At Florida Health Centers, “A Rush of Folks” Seek Mental Health Care in Hurricane Aftermath

Editor's note: This article is part of a joint editorial initiative between the National Association of Community Health Centers and Direct Relief.

The monstrous threat of Hurricane Milton had terrified meteorologists and emergency responders. Even after the storm was downgraded to Category 3 status, it caused severe flooding and widespread damage across Florida communities.

For one of Dr. Rhonda Cameron's patients, a middle-aged woman who'd lived in the state since age four, the storm hadn't just been frightening in its own right. It was an intrusive reminder of a childhood trauma.

In September of 1960, the patient recalled, the deadly and destructive Hurricane Donna made landfall just weeks after her family's move to Florida. She remembered her mother putting her under the bed, along with her brother, sister, and the family dog, to ride out the storm.

"Hurricane Milton stirred up her PTSD from Donna," explained Dr. Cameron, director of behavioral health services at Premier Community HealthCare, a federally qualified health center serving Florida's Pasco and Hernando Counties.

Milton, which made landfall in early October, close on the heels of the Category 5 Hurricane Helene, damaged many of the same Florida communities, primarily on or near the Gulf Coast. Mental health providers described patients who, barely scraping by financially before the storm, were now confronting cataclysmic damage from flooding or fallen trees. People without the money to evacuate, who'd ridden out dangerous hurricanes in mobile homes. And then, after Milton dissipated, an increase in nightmares, overwhelming anxiety symptoms, and other indicators of post-traumatic stress.

Floridians often emphasize that hurricanes are a part of life, baking storm-themed cakes and taking evacuation warnings in stride.

But natural disasters have indisputable mental health impacts, causing new symptoms or exacerbating already existing ones. Providers have long reported significant increases of post-traumatic stress, anxiety, overdoses, and other related concerns in the aftermath of severe storms and wildfires. Newer evidence, such as a 2022 study focused specifically on Florida residents who'd experienced multiple hurricanes, suggests that repeated exposure to natural disasters can compound mental health impacts over time.

Now community health centers that serve Helene- and Milton-impacted communities are responding to what Premier clinical social worker Larry Legg describes as a "rush of folks coming in" seeking mental health support.

Patients at Evara Health in Pinellas County, where both hurricanes caused extensive damage, were terrified, said Kelly Singleton, a clinical social worker and director of behavioral health at the community health center.

"Normally we manage our hurricanes, but these two [coming] back-to-back, they really did terrify people," she said. "This is the most scared I have ever seen people."

"They can have more connection"

Tampa Family Health Centers, with several locations in the Tampa area, is providing extended hours for mental health appointments - staying open until 8:00 p.m. on weekdays and offering Saturday and Sunday options, said Dr. Latamia Green, a pediatric and adult psychiatrist and the health center's director of behavioral health. Providers offer affected patients the option of shorter, more frequent appointments "so they can have more connection," she said.

While each patient's needs are unique, Dr. Green explained, hurricane response often requires a stronger focus on supportive therapy, helping patients navigate a stressful aftermath and overwhelming day-to-day tasks, rather than the insight-based approach that's more likely to characterize long-term work with a therapist.

Caring for patients affected by natural disasters is a multi-step process, Dr. Green said. In her diverse practice - which includes overseeing a clinic for patients with schizophrenia and caring for children with autism spectrum disorders, among other mental health needs - support often begins in the days before a storm makes landfall, when she helps patients manage their anxiety and make a plan for accessing care in the storm's aftermath.

Then, Dr. Green said, providers work with patients to meet the most urgent needs, and care navigators offer support for patients dealing with the complex bureaucratic processes of applying for emergency government support, staying in temporary housing, and getting power and water restored. "The physical destruction can make the mental health piece much more challenging," Dr. Green said.

At Evara, too, mental health providers were available into the evening and on weekends. Same-day appointments were available to patients who needed immediate care, and specialists were connecting people to community services and helping with applications and paperwork.

"If we don't catch them…we'll lose them"

While all of Evara's medical providers are trained in trauma-informed care and screen patients for mental health symptoms, Singleton says high awareness is especially important in the aftermath of a hurricane. "Patients who should be seen for behavioral health are presenting to primary care," she explained.

Singleton is concerned because storm-affected patients are often focused on medical needs or lost housing - not on their mental health.

"If we don't catch them in that moment…when they're sharing how stressed they are or how anxious they are, we'll lose them," she said. In a population that's already "grossly underserved," missing an opportunity to connect a patient to mental health care can worsen needs down the road.

At Premier, Legg was concerned about patients who, confronting severe flooding, damage, and power outages, had canceled appointments or weren't keeping in touch with mental health providers. One of his patients, a young adult, had dealt with a last-minute evacuation with a parent in a wheelchair as water flooded their home, and hadn't been able to come in.

"They're still in that survival mode," Legg said.

Premier staff were acutely aware that, even as power came back on throughout the region, patients - some of them reliant on powered medical devices - were still in the dark. Students had missed an entire week of school while school facilities served as community shelters.

Legg noted that, during his own childhood in rural Appalachia, the expectation that "I've just got to pull up my boots and go to work" was widespread, even in the aftermath of disaster. Today, he sees many patients at Premier who feel they should "just fight through" mental health symptoms, and are reluctant to seek treatment.

Florida's rainy season, which reminds people of past storms and past flooding, often triggers those symptoms all over again, he said.

The health centers interviewed were also concerned about staff members, who generally live in local communities and experience the same impacts their patients do. While staff often put their own emergent needs aside after a disaster, Legg was worried about colleagues dealing with neck-high flooding, fallen trees, and their own mental health symptoms while still showing up for work.

"We're trying to also keep an eye out for each other, to fight against the secondary traumatization" of caring for deeply impacted patients, he said.

"Part of the puzzle"

Dr. Green cautioned that hurricane-affected patients require mental health support long after the most emergent needs are met: "A large part of the aftermath happens months later." And as a psychiatrist who sees both pediatric and adult patients, and who treats a wide variety of mental health disorders, she stresses the importance of individualized treatment.

"Every patient that we see is unique," she said.

Rather than thinking in terms of disaster response versus routine care, Dr. Green helps patients prepare for the increased stress and traumatic response that a hurricane can evoke. "That's one part of the puzzle, living here in Florida: making sure they're aware of how to deal with trauma and how to deal with stress," she said.

Singleton, too, works with patients who experience symptoms of trauma to help them manage the triggering effects of storms. "A lot of people don't take the hurricanes super-seriously, because that's kind of the norm," she explained, but that attitude discounts the many people for whom encountering yet another storm - or even hearing about the impacts to another community - can jog painful memories or cause severe anxiety.

Evara, responding to a growing need for mental health services, has hired more providers and made behavioral health available not just to health center patients, but to the larger community. Staff are trained to provide mental health first aid.

These services aren't hurricane-specific, Singleton said - they're part of a larger awareness of growing mental health needs in the community. "That's just the population that we're managing," she said.

At TFHC, where mental health outreach and education work are strong priorities, it seems ironic that October 10, the day Hurricane Milton swept across Florida, is World Mental Health Day.

"We had activities planned for that day," Dr. Green said.

Staff made up for lost time after Milton, offering "hurricane make-up days" and a mental health fair. Screening for signs of depression and anxiety, always a priority during medical appointments, became part of what Dr. Green called a "heightened response."

Even at calmer moments, TFHC providers and staff focus on making mental health care more accessible. Care navigators, embedded at major hospitals, connect patients to providers. Education and community events are designed to raise visibility and eliminate stigma.

When it comes to mental health, "we are very vocal around here," Dr. Green said.

Direct Relief has provided more than $3 million worth of medical support to health centers responding to Hurricanes Helene and Milton, and committed an additional $2 million in cash funding to support recovery. The organization announced last week that 28 local partners, including Evara Health, Premier Community HealthCare, and Tampa Family Health Centers, would each receive a $25,000 emergency grant to meet the increased need for health services.

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