M

y grandmother was filled with grief as she told me by phone about life on the island of St. Thomas after Hurricanes Irma and Maria had blasted through it. “Tears keep running from my eyes uncontrollably because everyone on the island is suffering,” she lamented, then paused, too sad to continue. I could picture her in her car charging her cellphone — the engine idling in the background. The decades-old mango tree that I had climbed as a child was now uprooted and stripped of all its leaves; the vibrant tropical landscape replaced by an eerie brown hue. “Everything is now rubble,” she said.

At 80 years old, Gramma, as I affectionately call her, had weathered many storms. But Irma and Maria were different. These Category 5 hurricanes ravaged my island home, wreaking havoc not only on St. Thomas, but also on our sister islands of St. Croix and St. John. Many other islands across the Caribbean, including Puerto Rico, had suffered a similar fate. Together these hurricanes left thousands of people homeless, jobless, and without food, water, or electricity. For many on these islands — and other places where natural disasters have recently struck — it is all becoming too much to bear.

The danger of these disasters lies not only in the tremendous loss of life and property, but also in the psychological toll they take on survivors. When disaster strikes, mental health support should be a top priority. Amidst the chaos, though, it often isn’t.

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Sadness, shock, anxiety, and fear are normal stress responses for those who live through a natural disaster. For many of them, these feelings fade away. For others, though, they persist, affecting their quality of life and ability to function. Survivors of natural disasters are at risk for developing post-traumatic stress disorder (PTSD), anxiety, depression, and other mental health issues.

After Hurricane Andrew destroyed huge swaths of the Bahamas and Florida in 1992, about half of survivors met criteria for a new-onset mental health disorder such as PTSD, major depression, or other anxiety disorder.

As a physician, as well as someone with strong ties to the Virgin Islands, I am troubled by what could happen to my home if mental health is not adequately addressed. Post-traumatic stress is linked to increased rates of substance abuse, job-related difficulties, and violent behavior. Rates of suicide could increase, as occurred after Hurricane Katrina struck the Gulf Coast in 2005.

Relief efforts after Irma and Maria have been largely focused on food, supplies, and rebuilding the infrastructure. A quick scroll through social media sites dedicated to relief efforts in the Virgin Islands shows notices about food distribution sites, shelter locations, and disaster loan programs, but I have trouble finding any about mental health resources. Major organizations like the Red Cross share photos of cleanup kits and water delivery on their Facebook pages, but none about the mental health volunteers they typically deploy.

Almost 30 days after Irma hit, Dr. Michelle Davis, the commissioner of the Virgin Islands Department of Health, said during a press conference that federal mental health teams “finally landed in the territory” — one team for St. Thomas and another for St. Croix. With a population of 100,000 across the three main islands, two teams of psychologists, social workers, and a psychiatrist is simply not enough.

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Psychological first aid — a strategy for addressing psychological distress after a disaster — may help build resilience and mitigate the effects of overwhelming trauma and loss. This isn’t just counseling or debriefing. It provides survivors with emotional support, coping skills, and connections to practical services.

Without this type of aid, we have already started losing ground. In fact, many Virgin Islanders have fled to the U.S. mainland, unable to cope with the devastation around them. In Puerto Rico, there have already been reports of suicides.

The stigma of mental illness means that survivors are unlikely to seek help, so trained providers need to be embedded within communities. Aid organizations like the Red Cross need to deploy their disaster mental health volunteers to provide survivors with emotional support and connections to emergency resources. Furthermore, the local and federal government must develop an action plan that addresses the short and long-term psychological needs of the Virgin Islands and Puerto Rico.

One could argue that mental health support is not a priority, that delivering food, water, and electricity and rebuilding the infrastructure should take precedence. I disagree. As Dr. Sandro Galea, now dean of the Boston University School of Public Health, said in an interview following the 2010 Haiti earthquake, “psychological first aid is key to giving people what they need to rebuild their lives. If people are not able to return to mental functioning, it results in the delay in return to well-being and building society.” While meals and infrastructure rebuilding are essential, psychological support is equally important.

When I got off the phone with my grandmother, I thought about the new world she had awakened to. Buckets scattered around her house to collect the rainwater that drips through the holes in her tattered roof. Her beloved island now unrecognizable. Hurricanes Irma and Maria have passed, but these storms have traumatized my grandmother and thousands of people across the Caribbean. Amid the relief efforts, we must not forget that mental health is an essential piece of their recovery.

Alani Gregory, M.D., is a resident physician in the Yale Primary Care Internal Medicine program.

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  • I am planning a list of items for the next disaster, things people will need. Having done a last minute donation-shopping yesterday for people in Puerto Rico which included medical and hygiene products which are vital, I thought of things not viewed as so important. I intend to gather boxes of crayons and drawing pads for children and others who may care to use them. I had a granddaughter who was present when her father and grandfather burned brush, trimmings from bushes and Christmas trees. The flames were high, fierce and fast. She was shocked and frightened, and I gave her these to draw with in minutes. She swiftly drew the fire, dramatically and bright with red, yellow and orange. It did a great deal to calm her and ease her upset feelings. Small things can be more helpful than one might think.

  • Also the author’s point here seems intuitively to be correct, research into the idea of sending out mental health professional after disasters (eg, mass shootings, hurricanes, flood) actually indicates that such endeavors are generally a waste of resources. The World Health Organization (http://www.who.int/mental_health/publications/guide_field_workers/en/) specifically points out that psychological first aid consist of the following:

    » providing practical care and support, which does not intrude;
    » assessing needs and concerns;
    » helping people to address basic needs (for example, food and water, information);
    » listening to people, but not pressuring them to talk;
    » comforting people and helping them to feel calm;
    » helping people connect to information, services and social supports;
    » protecting people from further harm.

    And NOT the following:

    » It is not something that only professionals can do.
    » It is not professional counselling.
    » It is not “psychological debriefing” in that PFA does not necessarily involve a detailed discussion of the event that caused the distress.
    » It is not asking someone to analyse what happened to them or to put time and events in order.
    » Although PFA involves being available to listen to people’s stories, it is not about pressuring people to tell you their feelings and reactions to an event.

    So my understanding is you relieve the stress and psychological trauma by addressing medical needs and life basics — food, clothing and shelter. Rather than spend money to send a psychologist to a disaster, spend it on food and shelter.

  • Very nicely written. I am saddened by the destruction to the USVI and PR and other parts of the Caribbean. I’m glad you are bring attention to the mental health anguish that needs to be addressed — while at least it’s a start that mental health teams have been deployed, there needs to be more.

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