AbstractIt is nearly impossible for a large-scale emergency or disastrous event to be avoided, so communities have to take the necessary steps to help prepare for the inevitable. During the recovery phase, several people are impacted from the incident, including community members, their children, and a variety of first responders. Each of these individuals may find themselves dealing with mental health traumas and behavioral health issues as a result of the incident. In order to help mitigate this issue, each community has to take necessary steps to understand these issues to further develop and implement programs that will best serve the recovering community. This paper will go into great detail to breakdown the effects of these incidents on the different populations within the community and how it effects their everyday life. Suggestions will be made for a variety of reliable mental health programs needed, along methods to ensure that these programs are not ever overlooked again in a future incident. These recommendations come from validated sources such as the American Psychology Association and the Community Mental Health Journal. The information found from these sources help to further support techniques and recommendations to help accurately address the mental health traumas and utilize proven methods to help patients cope and later achieve a full recovery. Mental health traumas are a serious issue for recovering communities, even years after an event, but don’t have to remain this way. Tools are available and steps can be taken to ensure that disaster victims and responders no longer have to suffer in silence while waiting on prolonged assistance. Keywords: mental health, first responder, public health worker, disaster, emergency, response, recovery, trauma, behavioral health, disaster preparedness, emergency management, hazard mitigation plan, mutual aid agreement, emergency mental healthA Need for Mental Health Programs Following Emergencies and DisastersWhen emergencies and disasters strike, creating a crisis in an otherwise uneventful and peaceful community, the daily routines of everyday people are shaken up and disrupted on a massive scale. Thankfully, it generally takes no time at all for the public and government officials to take notice and take action, in order to help restore the affected community’s way of life. An outpour of help can be seen in areas such a finances, medical care, shelter, food, and clothing. However, it should be considered that while these areas are essential and needed, the public is often unware of the less physical damages, like the emotional and psychological status of the victims and on-site responders in these perilous times. So, this leads to additional focus and actions being required in affected communities. All emergency and disaster victims and first responders need access to a variety of mental health related programs to help them maneuver through these difficult situations. Likewise, it is also to imperative to fully understand the capability and scope of local behavioral health services. If the services provided are too limited, then additional resources for these areas must be made available. Lastly, the youth of these communities must not be overlooked, as they too suffer from unseen traumas. As more becomes understood regarding the needs of the victims and responders, better help can be provided, affording these individuals proper mental health care along with the many other necessary resources and assistance.The Community and First RespondersIn the wake of an emergency or disastrous event there are two categories of victims who find themselves directly effected in more ways than one. These victims are the community members that reside in the affected areas, along with the responders who find themselves making first contact. The encounters of responders include on the scene and in medical facilities, with an attempt to effectively assist in the response and recovery efforts for the incident. In this instance, it is important to know that the term first responder is synonymous with term public health worker and includes a variety of occupations and personnel. These responders, or public health workers, include “police, fire fighters, search and rescue personnel, emergency and paramedic teams, nurses, physicians, laboratory personnel, and ancillary hospital staff” (Benedek, et. al., 2007). Reflecting back on the community members dealing with these incidents, they are often left in a state of shock as they lose personal belongings, become displaced, experience injuries, and even potentially face the loss of loved ones and friends. Likewise, just as the residents are experiencing this plethora of tragedies from one perspective, the first responders are equally experiencing a difficult time. More specifically, “they encounter negative and emotional consequences from their disaster-related work, which develops from the exposures to traumatic events, high levels of work demand, work with disrupted communities, and separation from home and loved ones” (Benedek, et. al., 2007). This combination of increased stress for responders and the deracination of the community members requires a level of attentiveness to each of their needs, to help get them back to a normal life without all of the chaos.Impact on the Youth After acknowledging the both community members and responders alike, it is also crucial to consider the most delicate and vulnerable individuals in these situations, that being the youth. When it comes to children and adolescents, they are in less control than anyone else, because their entire existence and recovery will be based on the actions of the adults around them. “Among the hit to a child’s personal growth and development as a result of experiencing a disaster” (Silverman, et. al., 2002, p. 13), children experience difficulties finding ways to return to a sense of normalcy based on their own will and desire. They often find themselves uprooted and with no say on how they want recover. So, while it is necessary for the recovery phase to take effect, expecting such young individuals to cope with these struggles alone is unfair and unreasonable. They are also dealing with additional contributors following a disaster that have little to no influence on adults that include “missing school, having a reduction in academic functioning, missing vital social opportunities, and an increased exposure to life stressors like family illnesses, divorce, family violence, and substance use” (Silverman, et. al., 2002, p. 13). These are all difficult things for children to handle and these experiences can considerably affect their development. The younger that a child is and the frequency in which they encounter such events in their life, can have a direct correlation to potential mental health issues and traumas later on. 1According to an article by Social Science & Medicine, it was found that “children experiencing one or more natural disaster by the age of five had an increased risk of mental health disorders later on in adulthood, such as anxiety disorders” (Maclean, et. al., 2016, p. 78). However, the collected data also reflected that these risks extended to children upwards of age 10 (see Figure 1). As a result, children need to equally be afforded access to mental health programs following a disaster. This allows them to have a safe place to discuss what they are going through and have access to effective tools that will help them maneuver through these changes.Resulting Mental Health Traumas Considering the massive wave of disruption being experienced all at once, the victims suffering from these events may not even be aware that they are dealing with any sort of mental health traumas. This can lead to these issues going unnoticed and subsequently unaddressed in recovery efforts. A common trend that has been observed is that “nearly two years following a disaster experience, there is a convergence in mental health outcomes related to individuals exposed to high levels of disaster experiences and disaster exposures” (Cepeda, et. al., 2010). In other words, these victims are not even aware that their mental health has suffered from these experiences, until years later. So, understanding that it can take several years before a population begins to report these issues, it illustrates a failure to provide needed support in a timely manner and also the inability for victims to recognize the signs early on. Some of the mental health traumas that they can be experiencing include acute and chronic post-traumatic stress disorder (PTSD), traumatic and complicated grief, insomnia, anxiety, depression, behavioral health issues, and a plethora of other psychological and emotional traumas. Each of these falls under the concept of emergency mental health (EMH), which is “a field related directly to emergency preparedness and is a vital component to disaster response” (Homish, et. al., 2010). This variety of traumas and mental health issues further emphasizes the need to incorporate different programs types that can help victims get through these seamlessly.Reliable Mental Health ProgramsConsidering the fact that the list of mental health traumas and associated issues facing the disaster victims, their children, and the many public health workers is complex at best and a great deal of focus needs to be placed on providing programs and services that remain available for them. Additionally, the programs need to be capable of handling the different types of mental health traumas effecting the community, along with the quantity of victims in need of these resources. Therefore, the programs should be vast, while ensuring that each experience and encounter is tailored for the individual victim. Necessary programs should include “school readiness, disaster case management, crisis counseling, long-term mental health treatment, substance abuse interventions, disaster preparedness, responder training, social marketing to build community resiliency, and behavioral health planning” (Teasley, et. at., 2012). To ensure the longevity of programs and services similar to these, communities should include establishing the appropriate amount of funding for them during the preparedness phase of emergency management planning. This will allow for mitigating and recovery efforts in the community to progress a lot smoother, since both victims and first responders will have the tools they need to navigate through these difficult situations. Moving forward, it is important to highlight the inability for some communities to adhere to this concept. This can be due to a lack of time to prepare for the emergency or disaster and/or a lack of available resources to follow through and maintain such programming. In the event that this is the case, every community should begin by networking with surrounding communities and revise their appropriate hazard mitigation plans. The updates and revisions to this plan should include some form of a mutual aid agreement between the listed communities. The purpose of a mutual aid agreement is to “serve as a predetermined agreement between agencies, organizations, and jurisdictions to provide a mechanism to quickly obtain emergency assistance in the form of personnel, equipment, materials, and other associated services” (FEMA, n.d.). Likewise, these agreements can exist at multiple levels including local, regional, statewide/intrastate, interstate, international, and even automatic-like plans. As a result of communities listing each other as willing participants to provide assistance to the other in a disaster or large-scale emergency, it ensures that help will always be available. Therefore, if a community is lacking in available programs or are incapable of servicing all the victims, appropriate steps have been identified and taken to mitigate the risk by keeping this recovery source accessible.Follow-up MeasuresOnce the appropriate programs have been implemented and begin assisting victims, it is equally important to monitor their transition out of care. When recovering from traumatic events, this timeline varies from one individual to the next, so it is important that they are not cut off from much needed help too soon. In order to avoid this, each victim’s experience should be personalized. Likewise, regular check-ins should be conducted to ensure that the individuals are not experiencing any setbacks from factors such as the introduction of new or worsening stressors. An excellent way to promote patient participation in these follow-up measures include the utilization of peer-mentoring. In an article by the American Psychology Association, it demonstrates the success of “using peer mentoring as a method to offer educational training on trauma, both in a variety of settings and with the use of different modalities” (Bernardy, et. al., 2011). The use of such mentoring programs has been proven successful in regard to treating PTSD suffers. The statistics surrounding this disorder are incorporated into the pool of disaster victims in that “of the roughly 70% of adults in the United States who experience at least one traumatic event in their lifetime, nearly 20% of them go on to develop PTSD” (Sidran, n.d.). These figures of course are subject to change considering the severity of a disaster and how each victim experiences the situation. This leads to the importance of implementing programs similar to Bernardy’s design early on, to help improve the mental state of victims who find themselves dealing with PTSD.Another key reason for follow-ups being necessary, is the mental downward spiral that some patients begin to take, and they are completely unware. These follow-ups help to improve their mental health state by reaffirming that the patient has the necessary tools to cope with their changing environment, as well as adjusting and implementing new tools that may be needed. Additionally, it is important to conduct these follow ups early and regularly. As the victim maneuvers through the recovery phase, they need to know that they are supported the entire way, until they have reached their new normal. So, to help promote this effort, “follow-up visits should begin within the first four weeks of establishing care for the victim, as this timeline has been associated with a speedier recovery and more meaningful improvements for individuals suffering from issues like depression” (Zagorski, 2015). If communities are serious about having its residents and responders have the quickest recoveries, they will be sure to have these programs up and running as soon as possible. ConclusionIn conclusion, it is important for communities everywhere to place additional focus on the mental health of its residents and first responders in all recovery plans. This focus should include any necessary networking that is needed to get support from surrounding communities for additional services, along with designating funding to support the efforts of developing and maintaining quality programs in house. Likewise, it is important for these programs to have a solid foundation in handling the psychological and emotional traumas, and any behavioral health issues that may stem from the traumatic experiences the victims face. With this understanding, consistency, commitment, and follow-ups are needed. No one victim, whether it be a resident, first responder, or child, should be left without the proper tools they need to handle their stressors alone. They should be given adequate time to heal and a mental health professional should ensure that each person has been cleared before cutting off the assistance provided by these programs. In the end, the ultimate goal is to see each and every community overcome their disaster and return to the highest form of normalcy on all levels, including physically, mentally, and financially.