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Mitigating the mental health threats in mass shelters

While this is merely an excerpt of a much larger project, I wanted to share this today as it is time-sensitive. Please remember to keep the survivors of Idalia in your prayers as well as those that have been called upon to serve them.

As we watch the drama of Hurricane Idalia unfold, most of us are aware of the scramble to erect or establish shelters for those who have been displaced by this historic storm. It takes little to look westward and see the evacuations due to wildfires and one only needs to visit social media to see that Hawaii, although already out of the general news cycle, is still struggling.

Many of my readers are involved in this activity whether as emergency managers, responders, or contractors.

Thousands of Americans are entering the doors of shelters for the very first time in their lives and they will never forget this week as long as they live. Thousands upon thousands more have recently entered America only to find themselves in a similar place.

The goal of shelter management and administration should be to create an environment that minimizes not only safety and security risks to shelter residents but also to the shelter staff and personnel that will have contact with those residents. A situational awareness regarding the psychological effects of shelter living is crucial to the proper management of a shelter.

It is the opinion of this analyst that there are measures that can be taken and an awareness level that is required to minimize risk to not only the shelter residents and staff but to the shelter management contractor themselves.

It has become evident historically, medically, and within this analyst’s experience that the psychological effects of shelter living need to be addressed whether the shelter is for responders, evacuees, refugees, or immigrants.

This data supports the recommendations for the proper products and services to be installed and implemented in any shelter. The proper selection of products and services can mitigate much of what has been found to be a devastating effect of shelter living.

By providing a restful and peaceful shelter environment, we will be creating a safer environment that can avoid domestic disturbances, fights, mental collapses or breakdowns, radical behavior, argumentative attitudes, and failure to comply with shelter rules. By investing in creating this environment, both the shelter residents and the shelter staff are served and we can all but eliminate the rapid turnover of shelter personnel that experience undue stress from shelter residents.

Millions of people are affected by natural disasters per year but aside from the initial loss and horror experienced by these victims, there is a longer-lasting issue that is important to remember.

Research shows that disaster victims are at greater risk for experiencing mental health challenges, especially those who have resided in a disaster relief shelter. Considering the prevalence of natural disasters and the mental health risks associated with experiencing a disaster and residing in a disaster relief shelter, it is important to attempt to create a shelter environment that deals with this issue and strives to create a shelter environment that is one of healing and calm.

Research has cited the psychological challenges of natural disasters, risk factors for having difficulty in coping with disasters, and protective factors for coping with disasters. Psychological challenges refer to negative feelings that were experienced such as anxiety or depression. While research identifies disaster victims' psychological challenges, there is little research to date on the psychological challenges specifically for disaster victims who resided in disaster relief shelters.

Current research on the risk factors and protective factors for disaster victims is also not specific to people who have resided in disaster relief shelters. The data that is available along with anecdotal evidence suggests that shelter staff can be included in those affected by poor or poorly managed shelter conditions.

Numerous psychological challenges may be experienced after natural disasters. Some commonly reported challenges are doubting one's safety in their community, suicidality, vocational difficulties, physiological changes, and physical symptoms. It is also common to experience difficulty in making decisions, concentrating, eating, and/or sleeping after disasters. Victims may experience these challenges long after disasters have occurred.

While the focus of this article is on all shelters, it makes sense to refer to the hurricane as perhaps the most devastating as this phenomenon causes long-term disruption to lifestyles. From the moment that someone is told to evacuate, distress can take over due to the simple reality that they might not know if or when they'll be able to return home. These strong fears of the unknown along with the attached emotions are carried into the shelter scenario.

In a hurricane's immediate aftermath (as well as tornado and wildfire scenarios), displaced people may not have the mental bandwidth or the opportunity to process their feelings, as they focus on meeting their food, water, and shelter needs. To be placed in a shelter does not necessarily register for these evacuees which results in more challenges for the shelter staff. For years I have experienced the shared experiences of shelter staffers who complain that the shelter residents simply refuse to follow directions, but this is simply a by-product of an over-loaded mind attempting to accept the current situation and to process it in small and easier pieces.

Following disasters, victims are more at risk for developing psychological disorders. Post-traumatic stress disorder (PTSD) is the most common diagnosis among victims after disasters. Depression is the second most commonly diagnosed disorder, followed by anxiety. Victims are also of greater risk for developing substance abuse problems and psychological adjustment disorders.

The more traumatic a disaster, the greater the mental health risks for victims. The following experiences are associated with greater post-disaster symptoms: displacement from one's home or lack of resources for over a week, loss or damage to personal property or sentimental possessions, personal or household members' health problems, financial loss, increased relationship demands, incurring an injury, having a threat to one's life, experiencing a loss, living in a disrupted or traumatized neighborhood, or other severe causes of stress.

Some victims are more resilient than others. Older adults are more at risk than younger adults. Children are more likely to struggle than adults, although adolescents have fewer depressive and PTSD symptoms than adults. Children who have more psychological stress prior to disasters (e.g., history of trauma, limited social support, homelessness, or experiences with violence, foster care, special needs, or lower socioeconomic status) have a harder time coping with disasters than other children.

For adults, there are greater mental health risks for those who are female, unmarried, religious, fearful, an ethnic minority, divorced, a cigarette smoker, and/or who are impoverished. Additional adult risk factors include prior exposure to trauma, limited education, prior psychiatric history, lacking a supportive home environment, lacking social resources, and living with a spouse or children. People who believe that they have limited control over their lives or believe that their lives are more in danger after a disaster also experience more mental health implications. While research and surveys have found that having religious belief is a risk factor, it was found that an almost identical number identified religious faith as a protective factor. Unfortunately, a large percentage of those surveyed believed that natural disasters are considered to be a punishment from God, which may have intensified negative feelings.

As one can see, the proper outfitting of a shelter is crucial and thus the provisions within a shelter should address the real needs of a diverse population under great duress and highly susceptible to mental, medical, and physical injury.

Considerations should include but are not limited to:

Shelters that house families should provide for the separation of families to allow privacy and quiet. Families held in shelters require such a space to discuss their own survival, future movements, actions, losses, and emotions. Families with small children will require this restful environment in order to sleep properly and avoid sleep deprivation due to stress for both the parents and the children.

Family shelters should provide not only privacy per family but also designated areas for diaper changing and breastfeeding.

Shelters housing family units should also plan for and provide larger open spaces for children’s play and exercise. While outdoor areas are preferred, spaces should be provided within the shelter as well as many parents struggle with immediate separation anxiety following disasters and are not comfortable allowing their children to be any great distance from them.

These play areas should be stocked with soft balls, educational toys, coloring books, and crayons. It is not recommended that markers are made available in order to protect the shelter itself, but it is recommended that these areas be stocked with plain white paper or construction paper as children tend to use art (especially drawings and sketches) to share their experiences and feelings which will prove therapeutic.

Lighting should be chosen for the interior of shelters in order that they can be dimmed during nighttime hours to allow for the best sleeping conditions, however, it is not recommended that lights be simply shut off. Shelter residents should be made to feel secure with the use of well-lit pathways, clear directional signage, and a constant source of light that allows them to constantly observe their surroundings.

According to a 2013 study by the Journal of Neuroscience, nightlights can be harmful and normally will negatively affect rest and sleep. It was also discovered that blue light was determined to be the worst closely followed by white. The study found that red lights actually lessened nighttime depression while supplying the ability to move, visit the restroom, and observe sleeping children. The use of “nightlights” in this manner will also allow security personnel to have the ability to observe shelter residents without using flashlights as they avoid disturbing the shelter residents.

While a majority of mass shelters utilize the simplest of cots for reasons like cost-effectiveness and supply chain issues, it is important to remember that shelter beds should reflect that the client understands the needs of those residing in the shelter. Beds or cots that feature the ability to raise the head, beds or cots with side rails for children, smaller beds or cots for children and toddlers, bariatric beds or cots for larger individuals, nursing mothers, pregnant women, or the handicapped all can assist in creating a more restful environment and can lessen the impact of shelter living.

Minimizing loud noises and constant noises can play a massive role in providing a restful and peaceful environment in a shelter. For less than forty dollars, one can purchase a decibel meter and schedule regular checks within the confines of the shelter. Any noise, especially constant, over 70dB is considered disturbing. Residential limits usually start at 60 or 55dB but this would be difficult to maintain simply because of the nature of most shelters.

One should keep in mind while a lower dB is acceptable, constant noises such as the humming of fans, refrigerators, ice machines, or air conditioning units can cause a lack of sleep as well as anxiety that can easily display itself in an already stressed population. Constant dB humming at levels as low as 45dB has been associated with a lack of sleep, and prolonged exposure may also cause headaches and extreme irritability.

With a population of fearful and traumatized shelter residents, it is wise to maintain the regular and very visible presence of security personnel. Shelter residents will often feel helpless or more vulnerable if not even trapped and the choice of friendly but stalwart security can quell much of the fear that this vulnerability creates. The regular movement of security personnel will also work as a visible deterrent for those within the confines of the shelter with more violent or criminal tendencies.

Armed security guards give people increased peace of mind. Knowing a guard is not only on the premises but also carrying a weapon he or she is trained to use can make people feel safer and can give them the courage to able to move around the shelter or perhaps allow their children to take part in planned activities.

It is important to remember that shelter residents will go through phases as they mentally traverse through their new normal. Some may adapt quickly to shelter life and become a source of assistance to others while many will pull back socially, physically, emotionally and mentally from even their own family members. It is also important to recognize that the time frame for these changes and phases is different with each person and great measures should be taken to not lessen the number of attendants, staff or security weeks into the effort simply because the assumption is that everyone knows the routine. The question of what that new normal really looks like can prompt additional waves of distress that are worse than the original and can have long-lasting implications.

Simply hiring shelter staff should not be acceptable. Care should be taken during the interview process to make sure that the right person is placed in the shelter. Historically shelters are staffed by those who have been chosen based on lingual skills, cooking, cleaning or security backgrounds. While this seems logical, it is crucial that the personalities of shelter staffers be considered. Storm casualties and other events that cause one to leave their home suddenly with limited belongings often mean that personal items of comfort such as jewelry, family pictures, and keepsakes have been left behind. While these losses may seem small by comparison to the overall situation, it is incredibly difficult for shelter residents to feel grounded mentally without these items.

In order to provide not only the provisions named in a shelter contract but also a humane and dignified manner of housing large amounts of displaced people and children, we should be aware of the challenges those within the shelter are facing. In my career I have seen many shelters that, while meeting physical needs such as a roof, food and a place to sleep, were all severely lacking in any comfort that was sorely needed. We need to remember that this is the absolute worst moment in the lives of those that cast a shadow over that shelter’s threshold, that they are humans with families and loved ones. We need to remember that of all that life has to offer, both good and bad, loss is the worst life can bring.

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