Post-Disaster Mental Health

Piecing back together

In natural disasters, there are often reports of those whose homes are destroyed, whose loved ones are harmed, whose means of livelihood are disrupted.

Before an official disaster is declared and FEMA and the American Red Cross send in response teams, there’s immediate need to stabilize communities and neighborhoods and to help those who are least able to cope with the stress of having their world collapse around them.

Enabling communities to provide rapid, effective post-disaster mental health outreach to their most vulnerable residents is the aim of a study undertaken by Wilmington-based HERMES (Health & Education Research, Management & Epidemiologic Services). With a Small Business Innovation research grant from the National Institute of Mental Health (NIMH), the for-profit research firm has developed a training procedure that will help people in isolated communities help each other in times of crisis.

The model being tested is adapted from one developed by Stan Kutcher and Sonia Chehil for the World Health Organization, says Danielle Laborde, HERMES founder and the study’s principal investigator. Kutcher and Chehil have helped at-risk communities around the world, such as those in post-earthquake Haiti, address residents’ mental health issues that arise from crisis.

“Most people need psychological first aid after a disaster,” Laborde says. “They need basics and comfort so they can put one foot in front of the other. And they need it in the immediate aftermath, in the first forty-eight hours before the Red Cross comes in.”

Given immediate attention, most survivors are stabilized, but there are always those on the margins: the fragile elderly; the emotionally, mentally or physically challenged; the substance abusers.

They are the individuals who need to be on a community’s radar, Laborde says.

The NIMH identified a need for building that kind of community capacity among majority-black communities in underserved areas at risk for natural disasters, and HERMES won a grant to address the need.

The firm is ready to test its model in those communities. Investigators have chosen to focus their study on the coastal regions of North and South Carolina.

The first step is to identify and train individuals who become master trainers.

“We look for really good potential trainers who are medical or mental health providers serving the area,” says Lakshmi Fjord, a research anthropologist who is managing the project’s recruitment. As of early April, four North Carolina master trainers had been selected, and Fjord was working on finding four such individuals in coastal South Carolina.

Next, HERMES will cast a wide net to identify black urban neighborhoods or rural communities along the coast that would make good test sites. To participate in the study, the communities have to be at high risk of storm damage but have no mental health plan in place. They also have to be interested in and willing to develop such a plan.

“We don’t want them to feel this is something being piled on them but integral to building their community’s resilience,” Fjord says. “It’s ‘Us taking care of each other.’ ”

Study personnel will visit the sites under consideration, meet residents likely to be involved, and gauge their willingness to participate. Four sites in each state will be chosen.

“We’ll train local providers – whoever lives in the community, such as a pediatrician, school nurse, religious leader, or even someone who works with the homeless – people who are trusted by the community and will know high-risk individuals,” Laborde says.

“They may not be right there with mental health expertise, but with training, they can intervene.”

Once training is complete, each community’s core group will create a game plan and identify resources and areas where resources are lacking. They’ll figure out how the community will communicate in the hours immediately after disaster strikes and to whom.

“Rather than being top-down, (this process) is a dialogue, a sharing of information,” Laborde says.

Laborde says the residents will know the language of crisis intervention and be able to mobilize resources and have a map, plan, and communications tree that they can implement immediately in the wake of an event and then share with the Red Cross and other responders who come into their community.

One goal of the project is to see if HERMES’ adapted model works. A second goal is to see if the model is scalable. If it achieves both goals, the firm will enter Phase III of its study: commercialization.

“We are hoping to come up with a marketable product that we can sell to companies that are interested in private-public partnerships,” Laborde says.

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