As Hurricanes, Shootings Rise, Psychiatrist Discusses Mental Health in the Aftermath

Disasters, whether they are natural disasters like hurricanes or mass shootings like the one unfolding Saturday at the Tree of Life synagogue in Pittsburgh, Pennsylvania, are happening with increased frequency and at shorter intervals, according to a presentation at Psych Congress 2018.

And that means populations are being exposed to trauma more frequently and even re-exposed, according to Richard Weisler, MD, an adjunct professor of psychiatry at both Duke University and the University of North Carolina at Chapel Hill, who spoke about “Disaster Mental Health Principles and Practice.”

A disaster is different than a catastrophe and is defined as “a severe disruption, ecological and psychosocial, which greatly exceeds the coping capacity of the altered community,” said Weisler.

Disasters affect an entire community, exceeding local resources, and altering the “psyche” of a region, whether it is Hurricane Florence hitting North Carolina in August, or the nightclub shooting in Psych Congress’ host city, Orlando, which killed 50 people in 2016, Weisler said.

Catastrophes, on the other hand, affect an entire region or part of the world. Weisler, who volunteers in American Red Cross shelters after disasters, noted that hurricanes are happening more frequently and with greater intensity, and that mental healthcare in the aftermath of destructive events is crucial.

Category 5 hurricanes have hit 6 land areas dead-on in 2017, more than ever before, he said, citing the work of a researcher at the National Hurricane Center. The researcher, Brendan Moses, found that of all category 5 landfalls on record in the Atlantic since 1851, 25% occurred in the 2017 season. Last year was also the third warmest year on record, Weisler noted, highlighting the effects of climate change.

Hurricanes are also moving slower across land or circling back around for a second hit, as Florence did in North Carolina, he said, which causes even more damage, mostly due to immense flooding.

Stress after natural disasters

Some people have more risk factors than others for posttraumatic stress disorder (PTSD) after a major disaster, he said. They include:

• Severe exposure to the disaster
• Living in a highly disrupted community
• Female gender middle age, ethnic minority
• Poverty or low socioeconomic status
• Presence of children in the home
• Presence of a distressed spouse
• Psychiatric history
• Impoverished support system

Weisler said trauma and its effects, both physical and psychological, are major public health problems, and primary care providers should screen victims of trauma for PTSD, as it may be masked by somatic symptoms.

Unfortunately, Hurricane Katrina in 2005 provided important lessons for healthcare professionals. According to one study, nearly 26% of households had someone who needed counseling, but only 1.6% received services, Weisler said.

Mental health is identifiable and treatable, and from a societal perspective, it is better to pay for care upfront than to delay care and pay greater sums later on to restore a person to health, Weisler argued.

There are basics of psychological first aid, Weisler said, such as establishing safety and security, reducing stress-related reactions, and fostering adaptive short- and long-term coping. This can take place in a broad range of emergency settings, in either single or multiple sessions, adapted for use in group settings, and happen immediately and continue as needed.

Some events can be triggering, whether it is past hurricane survivors facing the prospect of another storm, or a survivor of a shooting hearing about another mass casualty event. Weisler said people, especially children, should be shielded from repititious news cycles or social media images that show the aftermath of a tragedy over and over.

Resilience

Certain things promote resilience and people may find they come out in a better place after a period of time, Weisler said. These include:

• More education
• Older age
• Social support
• Specific training
• Absence of early life trauma
• Genetics
• Having a "glass half full" mentality

In addition, people who recover from a disaster have certain psychosocial factors that provide a way to cope, such as having cognitive flexibility, getting exercise, having a positive outlook, having social support, and being altruistic.