Moving Mental Health into the Disaster-Preparedness Spotlight

Substance abuse. Child abuse. Intimate partner violence.

These are but some of the signs of emotional distress that public health officials suspect are on the rise in the wake of the oil spill in the Gulf of Mexico, as families nurse fears about their finances and as clean-up workers and other volunteers remain in the region.

Spikes in these kinds of emotional and behavioral health problems often go unnoticed—and untreated—in the aftermath of natural and human-caused disasters, according to Katherine Yun, M.D., a Robert Wood Johnson Foundation (RWJF) Clinical Scholar. That’s because public officials and the news media tend to focus on more visible problems like physical illness, injury and environmental devastation after most disasters.

But public officials should pay more attention to—and make a greater investment in—emotional and behavioral health services in the wake of disasters in order to curb long-term individual and community health problems, Yun says. She laid out her thesis in a commentary that appeared last month in the New England Journal of Medicine.

“Prior disasters have taught us that serious long-term emotional and behavioral health problems will emerge in the Gulf Coast in the wake of the oil spill,” Yun says. “Treating these kinds of problems early must be considered an important part of our disaster response efforts.”

Encouraging Signs

There are encouraging signs that are beginning to happen.

After Hurricane Katrina struck five years ago, public health officials and community groups strengthened existing behavioral and emotional health infrastructures in the region, Yun writes. Organizations such as REACH NOLA, which was founded by RWJF Clinical Scholar alumnus Benjamin Springgate, M.D., M.P.H., developed community-based Health and Resilience Centers and provided training for community mental health workers. Those efforts have helped residents cope with this year’s disaster, she says, and business and public officials have paid welcome attention to mental health issues this spring and summer.

There are many examples that demonstrate how this work is helping victims. U.S. Surgeon General Regina Benjamin, for example, addressed the impact of the spill on the mental health of those living in the region. State and local organizations are providing “psychological first-aid” to help residents return to normal routines. Non-governmental organizations have disseminated tip sheets with information about how to cope with emotional distress. Affected children have learned how to cope at summer camp and in mentoring programs. And mental health counselors have offered treatment at area marinas.

Another key sign of that overall trend came when BP—the company responsible for the spill—announced in August that it would provide $52 million for behavioral health support across the Gulf Coast. The money will help area residents access behavioral health support services and information.

“If one bright spot emerges from this catastrophe, it will be the incorporation of mental health-related emergency response into the core competencies for disaster response,” Yun writes. “Still,” she adds, “we are not where we need to be. There are too few providers of mental health and substance abuse services and too many barriers to care.”

A Clinical Scholar at Yale University, Yun was inspired to write the commentary during the program’s three-month policy internship. For her internship, Yun worked under Nicole Lurie, M.D., M.S.P.H., an alumnus of the RWJF Clinical Scholars program who is now the Assistant Secretary for Preparedness and Response at the Department of Health and Human Services in Washington, D.C. In June, Lurie invited Yun to attend a workshop convened by the Institute of Medicine to review the expected health effects of the Deepwater Horizon oil disaster.

Yun’s takeaway? That more research needs to be done on the health effects of oil spills and other disasters. More than 30 major oil spills have occurred, she notes, but little data about health has been collected in their aftermath.

The data that does exist, however, makes it clear that health officials should expect and prepare for considerable behavioral health problems in the wake of these kinds of disasters, Yun says.

“When you have a scenario like the one in the Gulf of Mexico, it places strain on people, families and entire communities,” she says. “That strain comes on top of behavioral and emotional health infrastructures that are already weak and jeopardizes the entire system.”