Can asking people “How are you?” after a disaster make a city more resilient? It just might.
The strong connection between urban planning, city resilience, and mental health may surprise some. Even before disaster strikes, many cities already have mental health preparations in place. Around the world, appreciation for the importance of mental health care is rising, especially as a means to understand and treat trauma. Terms like “psychiatric first aid,” “disaster psychology,” and “mental health surge capacity” are now common in emergency, social work, and academic fields alike.
Most disaster responses now include frontline mental health interventions, with the goal of instating permanent care options where they might not have previously existed. This can improve approaches to everyday mental health. And improving everyday mental health makes cities more resilient during crisis.
Researchers have found commonalities in effective post-disaster mental health responses to various traumas, ranging from oil spills to earthquakes, terrorist attacks, and inner-city violence. Mental health workers and researchers have identified striking similarities between PTSD in veterans and in young people living in violent urban neighborhoods; cities now use this knowledge to better address the needs of vulnerable populations both before and after the catastrophes that threaten mental health.
An ever-increasing number of government and NGO groups, including Cognitive Behavioral Intervention for Trauma in Schools (CBITs), Handicap International, International Rescue Committee (IRC), LifeNet, Mental Health First Aid, and SAMHSA, have created protocols designed to address mental health in populations subject to both ongoing and episodic traumas. As well, cities are beginning to put mental care at the forefront of both recovery efforts and long-term wellness.
When a magnitude 7.1 earthquake hit Christchurch, New Zealand in 2010, researchers had already begun a decades’ long study tracking the lives of 1,000 city residents. This study and a few others suggest that a “people-centric” flexible model for immediate and long-term treatment that focuses on mental health and social sustenance has significantly boosted the city’s renewal.
In the wake of the 2004 Tsunami and in the midst of a civil war that ended in 2009, Sri Lanka started a program in capital city Colombo to address the mental trauma, and its effects, stemming from these dual disasters. Workers evaluating the programs’ effects have seen how training and sensitivity can deepen treatment, and they hope to expand therapies in the region to include chronic stressors that undermine mental health.
Tamar Renaud, Health Integration Director at the NYC Department of Health Bureau of Mental Health, says the months following initial crisis response are sometimes the most critical for mental health care: “Isolated people are the most vulnerable,” she says. “Connecting them with existing community resources is really important… house visits work. You ask, ‘How are you? How are your kids?’ And they start to talk . . . City Health is also training local community leaders—pastors; imams; the friendly, vocal person you meet in the hall in a NYCHA building; natural community leaders—on how to guide residents after a crisis.”
However, cultural differences put a limit on how widely mental health approaches to resilience can scale.
Japan’s 2011 earthquake, tsunami, and nuclear meltdown left some of its communities ravaged by compounding mental health issues, and the country has needed to address the resultant trauma creatively. However, early mental health interventions there revealed that local context must dictate approaches for them to be effective. Evidence from other post-disaster mental health interventions supports this finding, showing that mental health programs must follow profoundly adaptable approaches in order to work in different cultures and communities.
Cities have begun to internalize the importance of mental health for disaster recovery. Many have found that the benefits of the nuanced care and approaches to mental health described above are not limited to periods of shock; they contribute to cities’ resilience in good times as well.