Four Recommendations to integrate psychosocial support as a cross cutting theme Hurricane Maria response 

Joseph O. Prewitt Diaz, PhD, LPC
CEO

Center for Psychosocial Solutions 

Alexandra, VA 22310 

Introduction 

 The impact of Hurricane Maria in Puerto Rico (September 20, 2017) resulted in total destruction of the infrastructure, and a significant loss of life. The level of previous disaster exposure and preparedness varied considerably in the last 50 years and gave disaster planners at FEMA and PREPA (the local disaster management agency) a false sense of their capacity to manage the impending disaster. Contingency planning was inadequate at best. From my optic, tailoring psychosocial disaster responses to this specific disaster, would have alleviated emotional suffering to thousands of island residents. While many previous disasters shared many characteristics as potentially traumatic events, distinct variations in the type, scope, and population impact of these events and the structure of existing health service systems highlighted the need to tailor psychosocial responses. For example, hospitals were without light in most of the island. The road infrastructure was damage, and transportation of emergency vehicles, including ambulances, was limited to none existent. In some locations of the Central Mountain region access is still limited, as I write this commentary, one month after the Hurricane. A large portion of mental health providers were survivors and would not return to their offices until the curfew was lifted, three weeks after the Hurricane. The impact of Hurricane Maria required the mobilization of local, national, and international resources to address the basic needs of the population. 

  1. Tailor the mental health and psychosocial support response to the disaster 

 It will take sometime to fully implement a mental health and psychosocial support program that addresses issues of traumatic stress as well as well as community social and emotional needs. These services, when implemented, will have to be tailored to the geographic areas, the perceived extent of loss, and the affected population, pre-existing mental health services, and cultural factors associated to mental health and psychosocial support. These are all predictors of post- and peritraumatic stress. Some natural disasters that destroy large parts of the infrastructure and lead to the break-up and dispersion of communities are also accompanied by very substantial mental health impacts (Galea, Brewin, Gruber, Jones and others, 2007). There are a variety of risk and resilience factors that need to be considered when planning the psychosocial response to disasters (Bonanno, Brewin, Kaniasty & LaGreca, 2010), such as Hurricane Maria. For example, the American Red Cross response practical assistance such as linking, first aid, a psychological first aid. By the second week after the Hurricane the response included psycho education, crisis and grief counseling to family members, and first responders, and the wider community. In the coming weeks as local facilities begin to operate the Red Cross will be making referrals for those in need of long-term care. 

  2. Target at-risk population groups 

 The identification and targeting of support at particular at-risk groups constituted a key task for disaster responses. All responses sought to target direct disaster survivors and Other at-risk groups. Population based psychosocial support needs assessment and health surveillance of high-risk groups are of immense practical importance to estimating psychosocial service needs and targeting interventions following disaster. It is important that we draw lessons from earlier catastrophes and integrate them in the service delivery to affected populations. Barriers in access to care (providing basic needs, and psychosocial support) have been identified in the Central and south east and west part of Puerto Rico. These barriers included aspects associated with the disaster response such as the identification of survivors, limitations of existing referral pathways, destroyed infrastructure, and other difficulties in accessing appropriate care. Screening provides a mechanism to identify survivors in need of treatment and to target interventions. For example, the American Red Cross has provided psychological first aid and psycho-education with information on disaster mental health care, self-care, and available services. Future attempts to improve service accessibility may need to take into account other factors (such as gender, age, disability, socio-economic status, language, or culture) that can impact on access to disaster care. 

3. Recognize the social dimensions and sources of resilience 

 Large hurricane responses in Puerto Rico such as Hugo and Andrew, highlighted the efforts to promote a positive recovery environment that is based on the knowledge of the social and the language and contextual dimensions of resilience and recovery within the context of Puerto Rico. Planners and responders need to acknowledge the importance of the Puerto Rican diaspora to the mainland and their immediate response to the affected population in the Island. They also have to acknowledge that recovery is different for the urban metro area than for the millions who live in small towns and the central mountain regions. From the psychosocial perspective it is important it is important to understand the place of community-level and self-help initiatives that needed to be recognized and fostered within disaster response planning alongside more formal psychosocial support strategies. Social support and bonding are important also to reduce negative psychosocial outcomes after trauma. One of the key tasks for disaster response planners therefore consists in recognizing both the value of existing and emerging support networks of those affected by disaster (as well as their limitations) within a broader framework of psychosocial disaster care. In this context, community-and family based supports and targeted capacity building initiatives deserve particular consideration (SPHERE Project 2012; Inter-Agency Standing Committee, 2007). 

4. Coordinate disaster response services appropriately 

 Hurricane Maria is probably the largest scale psychosocial disaster in the United States. Large-scale psychosocial disaster responses require coordinated efforts to address multiple competing demands in chaotic circumstances. These demands include the need to ensure the continuity of existing health services, establish enhanced psychosocial services for the disaster-affected population, coordinate response agencies, integrate international resources, monitor population disaster impacts, and outcomes of response services. To efficiently address the psychosocial support and mental health needs following Hurricane Maria, it was/is vital that national frameworks (FEMA & PREMA) for psychosocial disaster response exist, that integrate firmly with prevailing health emergency services and disaster response arrangements. Hurricane Maria needed integration of psychosocial support from the outset of the response and into recovery activities. The integration of psychosocial disaster response services with existing health services can increase their sustainability and facilitate a return to ‘‘normality’’ over time. 

Reference 

 Bonanno, G. A., Brewin, C. R., Kaniasty, K., & LaGreca, A. M. (2010). Weighing the costs of disaster: Consequences, risks, and resilience in individuals, families, and communities. Psychological Science in the Public Interest, 11(1), 1_49. 

 Galea, S., Brewin, C. R., Gruber, M., Jones, R. T., King, D., King, L., et al. (2007). Exposure to hurricane-related stressors and mental illness after Hurricane Katrina. Archives of General Psychiatry, 64, 1427_1434.