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Episode 6: Long-Term Recovery

Read the transcript of the sixth episode of the Resiliency in Disaster Behavioral Health podcast.

Moderator: Welcome to Resiliency in Disaster Behavioral Health, a six‑part podcast series from the Substance Abuse and Mental Health Services Administration. The goal of this podcast is to inform local behavioral health agencies on strategies for building resiliency in individuals and the community before, during, and after a disaster. The series discusses specific behavioral health interventions across the stages of disaster response, in addition to focusing on the needs of specific populations.

Natalie Grant is a Program Analyst in the HHS Office of the Assistant Secretary for Preparedness and Response, Division of Recovery. She has served as the Health and Social Services Field Coordinator for the federal interagency coordination following Hurricane Sandy from 2012 to 2016 and supported recovery planning and coordination in other disaster and emergency incidents nationwide.

Natalie Grant: Recovery. Resilience. What is the relationship between these two concepts? Where do they intersect? How can we engage these principles following trauma to foster and support individuals, families, and communities as they negotiate the process of reconstructing their networks and environment?

In this podcast, I will review the role and interplay of the environment to community recovery and resilience, and partnerships that can be utilized to leverage supporting resilience planning, and how this relates to community culture. Essential to such effort is the interaction between the various roles of government, nongovernment, private-sector, family, and individual households in supporting the recovery of the community following a disaster or emergency incident. The net effect of these activities can significantly influence the behavioral health of the community over time through the recovery process.

The ability to recover effectively from a trauma is critically important—as noted in the other podcast episodes—to the health and well-being of the individual. Less frequently discussed, however, is the importance of this recovery process to the overall health and stability of the community networks and infrastructure. A recovery process that is uneven, lacks transparency or equity in making key decisions regarding the community can create a challenging environment for open discussions on what the future of the impacted jurisdiction could and should look like.

As noted in the first podcast, community resilience is about a collective community or collective community members working together. As Brian Houston noted, “Community resilience is about engagement, interactivity, joining together, and deliberation.” These actions are essential to the foundation of a resilient community and much of that foundation can be determined in the immediate period following an emergency through a well-planned recovery process.

In discussing the concepts of recovery following a significant disaster incident, the focus is oftentimes on the “built environment” or those physical structures that comprise the community. From this perspective, the damaged structures are the visible scars reflecting the trauma sustained by a community following a disaster.

The difficulty with this representation is that the resulting conversation oftentimes centers on this commercial element of community infrastructure as an indication of progress—or lack thereof—in the community healing and recovery. That is, if the roads, bridges, and infrastructure have resumed functioning and the businesses are operating, then the community has recovered. This approach over-simplifies the relationship of people with their communities and could cause others to overlook the more nuanced interaction of place, social connectedness, and sense of well-being following a disruptive incident.

Blighted neighborhoods and empty lots can have a significant impact on the perception, pace, and possibility of recovering from the traumatic incident. This, in turn, factors significantly in the behavioral health of the community. The relationship between health, emotional recovery, and the environment is critically important to understand as the literature indicates that disaster displacement can be associated with psychological morbidity (IOM 428). When disasters result in the movement or displacement of individuals and families, there may be implications for their long-term emotional health and well-being—particularly if they are completely disconnected from their social networks and other connections.

In a related way, there are behavioral health implications for those who remain behind. As identified in the Sandy Child and Family Health Study: Person Report, “Residents whose homes had experienced considerable structural damage reported higher rates of PTSD than did residents whose homes suffered little or no damage.” The report goes on to state that “those with minor damage reported the highest rates of PTSD.” These findings reflect the notion that a consistent reminder of the trauma—through minimal damage and inability to repair—could exacerbate poor psychological outcomes over time.

So what can be done to mitigate these effects? Fortunately, several entities are examining and providing guidance on the relationship of the post-disaster recovery process and creating resilient communities. The National Institute of Standards and Technology (or NIST, for short) recently highlighted the relationship between place and infrastructure in their Community Resilience Planning Guide wherein they explain that the concept of building resilience necessarily requires “understanding the community’s social, political, and economic systems and… how [those] are supported by the built environment.”

The NIST planning guide sums up the nature of the interplay and relationships following an emergency by explaining that “achieving community resilience requires initiative and support from community leadership; broad community engagement that includes focus and persistence; and a willingness of public and private stakeholders to assess candidly the interplay of hazard events, social institutions, governance, economics, and the community’s buildings and infrastructure systems.” Through engagement, collaboration, and inclusion after disaster strikes, communities will be better equipped to respond, recover, and adapt more quickly to future incidents. Key to this engagement are the partnerships formed for supporting a myriad of behavioral health challenges and potential needs of the community over the long term as it gradually transitions to a “new normal.”

As community planning conversations are initiated, consideration in the immediate term should be given to the continuity of services from disaster to long-term care provision and the role of transportation infrastructure in impacting access to these services. Future planning discussions should include identifying mechanisms to construct an integrated care environment inclusive of the mental and behavioral health challenges of a community.

A 2014 compendium report by the Institute of Medicine similarly highlights partnerships as NIST, but also accounts for the importance of community culture. The report has dedicated two chapters to the importance of healthy housing and place-based strategies to support the creation of healthy, resilient, and sustainable communities after disasters. The IOM report focuses in on community identity pre-disaster and the importance of capturing that character to support the overall recovery effort and healing. The report also identifies the interaction between culture and “vulnerable” populations (such as children and older adults) and the necessary requirements for accommodating these groups in the community’s redesign.

In supporting recovery, a foundational component of any future planning for reconstituting resiliently is the idea of community identity and culture. Through this effort, community culture is a rare primary consideration and oftentimes asserts itself most vigorously when new plans—in the name of recovery and development—are presented to the community instead of being developed in concert with the community. A community of place is a complex intersection of individuals and households with various backgrounds and experiences over time. When a disaster disrupts this fabric, it can lay bare both positive and negative aspects (such as pre-existing community tension or essential community characteristics). The engagement of the various partners through the recovery process can identify the challenges and leverage the best qualities of the community to support the future planning and, in turn, build the social networks and connectivity essential to future resilience.

In closing, both the Institute of Medicine and NIST identify post-disaster reconstruction and relocation as steep hurdles for individuals and families. Upgraded construction codes, mitigation requirements, and changes in insurance rates are major challenges for all persons and particularly elderly and fixed-income individuals. Neighborhood changes can exacerbate the hardships faced by residents even if temporary housing is provided. Rarely do recovery plans address all of these needs, nor can restoration of full community services be accomplished immediately, leaving the population in dire straits at a time when all forms of stress and uncertainty are at their highest levels. Building a community under normal circumstances is highly complex, with many different actors involved. Despite the added challenges, this planning process should be guided by a shared goal of helping people create communities that are healthy and safe places to live that enable convenient access to all critical services. Sudden loss creates opportunities for reorganizing the elements of a community—not just facilities, but also the services provided. It is through this collective and collaborative post-disaster recovery process that communities can continue to look towards their recovery with an eye to a resilient future.

Moderator: Thank you for listening to the Resiliency in Disaster Behavioral Health podcast series. If you would like to learn more about the topics and materials discussed in this episode, contact the SAMHSA Disaster Technical Assistance Center at dtac@samhsa.gov or at 1-800-308-3515. For products such as tip sheets, webcasts, and collections of research materials, visit our website at www.samhsa.gov/dtac. If you or someone you know are experiencing distress related to a natural or human‑caused disaster, call the Disaster Distress Helpline at 1‑800‑985‑5990.

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Last Updated: 08/30/2017