Mental and Behavioral Health Considerations in Emergency Preparedness and Response

Under typical circumstances, rural populations often have unmet mental health needs due to barriers in the accessibility, availability, affordability, and acceptability of mental health services. Following a disaster, these needs may be exacerbated due to the increased challenges in receiving care and the effects a disaster may have on mental health.

According to the American Public Health Association, anywhere from 25% to 50% of people who are exposed to a climate disaster are at risk of adverse mental health effects, including anxiety, depression, suicide, and post-traumatic stress disorder (PTSD). When preparing for, responding to, and recovering from a disaster, it is important to consider a rural community's mental health needs.

Planning

During the planning phase, it is important to determine appropriate supports, approaches, and systems for addressing the mental health effects of an emergency or disaster. This includes the creation or acquisition of any required resources. It is also important to build personal and community resilience to safeguard populations from the risk of adverse effects following an emergency or disaster.

Guidance for building resilience, developed by the American Psychological Association and ecoAmerica and set forth in Mental Health and Our Changing Climate: Impacts, Inequities, and Responses, addresses both individual and community resilience.

Individual Resilience

Individual resilience is determined by a range and combination of factors. Tips for supporting individual resilience include:

• Building belief in one's own resilience
• Fostering optimism and hope
• Cultivating active coping and self-regulation
• Bolstering interpersonal sources of support
• Encouraging connection and care for children
• Finding a source of personal meaning
• Boosting personal preparedness
• Upholding connection to place, when health and safety allow

Community Resilience

Community resilience may help reduce adverse mental health outcomes. Tips for strengthening community resilience include:

• Expanding disaster response and resiliency plans
• Increasing social cohesion
• Addressing disparities
• Preserving cultural connections
• Involving the community
• Strengthening mental health services
• Updating infrastructure
• Developing a trusted and effective warning and communication system
• Training the people who will serve the community during a disaster
• Preparing post-disaster recovery resources

Response

A framework for mental health response to disaster, developed by the University of Missouri's Disaster and Community Crisis Center, identifies the mental health functions that communities should address when planning for and responding to a disaster. The mental health functions are:

• Identifying psychiatric disorders and mental health needs
• Triaging and referral to services
• Providing mental health services and interventions

Identify Psychiatric Disorders and Mental Health Needs

The first step, following the mental health response framework, is to assess exposure to trauma. Exposure may occur by being directly endangered, witnessing the impact on others, or having a close contact who was endangered. Following a disaster, there are three main individual responses: resilience, temporary emotional distress, and the development of a psychiatric disorder.

• Resilience – The ability of an individual (or community) to endure and cope with adversity. Each person has a different level of built-in resiliency, and it can be developed and strengthened over time. In addition, some people may experience post-traumatic growth, a sense of having gained something positive following a traumatic experience.
• Temporary Emotional Distress – A state of mental and emotional suffering. After a disaster, it is usually temporary and does not lead to a mental health diagnosis. Symptoms include:
  • Eating or sleeping too much or too little
  • Pulling away from people and things
  • Having low or no energy
  • Having unexplained aches and pains
  • Feeling helpless or hopeless
  • Excessive smoking, drinking, or using drugs, including prescription medication
  • Worrying a lot of the time
  • Feeling guilty but not knowing why
  • Thinking of hurting oneself and others
  • Having difficulty readjusting to normal life
• Post Disaster Psychiatric Disorder – The development of a mental health disorder, such as anxiety, depression, substance abuse, and, the most common, post-traumatic stress disorder (PTSD).

It is important to establish procedures for accurately assessing an individual's exposure and response to the disaster so that they may be referred to the appropriate services.

Triage and Refer to Services

Disasters vary in size and severity. Some disasters may affect an entire rural community while others may only impact a portion of the population. Either way, people affected by the disaster need a mental health evaluation so that planners, responders, and providers can determine what level of intervention is most appropriate. When a disaster affects a smaller portion of the community, conducting these evaluations may be manageable, but when it affects an entire community, it may be necessary to use a screening tool to triage community members and refer those who screen positively to further evaluation and resources. Screeners are an effective tool because they can be implemented quickly and in any location by trained volunteers. Large, public spaces like school gyms, libraries, places of worship, and community centers can be used as central locations to gather and screen community members. Trained volunteers can conduct the screeners in a few minutes and notify medical staff of results.

Provide Suitable Mental Health Services and Interventions

Most people will not develop psychiatric disorders. Therefore, most people will not need advanced treatment. There are three common interventions used to address post-disaster emotional distress:

• Psychological First Aid – An evidence-informed approach to delivering support and assistance to someone immediately after an emergency or disaster event.
• Psychological Debriefing – An approach to discussing experiences through individual or group sessions that provide a safe space to process emotions.
• Crisis Counseling – A strengths-based intervention that can be delivered in unconventional spaces with groups or individuals.

In addition, the 988 Suicide and Crisis Lifeline is available for free and confidential support to people in emotional distress or suicide crisis. This three-digit dialing code connects callers with a trained counselor who will listen, provide support, and connect the caller to resources, if needed.

Considerations for Populations

Some individuals are at greater risk of experiencing emotional distress following a disaster. These populations and specific considerations include:

• First responders – Due to their role in response and recovery, first responders may be among the most affected mentally and emotionally. Equipping first responders with the tools necessary to manage their stress and feeling prepared to respond to an emergency helps to protect them against severe distress.
• Tribal communities – Tribal communities are very connected to the land and the environment, so climate disasters may be particularly detrimental to their mental health. It is important to develop balanced partnerships and respect Native values and forms of healing.
• Farmers and farmworkers – Disasters can damage farmland and equipment, affecting the livelihoods of farmers and farmworkers.
• People with pre-existing mental health conditions – People with pre-existing psychological conditions, including substance use disorder, may experience a worsening of their condition after a disaster.
• Older adults – Older adults may be more susceptible to mental health effects after a disaster due to physical and emotional changes that may arise in later years. Some areas of concern include “transfer trauma” from moving from a residence or facility, greater vulnerability to heat or cold, reduced sensory acuity, and reluctance to seek help — all of which may cause distress in older adults.
• Children and teenagers – Young children are highly affected by disasters due to being unable to completely understand them and the disruption that disasters cause to daily routines. For teens, distress will depend on how much their daily life is impacted. Children and teens look to adults for emotional safety, so it is important to equip adults with the appropriate resources.
• People with disabilities – People with disabilities or special medical needs may feel particularly distressed during and following a disaster due to challenges with continuity of care and safety concerns.
• People living in poverty – Disasters can have negative effects on financial and housing security and other resources that are critical to livelihood for people experiencing economic instability.
• Communities of color – Due to existing inequalities, some communities of color may lack the resources to face a disaster.
• People with limited English proficiency – People with limited English proficiency may face additional stress during a disaster due to challenges understanding warnings in English.
• Refugees and migrants – Refugees and migrant communities may feel additional stress due to a lack of deep familiarity with the environment and local culture or not having enough resources to face and recover from a disaster.
• Families – Following a disaster, there is an increased risk of family violence, including intimate partner violence, due to increased stress and disruption. In addition, resources for victims may be limited, adding a layer of vulnerability.

For more information and considerations for specific populations, see Population Considerations for Emergency Preparedness and Response.

Recovery

Building and strengthening resilience is an important aspect of the planning phase of the disaster preparedness cycle, and it is also an important piece of recovery. In the early stages of recovery, strengthening resilience for individuals might be more focused on coping and well-being, including seeking mental health services, if needed. Community members who need further mental health services and assistance will likely need a referral to receive care.

Access to mental healthcare is an existing challenge that may be exacerbated following a disaster. Many communities are implementing promising and innovative models in rural areas to improve mental health. For example, during COVID-19, state and federal policies were implemented to increase access to telebehavioral health in rural communities.

For long-term recovery, it is important that rural communities gather lessons learned and improve mental health response plans for the next disaster. Additionally, it is important, if possible, to improve or implement mental health programs.

For more information on rural mental health programs, see the Mental Health in Rural Communities Toolkit and our Rural Mental Health Topic Guide.

Resources to Learn More

Disaster Technical Assistance Center (DTAC)
Website
Assists states, tribes, U.S. territories, and local organizations to prepare and respond to behavioral health needs related to a disaster.
Organization(s): Substance Abuse and Mental Health Services Administration (SAMHSA)
Date: 4/2022

Disaster Distress Helpline
Website
Provides information and resources to support individuals whose mental and behavioral health have been impacted by different types of emergencies and disasters.
Organization(s): Substance Abuse and Mental Health Services Administration (SAMHSA)

How Right Now
Website
Provides resources and support for people experiencing distress and mental health challenges. This campaign was developed to support emotional and mental health in the COVID-19 pandemic.
Organization(s): Centers for Disease Control and Prevention (CDC)

Mental Health and Our Changing Climate: Impacts, Inequities, Responses
Document
Reports on effects of a changing climate on mental health, inequities resulting in populations experiencing climate change, and how people perceive and respond to climate change.
Author(s): Clayton, S., Manning, C., Speiser, M., & Hill, A.N.
Organization(s): American Psychological Association (APA), Climate for Health, ecoAmerica
Date: 2021

Tips for Disaster Responders: Cultural Awareness When Working in Indian Country Post Disaster
Document
Recommends ways to help behavioral health responders learn how to appropriately work with Native American communities when addressing a traumatic event. Discusses historical trauma, types of trauma in Indian Country, respectful response efforts, traditional values, and community healing.
Organization(s): Substance Abuse and Mental Health Services Administration (SAMHSA)
Date: 9/2022

Mental Health Response to Community Disasters: A Fact Sheet for Disaster Mental Health Planners, Responders, and Providers
Document
Provides research-based principles for understanding the effects of disasters on mental health. Describes functions within a framework for mental health response to a disaster in addition to interventions addressing psychological distress following a disaster.
Author(s): North, C.S.
Organization(s): University of Missouri Disaster and Community Crisis Center
Date: 2014

Warning Signs and Risk Factors for Emotional Distress
Website
Describes common warning signs and risk factors for emotional distress often experienced by children, adults, first responders, and recovery work following a disaster.
Organization(s): Substance Abuse and Mental Health Services Administration (SAMHSA)