How I Became an Accidental Disaster Mental Health Specialist

On Sunday, October 8, 2017, I was throwing my daughter’s 1st birthday party in the backyard. She had been a colicky infant, so reaching this milestone felt like a victory to celebrate. My young family had just made a dramatic and bittersweet lifestyle leap. We decided to leave our village in San Francisco and a cozy 650-square-foot apartment on the fourth floor with no elevator and settle north in Healdsburg, a small town with a tight-knit community nestled in the beautiful Sonoma wine country. As we watched my baby smash her cake with ferocity, I marveled at the new friends we had already made in a few short months.

That night, exhausted but happy and hopeful for this new life chapter, we cleaned up decorations and got the kids ready for bed. It had been a hot day and very windy—I did not think too much about it. Originally a Tarheel from North Carolina, I could not possibly know what was coming.

While my family slept, the horrors of the Tubbs Fire unfolded. Twenty-two souls perished and nearly 6,000 structures burned in a matter of hours. Homes, schools, places of worship, shopping centers, parks, workplaces—multiple anchor points on the community map—disappeared. No warnings. No instructions. It was an unparalleled living nightmare. I awoke to a litany of texts and calls from friends and family near and far. “Are you safe? What’s going on there? Get out now!”

We did not lose our home that night, but our sense of safety was permanently violated. I was homesick, yet we had not gone anywhere. Disaster was now on my doorstep and no longer something only seen in newspapers or on TV.

For the next 23 days, I lived in terror fed by adrenaline, choking from toxic smoke and ash. My prefrontal cortex was in fight or flight mode as we packed passports, the kid’s favorite stuffed animals, my little brother’s ashes, and eight ripe bananas—and then evacuated. Later, when we returned, a family who lost everything came to stay with us. We witnessed their disbelief and grief. It was so heavy—almost surreal. However, as a psychologist all too familiar with trauma and resilience, I wanted to be a survivor and not a victim of this crisis.

After the Fire

After the fire, I decided not to be a bystander in the face of this historic and collective trauma. Other local healthcare leaders—many total loss survivors—felt similarly.  There was an urgent call to address the growing mental health needs in the community. We did not want a legacy of post-traumatic stress disorder (PTSD), substance abuse, divorce, first-responder suicide, student languishing, and communal suffering. Instead, we asked, “What if we got this part of the recovery process right or at least made it a little better?”

Together, we founded the Sonoma Wildfire Mental Health Collaborative to ensure that everyone impacted had access to free, science-backed mental health support. This included building a mobile mental health app in English and Spanish (Sonoma Rises), providing trauma-informed yoga sessions in the community, and training over 400 local mental health providers and paraprofessionals in Skills for Psychological Recovery.

I am so grateful a disaster mental health safety net was created after the Tubbs Fire because our community did not burn in a megafire just once—it burned three times in four years. In this polycrisis, recovery was still far away when we got hit by the Kincade Fire in 2019 and the Wallbridge and Glass Fires in 2020, during a global pandemic. With each evacuation, I held my breath, hugged my children, cried, and promised myself I would do something constructive with this lived experience.

Those who live through a disaster join the worst “club,” but be assured that this club has some of the best people. Transforming pain into purpose is deeply meaningful, and it is the portal by which I became an accidental disaster mental health specialist.

In partnership with After the Fire, my colleagues and I have now taken the lessons learned in Sonoma and shared them with other communities, such as Paradise, Lahaina, and Los Angeles. There is a path to getting survivors back home and they do not have to walk it alone.

Posttraumatic Growth and Wisdom

Injuries from disasters are largely invisible—they are the psychological wounds people carry. Amid lengthening fire seasons and more frequent and severe natural disasters, we face profound existential threat.  An unprecedented planetary boundary may be breached and the choice now is to adapt with emotional intelligence and rise to meet the moment. Accomplishing this requires fortification of community psychological immune systems to endure what is to come. We must plant seeds of hope that ignite collective action and build the infrastructure to carry it out.

There are many ways to live, love, and work within a tragedy. Embracing Viktor Frankl’s tragic optimism is a powerful framework for holding light in the dark. When figuring out how to tackle the polycrisis of overlapping disasters coupled with political and economic uncertainty, I can feel intensely overwhelmed some days. But looking around and seeing the helpers, the emergent leaders, and the innovators who are born of disaster, I am energized.

Many professionals working in disaster management may feel overwhelmed and at risk of burnout. It is important to remember that, even when covered in dirt and muck, the communities being served are seeds that can sprout despite adversity. People have the capacity to grow from pain and become more resilient and better prepared to fight the storms ahead. No one asks for a character-building lesson, but post-traumatic growth, wisdom, and recovery are possible with the right support and can be seen every day.

Reimagining Mental Health and Psychosocial Recovery After Disaster

In the years following a disaster, many survivors find themselves experiencing post-traumatic stress, ecological grief, disruptions in sleep, mood, and functioning, and added financial strain. Notably, only a subset of survivors will seek formalized care for post-disaster struggles, due to barriers such as cost, challenges with access, competing demands on their time, stigma, and comparative suffering—a condition in which individuals underutilize resources so as not to take a spot from someone they perceive to be more deserving (e.g., “I didn’t lose my home; it just has some water/smoke damage”).

Although the majority of survivors will not develop clinical pathology like PTSD, the absence of a diagnosis does not equate with wellness or provide conditions for flourishing. The reality is that there are not enough trained mental health providers to respond to the magnitude of need. An innovative, multi-pronged, and scalable public health approach to delivering support to disaster survivors across the continuum of need is necessary to prevent and heal disaster trauma.

• Approach mental health recovery as a long game (e.g., five years). Addressing the emotional wounds of disaster is equally as important as rebuilding
• Support the supporters. Proactively implement programs to care for leaders. Sustain and support the mental health of anyone serving disaster-impacted community members.
• Dissemination and implementation are mission critical. Just because mental health services and resources are available does not mean communities will know about and utilize them. Launch a public messaging campaign, co-locate services where affected communities already gather (schools, places of worship, barber shops, etc.), integrate into primary care settings, use mass texting, and train student mental health ambassadors to share information and resources with peers.
• Invest in, build, and support scalable technology that increases survivor agency and bolsters community mental health. Mobile apps are a critical part of the disaster recovery ecosystem and can reduce barriers to accessing support (free apps: PTSD Coach, Bounce Back Now). Apps can be deployed rapidly, be readily translated into other languages, and provide anyone who has a smartphone with instant access to mental health education, tools for coping, and connection to tactical resources. 
• Leverage trusted community leaders and paraprofessionals. Faith leaders, community elders, teachers, first responders, community organizers, etc., can provide mental health support beyond formal healthcare settings and refer those in need to higher levels of care.
• Avoid duplication—support the capacity for vetted mental health programs already in place. Shore up existing public services and community organizations to optimize and sustain their impact. Create a resilience hub that connects mutual aid programs, cross-maps resources, and centralizes information streams to provide what the community needs while reducing the administrative burden that leads to burnout.
• Build with, not for. Co-design a shared vision with the community. Create an advisory panel of individuals with different perspectives and lived experiences. Stakeholder feedback is essential for successful outcomes in the long run but also for giving agency and hope when the rebuilding process may feel slow and frustrating.
• Host community events to facilitate neighbor relationships. The block captain model was used following the Tubbs Fire and later in Los Angeles. In the event of disaster, block captains disseminate information using the hub-and-spoke model and facilitate conversations for healing and connection.
• Create low-cost, accessible nature-based options for healing.
• Set aside space and resources for public art by community members. This can serve as a beacon of hope and visual reminder of progress.

The traditional mental health system is not equipped to handle the consequences of worsening disasters. For survivors and impacted communities, the emotional toll does not end with the disaster itself. The second wave of trauma often comes from trying to navigate the overwhelming recovery process. This moment in time offers a compelling opportunity to (1) create innovative ways to democratize access to mental health support, and (2) set the conditions for transformational resilience to safeguard society and build mental wealth.

Acknowledgments: This article is the result of work supported with resources and the use of facilities at the National Center for PTSD. Support for this work was also provided by the Climate and Health CAFE Public Narrative Workshop, which teaches healthcare workers, researchers, and leaders how to tell stories that inspire change and action. The workshop is a joint effort between the schools of public health at Boston University and Harvard University and is funded by the National Institutes of Health Climate Change and Health Initiative.

Disclosure: The expressed views are solely those of the author and do not necessarily represent those of the U.S. Department of Veterans Affairs. Dr. Heinz serves as an adviser for Space of Mind.