In the Journals

How to rebuild mental health after Hurricane Harvey

Two authors of a recent viewpoint published in JAMA explored how mental health consequences of Hurricane Harvey can be mitigated.

During Hurricane Harvey, Texas and Louisiana experienced more than 33 trillion gallons of rain, setting a rainfall record in the continental United States at 51.88 inches, according to James M. Shultz, MS, PhD, of the University of Miami Miller School of Medicine, and Sandro Galea, MD, DrPH, of Boston University.

Thirteen million individuals were directly affected by the storm, of whom 22,000 were rescued from floodwaters and approximately 32,000 displaced survivors were temporarily housed in shelters.

Shultz and Galea wrote that at least 450,000 individuals will apply for Federal Emergency Management Agency (FEMA) disaster assistance.

“What made Harvey an exceptional hurricane was that water, rather than wind, was the major destructive force,” Shultz and Galea wrote. “Harvey will forever be remembered for the unrelenting inundation that results from rain bands that spiraled inland from the gulf, overflowing Houston’s reservoirs and overtopping dams before moving on to submerge Port Arthur, Texas, and drench western Louisiana.”

Psychological consequences of Hurricane Harvey stem from storm hazards, losses and hardships in the aftermath, and disruption in essential care and medications for individuals with chronic and persistent mental illness.

Comprehensive reviews indicated up to half of hurricane survivors who were directly in the storm’s path and 10% who lived in the vicinity had increased risk for PTSD.

Research conducted among individuals affected by Hurricane Katrina showed 31.2% experienced anxiety-mood disorders at 30 days.

“Ensuring that health care system managers and clinicians recognize these risks and implement appropriate screening and treatment systems is critical,” the researchers wrote.

In the immediate post-disaster phase of Hurricane Harvey, early psychological intervention is currently underway, according to Shultz and Galea.

Disaster behavioral health teams have been integrated into the response and are providing psychological first aid and screening for urgent psychiatric needs at two large consolidated shelters in Houston.

“However, the reach of these brief-duration approaches is limited,” Shultz and Galea wrote.

Conversely, studies have shown that replenishing social and economic resources that restore living conditions was just as effective for the protection of health and promoted resilience compared with short-term, individualized medical or psychological interventions.

With this in mind, Shultz and Galea recommended WHO’s “Building Back Better,” a population-centric, evidence-based post-disaster intervention with a mental health focus.

Post-hurricane urban redevelopment should concentrate on equal access to safe housing for poor, minority and immigrant populations, and reengineer urban centers to withstand wind and flood hazards.

“Disaster events such as Hurricane Harvey are occurring with accelerating frequency throughout the world, increasing complexity and the potential for more damaging effects,” the researchers wrote. “Population health science and policy provide critical inputs: identifying and intervening to address disaster risks to human health; guiding the reconceptualization of urban environments to prevent and mitigate disaster consequences; and, when disaster strikes, providing the roadmap for how to build back better — and smarter — in a manner that offsets the effects of trauma exposure and restores health.” – by Amanda Oldt

Disclosures: The authors report no relevant financial disclosures.

Two authors of a recent viewpoint published in JAMA explored how mental health consequences of Hurricane Harvey can be mitigated.

During Hurricane Harvey, Texas and Louisiana experienced more than 33 trillion gallons of rain, setting a rainfall record in the continental United States at 51.88 inches, according to James M. Shultz, MS, PhD, of the University of Miami Miller School of Medicine, and Sandro Galea, MD, DrPH, of Boston University.

Thirteen million individuals were directly affected by the storm, of whom 22,000 were rescued from floodwaters and approximately 32,000 displaced survivors were temporarily housed in shelters.

Shultz and Galea wrote that at least 450,000 individuals will apply for Federal Emergency Management Agency (FEMA) disaster assistance.

“What made Harvey an exceptional hurricane was that water, rather than wind, was the major destructive force,” Shultz and Galea wrote. “Harvey will forever be remembered for the unrelenting inundation that results from rain bands that spiraled inland from the gulf, overflowing Houston’s reservoirs and overtopping dams before moving on to submerge Port Arthur, Texas, and drench western Louisiana.”

Psychological consequences of Hurricane Harvey stem from storm hazards, losses and hardships in the aftermath, and disruption in essential care and medications for individuals with chronic and persistent mental illness.

Comprehensive reviews indicated up to half of hurricane survivors who were directly in the storm’s path and 10% who lived in the vicinity had increased risk for PTSD.

Research conducted among individuals affected by Hurricane Katrina showed 31.2% experienced anxiety-mood disorders at 30 days.

“Ensuring that health care system managers and clinicians recognize these risks and implement appropriate screening and treatment systems is critical,” the researchers wrote.

In the immediate post-disaster phase of Hurricane Harvey, early psychological intervention is currently underway, according to Shultz and Galea.

Disaster behavioral health teams have been integrated into the response and are providing psychological first aid and screening for urgent psychiatric needs at two large consolidated shelters in Houston.

“However, the reach of these brief-duration approaches is limited,” Shultz and Galea wrote.

Conversely, studies have shown that replenishing social and economic resources that restore living conditions was just as effective for the protection of health and promoted resilience compared with short-term, individualized medical or psychological interventions.

With this in mind, Shultz and Galea recommended WHO’s “Building Back Better,” a population-centric, evidence-based post-disaster intervention with a mental health focus.

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Post-hurricane urban redevelopment should concentrate on equal access to safe housing for poor, minority and immigrant populations, and reengineer urban centers to withstand wind and flood hazards.

“Disaster events such as Hurricane Harvey are occurring with accelerating frequency throughout the world, increasing complexity and the potential for more damaging effects,” the researchers wrote. “Population health science and policy provide critical inputs: identifying and intervening to address disaster risks to human health; guiding the reconceptualization of urban environments to prevent and mitigate disaster consequences; and, when disaster strikes, providing the roadmap for how to build back better — and smarter — in a manner that offsets the effects of trauma exposure and restores health.” – by Amanda Oldt

Disclosures: The authors report no relevant financial disclosures.