By Melinda Young

Mental health needs increase following a disaster. This is true of healthcare professionals as well as disaster victims.

New York City saw an increase in post-traumatic stress disorder (PTSD) after the 9/11 terrorist attack, says Aram Dobalian, PhD, JD, MPH, professor and director in the division of health systems management and policy at the University of Memphis.

Healthcare providers and affected populations can feel these long-term effects following a disaster.

“Not everybody is going to be receptive to mental healthcare, but being able to prepare people for it and normalize it ahead of time might make them more likely to seek out care later,” Dobalian says. “That could mitigate some of the impact.”

Even disasters that seem less personal, like the BP oil spill in the Gulf of Mexico, can raise long-term mental and behavioral health issues, he notes. For instance, people in regions near the oil spill were affected financially. Some might have become more reliant on substances that affect their marital and family lives.

“It’s not unusual for domestic violence or other things to escalate after an event,” Dobalian says. “Even something like smoking tends to be exacerbated by larger-scale events.”

These problems also affect the people who deliver care. Disasters can increase burnout and stress in healthcare providers.

“Case managers and others may have been impacted by the disaster and some could have a kind of secondary trauma,” Dobalian explains. “Organizations like the employee assistance program are not really well-suited to handle those kinds of things.”

Crises also can increase stress on healthcare leaders, says Wyona Freysteinson, PhD, MN, professor of nursing at Texas Woman’s University.

Freysteinson and co-investigators recently found that disaster policies and procedures are needed to alleviate leadership angst, build trust, and enhance communication.1 For example, case management departments could provide quarterly education on gentle deep breathing and mindfulness for staff as well as the leaders.

“Those three gentle deep breaths can hopefully pull you back into a calmer state,” she explains. “The gentle deep breathing technique can return the body to a parasympathetic state.”

Mindfulness techniques also can reduce emotional exhaustion, stress, and increase work engagement, Freysteinson says.

During the COVID-19 pandemic, case management leaders and other healthcare professionals sometimes had to change roles to help patients at the bedside or in the ICU. They had to learn how to turn over and transfer as well as provide other bedside care, she says. It would be better in disaster planning if health systems provided their staff and these leaders with clinical training so they could quickly move into these roles in an emergency.

When leaders and staff are asked to change their work routines overnight, they may experience higher levels of stress and distress. The key to helping leaders cope in these disaster situations is to improve communication and to be as transparent and honest as possible.

“Let people know that you’re in this with them,” Freysteinson says. “When I say I’m not holding anything back, it’s me being really honest about where they’re at.”


  1. Freysteinson WM, Celia T, Gilroy H, Gonzalez K. The experience of nursing leadership in a crisis: A hermeneutic phenomenological study. J Nurs Manag 2021; Mar 19. doi: 10.1111/jonm.13310. [Online ahead of print].