Overview

 Trauma and Retraumatization in times of Disaster

Many people in communities across the country have histories of trauma, as well as a serious mental illness and/or substance abuse problems.  This is especially true for those individuals who are served by the public mental health and correctional systems.  When those individuals are affected by a major disaster, its effects can be very emotionally and psychologically devastating.  Even for people who have never before experienced a severe trauma; post-traumatic stress disorder (PTSD), anxiety reactions, increased substance abuse, and many other reactions are common.  For those individuals who have a history of trauma, the cumulative impact of trauma in their lives leaves them even more susceptible to the psychological impact of a major community disaster, such as Hurricanes Katrina and Rita. 

Key concerns of the nature and impact of trauma and the experience of retraumatization:

• Traumatic events include interpersonal physical, sexual, and emotional violence, as well as accidents, disasters, and witnessing violence.
• Violence and trauma are far more prevalent than crime reports indicate–-many traumatic events experienced in childhood, adolescence, and adulthood are criminal acts of interpersonal violence, but many, likely most, go unreported to the police.
• Some coping responses to trauma such as dissociation, substance use, and risky sexual behavior heighten vulnerability to experiencing other traumatic experiences and to being incarcerated.
• A substantial number of people in jails and prisons are survivors of interpersonal violence and trauma, and, as a result, many struggle with mental health and substance abuse issues.
• The impact of trauma can be disabling and may be misunderstood, unnoticed, or misdiagnosed if the traumatic experience is not acknowledged and addressed.
• Trauma is transferable–-it can be indirectly or vicariously experienced when loved ones, caregivers, service providers, and first responders feel the impact of traumatic events experienced by others.
• An aspect of trauma’s transferability is its intergenerational reach, with children adversely impacted by witnessing domestic violence and parents adversely impacted by traumatic events experienced by their children.
• In the aftermath of disaster, coping responses such as isolation, depression, anger, substance abuse, interpersonal violence (including child abuse and domestic violence), and suicide all increase.
• Retraumatization refers to experiencing two or more traumatic events and the impact of those experiences. 
• Like trauma, retraumatization can be experienced indirectly or vicariously.  It may be experienced by first responders, medical personnel, and counselors.  It can also be experienced at a distance, as images of death and destruction are broadcast.

Potential solutions and recommendations to address trauma and retraumatization issues:

• Conduct “trauma-informed” public health education to increase everyone’s knowledge and understanding of the prevalence of trauma, retraumatization, and coping adaptations (and their unhealthy consequences) by individuals who have experienced trauma.
• Establish a universal presumption of trauma, recognizing that it could be part of the life experience of anyone with whom we interact.
• Focus helping responses on the self as situated in social bonds of family, friendship, and community, rather than on a solitary, psychological self.
• Focus interventions on community and peer support, as well as on trauma-informed clinical treatment.
• Create trauma-informed disaster response protocols that consider short- and long-term needs that are re-traumatization-informed, child- and family-focused, gender-specific, and community-conscious.

The After the Crisis Initiative:
Healing from Trauma following Disaster

Disaster response systems, much like the mental health system often reinforce the person’s belief that they cannot do for themselves. The impact of disaster and the impact of the disabling aspects of a mental illness can often create total inability to care for one’s self/family/community.  Resources for self-direction can be limited or non-existent.  Stigma replaces sympathy.  Both victims of disaster and persons with mental illness begin to be seen as the problem as supporters and resources run out.  This increases pre-existing issues of substance abuse, crime, hopelessness and helplessness as well as creates a new class of disempowered and disenfranchised people—evacuee populations.

The urgent need for the After the Crisis Initiative was most recently highlighted by the impact of Hurricanes Katrina and Rita in communities all along the Gulf Coast.  The key activities of the initiative are focused on the development of technical assistance strategies and support networks that are dedicated to addressing the long term mental health and trauma needs of disaster survivors.

The ATC Initiative has formed a working consortium, the activities of which are targeted toward creating change and building disaster response capacity.  The Initiative’s network is comprised of a broad array of experts, many of whom are trauma survivors and have had personal experience with disaster in their communities.  Collectively, membership of the initiative includes representatives from the community, state and national levels.  The Initiative has formed two innovative committees, the Community Mobilization Committee and the Peer Support/Response Committee, which are focused on developing individual and community-level support strategies and increasing community disaster response capacity. 

The ATC Community Mobilization Committee was developed to respond to the needs of communities in times of disaster.  The Committee discovered that one of the most important aspects of community life is the social networks individuals develop, whether it is through their neighborhoods, local businesses, or places of worship.  Regardless of the nature of the disaster, it is critically important for community recovery that people are provided with the tools necessary to stay connected.  When a disaster occurs, these social networks can be severely disrupted.  However, with a disaster plan in place to mobilize the community, individuals have the resources and ability to overcome obstacles to reconnection.  Reweaving the social fabric of a community may be just as important as rebuilding housing.  Creating a “Community Disaster Support network” that focuses on the ways in which disasters affect entire communities, and provides mechanisms for community reconnection, is a way to keep communities as permanent fixtures—fixtures that cannot be destroyed during or after times of disaster.   

The ATC Community Mobilization Committee believes that creating a disaster support network that focuses on ways in which disaster affect entire communities is the key in disaster planning.  The Mental Health Association of Southeastern Pennsylvania, in conjunction with the Center for Mental Health Policy and Services Research at the University of Pennsylvania, has developed a Disaster Community Support Network (DCSN) model.  This model, based on experiences in Philadelphia, PA, is an example of a program that facilitates recovery among individuals and communities affected by traumatic events that have a community impact.  Central to the DCSN model is strengthening the capacity of local leadership, whether it is through elected officials, the local business community, mental health and other human services agencies, or through mental health advocates, to assist into the healing of the community and to begin to implement a solid community structure following disaster.  The purpose of this model is to create settings in which self-help and mutual aid can occur in response to a traumatic community-wide event. The mission of the DCSN is to establish the groundwork for community meetings to take place in the event of national, state, or local events that impact, either directly or indirectly, Philadelphians and their communities.  The ATC Community Mobilization Committee has developed a concept paper on the topic of community mobilization and currently promotes the DCSN model on its website and through presentations and other forms of dissemination. 

The ATC Peer Support/Response Committee believes that a peer support network is a powerful force promoting community connection and hope in the lives of survivors of traumatic stress and retraumatization during and after a disaster.  The goal of our effort is to foster recovery by establishing productive communication, building long lasting effective relationships and to develop a peer support/response curriculum to promote “peers helping peers” for people who have experienced traumatic events and retraumatization during and after times of disasters.  The committee initiated the dialogue among the leaders of several successful peer support programs across the country, along with leaders from various national consumer technical assistance centers.  These leaders, along with local, state, federal officials have met in a variety of settings to discuss how important it is to include self-help and peer support as a part of the array of services in response to disasters.  This dialogue has provided the impetus for the development of a peer support/response training curriculum designed to develop community capacity to respond to the mental health needs of individuals in times of disaster by providing key support mechanisms to foster recovery. 
 
Summary and Recommendations for your Community

Mobilizing Communities and “Peers helping Peers” are powerful sources of survival and recovery during and after disasters. It is important to build on the strengths of communities and peer support models to keep locus of contact for all disaster response efforts in the local community and through agencies/organizations.  It is also imperative that there is communication among local, state, federal, nonprofit service providers, faith communities, and first responders, as well as improving service integration between the mental health and criminal justice systems during times of disaster.  It would be beneficial for leaders to develop mechanisms to support person-to-person relational connection and peer support for trauma survivors and mental health consumers to help foster the healing process and lessen the impact of trauma and retraumatization in times of disaster.  

Local communities can do a great deal to further the development of community disaster support networks and peer support networks to respond in disaster situations.  Communities can begin to build this capacity by staring the dialogue among existing community-based institutions and organizations.  Communities can work toward establishing their own Disaster Community Support Network using the framework developed by the MHASP.  This can be initiated by hosting a series of meetings that are can be utilized to mobilize community groups to begin systematically planning for reconnecting community members.  Communities can begin to explore the utilization of peer support groups in times of disaster by first exploring groups that may already exist in the local area.  Connecting existing peer networks with local consumer/peer leaders is a critical first step in this process.  These are important first steps that communities can and should take in planning and implementing strategies that can support individual and community-wide trauma healing following disasters.