct professor of psychology at both Duke University, Durham, North Carolina, and the University of North Carolina in Chapel Hill. More than one-fifth of firefighters and 19% of police officers reported PTSD symptoms, and symptoms of major depression were reported by 27% of firefighters and 26% of police.
“The important thing to be aware of is we can make a difference,” said Dr. Weisler, who donated his Psych Congress speaking honorarium to the American Red Cross for disaster relief. “We can be there and help people.”
After disaster hits, relocation adds to the stress many individuals experience, said session copresenter Pamela Tucker, MD, a senior medical officer with the Centers for Disease Control and Prevention, Atlanta, Georgia, who spoke remotely. In addition to resettlement strains, adults must often cope with the trauma they experienced, physical and financial losses, loss of family members and pets, and social disruption. Children, meanwhile, experience the stress of disruption from normal family routines, friendships, and school.
Consequently, supportive recovery environments are important in disaster relief efforts.
“It’s been found to help psychosocial recovery if, as soon as practically possible, people restore their normal daily routines,” said Dr. Tucker, “whether that’s something like a cup of tea in the morning, reading the paper, mealtime, or family activities such as walks, television watching, and bedtime stories for children.”
After the initial physical and emotional shock passes and people begin to rebuild their lives, they will likely require psychosocial support from family, friends, and health care professionals.
“Patients will reconnect with their physicians or find new ones. As part of crowd disaster counseling during visits, you can help your patient come up with a recovery plan, which is practical steps to help begin their physical health recovery and their emotional recovery,” Dr. Tucker advised. “Remember that working through the emotional consequences of the disaster may take months and will depend on their specific experience during the disaster and the unique psychology of the individual.”
HELPING PATIENTS HEAL
Psychosocial factors believed to protect against posttraumatic stress include an active coping style, a positive outlook, a moral compass, cognitive flexibility, social support, and exercise.
“I can’t overestimate the importance of exercise,” Dr. Weisler said. “If you can get in your 19 or 20 miles or so of walking a week or work outside and burn calories, that makes a huge difference.”
Signs of a psychological disorder in survivors include withdrawal, personality change, sadness that prevents working or coping with new situations, expressions of survivor’s guilt, nightmares, angry outbursts, emotional numbness, and harm to self or others.
For PTSD, prolonged exposure is the most common and effective form of cognitive-behavioral therapy, Dr. Weisler explained. The suggested treatment length is 10 to 15 sessions. First-line pharmacological PTSD treatments are selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors. A longer duration of pharmacologic treatment is associated with better outcomes.
So is a shorter duration of symptoms before treatment begins, he added later.
“My own bias is, if we intervene earlier, we get a whole lot better mental health outcomes, just like we do with physical problems,” said Dr. Weisler, who runs a private practice in Raleigh, North Carolina.
“You don’t want to wait until somebody’s hypertension has smoldered for decades, and you don’t want to do that with depression or PTSD or substance abuse. The sooner we address them, the better off that person will be—and usually their family and society. And that’s why we all need to work together.”
“Disaster mental health principles and practice.” Presented at Psych Congress 2018: Orlando, FL; October 27, 2018.