Hurricanes, COVID-19 and mental health- Part II

Hurricanes and COVID pt 2
FEMA deputy federal coordinating officer Louis Botta and community relations team members Pedro Pico and Jim Bowie listen to Islamic community leader imam Quasim Ahmed discuss flood-related issues. – Photograph by Andrea Booher/FEMA News Photo

 

 A storm’s long shadow

By DEAN RUSSELL

Columbia Journalism Investigations

and JAMIE SMITH HOPKINS

Center for Public Integrity

 

 

For Barbara Herndon, a Houston-area resident, the trauma started on Aug. 28, 2017. Harvey was, by then, into its fourth day assaulting southeastern Texas.

At around 2 a.m., when Herndon stepped out of bed to use the bathroom, her toes sank into cold water.

“No,” she remembers saying to herself. “No, no, no, no.” Three inches of musty, tea-colored water had seeped into her one-story home. And it was rising.

She had seen this 16 years earlier during Tropical Storm Allison. She and her husband, Oscar, stayed in the house all day, the water rising to their calves before they finally fled. Oscar, with a chronic lung condition, died a year and a half later – a death hastened by stress, Herndon believes.

Now, amid Harvey, she was on her own, with the rain picking up fast. Neighbors were making for dry land on air mattresses or trying to wave down helicopters. It took her nearly 10 hours to find a rescue boat. By then, she was chest-deep in floodwater and emotionally numb.

Days later, Herndon returned home. Furniture, floors, walls – everything was spoiled. She had married Oscar in that living room and promised him, as he lay dying, that she’d never sell; his spirit was there, she said. Harvey took that away.

She was so focused on survival – applying for the housing and property aid she desperately needed – that months passed before her feelings finally caught up to her. By winter of that year, she remembers feeling drained and lonely. She was crying more and more. She recalls praying for a change one night.

“God,” she asked, “why’s this got to be so hard?”

 

A small amount of help

FEMA’s Crisis Counseling Program was made for people like Herndon. But she says it never reached her.

Established in the 1980s as a short-term disaster relief grant, the program funds free emotional help for anyone affected by a major disaster. It’s been used in every state, plus Puerto Rico and other territories, for more than 400 traumatic events in all.

 

States with some of the most damaging climate-related catastrophes in the last decade said they rely largely – often entirely – on the program’s funding to support disaster survivors’ mental health. That typically includes state hotlines and crisis counselors who, until the pandemic hit, would go into communities and offer help in person, sometimes door-to-door. After floods and hurricanes in South Carolina, for instance, counselors showed up to town halls, local meetings, even Christmas parades.

States are required to plan for the mental health consequences of disasters. Officials said they’re grateful when they get CCP funding and appreciate the flexibility to plan the response they think will suit their communities best. But the way the program works can also impede efforts to help.

Though disasters always impact mental health, states don’t automatically get the funding. Wildfires often aren’t deemed large enough to qualify. When events do pass the magic threshold, states must complete long applications justifying the need. Iowa’s most recent request, for instance, ran 168 pages. And states must fill out two applications if they want to access the full program because FEMA splits it into “immediate” and “regular” phases. The second application can take months to be approved.

The agency’s reasoning is that states should only receive assistance if the event would overwhelm existing mental health services. But that’s almost always the case for major disasters, said Karen Hyatt, emergency mental health specialist for the Iowa Department of Human Services.

“Even when … other FEMA programs are up and running, crisis counseling program administrators are still writing the grant,” she said.

In wildfire-prone California, where counties provide much of the mental health response to disasters, local officials have found the federal program difficult to manage in part because they were on the hook to pay upfront. “It took a long time for them to get reimbursed,” said Michelle Doty Cabrera, executive director of the County Behavioral Health Directors Association of California.

Then there’s the problem of how long funding lasts. The program typically ends after a year, even though studies show that emotional burdens can persist far longer.

“When you’re talking about mental health, recovery takes years,” said Dr. Karen G. Martínez, director of the University of Puerto Rico’s Center for the Study and Treatment of Fear and Anxiety. “Disaster programs don’t really address that.”

Of the nearly 200 survivors that responded to the survey by Public Integrity, CJI and partner newsrooms, a third were still reporting five or more types of emotional struggles today – at least three years post-disaster, in many cases. Though people across the country participated, the survey isn’t nationally representative, and it may have drawn respondents who are more affected by disasters than average.

But this finding echoes earlier research: Epidemiological studies found emotional disturbances three years after Superstorm Sandy in 2012. One study of low-income mothers affected by Hurricane Katrina in 2005 discovered one in six with post-traumatic symptoms 12 years after the storm.

And the new reality of back-to-back disasters gives people little time to heal, said Amber Twitchell, associate director at On The Move, a social-services organization in California’s Bay Area. Since the Sonoma Complex Fires in October 2017, she said, “We have been in a constant state of disaster response.”

Public Integrity and CJI reviewed the Crisis Counseling Program response to six major disasters: Floods in Missouri and Iowa; the Camp Fire in California; and Hurricanes Harvey, Maria and Florence in Texas, Puerto Rico and South Carolina, respectively. The program’s reach varied but was small compared with the scale of the disasters, according to federal data obtained through a Freedom of Information Act request.

Puerto Rico’s CCP, which was extended beyond two years to accommodate the high level of need, reached the most people. Of the island’s 3.2 million residents, 580,000 met with counselors for sessions lasting longer than 15 minutes. Yet even there, some areas appear underserved. In Ponce, 35% of residents applied for FEMA financial aid – one indication of how many people were affected – and only 7% received counseling sessions.

Texas has relied on the CCP for 35 disasters, some simultaneously – more than any other state or territory.

“Responding to multiple disasters is nothing new for our program and for the state,” said Chance Freeman, director of Disaster Behavioral Health Services at the Texas Health and Human Services Commission.

In many ways – in part because of the repeated poundings – the state has one of the most advanced disaster mental health systems. Yet a review of its Harvey response in Houston shows that even there, relatively few survivors are reached by the federally funded counseling program.

Roughly 22,000 Houston residents received individual, family or group counseling within the 14 months the program was active, according to Public Integrity and CJI’s review. At the same time, about 341,000 people there applied for housing or property aid from FEMA.

Freeman says the state used that list of applicants to help identify the hardest-hit areas.

But in the nine Houston ZIP codes with the highest per-capita share of FEMA applicants – all lower-income, majority Black and Hispanic areas – 1% of the population received counseling. That’s about the same level of help provided in some higher-income, majority-White ZIP codes, even though a smaller percentage of residents there applied for aid.

In Herndon’s ZIP code, which ranked second on that FEMA-application list, some 4,700 people asked for aid. Just 105 met with counselors.

Dr. Annelle Primm, chair of the All Healers Mental Health Alliance, a group that taps volunteers to fill gaps in the government response to disaster-struck communities of color, is not surprised by the data. The unequal distribution of assistance she sees in Black neighborhoods in particular, from food to disaster loans, adds to the emotional toll for residents.

“In this country, the response seems to assume that the people who are affected are middle-class White folks,” Primm said. “They really aren’t thinking about, well, what if the community that is affected was already behind the eight ball, or had preexisting challenges, which the disaster just made … that much worse?”

Presented with Public Integrity and CJI’s findings, a FEMA spokesperson said the program supplements local mental health services, so “there is no universal ideal or adequate level of counseling post-disaster – it varies not only by locality but also by disaster.” The agency added that crisis counseling is available to all U.S. residents through the federal Disaster Distress Helpline.

 

The Harris Center for Mental Health and IDD, which ran the CCP in Houston after Harvey, said that the findings don’t include other forms of support beyond counseling. The agency led educational sessions with thousands of residents that, it said, could inform and motivate survivors to seek help from other mental health organizations, religious groups, family and friends.

Freeman, of the Texas health department, said the program serves all survivors equally. Among the 16,000 who received individual counseling in Houston, 38% were Black, 30% were Hispanic and 18% were White, according to the counselors’ observations.

“More time would be great and more resources would be great,” he said, but “we’re not there to create a need that doesn’t exist. Communities are resilient.”

Stigma around mental health care and people’s desire to be self-reliant both make it difficult to know when a community no longer needs aid, experts caution. After Katrina, teams dispatched to hard-hit communities found that no one stopped to talk if they set up a table with a “free crisis counseling” sign. “But when we began posting ‘tell us your hurricane story,’ people stopped,” said Danita LeBlanc, manager of Louisiana Spirit, that state’s crisis counseling program.

When Texas reached the end of its Harvey counseling program, 40% of the grant was unspent. Positions were never filled and some staff, including counselors, left before their contract was up. “This is not uncommon given the temporary nature of the program,” a state health department spokesperson said in an email.

The agency didn’t directly address a question about whether thousands more people could have been counseled with the unused funds. It said it exceeded its goals and got a commendation from the federal government. The money, $5.6 million, went back to FEMA.

 

Disclosure: Rice University and Texas Southern University have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. Find a complete list of them here.

This article was first published at https://www.texastribune.org/2020/08/25/texas-natural-disasters–mental-health by The Texas Tribune.

 

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