A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

2022 | VOLUME 17 | ISSUE 3 

Disaster Behavioral Health 

in an Era of Climate Change 
 

 

 

 

 

CONTENTS 

3 In This Issue 

5 Contributors 

6 Climate Change and Community: Addressing Vulnerabilities and 

Challenges To Encourage Resilience 

10 Lessons Learned From Ground Zero: Preparing for Future Disasters; A 

Personal Account 

13 Building Resilience in the Face of Climate Change 

15 Recent Technical Assistance Requests

18 Recommended Resources 

19 References 

In September of 2021 a collection of more than 200 medical journals asserted that climate 

change represents the greatest threat to human health in this century. While a great deal of 

attention has been given to the impact climate change has on physical health, both through 

catastrophic events and chronic disease, associated mental health and behavioral health 

risks are also very significant, particularly for disadvantaged and vulnerable populations. 

The salience of mental health was recognized in the 2016 United States Global Change 

Research Program Climate and Health Assessment, not only among those experiencing life 

threatening climate disasters, but those who anguish over damage to natural environments 

from perspectives of cultural heritage and connections between human, animal, and 

environmental wellbeing. The U.S. Department of Health and Human Services has recently 

established an Office of Climate Change and Health Equity (OCCHE) with a primary mission 

to protect the health of all people in the United States from the impacts of climate change, 

especially the most vulnerable. This will require a focus on the behavioral and mental health 

threats associated with climate change, not only from a treatment perspective, but important 

also from a resilience or preventive health perspective. The Substance Abuse and Mental 

Health Services Administration (SAMHSA) and OCCHE will be strong partners in addressing 

the mental health impacts from climate change and helping those who need help the most. 

The Dialogue is not responsible for the information provided by any web pages, materials, or organizations referenced in this publication. Although 

The Dialogue includes valuable articles and collections of information, SAMHSA does not necessarily endorse any specific products or services 

provided by public or private organizations unless expressly stated. In addition, SAMHSA does not necessarily endorse the views expressed by such 

sites or organizations, nor does SAMHSA warrant the validity of any information or its fitness for any particular purpose.
 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

In This Issue 

In recent reports, government agencies and other entities 

have described the impacts of climate change, as well as 

future threats it may involve. The U.S. Environmental 

Protection Agency (EPA) notes that average U.S. 

temperatures have been climbing, and the warming 

rate has increased in recent decades, with 8 of the top 

10 warmest years on record since 1998 (EPA, n.d.). 

The agency also reports that heat waves happen about 

3 times as often as in the 1960s (EPA, n.d.). The U.S. 

Global Change Research Program (USGCRP) projects 

that average U.S. temperatures will continue to rise, and 

more frequent and/or intense droughts, wildfires, floods,

and other extreme weather events are likely to occur 

(Hayhoe et al., 2018, Ebi et al., 2018). 

Along with weather and disaster impacts, reports predict 

increasing impacts of climate change on human health. 

The USGCRP writes that more frequent and intense 

disasters and extreme weather events linked to climate 

change will likely have negative effects on public

health, as these events may aggravate underlying health 

conditions, increase stress, and worsen mental health 

(Ebi et al., 2018). At present, more people in the United 

States are experiencing anxiety, stress, and sadness 

linked to climate change (Clayton et al., 2021). 

Given the warnings and reports, and the vastness 

of the challenge, it is easy for individuals and even 

governments to become overwhelmed. At individual 

and collective levels, we need to manage our thinking 

about climate change so its immensity doesn’t lead us 

into avoidance and stagnation, and so we maintain focus 

on what we can control. Fortunately, there are many 

steps all of us can take to cope with climate change, 

Heat Warnings and Advisories, 2010 and 2021 

2010 2021 

Excessive Heat Warning Heat Advisory 

Notes: An excessive heat warning is issued when extremely dangerous heat conditions will start in the next 12 to 24 hours. A heat 

advisory is issued when the extremely dangerous heat conditions have already begun (National Weather Service, n.d.).

Source: Iowa State University, Iowa Environmental Mesonet, https://mesonet.agron.iastate.edu 

2022 | VOLUME 17 | ISSUE 3 | PAGE 3 
 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

both now and in the future. For example, officials,

emergency managers, and public health professionals 

can guide individuals and families in increasing disaster 

preparedness. Medical and mental health professionals, 

among others, can educate the public about ways to 

cope with stress and enhance resilience. Government, 

policymakers, and public officials all have roles to play

in helping disaster planners ensure that existing plans 

account for projected impacts of climate change. The 

SAMHSA Disaster Technical Assistance Center (DTAC) 

and other government entities, as well as entities in 

other sectors, can continue or initiate work to build 

public awareness of disaster behavioral health. Business 

leadership organizations, emergency management and 

public health, and experts in various sectors can offer

suggestions for building community cohesion and 

resilience. 

This edition of The Dialogue features articles with 

insights and recommendations from leaders and experts 

in disaster behavioral health and disaster response 

regarding ways to cope with the threats of climate 

change, including threats to mental health. The first

article in this edition conveys insights from a leader 

in conservation psychology and one of the primary 

authors of a major report on the mental health impacts 

of climate change. In the second article, the founder 

of the Institute for Disaster Mental Health at the State 

University of New York at New Paltz recounts lessons 

learned from responding to 9/11 and how those lessons 

can be applied to preparing for and coping with climate 

change. The third article, written by the Director of the 

National Center for Disaster Preparedness at Columbia 

University, reviews probable impacts of climate change 

and discusses ways to manage uncertainty, increase 

effectiveness of responses, and build resilience.

Has your work changed because of the effects of climate

change? Have you been involved in updating disaster 

plans, or developing plans to address new threats owing 

to climate change or more frequent or different types

of disasters? Others can learn from your efforts. We

encourage you to contact us to share your stories and 

lessons learned.■

CAPT Erik Hierholzer, B.S.N. Program Management 

Officer, Emergency Mental Health and Traumatic Stress

Services Branch 

erik.hierholzer@samhsa.hhs.gov 

Nikki Bellamy, Ph.D. Public Health Advisor, 

Emergency Mental Health and Traumatic Stress 

Services Branch 

nikki.bellamy@samhsa.hhs.gov 

Shannon Loomis, M.A. Director, SAMHSA DTAC 

dtac@samhsa.hhs.gov 

2022 | VOLUME 17 | ISSUE 3 | PAGE 4 
 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

Contributors 

Susan Clayton, 

Ph.D., is the 

Whitmore-Williams

Professor of 

Psychology at 

the College of Wooster in Ohio

and a visiting fellow at the Paris 

Institute for Advanced Studies, 

2021–2022. Clayton’s research 

examines people’s relationship 

with the natural environment, 

how it is socially constructed, and 

how a healthy relationship with 

nature can be promoted. She has 

written about the effects of climate

change on mental health and 

developed a scale to assess climate 

anxiety. She is author or editor 

of six books, including Identity 

and the Natural Environment, 

Conservation Psychology, and 

Psychology and Climate Change, 

and she is currently the editor of 

the Cambridge Elements in Applied 

Social Psychology series and on 

the editorial board for journals such 

as the Journal of Environmental 

Psychology and Sustainability. 

A fellow of the American 

Psychological Association, she is 

a lead author on the forthcoming 

Sixth Assessment Report of the 

Intergovernmental Panel on 

Climate Change. 

James Halpern, 

Ph.D., is Professor 

Emeritus and 

Founding Director 

of the Institute for 

Disaster Mental Health at the State 

University of New York at New 

Paltz. He has received numerous 

grants to develop curricula and 

provide training in disaster mental 

health throughout the United 

States and abroad. Halpern has 

co-written three disaster mental 

health textbooks, consulted for 

the United Nations on assisting 

victims of terror, and developed 

training modules for United Nations 

Emergency Preparedness & Support 

Teams and mission leaders. He has 

provided direct service to disaster 

survivors and served in a leadership 

role at large-scale national and 

local disasters (e.g., 9/11, Flight 

587, Florida hurricanes, Hurricane 

Katrina, Newtown school shooting, 

explosions, fires, floods, COVID-19).

Jeff Schlegelmilch 

is a Research Scholar 

and the Director 

of the National 

Center for Disaster 

Preparedness, Columbia Climate 

School, at Columbia University. In 

this role he oversees the operations 

and strategic planning for the center. 

Before becoming Director, he served 

as the center’s Deputy Director for 

more than 5 years. He also oversees 

projects related to the practice and 

policy of disaster preparedness, 

including the multi-award-winning 

Resilient Children/Resilient 

Communities Initiative. His areas 

of expertise include public health 

preparedness, community resilience, 

and the integration of private and 

public sector capabilities. He is also 

the author of Rethinking Readiness: 

A Brief Guide to Twenty-FirstCentury Megadisasters published by 

Columbia University Press. 

Climate change is intensifying 

the natural disasters we experience 

and broadening the areas these disasters affect, 

from hurricanes increasing in size, strength, and range to wildfires 

across the American West to worsening floods. 

Source: Pruitt-Young, 2021 

2022 | VOLUME 17 | ISSUE 3 | PAGE 5 
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A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

Climate Change and Community: Addressing 

Vulnerabilities and Challenges To Encourage 

Resilience

By Susan Clayton, Ph.D., College of Wooster in Ohio, Paris Institute for Advanced Studies

Climate-related crises can affect not 

only the mental health of individuals 

but the unity and resilience of 

communities as a whole. SAMHSA 

Disaster Technical Assistance Center 

staff recently spoke with Dr. Susan 

Clayton, Professor of Psychology at 

the College of Wooster and one of 

the main authors of the American 

Psychological Association and 

ecoAmerica’s recent report Mental 

Health and Our Changing Climate

(Clayton et al., 2021). Dr. Clayton’s 

research explores the public’s 

evolving relationship with the 

environment, highlighting the effects 

of climate change on the health and 

resilience of the public to promote 

healthy individual and community 

response.

What do you believe has 

influenced the surge of public 

interest and concern regarding 

climate change, particularly 

climate-related events?

In the last 10 years, and even more 

so in the last 5 years, there’s much 

more awareness not only that climate 

change is happening but that there 

are human impacts. Ten years ago, 

people were still thinking climate 

change was about polar bears and 

glaciers melting. They didn’t have a 

real sense that people were going to 

be affected, at least not in the near 

future. There was a sense that those 

kinds of impacts were 50 years away. 

Yet now we’ve seen the wildfires, the 

heat, the hurricanes. People are now 

very aware that humans are and will 

continue being affected by climate 

change. 

The wildfires in particular have made 

us more aware of the global impact of 

climate change on extreme weather 

events. The number of people directly 

affected by the wildfires may not 

have been that great, but the entire 

nation was very aware that the 

disaster was occurring. People all the 

way on the East Coast were sensing, 

smelling, or seeing the effects of the 

smoke. It made people experience 

that visceral impact of climate change 

on a very basic, sensory, collective 

level. This recognition of a shared

experience is really important.

About the Report

In Mental Health and Our 

Changing Climate: Impacts, 

Inequities, Responses, Clayton 

and coauthors identify health and 

mental health effects of climate 

change, note how climate change 

worsens inequities already 

present in U.S. society, and 

offer suggestions for building 

individual and community 

resilience. The report proposes 

ways for individuals and 

communities to adapt and respond 

to climate change. The report 

is online at https://www.apa.

org/news/press/releases/mentalhealth-climate-change.pdf. 
A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

2022 | VOLUME 17 | ISSUE 3 | PAGE 7 

How influential do you believe

the COVID-19 pandemic has

been in the rise of public

interest concerning climate

change and acknowledgement

of its impacts?

Coming back to that point of a 

shared experience, we see this 

come into effect with COVID-19 

and climate change impacts— 

the recognition that you are 

not necessarily protected. Your 

economic status won’t necessarily 

keep you safe from the pandemic or 

from climate-related events. We are 

all vulnerable. 

In cases of both climate change 

and the pandemic, we’ve seen 

some people willing to confront the 

issue and some that are in denial. 

We’ve highlighted the importance 

of communication and messaging 

and finding ways to talk to people 

about a problem they would rather 

not think about. You don’t create 

behavioral change by hitting people 

over the head; you have to find 

subtle ways to spread the message. 

I think one of the reasons people 

had a hard time thinking about 

climate change is that they just 

couldn’t envision society changing 

that much. It’s very hard to imagine. 

And yet, society changed a lot 

because of COVID-19. We had 

to. The recognition that you’re 

going along with how things are 

and suddenly things change in a 

very dramatic way is a message 

COVID-19 has given us that can be 

applied to climate change. 

This can also be applied to our 

societal approach to mental health. 

We have all personally experienced 

how COVID-19 has had an impact 

on our mental health, and it’s 

changed our attitudes a bit. There 

was a tendency to think mental 

health is an individual problem, that 

individuals are being weak in some 

way or are incapable of coping. 

Yet now we realize it is because of 

things happening outside of you, 

or at least in part the circumstances 

you are confronted with. There is 

certainly more conversation about 

mental health and the importance 

of supporting mental health, which 

builds greater awareness and less 

stigma. 

What effects can climaterelated disasters and crises

have on the resilience and

well-being of communities?

Are certain communities more

likely to experience greater

negative impacts?

People are actually surprisingly 

resilient following a disaster, and 

communities can often be fine. In 

some cases, communities actually 

come together to rebuild in very 

positive ways, so there is potential 

for positive outcomes. However, 

you do often see increased 

community tensions after an event. I 

think that’s often associated with the 

inequity involved. 

Sometimes it’s just random. The 

hurricane hits these people but 

not those people. But there are 

also underlying system inequities, 

such as racist housing practices 

and so on, that can lead to some 

people being more vulnerable 

than others. Hurricane Katrina, for 

example, was a real turning point 

for people to recognize that how 

you were affected by a disaster 

was strongly influenced not only 

by your economic status, but also 

by race. When you recognize those 

inequities, it can be harder to come 

together as a community. It can even 

increase community tensions. 

Disadvantaged groups in society, 

such as people in minority groups 

or families of low income, are 

in many cases already facing the 

impacts of climate change. For some 

racial groups, there is a history of 

them being in more geographically 

vulnerable locations like low-lying 

land or substandard buildings that 

are more vulnerable to the elements. 

Displacement can also increase 

community tensions. When you

have communities that are strongly 

affected by climate change, either

by a short-term event or a slower 
 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

displacement, the community tends 

to be dispersed. Consider the coastal 

communities in the Gulf of Mexico; 

the people there don’t pick up and 

move all together, they move to 

different places. After a disaster,

people tend to move away from one 

another. You lose those social ties, 

or at the very least weaken them. 

And we know those social ties are 

so important for helping people 

build resilience and promote mental 

health. 

That loss of community connection, 

of feeling rooted, of place identity— 

those things are really affected

by the impacts of climate change. 

Indigenous peoples’ cultures often 

emphasize connection to the land. If 

I had to move from my hometown, 

it wouldn’t affect me that much.

I would like to stay close to my 

friends, and I might be annoyed that 

I would need to find a new doctor.

But for people who feel strong ties 

to a location, having to move from 

that place can bring real grief and 

threaten their mental health and 

sense of community. 

People with disabilities are often 

left out of rescue efforts and don’t

receive appropriate support during 

or after a climate-related disaster, 

as we’ve seen in many hurricane 

responses where materials like 

rafts are not accessible. And some 

groups we may not consider at first,

like young children, can be more 

vulnerable to negative impacts, 

especially if there’s an immediate 

threat they can understand. 

How important is the role of

a community leader in the

efforts to build community

resilience, and how can these

individuals influence their

communities to be involved

in climate-related disaster

planning or response?

A community is most able to 

come together when it has strong 

community leaders. We often

consider elected officials as the

community leaders to look to, but 

it’s important to consider other 

important and influential players.

School boards, citizen groups, 

religious leaders, local parent 

groups, and many other groups 

can be extremely influential at the

community level. These group 

leaders have often established 

a connection to individuals in 

the community, and community 

members can recognize these groups

as a good place to start taking 

action. One person can make more 

of a difference when working in a

group. Community campaigns to 

talk to local businesses or politicians 

or group efforts to discover local

vulnerabilities and prepare for 

disasters are great ways to build 

community resilience, develop 

social ties, and help people feel 

more involved. 

Health leaders are also in a great 

position to build individual and 

community resilience because they 

tend to be trusted by the public. I 

encourage health leaders to normalize 

any messages about climate change 

or its effects. Instead of making a

big deal out of a possible disaster 

event, you can say, “Because we 

can expect more wildfires in this

area, here is what we should prepare 

for.” The goal is not to instill fear, 

but to empower people so they feel 

prepared for possible effects. They

have an important voice that can give 

meaningful messages, which can 

often be tailored to individual needs to 

develop some exigence. Personalize 

your messages to those you provide 

services for so they understand the 

challenges they may face in case of 

a climate-related crisis and can plan 

their response accordingly. 

2022 | VOLUME 17 | ISSUE 3 | PAGE 8 
 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

A great message to share with your 

community is that a good action 

is worth doing, regardless of the 

outcome. Some may feel like a 

small change in their personal life— 

recycling, using less water, eating 

less meat—won’t make an impact. 

Individual behaviors are valuable 

because they can make a difference,

but also because of what they 

symbolize. More practically, one of 

the reasons it’s worthwhile is your 

action is not limited to you. Other 

people see you act. The more people 

see you do a particular thing, the more 

likely other people are to do it as well. 

Individual household behaviors are 

incredibly impactful and can become 

community behaviors. 

As communities reevaluate

their climate-related disaster

preparedness plans or

evaluate their needs, what

steps should community

leaders be taking to ensure

community needs and disaster

vulnerabilities are addressed?

Emergency preparedness plans 

should certainly be reviewed and 

renewed. I suggest community 

leaders and planners talk to people 

of different backgrounds to ensure

their interests are being represented. 

There is often a lack of political 

representation for underserved 

groups. Community leaders should 

be reaching out across racial and 

economic lines, making sure 

everyone is involved in the planning 

process, so they have a chance to 

share their concerns and experiences 

in a welcoming environment. Make 

an effort to hear them. You can say,

“Try and imagine what it’s like for 

someone with a physical disability,” 

or “Try and imagine what it’s 

like for somebody with a mental 

health challenge who needs regular 

treatment.” But even better is if 

you reach out to those members of 

your community and ask them what 

they need instead of imagining their 

circumstances. Also, if you have 

community meetings, consider that 

some members may not attend if it is 

hosted in a space that is inaccessible 

or considered unwelcoming to a 

certain group. 

When approaching your community

with information about climate 

change or the need to revise your 

community behaviors, you can 

expect some people to be resistant. 

People are often afraid that if they 

admit climate change is a problem, 

they’ll have to do something drastic 

to their lives like stop driving, 

flying, or eating meat. It is assumed

we have to do extreme things 

to slow the possible impacts of 

climate change. If we make it more 

acceptable for people to do small 

things that are not such a heavy 

burden on their daily lifestyle, 

these actions can be helpful and 

help people feel empowered, not 

burdened. 

I also suggest that people stop 

talking about “climate change” and 

instead talk about things on a smaller 

scale. People can get overwhelmed 

with the idea that they need to save 

the world with their actions. If, as 

a community, you can bond over 

the need to prepare for a heat wave 

or make plans to connect with the 

environment, you’re promoting 

change and resilience.■

2022 | VOLUME 17 | ISSUE 3 | PAGE 9 
 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

Lessons Learned From Ground Zero: Preparing 

for Future Disasters; A Personal Account 

By James Halpern, Ph.D., Institute for Disaster Mental Health, State University of New York at New Paltz 

The full version of this article 

appeared in Trauma Psychology 

News, the newsletter of the 

American Psychological 

Association’s Division of Trauma 

Psychology (https://www. 

apatraumadivision.org). SAMHSA 

DTAC worked with the author 

to identify the parts of the article 

included in this edition of The 

Dialogue, with sections appearing 

here limited to those related to 

climate change. You can access the 

full article in Trauma Psychology 

News, Volume 16, No. 3, at https:// 

traumapsychnews.com. 

On September 11, 2001, I led the 

first American Red Cross mental

health team to Ground Zero 

looking for “walking wounded.” 

On September 12, I began a weeklong assignment managing the 

Missing Persons Hotline. Over the 

next few weeks, I escorted family 

members of first responders to

Ground Zero as they looked over 

the site to see where their loved 

ones perished. For the next year, I 

supported memorials and funerals 

and counseled survivors, first

responders, reporters, government 

officials, and clergy who worked at

the site. Most of us who responded 

were shocked, confused, disoriented, 

and vicariously traumatized, and 

because there was so little research 

and guidance, I went on to found the 

Institute for Disaster Mental Health 

at the State University of New York 

at New Paltz (https://www.newpaltz. 

edu/idmh); write, train, and present 

on disaster mental health locally, 

nationally, and internationally; and 

coauthor three textbooks on disaster 

mental health. I continue to serve as 

a Red Cross volunteer and member 

of the Board of Directors of the 

Hudson Valley Chapter, planning for

and responding to COVID and other

disasters. 

I am sharing this personal account 

of my response to the 9/11 

attacks, hoping that readers will 

better understand how to prepare 

themselves and those they serve for 

disasters that are sure to come. 

Overcoming Denial To Improve

Planning and Preparation

On May 18, 2001, there was a 

tabletop exercise at the American 

Red Cross Greater New York 

location in Manhattan. The focus of 

our exercise was how our chapter 

would respond to an aviation incident 

in the New York metropolitan area. 

Under the Family Assistance Act 

of 1996, in the aftermath of a mass 

transportation accident, the Red 

Cross is responsible for family care 

and mental health. 

The scenario presented was an air 

traffic control tower accident at

a Queens airport resulting in two 

passenger planes hitting a populated 

area in New York City, leading to 

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A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

hundreds of casualties. What?!, most

of us complained to the exercise 

organizers. We should be planning for

a disaster that might actually happen 

and not some preposterous scenario. 

Of course, what happened on 9/11 

was far worse than this “worst-case 

scenario.” But although most of us 

were experienced disaster responders, 

we could not accept that this lowprobability, high-impact disaster 

was even a possibility. If we were 

in denial, how can we expect others 

in the general population to be more 

connected to a potential reality and to 

plan and prepare effectively?

Based on my own experience of 

the May 2001 disaster exercise, 

the simplest answer to why we do 

not adequately prepare for disaster 

is denial. Denial occurs when 

someone is faced with a fact that is 

too uncomfortable to accept and so 

they reject it despite overwhelming 

evidence. Since we are surrounded by 

danger, and it is not helpful to be in a 

constant state of fear, denial is a basic 

and useful defense mechanism—but 

only up to a point. Denial can keep us 

from being prepared for and planning 

for disasters. 

We are more likely to deny and

inadequately prepare for disasters that 

are neither visible nor understandable 

(Bormudoi & Nagai, 2017). These 

factors contribute to the poor 

initial and continuing response to 

COVID-19 and our inability to

take bold action on climate change. 

Climate change makes disasters 

bigger and badder and longer but 

is neither seen itself nor easily 

understandable. We don’t see the

greenhouse gases in the atmosphere. 

People don’t pay attention to 

threats if they lack early warning, 

information, skills, or knowledge 

(Liu et al., 2017). Our response to 

the threats of pandemic and climate 

change are made worse by rumor 

and misinformation, always present 

after a disaster, but made much worse 

with social media and extremist 

ideologies. 

Denial keeps people from having 

first aid kits, N95 masks, and smoke

detectors, and from discussing 

emergency plans. We can help

individuals and communities be safer 

at reasonable costs with effective

threat assessment and mitigation 

without fearmongering. We can help

prevent disaster trauma. We can ask

those we work with and serve about 

their disaster planning. Depending 

on local risk, you can ask those you 

serve, as well as friends, family, and 

loved ones, about their preparedness 

for heat waves, wildfires, floods,

tornadoes, or hurricanes. Refer them 

to websites with emergency kits like 

the Red Cross or Ready.gov. 

The Increasing Importance

of Remote Mental Health and

Mental Health Call Centers

On September 12, 2001, and for 

over a week, I managed the Missing 

Persons Hotline, set up in the call 

center for New York City’s public 

television station. People from all 

over the world called in to find

out the status of their loved ones, 

many of whom were expected 

home but had not arrived. Hundreds 

of counselors made thousands of 

calls to frightened, anxious, and 

grieving relatives. At that time, 

it was one of the largest mental 

health responses to disaster. It was 

also the first significant disaster

crisis hotline. Beginning on the 

evening of 9/11, the American Red 

Cross in the Greater New York 

area managed the call center. The 

operation had two goals: develop 

a database for missing persons and 

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A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

provide crisis counseling. After 

a few days, counselors received 

some training (e.g., meet the client 

where the client is) and debriefings

at the end of shift and the end of 

deployments. We now know that

exit interviews (i.e., checking in 

with volunteers on self-care) are 

recommended while debriefings

are no longer best practice. The 

vast majority of counselors did an 

excellent job of providing assistance 

for long hours and returned to help 

for many days. However, some 

volunteers decompensated either 

during training, during the response, 

or at the end of their shifts. Some had

to leave the assignment even before 

they started answering phones. 

Since then, the Red Cross and 

other state and local agencies have 

organized remote mental health 

responses to more frequent mass 

shootings, killings, natural disasters, 

and other large-scale catastrophic 

events. Since 2012, the Substance 

Abuse and Mental Health Services 

Administration (SAMHSA) has 

supported a national disaster distress 

helpline (https://disasterdistress. 

samhsa.gov), and communities all 

over the country have counselors 

available by phone to assist 

COVID survivors. New York State

responded to well over 60,000 calls 

during COVID, mostly with clients

experiencing anxiety, loneliness, and 

fear. Climate change will bring us an 

increasing number of mass casualty 

incidents that will necessitate 

remote counseling (e.g., phone, text, 

video). They will include events like 

transportation accidents, shootings, 

fires, floods, structural collapses,

hazmat/industrial accidents, 

radiological events, public health 

emergencies, and events that we 

cannot even imagine. 

We need to give the helping

community more training in remote 

disaster counseling because in the 

aftermath of mass casualty incidents, 

the point of contact between client 

and counselor is frequently over 

the phone. Communities should 

prepare for large-scale phone crisis 

counseling operations. This work 

should include identifying adequate 

facilities and developing plans 

and protocols for staff serving as

counseling supervisors and managers 

as well as phone crisis counselors. 

It is not alarmist to state that there are 

disasters and catastrophes coming 

our way. We can help those we work

with and serve to prepare, and we can 

prepare ourselves to respond to the 

increasing number of mass casualty 

incidents in our future by planning 

for or participating in disaster mental 

health training for both in-person and 

remote counseling.■

2022 | VOLUME 17 | ISSUE 3 | PAGE 12 
 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

Building Resilience in the Face of

Climate Change 

By Jeffrey Schlegelmilch, Director, National Center for Disaster Preparedness, Columbia Climate School, 

Columbia University 

The Climate Crisis and averting the 

most catastrophic consequences of 

anthropogenic climate change is one 

of the defining challenges of our

generation, and perhaps generations 

to come. Audacious goals have been 

set, missed, and re-set to reduce 

harmful greenhouse gas emissions 

and to mitigate against further 

damage to our planet. But regardless 

of the success of these efforts,

many of the feared consequences 

of climate change are no longer 

realistically avoidable. In addition to 

mitigation, we need to increasingly 

adapt our disaster management 

and resiliency efforts in the face of

these consequences. The increase in 

disasters will continue to stress our 

physical infrastructure as well as our 

social infrastructure with direct and 

indirect impacts on our physical and 

mental health. 

What kinds of impacts should

we expect?

Extreme weather, prolonged 

droughts, and record-breaking 

wildfires are among the types of

hazards we will likely see with 

greater frequency and ferocity. 

Events like the December 2021 

tornadoes in the Midwest can sweep 

entire towns off the map, leaving

survivors rebuilding their lives and 

livelihoods for years to come.1 

1 A tornado outbreak occurred on the night of December 10, 2021, in Kentucky, Arkansas, Illinois, Missouri, Mississippi, and Tennessee. At 

least 88 people in 5 states lost their lives in the storms, and many more were injured. The storms were estimated to have caused billions of 

dollars in damages (Victor et al., 2021).

 

Based on our research at the National 

Center for Disaster Preparedness 

at Columbia University’s Climate 

School, among the most vulnerable 

are children. Exposure to disasters 

has been seen to increase the 

likelihood of having a mental health 

diagnosis for children. Data from 

Hurricane Sandy also showed, 

somewhat counterintuitively, that 

damage may not directly correlate 

with health and mental health risk. 

The researchers found households 

with minor damage to their home 

were more likely to have children 

reporting emotional and mental 

distress than those with major 

damage. The root cause of this is 

not known, but it may be related to 

the complexity and prolonged nature 

of recovery, and having to live in a 

partially damaged home versus one 

that was totally destroyed (it should 

be noted that there was still a higher 

risk of adverse outcomes for those 

with major damage vs. those with no 

damage) (Abramson et al., 2015). 

And as is too often seen, those on the 

margins of society are more likely 

to be left behind. Programs designed 

to assist those most in need have 

been seen to favor more advantaged 

communities in their implementation 

(Howell & Elliott, 2019). Legacies 

of structural racism such as redlining 

have also left many areas more 

exposed to rising seas and extreme 

heat (Katz, 2021). An analysis of an 

extreme cold snap in Texas found 

significant disparities in terms of who

lost power and for how long, and 

another analysis found indirect deaths 

that greatly outnumbered official

death counts (Carvallo et al., 2021; 

Aldhous et al., 2021). The role of 

indirect deaths is another facet of 

2 

2 Severe winter storms in February 2021 led to massive power outages in Texas, which in turn caused problems with access to water for 

drinking and cleaning, food shortages, and unheated residences (Rice, 2021; McDonnell Nieto del Rio, Fausset, Diaz, 2021; Levenson, 

Caldwell, & Vera, 2021). At least 200 people died in the crisis (Hauser & Sandoval, 2021).

2022 | VOLUME 17 | ISSUE 3 | PAGE 13 
 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

trying to understand the impacts of 

climate change and disaster through 

more than just those most directly 

affected, with many more often

succumbing to the loss of critical 

lifelines, and the cascading stressors 

that we can expect with more 

extreme climatic events. 

How do we manage the

uncertainty of climate change?

Tools such as the Centers for 

Disease Control and Prevention’s 

Social Vulnerability Index (https:// 

www.atsdr.cdc.gov/placeandhealth/ 

svi/index.html

innovative approaches can be seen 

in the form of neighborhood block 

parties with civic engagement 

components like those done under 

San Francisco’s Neighborhood 

Empowerment Network. 

) provide important 

indicators on different types of

vulnerability, with geospatial 

components to help in targeting 

outreach and resources. Additionally, 

community-centric approaches that 

meet communities where they are 

and integrate their needs, barriers, 

and other factors into the disaster 

cycle may seem like they take more 

time and effort, but can provide more

genuine and equitable outcomes. 

Pre-disaster investments in building 

social capital may also be as valuable 

as traditional preparedness activities 

like building emergency kits. Some 

Ultimately, the experience of a 

disaster is often set up long before 

one occurs through investments 

and policies that seemingly have 

little to do with disasters. Building 

communities with better access 

to transportation, more healthcare 

resources and access to affordable

housing, among other investments, 

can help reduce aspects of social 

vulnerability, and thus improve 

their capacity to cope with disasters. 

Further, targeting investments 

in community-based institutions 

and social organizations in 

more vulnerable and historically 

underserved areas will also generate 

greater societal benefit than the

same investments in areas that are 

less vulnerable. But development 

projects at best only include limited 

social benefits and are usually

focused on direct economic benefit.

These projects are also often looked 

at through a lens of historical 

disaster losses rather than looking 

at projected losses under a changing 

climate. Because of this, costlier 

projects with social resilience 

dividends may not be competitive 

under traditional valuation 

schemas because that value goes 

unrecognized. 

What comes next?

The truth is that this will likely 

get harder before it gets easier. 

The overstretched resources of our 

mental health and social service 

providers will continue to be in 

increasing demand in the face of 

more disasters overlapping with 

recovery from prior events. But there 

is a silver lining. The COVID-19

pandemic and the increasing climate 

disasters are making these scenarios 

less abstract and having impacts 

on more and more people where 

they live. With this comes more

lived experience as well as data to 

help quantify the value of social 

and mental health services. We will

also have more opportunities to 

recognize, value, and even celebrate 

the hard work of those that keep our 

social infrastructure functioning. And 

in doing so, can begin to change the 

math to more appropriately value 

social infrastructure. While we may

not be able to predict with certainty 

what the next weather event will be, 

we do know what will be needed 

and who will need it. Integrating this 

into our community development 

planning will not only build more 

robust responses—it will also build 

resilience.■

2022 | VOLUME 17 | ISSUE 3 | PAGE 14 
 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

Recent Technical Assistance Requests 

In this section, read about responses SAMHSA Disaster Technical Assistance Center (DTAC) staff have provided to

recent technical assistance (TA) requests. Send your questions and comments to dtac@samhsa.hhs.gov. 

Request: SAMHSA DTAC received a request for 

letters with lists of relevant resources to be sent to the 

State of Michigan in response to a shooting at a high 

school in the state. 

Response: SAMHSA DTAC produced a list of related 

resources and the letters. The resources below are a 

sample of those sent. For the complete resource list, 

please contact SAMHSA DTAC at 1–800–308–3515. 

 Age-related Reactions to a Traumatic Event—In 

this information and tip sheet, the National Child 

Traumatic Stress Network (NCTSN) provides an 

overview of how children and adolescents may react to 

a traumatic event, including a natural or human-caused 

disaster. This resource describes reactions typical 

within specific age ranges and offers tips for families,

doctors, and school personnel to help children and 

adolescents cope. https://www.nctsn.org/resources/ 

age-related-reactions-traumatic-event 

 Helping Youth After Community Trauma: Tips for 

Educators—In this 1-page tip sheet, the NCTSN 

identifies 10 ways youth may react to community

traumas such as natural or human-caused disasters 

and suggests ways for educators to respond to these 

reactions and support youth in coping. The tip sheet 

also advises educators to find professional mental

health support for youth—and for themselves—as 

needed. https://www.nctsn.org/resources/helpingyouth-after-community-trauma-tips-educators 

 Mental Health Considerations After a Traumatic 

Event—A product of Voices Center for Resilience, a

nonprofit formed after the attacks of September 11,

2001, this tip sheet highlights common reactions to 

acts of violence, civil unrest, or terrorism. It identifies

signs of the need for professional mental health 

support, coping tips during short- and long-term 

recovery, and signs of mental illnesses that may arise 

in the aftermath of exposure to violence. https:// 

media.voicesofseptember11.org/projects/tipsheets/ 

trauma_tips_mentalhealth_001.pdf 

 Parent Guidelines for Helping Youth after the Recent 

Shooting—In this 3-page tip sheet released shortly 

after a shooting, the NCTSN describes how such an 

event may affect children and teens as well as parents

and other caregivers. The tip sheet lists reactions 

common among people of all ages, offers coping

tips for caregivers, and suggests ways for caregivers 

to support children and youth in talking about and 

managing their reactions. https://www.nctsn.org/ 

resources/parent-guidelines-helping-youth-afterrecent-shooting 

Help Improve SAMHSA’s Disaster

Services and Products 

As a subscriber to this 

newsletter, you are 

invited to participate 

in a short, web-based 

survey to provide the 

SAMHSA Disaster 

Technical Assistance Center (DTAC) with 

feedback about your experiences with our 

products and services. The survey should take 

no more than 15 minutes. Complete the survey 

by clicking on this link, or copy and paste the 

URL https://iqsolutions.qualtrics.com/jfe/form/ 

SV_bjYCSJDUQAGi1h3 into your web browser. 

2022 | VOLUME 17 | ISSUE 3 | PAGE 15 
 

Request: SAMHSA DTAC received a request for 

a list of resources for those affected by recent bomb

threats to historically Black college and universities 

(HBCUs). 

Response: SAMHSA DTAC produced and sent a list 

of resources, a sampling of which appear in the list that 

follows. For the complete resource list, please contact 

SAMHSA DTAC at 1–800–308–3515. 

 SAMHSA Disaster Distress Helpline—The Disaster

Distress Helpline can provide immediate counseling to

anyone who is seeking help in coping with the mental

or emotional effects of the bomb threats that have been

made to HBCUs throughout the nation. Counselors

are available 24/7, by voice and text, to respond to

people who need crisis counseling after experiencing

a traumatic event or a disaster, at 1–800–985–5990.

https://disasterdistress.samhsa.gov

 Tips for College Students: After a Disaster or

Other Trauma—This fact sheet from SAMHSA

describes common reactions to trauma and provides

coping strategies and stress management tips for

college students. This fact sheet is also available in

Spanish at https://store.samhsa.gov/product/Tipsfor-College-Students-After-a-Disaster-or-OtherTrauma-Spanish-Version-/SMA13-4777SPANISH.

https://store.samhsa.gov/product/Tips-for-CollegeStudents-After-a-Disaster-or-Other-Trauma/

SMA13-4777

 Tips for Survivors: Coping With Grief After

Community Violence—This SAMHSA tip sheet

identifies signs of grief and anger after an incident

of community violence, provides useful information

about to how to cope with grief, and offers tips for

helping children with coping. https://store.samhsa.

gov/product/Coping-With-Grief-After-CommunityViolence/SMA14-4888

 Addressing Race and Trauma in the Classroom: A

Resource for Educators—This 11-page guide from

the NCTSN provides information about trauma,

historical trauma, and racial trauma. It identifies

effects of racial trauma by age group and suggests

steps educators can take to establish safe environments

for discussion, teach students about historical trauma

and racism, and encourage and empower students.

https://www.nctsn.org/resources/addressing-raceand-trauma-classroom-resource-educators

Request: SAMHSA DTAC received a request for a 

list of resources for Ukrainian Americans experiencing 

distress and grief related to the Russian invasion. 

Response: SAMHSA DTAC produced and sent a list 

of resources, a sampling of which appear below. Please 

contact SAMHSA DTAC at 1–800–308–3515 for the 

full list. 

 Tips for Survivors: Coping With Grief After a

Disaster or Traumatic Event—In this tip sheet,

SAMHSA defines and describes grief, discusses

ways of coping with grief, and explains complicated

or traumatic grief. The tip sheet also offers relevant

resources for additional support. https://store.samhsa.

gov/product/Tips-for-Survivors-/SMA17-5035 

 Tips for Survivors of a Disaster or Other Traumatic

Event: Managing Stress—This SAMHSA tip sheet

gives stress prevention and management tips for

dealing with the effects of a disaster or trauma. It

identifies common reactions to disasters and other

traumatic events, lists tips to manage and lower stress,

and highlights signs of the need for professional

support. https://store.samhsa.gov/product/Tips-forSurvivors-of-a-Disaster-or-Other-Traumatic-EventManaging-Stress/SMA13-4776

2022 | VOLUME 17 | ISSUE 3 | PAGE 16 
 

 Disaster Preparedness in Migrant Communities: 

A Manual for First Responders—In this 41-page 

manual for responders, the Lutheran Immigration and 

Refugee Service gives information on how to include 

communities it collectively refers to as newcomers— 

immigrants, refugees, migrants, asylum seekers, 

and unaccompanied children—in disaster planning, 

response, and recovery. It describes unique qualities of 

newcomer communities; recommendations; and tools 

to support disaster planning, response, and recovery 

that includes newcomers. https://www.lirs.org/ 

assets/2474/disaster_preparedness_for_migrant_ 

communities.pdf 

 Responding to Stressful Events: Helping Children 

Cope—This brochure contains information on 

helping children cope after disaster or acts of war. It 

highlights common reactions in children in specific

age ranges and describes how parents and other 

caregivers, families, and teachers can provide support. 

The brochure was developed by the Mental Health 

Support Network of Canada, a coalition of Canadian 

associations focused on mental health and stress 

management. https://www.canada.ca/en/publichealth/services/reports-publications/respondingstressful-events/helping-children-cope.html 

 Responding to Stressful Events: Helping Teens 

Cope—Developed by the Mental Health Support 

Network of Canada, this brochure advises parents and 

other caregivers and teachers on how they can support 

teenagers in coping with disasters or acts of war. The 

brochure describes common reactions to disasters 

in teenagers, ways adults can respond that may be 

helpful, and activities for teens that may help them in 

coping. https://www.canada.ca/en/public-health/ 

services/reports-publications/responding-stressfulevents/helping-teens-cope.html 

Request: SAMHSA DTAC received a TA request 

from a survivor of Hurricane Ida who asked for 

assistance in identifying possible financial resources to

assist with recovery needs after losing employment and 

transportation. 

Response: SAMHSA DTAC shared information 

regarding potential sources of assistance: 

 American Red Cross—Information specifically

about assistance after Hurricane Ida can be found 

at https://www.redcross.org/about-us/our-work/ 

disaster-relief/hurricane-relief/hurricane-ida-relief/ 

hurricane-ida-assistance.html. 

 Federal Emergency Management Agency—More 

information can be found at https://www.fema.gov/ 

disaster/hurricane-ida. 

 Catholic Charities—More information for 

Ida survivors is available at https://www. 

catholiccharitiesusa.org/help-for-victims-ofhurricane-ida. 

Are you looking for disaster behavioral health resources? 

Check out the new and updated 

SAMHSA DTAC Disaster Behavioral Health Information Series (DBHIS) installments. 

https://www.samhsa.gov/dtac/dbhis-collections 

2022 | VOLUME 17 | ISSUE 3 | PAGE 17 
 

RECOMMENDED RESOURCES 

SAMHSA Disaster Behavioral Health Information 

Series (DBHIS): Climate Change 

This part of the SAMHSA DBHIS resource collection 

includes a wide range of items related to preparing for and 

coping with climate change. This vetted collection features 

guides, fact sheets, recorded webinars, reports, and other 

resources on topics such as weather-related impacts of 

climate change; impacts of climate change on children’s 

health, public health, and mental health; populations 

at heightened risk in the face of climate change; and 

community resilience planning. 

Access the collection at https://www.samhsa.gov/resourcesearch/dbhis?rc%5B0%5D=type_of_disaster%3A21068. 

How Climate-related Natural Disasters Affect

Mental Health 

This article by the American Psychiatric Association covers 

how extreme weather events caused by climate change can 

increase stress and mental health issues. It explains how 

some people are more vulnerable to the potential effects of

climate change such as children, older adults, and people 

with mental illness. Related resources are also provided. 

This resource is available at https://www.psychiatry.org/ 

patients-families/climate-change-and-mental-healthconnections/affects-on-mental-health. 

Preparing for the Regional Health Impacts of Climate 

Change in the United States 

This report was developed by the Centers for Disease 

Control and Prevention’s National Center for 

Environmental Health. Each region of the United States 

experiences climate change and its impacts on health 

differently. This report can help states, counties, cities,

tribes, and territories better understand how climate change 

may affect their community, identify populations that are

most vulnerable, and prepare. 

The report is available at https://bit.ly/3orrLny. 

Climate Change 

This page from the Federal Emergency Management 

Agency has information on what is being done to 

address climate change and resources for emergency 

managers. The page features resilience initiatives, 

press releases about work related to climate change, 

materials to support emergency management in a world 

increasingly affected by climate change, and relevant

policy documents. 

Find the web page at https://bit.ly/3xXcLB8. 

Managing the Risks of Extreme Events and Disasters 

To Advance Climate Change Adaptation 

In this report, the Intergovernmental Panel on Climate 

Change explains the relationship between climate 

change and extreme weather, the effects extreme

weather can cause, and how to manage associated risks. 

Different chapters cover issues and opportunities at the

local, national, and international scale. Case studies 

that help illustrate examples of managing risk are 

also included. 

Find the report at https://bit.ly/3xX84ag. 

2022 | VOLUME 17 | ISSUE 3 | PAGE 18 
 

 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

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YdcavP7MI2y 

2022 | VOLUME 17 | ISSUE 3 | PAGE 20 
Prepare • Respond • Recover

Inform • Assist

SUBSCRIBE 

The Dialogue is a publication for professionals in the disaster behavioral health field to 

share information, resources, trends, solutions to problems, and accomplishments. Contact 

SAMHSA DTAC to be added to The Dialogue subscription list. 

SHARE INFORMATION 

Readers are invited to contribute to The Dialogue. To author an article for an upcoming issue, 

please contact SAMHSA DTAC at dtac@samhsa.hhs.gov. 

ACCESS ADDITIONAL SAMHSA DTAC RESOURCES 

The SAMHSA DTAC Bulletin is a monthly e-communication used to share updates in the field, 

post upcoming activities, and highlight new resources. Contact SAMHSA DTAC to be added 

to the SAMHSA DTAC Bulletin subscription list. 

The SAMHSA Disaster Behavioral Health Information Series contains resource collections 

and toolkits pertinent to disaster behavioral health. Installments focus on specific populations, 

specific types of disasters, and other topics related to all-hazards disaster behavioral health 

preparedness and response. Visit the SAMHSA DTAC website at 

https://www.samhsa.gov/dtac/dbhis-collections to access these materials. 

CONTACT US 

SAMHSA Disaster Technical 

Assistance Center 

Toll-free: 1–800–308–3515 

dtac@samhsa.hhs.gov 

https://www.samhsa.gov/dtac