Mental Health Care Must Remain Priority Within Disaster and Emergency Response Profession
I have previously written about the urgent need to address mental health support for those who work in fields where they are at risk of exposure to stress, high-stress and hyper-stress events. This need is heightened where there is the possibility of experiencing traumatic events. The recently announced rise in PTSD military veterans suicide numbers nonetheless shocked me and they should be shocking to us all. The U.S. Department of Veterans Affairs has provided important information to help us understand the scope and salience of the crisis. Further, the numbers of professionals in the emergency management, disaster recovery and crisis/consequence management who suffer from PTSD are little recognized, poorly defined and receive far too little in terms of mental health support and healing options.
Suicides are the Peak Point for a Larger Problem
Per the U.S. Dept. of Veteran Affairs, it is challenging to determine an exact number of suicides. Many times, suicides are not reported and it can be very difficult to determine whether an individual’s death was intentional. For a suicide, even to be officially recognized, medical examiners must be able to say conclusively that the deceased meant to die. Data from the National Vital Statistics System, a collaboration between the National Center for Health Statistics of the U.S. Department of Health and Human Services and each U.S. state, provides the best estimate of suicides. Overall, men have significantly higher rates of suicide than women.
For comparison review the following Veteran Affairs statistics:
- From 1999-2010, the suicide rate in the general U.S. population among males was 19.4 per 100,000, compared to 4.9 per 100,000 in females.
- Based on the most recent data available, the suicide rate among male Veteran VA users was 38.3 per 100,000, compared to 12.8 per 100,000 in females.
Do professionals in the Emergency Response, Crisis Management and Disaster Recovery Field Experience High Levels of Stress and/or Traumatic events?
When individuals experience a disaster (including those who plunge into the middle of a disaster as a responder), they may experience a variety of psychological reactions to the situation. Most of the time, people demonstrate psychological resilience, effective stress management and with the passage of time they cope with the experience(s) without enduring adverse complications. Unfortunately, there are others who find themselves suffering with enduring adverse complications long after the traumatic event has passed.
Although everyone reacts differently to disasters, some of those affected may suffer from serious mental or emotional distress. These individuals may develop or experience exacerbation of existing mental health or substance use problems, including for example, post-traumatic stress disorder (PTSD). Finding treatment in a timely fashion will help individuals minimize negative outcomes. SAMHSA provides a treatment locator and trains responders how to recognize and respond to symptoms of PTSD, depression or severe reactions.
Does Experiencing Traumatic Events Negatively Impact Mental Health and/or Increase an individual’s Suicide Risk?
Disasters are traumatic experiential events (involving stress, risk, exposure to negative stimuli, adverse emotional and distressing) that may result in a wide range of mental health consequences. Post-traumatic stress disorder (PTSD) is probably the most commonly studied post-disaster psychiatric disorder. Research conducted after disasters in the past decades suggests that the burden of PTSD among persons exposed to disasters is substantial.
A body of research indicates that there is a correlation between many types of trauma and suicidal behaviors. For example, there is evidence that traumatic events such as childhood abuse may increase a person’s suicide risk Though considerable research has examined the relation between combat or war trauma and suicide, the relationship is not entirely clear. Some studies have shown a relationship while others have not. There is strong evidence, though, that among Veterans who experienced combat trauma, the highest relative suicide risk is observed in those who were wounded multiple times and/or hospitalized for a wound. This suggests that the intensity of the trauma experienced, and the number of times it occurred, may influence suicide risk.
Among scholars and mental health professionals, there is disagreement about the reason(s) for the heightened risk of suicide in those who have experienced traumatic events. Whereas some studies suggest that suicide risk is higher among those who experienced trauma due to the symptoms of PTSD, others claim that suicide risk is higher in these individuals because of related but distinct psychiatric conditions.
One study analyzing data from the National Comorbidity Survey, a nationally representative sample, showed that PTSD alone out of six anxiety diagnoses was significantly associated with suicidal ideation or attempts. While the study also found an association between suicidal behaviors and both mood disorders and antisocial personality disorder, the findings pointed to a positive relationship between PTSD and suicide after controlling for other variables. A later study using the Canadian Community Health Survey data also found that respondents with PTSD were at higher risk for suicide attempts after controlling for physical illness and other mental disorders.
Per the U.S. Deptartment of Veteran Affairs, some studies that point to PTSD as a precipitating factor of suicide suggest that high levels of intrusive memories can predict the relative risk of suicide. Anger and impulsivity have also been shown to predict suicide risk in those with PTSD. Further, some cognitive styles of coping such as using suppression to deal with stress may be additionally predictive of suicide risk in individuals with PTSD.
Can Mental Health Treatment Help Respond to the Disaster?
Current practice guidelines for treatment of PTSD indicate that trauma-focused therapies are not recommended for individuals with “significant suicidality tendencies.” However, individuals with PTSD who present with intermittent but manageable suicidal thoughts may benefit from trauma-focused therapy. Two effective treatments for PTSD, Cognitive Processing Therapy (CPT) and prolonged exposure (PE) have been shown to reduce suicidal ideation. A recent study that randomized women who experienced rape into CPT or PE treatment found that reductions in PTSD symptoms were associated with decreases in suicidal ideation throughout treatment. The reductions were maintained over a 5-10-year follow-up period.
It is imperative to work directly with the appropriate mental health provider professionals to begin to address the damaging fallout from hyper-stress and traumatic stress on ourselves and our colleagues. We have too long ignored the problem, or tried ad hoc or self-constructed “solutions” that have proven inadequate.
It is common for some people to show signs of extreme and traumatic stress after exposure to a disaster. It is therefore important to have processes in place to monitor and where appropriate intervene to help ensure the physical and emotional health of these individuals. Building stress resilience and providing post-disaster mental health support must become a standardized part of our crisis management and disaster recovery plans. This has been a missing piece of our preparedness planning for too long.
Call to Take Steps Forward
The disaster, emergency and crisis management professional field must prioritize the prevention and treatment of PTDS by responders and managers. We must make mental health support and treatment options common and ubiquitous. We need to talk openly and frankly about the nature of the problem and bring it out of the dark closet and into the light. We must declare the mental health disaster that is claiming those who have been in harm’s way and continue to suffer the consequences of that experience. This is one disaster to which we as a professional community are not (yet) responding to. We must respond to manage and resolve this mental health issue with same tenacity and purposefulness that emergency responders and disaster workers push ahead to do their jobs responding to physical disaster.