Published on December 18th, 2018
A blog post by Kari Stromhaug.
The back-to-back impacts of Hurricanes Irma and Maria on Sept. 6 and 20, 2017 brought devastation that Puerto Rico had never before experienced. Irma knocked out power for a million residents on the island and destroyed dozens of homes. When Maria hit just two weeks later, the island was overwhelmed with destruction. Maria was the deadliest Atlantic hurricane since Hurricane Jeanne in 2004 — responsible for deaths in Puerto Rico, Dominica, the Dominican Republic, Haiti, Guadeloupe, and the U.S. Virgin Islands.
It has now been more than a year since the hurricanes struck, and Puerto Rico is still in the process of its long recovery. Despite basic infrastructure being restored — people are moving back into their homes, returning to their jobs, and settling back into their new routines — much of the trauma suffered has not gone away. Puerto Rico is now contending with a problem that many communities experience after a disaster: mental health challenges that accompany a disaster and often linger long after the incident. Experts are now wondering how to address these growing mental health concerns.
The Importance of Community
Since Hurricane Maria made landfall on September 20, 2017, it is estimated that more more than 400,000 Puerto Rican residents — close to 12 percent of the population — left for the United States. CityLab has used mobile carrier data to track the movement of these individuals to various cities across the United States. Dr. Carrion-Baralt, a psychologist at the University of Puerto Rico, pointed out that the majority of those who left are young adults, leaving behind many of the elderly and caretakers of the elderly.
Community is known to be incredibly important for post-disaster mental health recovery. Disasters tear apart community foundations — destroying gathering places and shifting the focus of individuals to their immediate needs. The exodus of residents from their communities after a disaster poses an added barrier to the mental health recovery of those who remain in disaster-affected areas.
A Global Concern
Post-disaster mental health recovery is not a problem that is unique to Puerto Rico; rather, it is experienced after natural disasters all across the world. Countries have plans in place to restore needs like transportation, cell reception, and power, but mental health has only recently entered the equation. Furthermore, mental health is a stigmatized topic in many places, making it a difficult topic to address.
Simply put, there are not enough mental health professionals to provide care to everyone who needs it. In post-disaster situations, psychologists often volunteer their time, traveling to impacted areas and providing one-on-one or group therapies. Unfortunately, these interventions are short-lived, and do not address the long-term decline in mental health often experienced post-disaster.
Technological Advances in Mental Health Care
Puerto Rico recently established a suicide hotline, Línea PAS, that individuals can call in to if they are experiencing suicidal ideation. After calling, they are connected to a person who has been trained to de-escalate the situation and can contact the authorities if the caller appears to be in danger. After Hurricane Maria, it was reported that the number of suicide-related calls more than doubled. Puerto Rico’s suicide rate in 2018 also increased from the previous year, though it is debated whether this increase was caused by the hurricane. What is clear, however, is that natural disasters, especially hurricanes, do have a significant negative mental health impact on survivors, and that there is currently a lack of mental health professionals and treatment in post-disaster situations.
The lack of mental health professionals poses a serious problem, and one that is difficult to fill. Cognitive Behavioral Therapy (CBT) is one of the most common treatment approaches for conditions such as anxiety, depression, PTDS, and OCD, often performing better than medication. There are few things that can replace the effect of talking to someone face-to-face — someone who will listen without judgement, provide encouragement, and help change negative thought patterns and the attendant behavior. Providing new, effective solutions to mental health problems after disasters requires getting creative. By leveraging the resources and technologies already present in a community, we can design culturally appropriate services tailored to the needs of individual communities that incorporate important aspects of treatments like CBT.
Mobile phones are a powerful tool for reaching a large number of people. Sending SMS messages, in particular, is fast, cheap, and easy. The impact of mobile technology in mental health care treatments is powerfully demonstrated through services like Puerto Rico’s suicide prevention hotline and Crisis Text Line, a service available in the United States.
Crisis Text Line is an SMS messaging service and resource for individuals in crisis. These individuals can message in and be matched with a trained volunteer who will work to de-escalate the situation and call the authorities if needed. To date, nearly 90 million messages have been exchanged between texters and volunteers, leading to around 20 daily active rescues. Further statistics gathered by Crisis Text Line are available at crisistrends.org.
Línea PAS and Crisis Text Line are two incredible resources that have provided support for countless individuals. However, these services are limited by the need for trained volunteers, and are often used only as a last resort. The success of mobile-based hotlines and crisis resources, coupled with the proven need for post-disaster mental health resources, points to a space for further work at the nexus of mobile healthcare solutions and disaster recovery processes.
Libremente is a research project that hopes to address this gap through the use of mobile messaging. In 2017, Libremente grew out of a need for mental health care after landslides destroyed communities in the outskirts of Lima, Peru. A pilot program used SMS to deliver messages with quick, simple self-care oriented activities to participants living in affected communities. Overwhelmingly positive feedback pointed towards the promise of using mobile technologies to reach a large number of people in an effective way. Participants said that in their day-to-day, that would forget to take that time for themselves. By receiving simple text messages, they were reminded of the need to remember to care for themselves, and felt that there was someone out there who cared about how they were doing.
These observations show something profound, yet incredibly simple. Simple actions like providing daily encouragement, reminding people to take a moment to do something they love, or even just to pause and take a few deep breaths, can make a positive impact in the life of someone living through constant, daily stresses. Programs like Libremente address the gap between having no access to mental health resources, and using services like a suicide hotline when things have escalated too far; they also provide resources and tools to individuals seeking mental health care in the face of a shortage of mental health professionals.
Services like this cannot replace a psychologist, but they can provide support, education, and build resilience in disaster stricken communities; one more step towards happier, healthier, and stronger communities during recovery from a natural disaster.