Caring for disaster victims’ mental well-being: A first responder’s story

 Mark J. Macgowan is the associate dean of academic affairs for the  Robert Stempel College of Public Health & Social Work and a professor of social work. A licensed clinical social worker, he serves on one of Florida’s Disaster Medical Assistance Teams and has also worked as a disaster mental health worker with the American Red Cross.

The emergency notification app goes off on my phone, then a text comes in and, finally, someone calls me with the news: My disaster response team is to deploy within 24 hours to help in the aftermath of Hurricane Harvey. I have to get ready.

In my day job, I am a professor of social work and associate dean of academic affairs for the Robert Stempel College of Public Health and Social Work. But when disasters strike, I transform into a behavioral health specialist on a medical response team that includes physicians, nurses and paramedics also ready to leave on short notice. I travel with a backpack outfitted with essential supplies and nonperishable food to carry me for up to 48 hours on my own and a bigger bag to keep me going for the remainder of the two-week deployment.

Our team’s duties are to help out in all aspects of a rapid deployment, including setting up a base of operations. We are trained to potentially deploy into austere environments; we may sleep in the open air, aircraft hangars or in hotels. In Houston, we were stationed beside one of the large convention centers that sheltered evacuees from floods. 

Attending to people’s behavioral and mental health is an essential part of disaster response and recovery. Evacuees frequently seek medical care and tangible services such as financial assistance, but they also often have psychosocial needs as a result of the disaster or exacerbated by the event. There is a general consensus that mental health should be integrated into disaster response as most people will experience some level of distress. Although the majority of those affected do not have severe symptoms, post-traumatic stress disorder and major depression can appear in up to a third of “highly exposed” survivors.

During our short deployments, we do what we can to address the range of emotional responses even as the full range of symptoms may not yet be evident. We typically use brief interventions such as psychological first aid, an approach that is built on the concept of human resilience. For example, on one deployment, a person seeking financial assistance sat crying quietly. While she waited, I sat down beside her, offered her a tissue and a bottle of water. I said nothing until she was ready to talk. She opened up about losing precious old family photographs in the storm. She spoke about being nervous to go to sleep as the storm had happened at night. Having someone available to talk about how she felt and what she could do next to get her life back in order was important.

In another case, on a community visit, I met with a single mother of four children who was living in a trailer partially destroyed by a hurricane. She had pre-existing and aggravating stressors, including a recent car crash. Now, after the storm, her home had no air conditioning, and many of her family’s belongings were ruined. As I met with her away from the kids, she broke down and cried and said that she needed to “be strong” in front of them. Beyond providing emotional support, we connected her with a local store that donated gifts cards so she could secure new bedding, clothing and children’s toys.

In addition to working with those directly affected by disaster, I care for the mental well-being of responders. The stress of a deployment can take a toll as those charged with helping are themselves cut off from their own support systems. Sometimes responders handle this through humor at the expense of others, as was the case with one who had a pattern of making fun of teammates. While humor can serve to diffuse stress, in this instance it came at the expense of others. I spoke privately with the man about the habit, which had caused some friction among his colleagues. He responded well and was more mindful of his actions.

Sometimes responders become angry or frustrated. In such cases, the answer may be to accompany the individual on a walk away from the center of operations to talk things out. I will also check in with that person periodically throughout the deployment to help him or her avoid compassion fatigue, or burnout.

How do I keep my own balance during a deployment? Calling or texting home as often as time and cell service permit is one way. Talking with my teammates about family and activities outside of the deployment also helps as does making personal space away from the center of operations to read or listen to music. And having a second mental health responder on the team allows me to discuss with him or her any built-up emotions associated with, for example, witnessing medical trauma or empathizing with evacuees who have faced major losses. For first responders, access to psychosocial caregivers plays a critical role in promoting compassion satisfaction, the pleasure derived from helping others. An ability to find such fulfillment keeps disaster personnel going back in times of need, myself included.

It wasn’t long after returning home from Texas that my emergency notification went off again: on standby to help after Hurricane Maria. It’s been a busy fall!