Major Disasters and the Mental Health Community

The list of large-scale disasters has seemingly grown in the recent years such as the statewide fires and floods that hit Colorado over the summer. This has left mental health professionals scrambling to address the needs of their patients and staff following such an event, as well as the practicalities of operating facilities following events that cause widespread disruption to services and infrastructure.

During an afternoon session on the first day of the 2013 NEI Psychopharmacology Congress, held November 14-17 in Colorado Springs, Colorado, Ronnie Gorman Swift, MD, discussed her personal involvement at the New York Metropolitan Hospital Center as their Chief of Psychiatry and Associate Medical Director during both 9/11 and Hurricane Sandy, as well as emergency strategies and procedures that every mental health professional needs to consider in the event there is a local emergency.

Swift stressed the importance of preplanning, such as setting up a command center before disaster strikes that includes nursing, senior medical staff, and administrative personnel. She recommends that clinicians become involved with nearby hospitals and local emergency contacts to develop a relationship ahead of a natural disaster in addition to having screening forms, mobile med boxes, phone trees, and contact lists readily available.

She added that during a disaster, clinicians and hospitals can take a few basic steps immediately such as determining who is on staff and what portion of the staff is within walking distance or can reach the facility. She suggests that physicians operate on shifts to not only avoid fatigue but to give staff the opportunity to break. She insisted on the importance of patient well-being and the well-being of staff, which is why she suggests developing plans and procedures that will aid the mental health of both.

Swift noted that following a major disaster, three out of four people are affected by specific psychological problems such as anxiety, depression, and post-traumatic stress disorders and that an additional 39% of people will experience non-specific distress. Additionally, a whopping 52% of people will experience moderate impairment. She discussed the factors that contribute to the intensity of the effect of these disorders, such as the “degree of controllability, predictability, and perceived threat,” as well as “exposure to pain, heat, cold,” and the “perceived sense of failure to act in ways that might have mitigated the circumstances of the event.”

She pointed out that severe psychological effects are characterized by “at least two of the following: extreme and widespread damage to property; serious, ongoing financial problems for the community; human carelessness/intent; and a high prevalence of injury, death, and threat to or loss of life.” She added that individuals with access to support, a belief in themselves, positive thinking, and contingency preplanning are major factors of resiliency.

In terms of treatment for individuals with PTSD specifically, Swift stated that the “first line of treatment includes exposure therapy, cognitive restructuring, and SSRI/SNIR.” However, Swift warned against the use of benzodiazepines because they have no evidence of efficacy in this setting and may even cause harmful effects. Conversely new studies, while small, show that hydrocortisone may be helpful due to the belief that PTSD may be the result of low cortisol during a stressful event. Another interesting avenue for future treatment may include the use of IV morphine administration during trauma care, as this was found to lower the chances of developing PTSD in US military personnel. Additional study is required to replicate these results.