Experts say disaster victims face mental health hurdles as new disorders develop in 30 percent of survivors
After an active month of wildfires in December, including the largest in California history, and mudslides that wiped out homes and shut down major interstates across Southern California, Californians remain at risk.
Not only are California residents at continued risk of danger from wildfires and mudslides, but also a different type of risk, this time to their mental health. These California residents, and anyone who has recently suffered through a disaster, face an increased risk of developing disorders such as depression or post-traumatic stress disorder (PTSD).
In events this damaging and life-threatening, around 30 percent of those that had “direct experience” with the event will develop a mental health disorder that they did not previously have, according to Dr. Merritt Schreiber, professor of clinical pediatrics at the David Geffen School of Medicine at UCLA and the LA Biomedical Research Institute at Harbor-UCLA Medical Center, and disaster response chair for the California Psychological Association.
Direct experience includes “physically experiencing or directly seeing where others are severely injured or killed, losing loved ones, being evacuated or having severe damage to where you live causing you to move, and feelings as if your life or the lives of your loved ones is in danger,” according to the Listen, Protect, and Connect psychological first aid system.
Howard Lasker, right, comforts his daughter, Gabrielle, who is visiting their home for the first time since a wildfire swept through it Sunday, Oct. 15, 2017, in Santa Rosa, Calif. (AP Photo/Jae C. Hong)
Most people that were impacted, especially those with direct experience, endure temporary distress after the event. Temporary distress, according to Schreiber, affects most victims and diminishes in a matter of hours, days or weeks.
“Many people have distress symptoms right away,” Schreiber said. “That doesn’t mean they have a mental health condition that needs a mental health provider.”
Common reactions of those experiencing temporary distress include trouble sleeping, becoming angry or upset more easily, problems at work or school, difficulty concentrating or listening and constant thinking about what happened in the event.
Temporary distress differs from a diagnosable mental health condition, which can develop from experiencing a significantly traumatic event. PTSD and depression are the most common mental health conditions diagnosed after such events.
Schreiber said that often those who don’t show any signs of distress directly after the event can have longer-lasting mental health conditions.
“One of the manifestations of PTSD is something called numbing, which means the person doesn’t show any obvious signs,” Schreiber said. “They’re so overwhelmed that they kind of shut down.”
Those with PTSD can also be avoidant, which means they disengage from the interactions with people. Schreiber explains that numbing and avoidance are why PTSD and depression “are very hard to recognize just by looking at someone.”
Schreiber created PsySTART, a rapid mental health triage and incident management system, which does not use symptoms but instead risk factors in order to make mental health care decisions more efficient before, during and after disasters.
PsySTART also has the ability to map risk of an area as a function of region, counties, shelters, clinics and hospitals.
“In that way, we get an indicator of what the total risk impact is on the population,” Schreiber said. “We can start to do planning, we can move resources to where they’re actually needed.”
Napa County used PsySTART to estimate risk after the Tubbs Fire in October.
According to Schreiber, in the 1950s professionals started to notice that there needed to be a psychological first aid as a parallel for first aid for injuries.
“Psychological first aid is not like an intervention, it’s not therapy, it’s not treatment,” Schreiber said. “It's supporting one another and then just like first aid, if you identify someone who has a serious issue, you refer them on to a hospital or clinic or something.”
FEMA uses the LPC psychological first aid system, which has four different versions based on relationship to and age of the victim. The system, originated by Schreiber, suggests ways in which individuals can support others' resilience after emergency events.
“The system involves listening, protecting where you can with practical assistance, and then connecting the person to other resources they may need based on their concerns,” Schreiber said.
The LPC system recommends that individuals should seek professional assistance if they or someone close to them “feel overwhelmed or overly stressed for a long period of time or after you have provided psychological first aid.”
“The good news is that when people get something like PTSD or depression after a disaster, those are very treatable conditions,” Schreiber said. “There are standardized approaches to PTSD in both adults and children and they are known to be very efficacious.”
Prolonged exposure therapy and trauma-focused cognitive behavior therapy are two therapy types used to treat PTSD, according to Schreiber.
PTSD Coach, a mobile app developed by the U.S. Department of Veterans Affairs, is another tool available for those suffering from PTSD. The app provides information on PTSD, treatments and helps users handle stress symptoms. The app is not definitive care or treatment, according to Schreiber, but it can definitely start to provide individuals with assistance.
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