When the San Bruno (Calif.) fire ravaged parts of San Mateo County, it was fire and EMS personnel who rushed to the scene to fight the flames and tend to the injured.
But days later, after the first responders’ jobs were done, another type of aid was still being rendered by — call them "second responders" — mental health professionals attending to survivors’ emotional and psychological needs. The Sept. 9 gas line explosion and fire killed eight people and destroyed 37 homes.
"It’s really part of a disaster response to lend support to educate individuals that have been impacted about what is normal to expect from a psychological or emotional or even behavioral perspective," said Celia Moreno, M.D., director of San Mateo County’s Behavioral Health and Recovery Services division — so they can recognize if their symptoms are "crossing the line" into something more serious.
Months later, the mental health response is ongoing. Dr. Moreno said her office is still working with the Red Cross to provide vouchers for mental health treatment for individuals who don’t have insurance coverage.
It’s a situation that has played out after natural and manmade disasters across the country, from hurricanes Rita and Katrina, to the Interstate 35W bridge collapse in Minneapolis to the Midwest floods that devastated the Cedar Rapids, Iowa area two years ago.
According to a Centers for Disease Control disaster mental health primer, survivor responses to trauma can range from grief over the loss of loved ones and property or possessions, to concerns about relocation and the related isolation or crowded living conditions.
Linn County, Iowa was at ground zero when flooding hit Cedar Rapids in 2008. Linda Langston, chair of the Board of Supervisors and a former mental health professional, says problems typically arise after the adrenalin rush of the first response wears off.
"In the immediate aftermath of the flood, people [were] very busy. There’s a lot to do whatever the disaster is. The mental health needs come progressively over time," she said. Langston is also involved with the National Commission on Children and Disasters.
In San Mateo County, a community response team of county staff and contractors deployed to reach out to those affected directly or indirectly by the fire. Indirect effects for those whose homes were spared can include their being traumatized by having to view nearby devastation on a daily basis.
"It’s not like you wait for the person to come to you," Dr. Moreno said. "If you’re at a shelter or a resource center, you do have to be fairly proactive and engage with anybody who seems distressed." The initial contact can be as simple as striking up a conversation or offering a drink of water, she said.
According to professional literature, Dr. Moreno said, early intervention can prevent the onset of post-traumatic stress disorder. "If you can prevent PTSD, then you’re going to reduce the suffering," including economic losses from medical bills or missed days of work.
In Minneapolis, after the bridge collapse in 2007 Hennepin County was quick to provide "psychological first-aid," officials said. That included working with emergency and mental health responders. During disasters, their long hours and exposure to destruction can also take an emotional toll, according to Andrew Baker, M.D., the county’s chief medical examiner.
"When you go through events like this, you bottle up and internalize a lot of stress," he said at the time. "If you don’t come up with healthy ways to get rid of that stress, it will come back to bite you in a very bad way at a very inopportune moment."
Dr. Moreno said her county’s community response team coordinator spent a lot of time "making sure people didn’t over-extend themselves" — rotating personnel and enforcing rest schedules, which can be a necessity for people in "helping" professions, whose first inclination is to think of others first, self last.
She said one lesson from the San Bruno fire response is the need to "bring new energy" to the mental health response team and keep it large enough to respond to an ongoing situation.
"[T]his incident was interesting in that it really went on and on and on," she said. "It wasn’t just one day; the needs were ongoing for over a month at a high level."