Residents of the Caribbean and the southern United States are still grappling with the aftereffects of two immensely powerful and destructive hurricanes — Harvey and Irma — both of which caused widespread damage and left millions of people displaced. Rebuilding what the hurricanes destroyed will be a long and painful process, but counselors who live and work in the hardest hit areas have seen people from within and without the damaged communities come together to help each other. This sense of community and resilience will help many of those affected to recover without signs of mental health problems, but counselors also caution that some residents of the storm-wrecked areas may experience greater trauma and require more time to recover.
Maureen C. Kenny, a professor of counselor education at Florida International University in Miami, has seen Hurricane Irma spur a significant amount of anxiety in her area, from worry over whether to evacuate to the stress of having children home from school for an unknown length of time.
“For many parents, they may need to return to work but the children are not [back] in school yet, so child care is an issue. Many families are without power and still dealing with hot weather, uncomfortable living situations and limited ability to cook or eat,” Kenny, an American Counseling Association member with a part-time counseling practice in Fort Lauderdale, said in the days following the storm.
At the same time, Kenny said she’s seen community members come together to help one another, such as neighbors helping neighbors install hurricane shutters and fix generators.
“Since people are often without power for extended periods of time, they spend time outside talking to their neighbors. People are out walking dogs, kids are riding bikes and neighbors are sharing storm stories,” Kenny said. “In a strange way, it brings people together. Without electricity, people are forced outside and have more contact with one another.”
Harvey was a Category 4 hurricane as it made landfall near Corpus Christi, Texas, on Aug. 25. The storm then stalled over southeast Texas for days, bringing heavy rainfall and catastrophic flooding. Irma — one of the most powerful Atlantic storms ever recorded — was a Category 5 hurricane when it razed many of the islands in the northeastern Caribbean and “skirted” Puerto Rico, leaving 1 million residents without power. The storm had dropped to a Category 4 hurricane when it made landfall in the Florida Keys Sept. 10 and began its slow march up the Sunshine State.
Forecasters are also keeping an eye on two more hurricanes, Jose and Maria, which are currently churning in the Atlantic Ocean.
The barrage of catastrophic weather has brought weeks of news coverage and warnings to evacuate or stock up on emergency supplies.
“With technology’s advance notice of hurricanes, it allows people to get ready but also adds a lot of anticipatory anxiety,” Kenny said. “Schools and businesses were closed several days before
the storm actually hit. This left people waiting for the storm to hit and unsure of what exactly would happen. … As days grew closer to the storm, there were long gas lines [at gas stations], the shelves at the stores were empty and people may have not been able to get supplies.”
ACA member Jeffrey Kottler also saw people pushed to their limits during the time he spent as a disaster mental health volunteer at Houston’s George R. Brown Convention Center in the days after Hurricane Harvey. At the peak of the crisis, the facility sheltered more than 9,000 people.
Kottler, a clinical professor of psychiatry at Baylor College of Medicine in Houston, worked with psychiatry colleagues from Baylor in a tent at the convention center, offering support and a sympathetic ear. They did everything from offer psychological first aid to help people contact family members, refill medications and get a new driver’s license because theirs was lost in the flooding and chaos that followed the storm.
When a distraught person would enter his team’s tent, Kottler said his approach was to pause, calm the person down and give the person time to tell his or her story, even if that meant walking around the conference center with the person or finding a quieter place to talk.
People were overwhelmed on many levels, Kottler said. Not only were they reeling from the loss of homes, vehicles and other personal property, but they were crammed in close quarters with complete strangers.
“[The convention center] was the most chaotic environment imaginable, and people’s brains were going off like fireworks,” Kottler said. “It’s hard to describe the chaos of what it was like to be there, seeing [thousands] of beds, with dogs barking and babies crying. People were just in shock.”
“Imagine having a car, a job and a home, and then in one day, it’s all gone and you’re living with 9,000 people. Those were most of the people that I was spending time with [as a disaster mental health volunteer].”
Kottler noted that the center featured a large police presence – alongside many, many volunteers and aid agencies – for safety and to ensure that weapons, alcohol and other banned items were not brought into the facility. For some, this added to the tension of an already anxious situation.
Kottler, a keynote speaker at ACA’s 2015 Conference & Expo in Orlando, Florida, recently moved to Texas to start a new position at Baylor College of Medicine and to serve in a volunteer role (consultant and staff trainer) at the Alliance for Multicultural Services, a refugee resettlement agency. Previously, he was a professor at California State University, Fullerton.
Kottler said he has been struck by the resilience of his new hometown – from grocery store cashiers asking if he’s OK to the local American Red Cross chapter having too many volunteers.
“I am new to Houston, and I’ve just been blown away by how the city and community have come together to help each other selflessly,” Kottler said. “What I found so personally disturbing is [the realization] that this could happen to any of us.”
Many in Houston have now begun the process of clearing out damaged homes and rebuilding lives after Harvey. In Florida, some residents are waiting for utility service to be restored, one week after Irma. Residents are still displaced and emergency shelters are still open in both Texas and Florida.
In Miami, Kenny said she had power in the days after Irma, but no phone or internet service. Classes resumed at Florida International University Sept. 18 after a nearly two-week closure. Some of the school’s facilities were being used as shelter for evacuated residents of the Florida Keys, Kenny said. Professors have been advised to be flexible with deadlines and assignments.
In her role as a counselor educator, Kenny said she has also witnessed anxiety among some counseling students who are concerned about the loss of internship hours because clinical sites were closed in the storm’s upheaval. In her private practice, Kenny had numerous clients cancel appointments prior to the hurricane because they were busy with preparations or didn’t want to travel for fear of using gasoline that might be needed later.
“Thankfully, cell phones [are currently working], so you are able to check in with clients and see who can return,” she said. “Many clients – those who were able – left town and still have not returned. Thus, practice remains slow. For some clients without power, coming to an air-conditioned office for an hour to cool off and vent is a welcome relief.”
Although hurricanes are part of the reality of living in South Florida, the upheaval that Irma brought has stirred up difficult memories for some longtime residents, Kenny noted. For others, watching Hurricane Harvey’s devastation from afar was equally troubling.
“For some in South Florida, [Irma] was also a reminder of Hurricane Andrew 25 years ago. For those [individuals], it definitely brings up posttrauma issues. These are people who lost their entire homes, businesses, etc., and were fearful of the same thing happening again,” Kenny said. “Others who are living here but have lived through storms in other parts of the country were also triggered by this storm. Some [of my] clients had family in Texas [who] had just survived Hurricane Harvey and were still dealing with them when this storm was approaching. For those clients, the back-to-back storms seemed overwhelming. I had a client who was able to arrange for evacuation of a family member in Texas through Facebook. The family member was elderly and in need of medical attention post-surgery but was in a completely flooded area. A stranger responded to the request and used their boat to get the relative to a hospital. This type of kindness demonstrates how a community can come together.”
The road ahead
For people who are directly impacted by a natural disaster, the aftermath can be marked by feelings of loss, fear, panic, grief or guilt, said Anka Vujanovic, an associate professor and director of the Trauma and Stress Studies Center at the University of Houston. Counselors may hear clients talk about strong feelings of irritability, anger or guilt, having difficulty sleeping or a sense of wanting to do more for their community because they made it through the storm relatively unscathed.
“There may be guilt in those who are not severely impacted – survivor’s guilt of ‘why them, why not me?’” said Vujanovic, a licensed clinical psychologist and co-director of the University of Houston’s Trauma and Anxiety Clinic.
Other clients may be in shock right now and focused on the immediate needs of putting their life back together in the storm’s aftermath, Vujanovic said. Mental health struggles can surface weeks, months or even years later when triggered by another natural disaster or traumatic event.
“Once they’re past the crisis, they may have symptoms. … Once things settle down, they have their house [renovated], they’re back to ‘normal’ and life has settled down. They may feel the aftershock even months later,” Vujanovic said. “People may or may not experience symptoms until the next rainstorm with high winds, or [next year’s] hurricane season. That may trigger people and activate some of their difficult memories.”
“It’s something to check in about for practitioners, especially if they work with people who were directly impacted. Keep in mind that there may be things that crop up. Clients may not be ‘over it’,” Vujanovic said.
Counselors may see clients develop panic attacks, intensifying anxiety or depression, loss of interest in things they normally enjoy, mood fluctuations or increased substance abuse. People often use alcohol or drugs to cope with feelings of stress, loss and grief after a natural disaster, Vujanovic said.
It’s vitally important for counselors to check in with clients in affected areas to see how they’re coping in the storm’s aftermath and to monitor their symptoms. Practitioners should encourage clients to maintain social connections with friends and family and “fight the urge to isolate,” Vujanovic said.
“Take time for self-care, which can be incredibly difficult if you’re living in a shelter. Take time for appropriate sleep, exercise, social activity – whatever is important to that person,” she said.
Vujanovic’s area of research is posttraumatic stress disorder (PTSD). Although 30 to 40 percent of people who are directly impacted by a natural disaster will develop PTSD, it is important to note that a majority of people who survive a natural disaster will not develop mental health symptoms, she said.
A number of factors – from whether individuals have pre-existing mental illnesses to how much social support and financial stability they have – contribute to whether they might struggle after a natural disaster. “All of those things will go into the complex equation of who develops a problem [after a natural disaster]. These factors up the risk, but it doesn’t mean they definitely will,” Vujanovic said.
Counseling Today’s August cover story, “Lending a helping hand in disaster’s wake”
From Counseling Today columnist Cheryl Fisher, “Mental health cleanup following a natural disaster”
Bethany Bray is a staff writer for Counseling Today. Contact her at firstname.lastname@example.org
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