by Chip Benight, Ph.D.
Executive Director
Lyda Hill Institute for Human Resilience

When writing the Director’s Corner, I always like to address challenging and relevant topics that are on the top of my mind. Recently I have found myself thinking about disaster mental health. This is a topic I have researched and discussed in great detail throughout my career, and I find myself thinking about it again as the 2022 hurricane season comes to an end. The recent devastation and displacement caused by Hurricane Ian will leave a permanent mark on the individuals who survived the event, and for many, disaster mental health will be key to making it through the aftermath.  

Disaster mental health focuses on providing support to individuals within communities impacted by a major disaster. In the past several years, we’ve seen everything from wildfires and historic floods to numerous hurricanes and a global pandemic. Each of these events leaves a wake of trauma in its path, with countless people left needing varying levels of mental health support. To put it mildly, the current disaster mental health support model is not working and must be updated.

How Disaster Mental Health Works

After a U.S. President declares a federal disaster, the impacted community must write a federal grant to the Substance Abuse and Mental Health Services Administration (SAMHSA) to receive funds and provide mental health support for the impacted community. For obvious reasons, this is a time-consuming process and delays the availability of desperately needed services. Imagine for a second if this were the case for physical trauma. Clearly, we are operating on different standards when it comes to the expectations for mental health. One reason for this is the assumption that disaster mental health support should not be focused on mental health problems (such as posttraumatic stress disorder or depression) but instead should focus on resilience support.

The Crisis Counseling Program (CCP) description on the SAMHSA website indicates specifically that CCP follows the key principles listed below:

• Strengths-based: CCP services promote resilience, empowerment, and recovery.
• Anonymous: Crisis counselors do not classify, label, or diagnose people. No records or case files are kept.
• Outreach-oriented: Crisis counselors deliver services in the communities rather than wait for survivors to seek their assistance.
• Conducted in nontraditional settings: Crisis counselors make contact in homes and communities, not in clinical or office settings.
• Designed to strengthen existing community support systems: The CCP supplements, but does not end or replace, existing community systems.

Please don’t interpret my concern to mean that these are not good ambitions as part of a disaster response. The problem is that this approach does not provide a targeted system of response that easily identifies and provides appropriate resources to those most in need from a mental health perspective. Moreover, the current model does not have evidence to support its use beyond the number of contacts that are made within a community. In addition, the timing for standing up these programs and how long they last in a community is a challenge. It is not unusual for a CCP to take up to 3 months to be fully staffed and operational. It is also not uncommon for a program to be closed by the end of a year. The disaster literature demonstrates that many in an impacted community will struggle with rebuilding, and emotionally for years.

Thus, our country is paying millions of dollars every year for these programs that are:

1. Slow to get started after a disaster
2. Are not focused on the identification and response to those with more serious emotional challenges
3. Are not based on any scientific evidence demonstrating effectiveness
4. Are often closed before the need is gone

I strongly believe that a new approach is needed to address these four concerns. We need a system that is ready to respond before a disaster occurs and can be responsive to those with the most need. The approach must be based on science and provide evidence-based solutions. Infrastructure across the U.S. should be strategically funded to ensure that everyone has access to the system, not just those living in areas with financial or political resources. Year after year, disasters are becoming more frequent and more intense, and the human cost is only getting worse. We must create a comprehensive disaster mental health system, and the time for action is now.