If you have not yet read the first installment of this series on Mental Health and Sheltering, please step back two blog posts and start at the beginning!
While working on an analysis project recently, I was reminded how remiss we have become in treating people like people. When it comes to mass sheltering, there are many guidelines followed in the planning, mobilization, and management of shelters for both evacuees as well as responders. My finding, and again I refer to this recent project, is that much if not all of the guidance can be reduced to Excel spreadsheets because it is about numbers.
Using mathematical equations is a safe and reliable way to manage everything from a small company to a mass care shelter, but when the entire system is reduced to Excel spreadsheets we quickly begin to lack that human touch, and our response becomes robotic.
Robotic response is the last thing shelter residents need and therefore I have been writing this series on mental health and sheltering. Mental health care in sheltering cannot be mathematical. There is no way to plan for 12% of the youth in a shelter to have nightmares every night they are in our care. There is no such statistic. Each shelter, each disaster, and each individual is just that: individual.
I have already written on the general needs of shelter residents and also the need for mental health situational awareness in wildfire-related shelters. In this installment, O will be discussing shelters that have been created or mobilized for the survivors of hurricanes. Why spend so much time on these disasters individually? As anyone in a marriage knows, certain things can affect the mood or mental state of our partners. Some of these effects can be drastic, others only slight. It is the same with the thoughts, emotions, and even imaginations of those who are under duress due to a disaster or traumatic experience.
Hurricanes are the worst. The very forecasting of a hurricane alone causes stress in large amounts of the population of coastal states and islands. While it is life-saving to have long-range forecasts for hurricanes as opposed to short-term (often less than two minutes) warnings for tornadoes and no warning on wildfires, the long-range forecast for a large tropical storm can set the stage for widespread mental duress and crisis.
The reason is simple; if we are to raise a standard of excellence above what we presently provide, we need to be aware of how unique each experience can be, what each disaster or scenario may cause, and how people respond to different types of stimuli and stressors.
Hurricanes are types of tropical storms that form in the southern Atlantic Ocean, Caribbean Sea, Gulf of Mexico, and eastern Pacific Ocean. Hurricanes affect millions of people who live along the Atlantic and Gulf of Mexico coasts each year. Parts of the Southwest United States and the Pacific Coast can also experience severe weather associated with hurricanes, which include other stressor events such as tornadoes, floods, and windstorms.
It’s quite normal for hurricanes to cause people to experience emotional distress. Feelings such as overwhelming anxiety, constant worrying, trouble sleeping, and other depression-like symptoms are common responses before, during, and after these types of storms. The elongated forecasts and constant coverage by the media can begin to affect coastal and inland residents alike as they watch an “impending doom” grow larger and more severe as it creeps closer and closer to everything they hold dear. It is no wonder that shelter workers experience hostile and sometimes violent evacuees in the wake of a hurricane evacuation.
While it appears that evacuees are only beginning their experience upon arrival at the shelter, they have actually been subjected to unpleasant feelings triggered by days upon days of the perception of danger, real or imagined.
Fear is a strong emotion that can be scarring at its worst and at its best is still uncomfortable. It can be crushingly strong and paralyzing, but it’s also necessary for our safety. In fact, some types of fear we experience today are still closely linked to our instinctual need for survival, such as the common fears of heights and insects.
While evacuees will attempt to push past most of their fears, what happens physically is largely automatic and uncontrollable. This is why we may encounter evacuees in a shelter who were perfectly normal and mild-mannered people one week ago but suddenly are creating disturbances in the shelter.
Most of the physical symptoms one experiences when it comes to fear come from the changes in the cardiovascular system. There is a special level of situational awareness that must be present in a shelter as evacuees fill the space as we know that what they are experiencing can raise heart rates and make blood vessels restrict. It is also important to know that because of the experience of evacuating also causes respiratory rate increase, and adrenaline surges. All of these physical manifestations can result in medical and mental emergencies among people who are normally healthy.
Since fear causes the body to believe it must prepare for a fight or to run, the muscles tighten. Prolonged fear and anxiety often lead to chronic pain in the muscles for this reason. This is one of the main reasons that I recommended in the first installment of this series to consider better bedding and cots for long-term mass sheltering and why I insist that you cannot reduce shelter provisions to a cost analysis, purchasing the cheapest or the easiest products available.
If this is the first time you have read my blog and you have never heard me speak, then you might not be aware of my love for definitions and the dictionary. I believe that the proper defining of words can save lives, increase the quality of life, and can end arguments and wars.
There are many definitions of the word “shelter” including “something beneath, behind, or within which a person, animal, or thing is protected from storms, missiles, adverse conditions, etc.; refuge.”
But more interesting is the etymology or origin of our English word which was first recorded somewhere between 1575 and 1585. It seems to have come from a Roman word “testudo” referring to a protective vault formed of Roman legionaries’s shields. The old English “scieldtruma” was equivalent to “scield + trauma” or “body of men in battle formation”.
With this visual description, we might look at the shelter as not being the massive tent structure or building in which we are operating but rather that the shelter is the personnel selected to operate and manage the shelter. This thrusts a great responsibility on shelter personnel to remember that shelter residents are not "numbers served" but rather people each presenting unique and understandable needs.
One unique aspect of hurricane evacuations is the vast numbers that respond to an evacuation order. While a post-tornado shelter may include some residents of a community and a wildfire shelter may do the same, a hurricane shelter is much different in that many communities will gravitate toward shelters which causes most shelters to run over capacity. These large numbers will make situational awareness of mental stress even more difficult.
In the shelter environment, there is little privacy and in hurricane shelters, the high numbers of people can cause social anxiety among people who would normally not have any issues with crowds or close quarters. When dealing with shelter residents it is important to remember that a majority of them will have overactive nervous systems caused by the recent trauma and experiences and they will become overwhelmed easily. Crowded rooms, public spaces, or even standing in line can be highly stimulating. Trauma can cause residents to feel edgy and overstimulated in the shelter environment so it is imperative that shelter processes be well-organized, well-timed, and spaced out into different areas of the shelter.
For example, once initial intake is accomplished, the resident should be allowed time before being directed to another sensory input such as a meal line or the showers. Allowing for a “calming period” in between interactions can assist in keeping incidents to a minimum.
One last portion of hurricane sheltering that requires attention is the treatment and processing of those with disabilities. While most of this is true for any shelter, the hurricane shelter will encounter greater numbers and a more diverse group of handicapped residents than most other scenarios.
There is a significant body of evidence that persons with disabilities are at an increased risk for suicide or suicidal ideation. However, the evidence also shows that it is not the disabling condition per se that most often leads to suicidal impulses.
Rather, it's the social constraints that so many people with disabilities regularly face that can lead to life-threatening depression. Research shows, for example, that people with disabilities encounter tremendous obstacles to "normal" social functioning that have little or nothing to do with the injury or illness itself. This inability is compounded in a shelter environment following the trauma of being evacuated. Unlike others in the shelter, those with disabilities become frustrated due to barriers that are both structural and ideological, from limited access to (which probably delayed their safe evacuation) to simply room to maneuver a wheelchair or walker throughout a crowded shelter.
Aside from just situational awareness regarding the special needs of those with disabilities, shelters should be managed by decreasing barriers to inclusion and participation in all of the shelter’s activities including showering, accessing the portable toilets, navigating meal lines, etc.
It is paramount that shelter management provide an environment not only for the visibly disabled but also for the neurodiverse shelter resident.
The word “neurodiversity” describes the wide range of neurological functioning that exists among humans and the many ways human brains differ from each other. Some of these differences have a history of being pathologized, while the people with the differences have been seen and treated as lesser than others. All types of brain functioning are valid, however, and none is inherently better or worse than another.
Both neurodivergent and neurotypical people are part of neurodiversity. Neurodivergent people have brain function that is different from what is considered common or neurotypical by Western medicine. This is problematic in that it sets neurotypical people up as “normal” and neurodivergent people as “abnormal,” but it is currently the way neurodivergence is understood. Both neurodivergent and neurotypical people are extremely susceptible not only to heightened anxiety by increased stimuli and trauma, but are often times more prone to outbursts that could threaten the environment of the shelter.
While this all must be understood by every level of shelter staff, it is difficult to train staff on the subject of neurodiversity in a short period of time as the spectrum and variety is quite vast. Describing neurodivergence can be difficult because standard medical diagnoses of it are framed around identifying problems. Two common examples of neurodivergence, autism and attention-deficit/hyperactivity disorder (ADHD), are defined in the diagnostic manual solely as a collection of impairments. In contrast, individuals with these neurotypes often emphasize the commonly associated strengths and quirks as an equally important part of their autistic or ADHD identities.
That being said, autism, ADHD, dyslexia, and other types of learning and intellectual disability are all current ways people describe neurodivergence. Some might include traumatic brain injury (TBI) and mental illnesses like anxiety, depression, and obsessive-compulsive disorder (OCD) in describing neurodiversity because of the way these conditions can alter brain functioning.
Having even a basic knowledge of how those with these disabilities are affected by and react to trauma and added stimuli can direct shelter staff into making wiser decisions as to the placement of these residents as well as the observation they may require in order to prevent outbursts or incidents that could disrupt normal shelter operation.
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