Preparing for multiple disasters – transcript

Professor David Forbes:

So I’ll be talking with you for a few minutes, about 15 minutes really about – what does the research tell us about the impacts and implications of multiple disasters on communities.

And I’ll do so first of all by focusing on ‘what does the research tell us about a single disaster’?

And then building on that to be to be able to say ‘what does this mean then for multiple disaster?’ The single disaster we’ll be looking at is the Black Saturday bushfires data.

So first of all, what do we know about the prevalence of disasters and other trauma? We know that 75% of Australians are affected by trauma at some stage in their life, we know that 68% of kids and adolescents are impacted by trauma at some point in their childhood. We also know that 10 to 15% of Australians are impacted by disasters caused by natural hazards so trauma is ubiquitous across Australian society, as it is internationally. And of course disasters are a significant part of that and startlingly since COVID reached our shores there’s been more than 60 disasters that have actually been experienced in Australia since that time.

Really important from the outset is when we’re thinking about the impacts of disaster we think about the multiple domains of impact: the human psychosocial impacts, the community impacts, the social, environmental impacts the built environmental impacts, the economic and financial environmental impacts and the natural environment impacts.

And all of those things are part of what can influence our thinking in relation to how we need to support communities afterwards so we need to keep these multiple domains in mind when we’re thinking about the impact of disasters as we’ll go on to see in more detail.

If we’re thinking about ‘what’s the recovery look like’ from large-scale emergencies and importantly this is just a heuristic, there’s lots of variations by individual, by community, by event, but by and large the kind of heuristic we see, the kind of recovery trajectory we see after disaster is in the first three months.

There’s chaos, there’s hyperactivities there’s lots of intense emotions. There’s a focus on safety and that moves across in the next three to six months towards a focus on recovery and on rebuilding.

In the six to 12 month period there’s a kind of dialectic or interchange around the anxiety and distress and recovery associated with trying to reassert a level of calm and control their focus on rebuilding continues; thinking about the next or the first anniversary that’s coming up and also thinking about potentially the next disaster season.

And then beyond 12 months there’s the journey to the new normal and the emotional ups and downs that go with all of that. And then up through to a long tail of about 10 years kind of subsequent mental health issues subsequent stresses and potential lasting impacts which we’ll talk about shortly.

So to give us an example of what this looks like in a single event is the beyond bushfire studies. This was led by Professor Lisa Gibbs at public health at Melbourne University but it’s a collaboration across a range of universities across a range of governments both state and federal, a range of NGO’s. For others, there’s a large scale starting at a very solid systematic study that looked at comparing high impact and low affected areas and went over the course of 10 years. So a great exemplar for us to be looking at from a research perspective that over 30 or 35 papers have been published on this data set since this we’ve been working on this study. But I’m just going to throw some highlights that are useful for us to reflect what does this mean for compound disasters.

So in terms of the mental health impacts when we look at PTSD, depression or severe distress, we see that three years post fires about 12 percent experiencing in the load affected areas, 17 percent in the medium, 26 percent in the high affected areas. If we look at five years that’s down to 22 percent in the high affected areas by 10 years it’s still 22 percent in the high affected areas. Still at this stage double what we see at least in the other, in the low and medium affected areas so we still see 10 years later the elevated psychological impacts of this event, the Black Saturday bushfires.

Really important though is we can see there’s five years there’s 22 percent, 10 years 22 percent, but what we also know is that a third to a half of those participants who were putting probable PTSD or probable depression at any of those assessment points, didn’t display it at the next assessment which means that whilst we’ve got 22 percent at five years and 22 percent to 10 years they’re not the same they’re not all the same people

So some people are recovering, some people are experiencing stresses and subsequent trauma that’s resulting in them becoming worsening and potentially developing PTSD and depression. So we see movements both in terms of worsening and improvement.

So really important, is that we need to be thinking about, it’s not about identifying the 26 percent right up the outset and then tracking those over the course of time we need to be vigilant around communities that are impacted because of new presentations recovery but also new presentations and this is an example I guess using PTSD more specifically so what we see over those three time points is people recovering some people getting worse and this moves around so this has really important implications for surveillance.

We need to be aware of the fact that recovery or indeed exacerbation that there’s this it’s just not a static thing and it’s not about identifying people only at the outset we need to be vigilant in a longitudinal fashion.

We think often and we hear often and we talk often about PTSD, about depression, about anxiety, about substance use. They’re kind of recognized disorders. We’re aware of them, we’re often trained in them, and we’re on the lookout for them.

One of the issues that we are often less aware of in a clinical sense or in a service delivery sense, is the issue of problematic anger. And probably problematic anger means anger that’s actually causing you significant distress, happening a lot, and actually interfering with your life, interfering with your functioning. And what we know from the Black Saturday data is that 10 percent of people who are in the high affected areas were experiencing problematic anger, three times that of the low and moderate affected areas.

We also know that if you met criteria for problematic anger you were 8 times more likely to have an increase in suicidal ideas and you were 13 times more likely to increase in hostile aggressive behavior.

So we also know that not only does anger cause a problem in its own right it’s also associated with increased suicidality and increased aggression and violence.

When we look at the flip side of that, in the high impacted areas 7.4 percent of women reported having experienced violence in the previous 12 months compared to 1 percent in the low and 2 percent in the medium affected areas. So on the one hand we’re identifying heightened rates of anger associated with 13 times the rate of aggression we’re also seeing on the flip side of that women reporting an increase in violence.

If we think about other impacts on families, we’ve had a look at the trajectories of children through their Naplan scores and identified that in terms of the impacts of the disaster, identify that there is a there is a bifurcation, there is a parting of the trajectories for kids, in terms of their learning trajectories particularly in areas that require concentration and working memory. So particularly things like reading and arithmetic where they’ve got to hold information in their heads as they’re going, and comprehension where there is a change in terms of their learning.

So what are the risk factors what are the factors that influence whether someone’s likely to develop difficulties or not in the aftermath of disaster?

Looking at the Black Saturday data, here what we see across trauma more broadly and across disasters more broadly which is the experience.  It’s not only about what happens to you during the fires, the extent of life threat the extent of losses but also the experiencing major life stresses in the aftermath either as a result of the of the disaster itself or in the context on the context of subsequent events that occur so change in income, the extent of property loss, exposure to recent further traumatic experiences, exposure to other recent stresses, all of these compounded and increased the risk of worsening by the 10 years post-fire and really importantly – and this has implications for services and service delivery, only 24 percent of those with a probable disorder at 10 years had sought professional help for this in the previous six months. That’s not to say they hadn’t sought help for it historically, but at that moment in time while they were still having depression, or PTSD or substance use only 24 percent were in the process of seeking help.

The other thing we know from the Black Saturday data, and this is very much consistent with what we know from trauma, very much consistent with what we know about disasters.  Is that the idea of social support is incredibly protective. It’s one of the most potent protective factors we have. And here again with the Black Saturday data, what we found is being involved in one or two community groups or organizations was associated with much more positive outcomes in relation to mental health and wellbeing.

So what does all this mean for multiple disasters? And if we look at the heuristic below remember that was the one we put up for the, for the single event. What we see is that when you start to overlay and compound traumas or disasters is that the zero to three month period of chaos, hyperactivity, intense emotions can coincide for example with the 12 month anniversary of the previous event or with other elements of the trajectory or recovery trajectory. So what we see is the overlaying impacts as each new disaster given what we know about stresses and trauma being influencing the potential to recover or not recover from event the overlaying effect as each in disaster or event becomes a barrier to recovery from event and come with new stresses of their own that become risk factors further again.

What we also see is some of the impact of COVID in relation to connectedness. We mentioned before that social connection, social support, community engagement, were key protective factors across the field and also in terms of disaster and this is something that’s been specifically an issue in relation to covert in terms of potentially I won’t say dismantling but also but making more difficult one of the key pillars or scaffolds of recovery which is the idea of social connectedness through a range of the social distancing and difficulties in terms of social interactions.

In addition to that what we identified was in the in the Black Saturday data was around financial problems.  Other levels of instability and here in the context of COVID the financial instability, the occupational instability, impacts on community become a further stressor and that’s very much what we observed.

So what do we know from the literature, so this as Nicole mentioned at the outset this is the start of a literature review around the impacts of  COVID and compound disasters. It’s funded through the National Mental Health Commission we’re kind of grateful
for their support of this project. So there’s about 45 pretty good solid studies that look at compound disaster and their impact.

A range of them come around the greatest Japan earthquake followed by the tsunami, followed by the nuclear meltdown of Fukushima, the hurricanes in the U.S. – Katrina, followed by Sandy followed by Gustav, followed by oil spills.

One of the studies looks at COVID. Most of them look at the community with a small number looking at health professionals. And two of them start to look at the Australian population in the context of bushfires followed by floods and cyclones by analyzing the national mental health and wellbeing data set.

So what are the impacts of multiple disasters? How does this work? And what we see is very much consistent with how we understand trauma more broadly, which is that there is a dose effect, there is a cumulative or additive effect of these experiences rather than a desensitization effect. And we do see these having an additive effect as people experience them as communities experience them as it starts to push on the pressure points within those communities as people struggle to recover from event A pushing some of the vulnerabilities and risk and protective factors which we’ll talk about in a moment in the relation to that.

The nature of the sort of presentations themselves, what mild to moderate mental health problems looks like, looks much similar, to what severe mental health problems when they manifest looks like is much similar is quite similar. But it’s the potential risks for all of those things are added up through the compound nature of the trauma and further exacerbated by severity of adverse events the multiple resource losses, difficulties with the lack of social supports interfering with the ability to recover, and low socio-economic communities where there’s already disadvantage.

Multiple trauma really compounds the levels of disadvantage and vulnerabilities at a financial level, at each educational level and each social level.

The risk factors, again psychotherapy pathology and true prior trauma. Again what we see are consistent themes coming out – instability and disconnection around housing, finance, employment, social supports, job losses, personal relationship problems, unhelpful coping strategies like substance use and physical activities.

And protective factors importantly at a pre-disaster level, we’ve got good data that say that positive individual perspectives and cognitive outlooks like hopefulness and optimism actually do have an impact in terms of being protected from mental health. And in a communal level, pre-disaster supports around enhancing community bonds, enhancing communities, perceived capacity to deal with adversities, preparedness around drills and response strategies. Training community members in preparedness increased their social and
cohesion and help-giving intentions. And at a post-disaster level
optimism, social support benefit finding, sense making, positive reframing and resilient mindsets all did significantly contribute to improved outcomes.

And in a community level very consistent with everything we’ve been saying is the notion of community resilience, connections with neighbours, support, community resources, being provided disaster related information and communication with community leaders
even when the individual might be displaced from that community, keeping them in the loop.

This is very much consistent, I won’t go through this in detail but we’ve been working with a range of the communities impacted by it through ‘Black Summer’, all of whom have subsequently, around
some training for responders, all of those have been subsequently impacted by COVID obviously and each community – New South Wales, Victoria and South Australia subsequent traumatic events and what we’ve observed is the kind of compounding effects that I’ve just described.