Hurricanes have had devastating and lasting effects on Eastern North Carolina communities. Often, when subsequent damages are assessed, they are generally reported based on dollars and cents, with a strong emphasis on the economic cost to the region. Having worked in community-based post-disaster relief and recovery since 2011, I realize the emotional and mental health impact is equally costly and, in many cases, is more challenging to recover from.
After Hurricane Florence, our outreach organization, Peletah Ministries, had the opportunity, through several grants, to assist more than 5,000 individuals, many of whom lived in marginalized communities, with immediate, short-term recovery assistance. In meeting and talking with these individuals, our case managers found that many were despondent, experiencing anxiety, and struggling just to make it through the day.
For so many residents in this region, their home and job provide a sense of safety and security. However, the impact of a hurricane tends to disrupt both safety and security. After experiencing a critical and stressful life event, like a hurricane, survivors can undergo a full range of emotional responses such as apprehension, emotional numbness, outbursts, shock, fear, grief, helplessness, hopelessness, irritability, and shame. This is what we have been seeing in so many of the survivors we serve.
The ongoing stress caused by experiencing a traumatic event like a hurricane can lead to depression, post-traumatic stress, and for some, the risk of suicide [1]. Trauma is a very personal experience and the trauma associated with witnessing a flood, fearing for your or your family's life, or being displaced from your home can have long-term effects, according to Dr. Emanuela Taioli, director of the Institute for Translational Epidemiology at Mount Sinai. Premised on what we have observed over the last nine years, the central element driving these unwanted, intrusive emotions is the loss of a feeling of safety. Helping people to talk about their loss beyond the material to the emotional can help them begin to move toward feeling safe again.
As has been noted by various clinicians, natural disasters put a spotlight on the disparities that exist in many low-wealth communities impacted by devastation. The socioeconomic and health disparities that existed prior to a hurricane make recovery longer and more challenging to achieve. For example, we found many people had no health insurance to address their emotional and mental health needs. As a result, the uninsured utilized crisis and emergency room services more often to address mental health needs, which often accounts for more acute psychiatric stays. Without insurance, many are unable to follow through with an aftercare plan that requires outpatient therapy and medication management.
In our post-disaster work centers, the core question posed by many is whether they will be emotionally and mentally prepared for the next storm. Support groups and individual therapy are great methods of helping people think about where they are and the steps needed to get them to their goal of feeling safe again. However, many in marginalized, low-wealth, and/or rural communities in Eastern North Carolina lack access to behavioral and mental health services.
As a result, much of the work we do at Peletah Ministries is providing trauma-informed supports for survivors in this region. We are grateful for mental health partnerships with organizations and clinicians on the front line doing this work. However, we knew that as the need was growing from repeated hurricanes and detrimental economic and health impacts, along with fraying community supports … we had to do more.
Last year, we developed and copyrighted a comprehensive wellness resiliency model called SHELL (Safety, Hope, Efficacy, and Lasting Linkages) for the hurricane survivors we serve. Monthly sessions focus on a SHELL core component. On our opening night, we expected 20 individuals from our primary focus region of the Craven, Pamlico, and Jones tri-county area. The session, led by a licensed clinician, licensed clinical addiction specialist, and two qualified mental health professionals, had more than 100 people in attendance.
These sessions have introduced coping skills, and we are creating a SHELL wellness plan to keep survivors focused on their ability to prepare, adapt, deal with, and overcome difficult times while recovering from disasters.
Even as COVID-19 began to impact our ability to physically meet, especially with the majority of our participants being in the vulnerable populations category, we transitioned survivors online or to conference call platforms. We have maintained a participation of 60-70 participants for each session with the licensed clinician.
As we approach another hurricane season, we are preparing survivors for what is being forecasted as a highly active season. In the lead-up to hurricane season, we will be providing healthy food distributions and mental health SHELL packets that will include hurricane preparedness items with COVID-19 drive-thru testing.
The needs around mental health in Eastern North Carolina are significant and the isolation along with anxiety of COVID-19 [2] has not helped, but we must work toward community resiliency models that will advocate for resources while supporting community-led models to serve those in need.
Acknowledgments
Potential conflicts of interest. D.B.G. reports no conflicts of interest.
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