The increase in repeated disasters and associated social stressors linked to global warming is likely to affect the mental wellbeing of billions of persons in the 21st century, increasing risk for depression, anxiety, PTSD, anger and violence, social disruption and displacement, and social conflict. This means that our current conceptual frame of disaster response will be too narrow to address the many problems created and exacerbated by climate change—disaster mental health no longer should remain the sole model guiding our preparation and response. We need an expanded view that encompasses diverse responses to match a greatly expanded set of threats.
The importance of strengthening disaster mental health response system
Disaster mental health response in the US commonly includes a stepped care system that includes community outreach and delivery of psychological first aid (PFA), crisis counseling, and, for those most greatly affected, formal treatment. The brief education and support included in PFA is offered to as much of the affected population as possible, with more intensive services made available for those at greatest risk for problems. Brief crisis counseling programs offer support and, increasingly, teach skillsets to improve coping (eg, problem-solving, relaxation, positive activity scheduling).
Most communities only develop the ability to implement these disaster response elements after they find themselves affected by a disaster. Prior to such emergent need, these services seem relatively optional and have not, to date, been able to compete with other political priorities. As a result, they do not attract significant organizational focus and allocation of resources. Moreover, after external funding goes away, the various organizational structures used to respond often disappear. If we are to improve our ability to respond to repeated events, an effort to transform acute response systems into enduring, sustainable programs is needed. Given the heightened awareness of disaster in the face of climate change, greater levels of preparation are needed for responding to mental health requirements as well as a way to sustain the capacities developed in response to specific disasters for ongoing use in future events.
The problems created by global warming (including recurrent disasters) are multifaceted. The all-hazard community-based resources and capabilities will enable more effective action in the face of climate-induced problems and will also spill over into the many challenges already troubling our communities (eg, family problems, work stress, drug addiction, suicide). In this sense, actions to increase climate change resilience tie in with other existing programs and services for social problems and life improvement.
Towards resilient communities: some components of a more adequate response
Improving disaster mental health programs will not be adequate to meet upcoming challenges. Rather, these programs will need to be supplemented by novel initiatives and combined into an integrated program of community support and resilience. They will require creativity and significant contributions from many quarters.
Coping skills training and support. Individuals who have effective coping and stress management skills, such as problem-solving, mindfulness, physical relaxation, and conflict resolution, will more successfully manage their experiences of disaster and exposure to climate-related stressors. Dissemination of these skills across larger populations in neighborhoods and regions is feasible and can include several strategies. Perhaps the most straightforward strategy is to develop, deploy, and maintain internet and mobile technologies for resilience. These technologies can include educational content and brief, interactive training materials that can serve as stand-alone resources or supplements to other support offered by mental health professionals and peers.
Findings from research suggest that internet-facilitated interventions can be effective in addressing a range of mental health problems especially when supplemented by human support.1,2 Mental health apps such as Calm and PTSD Coach are widely used and can reach large numbers of individuals; similar approaches are being harnessed for disaster response. For example, the Sonoma County Wildfire Collaborative deployed MySonomaStrong, an internet-based self-management tool (MySonomaStrong.com) and a mental heath app (SonomaRises).
Another strategy for strengthening effective coping and spreading key skills is to expand training for health care professionals as well as lay community members on effective coping and and crisis counseling. Primary and acute care medical clinicians can provide disaster response and critical incident stress management.
Dr Ruzek is Co-Director Center for m2 Health, Palo Alto University and Adjunct Professor, Department of Psychiatry and Behavioral Sciences, Stanford University, CA. He reports no conflicts of interest concerning the subject matter of this article.
1. Andrews G, Basu A, Cuijpers P, et al. Computer therapy for the anxiety and depression disorders is effective, acceptable and practical health care: an updated meta-analysis. J Anxiety Disord. 2018;55:70-78.
2. Kuester A, Niemeyer H, Knaevelsrud C. Internet-based interventions for posttraumatic stress: a meta-analysis of randomized controlled trials. Clin Psychol Rev. 2016;43:1-16.