Disaster and
Mental Health
Steve Moskowitz, LMSW
Bureau of Emergency Preparedness & Response
Disaster Characteristics
and Reactions
Bureau of Emergency Preparedness & Response
Disaster Characteristics and their
Mental Health Impact
Disasters are not uncommon events
No two disasters are exactly alike, but certain characteristics
tend to be associated with specific reactions among survivors
However…
No two survivors are the same
No two disaster experiences are the same
No two response and recovery experiences are the same
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Predictors of Survivor Reactions
Any one survivor’s reaction will result from an interaction
between the characteristics of the disaster, the individual,
and the response.
Disaster Individual Response
characteristics characteristics characteristics
Survivor reaction
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Characteristics of Disasters
Size (scope, intensity, and duration)
Cause (natural vs. human)
Expected or unexpected
Timing (time of day, day of week, season)
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Characteristics of Disasters: Size
“Dose-response relationship”
Greater scope, intensity, and/or
duration
Typically more traumatic impact on
survivors
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Characteristics of Disasters: Cause
Natural
Human-caused
Na-tech
(natural event leading to technical failure)
Public health emergencies
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Disaster’s Impact:
A Range of Reactions
Common vs. Extreme
Recovery as the expectable outcome
Post-disaster traumatic stress does not equal
posttraumatic stress disorder
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Disaster’s Impact: Risk factors
Vulnerable populations - groups that may have more
intense needs before, during, and after disaster,
include:
Children
The elderly (particularly the frail elderly)
People with serious mental illness
People with physical disabilities
People with substance dependency
People living in poverty
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Common Reactions
Physical
Emotional
Cognitive
Behavioral
Spiritual
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Common Reactions
Expectable reactions based on exposure to
extreme stress
Range of possible reactions makes early
assessment challenging and underscores
importance of establishing a positive and
supportive recovery environment
Dynamic, not static - reactions evolve over time
and are influenced by the disaster life cycle
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Proximity and the
Dose-Response Relationship
Those most exposed to a disaster typically will
have the most immediate needs and perhaps
more serious psychological consequences
Main convergence of aid and supportive services
is at the epicenter of a disaster
However: Intense reactions are not predicted by
this alone and even those who do not have direct
exposure may have strong reactions
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Life Cycle of Disaster Reactions
Reactions occur in stages/phases:
Pre-impact: Disasters with warnings allow people
to prepare and initiate coping mechanisms
Impact: Magnified arousal levels (fight, flight, or
freeze); usually little panic; behavior in this phase
is related to later recovery
Post-impact: Reactions unfold over the heroic,
honeymoon, disillusionment, and reconstruction
phases
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Phases of Emotional Response
Disaster Loss and Grief
Disasters bring tangible/physical losses as well as
symbolic or more abstract ones
Tangible losses include loved ones and pets, property,
job, mementoes
Less obvious, but no less real, losses include a way of
life, a sense of personal invulnerability, self-esteem or
identity, and trust in God or protective powers
Disaster mental health workers’ awareness of the types
of losses:
enables validation of the experience of disaster victims who
may be unable to understand or legitimize their sadness or
grief
supports the natural grief and recovery process
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Survivor Guilt
Subtle secondary emotion which may occur in
those who survive a disaster where others have not
those who identify with victims
May interfere with recovery
Characterized by cognitive misappraisals or illogical
conclusions
Disaster mental health workers can listen for such
indicators and gently challenge them
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Extreme Reactions: PTSD
Most common extreme reaction is posttraumatic
stress disorder (PTSD)
Not a “typical” response to stress:
Estimated rate post-disaster is approximately 20%
Rate varies widely by event type, from 4-5% after
natural disasters to 34% after a bombing
Considered a treatable disorder which currently
has several evidence-based therapies to promote
recovery
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Extreme Reactions:
Complicated Grief
Grief is not a mental disorder, but an expected
process in response to the death of a loved one
that is followed by a gradual return of the
capacity for reinvestment in new interests,
activities, and relationships
Complicated grief not yet a DSM diagnosis
Alludes to an unremitting grief response that can
interfere with a return to a full life
May be confused with PTSD
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Extreme Reactions:
Co-Morbid Disorders
Often, more than one disorder is present post-
disaster
80% of those diagnosed with PTSD will also have
another diagnosable condition, most commonly:
Depression
Generalized anxiety disorder
Using alcohol as a way to cope with disaster stress
may be common but is not typically problematic:
New presentations of alcohol or substance disorder post-
disaster are infrequent
However, in those with pre-existing substance use
disorders, disaster stress can exacerbate it
Disaster Mental Health: Essential Principles and Practices
DMH Interventions:
Current Best Practices
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The Importance of Early
Intervention
Traditional mental health
intervenes here
addressing what people tell
themselves for the rest of
their lives
Early interventions can mitigate need
for long-term care by addressing
immediate reactions to distressing
event
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Evidence-Based Principles of Early
Intervention
Intervention and prevention efforts should
include:
Promoting sense of safety
Promoting calm
Promoting sense of efficacy in self and
community
Promoting connectedness
Instilling hope
(Hobfoll et al., 2007)
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Maslow’s Hierarchy of Needs
Self
actualization
Esteem needs
Belongingness
and love needs
Safety needs
Biological and physiological needs
Defining Psychological First Aid
Evidence-informed and pragmatically oriented
early interventions that address acute stress
reactions and immediate needs for survivors
and emergency responders in the period
immediately following a disaster
The goals of Psychological First Aid include the
establishment of safety (objective and subjective),
stress-related symptom reduction, restoration
of rest and sleep, linkage to critical resources
and connection to social support
(NIMH, 2002)
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How is PFA Distinct from Therapy
or Counseling?
Short-term
Symptom reduction, not treatment
Promotion of healing, not opening up
past wounds for examination
Focus on interrelated practical,
physical and emotional needs
Here and now
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Theoretical Roots of PFA
The core attitudes and actions of effective PFA
can be traced to the work of two eminent
humanistic psychologists:
Carl Rogers emphasizes unconditional positive regard,
empathy, and genuineness
Abraham Maslow’s hierarchy of needs emphasizes the
importance of attending to survivors’ physical and safety
issues first
DMH counseling involves “working the Maslow
hierarchy” from the bottom up
Flexibility, flexibility, flexibility
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Settings for DMH Work
At the site of a disaster/traumatic event
Disaster Recovery or Assistance Centers
Headquarters or Command Centers
Shelters
Schools and hospitals
Memorials
On the phone
Just about anywhere
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Challenges in DMH
The practice of DMH is unpredictable:
DMH response varies widely from one event to the next
Counseling can last for a few minutes or a few hours
DMH lacks standardization:
Who provides DMH, under what circumstances, and with what
training and background varies widely
DMH response is not always well defined in local CEMP:
To be effective DMH needs to be a well-defined and exercised
part of emergency management planning and preparedness
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Thank-you…
Material for this presentation is drawn from DMH training
curriculums developed for NYS OMH and DOH by the
University of Rochester and the
Institute for Disaster Mental Health at SUNY New Paltz.
Steve Moskowitz, LMSW
OMH Bureau of
Emergency Preparedness and Response
steven.moskowitz@omh.ny.gov
