The U.S. has had an unprecedented year of climate disasters—a relentless whirlwind of droughts, floods, cyclones and wildfires costing billions of dollars. Catastrophic events such as the firestorm in Hawaii and Hurricane Idalia in Florida have been battering down the homes and livelihoods of countless people, leaving trails of long-lasting destruction across the country.
Marty Dwyer, a disaster mental health supervisor with the American Red Cross, says the psychological impact of such sudden and massive losses can make it especially difficult to make big decisions in the aftermath, when they are often most urgently needed. And a hugely consequential choice immediately faces most survivors when they return to their destroyed homes: Should they stay and rebuild or migrate to someplace that seems safer?
“Whether you are a person experiencing homelessness or transiently unhoused because of disaster, that is a risk [to mental health],” says Joshua Morganstein, chair of the American Psychiatric Association’s Committee on the Psychiatric Dimensions of Disaster. Morganstein has worked with survivors of mass shootings, Hurricane Katrina and various wildfires and has witnessed firsthand how disaster trauma impacts mental wellbeing.
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A growing body of research is revealing how crises of climate change—including wildfire smoke, pollution, flooding and extreme heat—are worsening conditions such as anxiety, depression and post-traumatic stress disorder (PTSD). While experts emphasize the importance of quickly getting people rehoused, rebuilding in a disaster-prone area could subject people to the trauma of losing their home yet again.
Scientific American spoke with Morganstein and Dwyer about the correlation between housing and mental health post-disaster and about measures to prevent repeated traumatization as these disasters persist.
[An edited transcript of the interview follows.]
How does climate disaster trauma differ from other kinds and symptoms of trauma?
DWYER: A climate disaster raises the level of trauma significantly when people don’t have a chance to prepare and wait. For example, with the wildfire in Maui, they basically had no notice. But in all disasters, you see some pretty similar responses: people might be feeling just absolutely overwhelmed or numb or experiencing high levels of anxiety. It’s not uncommon for people to be very angry.
The first things I see are more physical complaints. People describe having insomnia, diminished appetite, headaches or stomachaches. On top of that, many people have preexisting mental health conditions or they have had prior trauma that makes them more likely to need additional assistance.
MORGANSTEIN: People who are exposed to any given disaster have different types of exposure. Many people experience distress, annoyances and general stressors. And there can be many of those that pile up on top of one another. Of course, the stresses that people experience change over time. The stresses of the moment of a hurricane are very different from the stress of two weeks, six weeks, six months and 12 months after the event.
Immediate stress reactions include feeling unsafe, which causes significant negative health effects. People who feel unsafe, for instance, are more likely to have difficulty with sleep, and they’re more likely to increase their use of alcohol and tobacco. They’re also more likely to indicate symptoms of general distress.
Some people may ultimately develop psychiatric disorders. Most often we think about PTSD in the event of a disaster. PTSD is not the most frequent disorder, however. Depression is more common.
It’s hard enough to move to a new place when you want to, and you’ve planned for it, and all of your possessions are with you. But people who have been forcefully displaced are dealing with issues of grief, which is a very overlooked but universal response to disasters. It’s often the thing that hangs on for people long after scars are healed. Mental health professionals will diagnose depression, anxiety or PTSD. But we as a society do not do a very good job, I think, at anticipating and addressing the almost universal issue of grief that happens in the wake of all disaster events.
Why is housing important to mental health in post-disaster relief?
MORGANSTEIN: There are negative physical health and mental health effects that become enhanced when people are unhoused.
Many people who are displaced find themselves in shelters, makeshift or otherwise, with a bunch of strangers. They are without comfort or things that make them feel safe—such as a locked door or just some place to go where they don’t feel exposed to other people. People have difficulty sleeping in loud, noisy places, and they’re limited in their ability to protect whatever property they’re able to take. When someone has chronically underslept, almost everything in their life gets worse: their ability to make decisions, to exercise good judgment, to take protective actions, to assess threats properly in ways that protect themselves and their family.
In an attempt to address that, hotels have offered support and have tried to be good stewards in their community after disasters. They move people into their facilities. Being in a place where your family can go and be together and lock a door will help some people to feel safer. People find they can connect with, learn from or share adversity with others who are going through this difficult situation. But one of the things that this might also do is lead some people to feel isolated. Different people have different needs.
DWYER: Housing is very, very important. One of the things we have seen, especially during the COVID pandemic, is that organizations in the U.S. seem to be getting people out of congregate group shelters and moving towards what we refer to as “noncongregate shelters” [such as hotels]. It might not be home, but it’s not a large building where you’re sleeping right next to strangers.
What are some pros and cons of staying and rebuilding?
MORGANSTEIN: Some people leave because they feel a sense of threat and feel unsafe. Disasters often do not just take people out of their home but also scatter the community. Everyone disperses because their communities were wiped out by a tornado, hurricane or wildfire. Everyone had to move. Now all of that support is sort of gone. It’s probably important to think about the extent to which people choose to stay versus people who simply do not have the means or resources to go [who say] “I’m here because I have no other choice.”
For others, staying can be a way to build a sense of resilience. It can be a path to recovery to go back to and to be present in a place where something difficult happened. We have to remember that most people, even people who have difficulties along the way, will ultimately be okay—and this is very important. Eventually people are able to make meaning of those events. And at some point, people can look hopefully to the future.
How can people rebuilding in disaster-sensitive areas prevent retraumatization?
MORGANSTEIN: The fundamental framework for interventions that we know protect mental health, foster resilience and improve people’s ability to function after disasters involves five essential elements: enhancing a sense of safety, calming, social connectedness, self- or community efficacy and hope. Before it gets to the point where we’re talking about medications and therapies, fostering those five essential elements really is the framework for protecting people who are experiencing extreme stress.
We also want to remind people of their innate strengths and capabilities. When we see someone doing something, our goal is not to take over and do everything for a person. We might feel, “Oh, my gosh, this person has been through so much. I’m just going to help them.” Unfortunately, when we do everything for someone, the feeling of helplessness can almost be exacerbated. Helping someone to know where to go encourages them to take those steps. Lower those barriers for people who are having a lot of difficulties.
Is it going to be worse or better? I’d like to be able to give you a simple answer to whether people should come back. The reality is that there are many factors for individuals that will likely come into play. I do think it’s important to think about—because these events are happening more frequently.
If you simply search the literature for “repeat disasters,” there isn’t a lot out there to show what happens over time for people who are exposed to events over and over again. Certainly we have some evidence to show that after difficult situations, people learn from them and feel better equipped to handle them in the future.
DWYER: Our goal is not to replace the community resources. We are there to supplement and strengthen what the local community has in place, especially in places such as Hawaii or Puerto Rico, where the culture is so important. We want people to get support in a culturally sensitive way. We come from all over; we don’t necessarily know what it’s like to live in that community.
If you can alleviate immediate emotional distress, it really does make a difference. Most individuals and families are able to function adequately after a disaster. They may not be as effective in their daily activities. They may have difficulty processing and problem solving, for example. But most people, as devastating as [the disaster] seems, are able to move forward. We help them to discover their resilience and take those first steps.