When Disasters Strike

By Grant H. Brenner, MD; Sander Koyfman, MD; and Kathleen Clegg, MD; and the Committee on Disasters, Trauma and Global Health at the Group for the Advancement of Psychiatry

As COVID-19 first broke in March 2020 and California wildfires raged, one thing became clear: The field of psychiatry needed a new way of thinking about and responding to complicated, overlapping disasters. Thus was born the Model for Adaptive Response to Complex Cyclical Disasters (MARCCD), developed collaboratively by the GAP Committee on Disasters, Trauma and Global Health; Vibrant Emotional Health Disaster Services, and Decision Point Health Systems (now part of mPulse), with an emphasis on behavioral health.

Extant models—nearly 40 in the literature—did not cover all bases in one conceptual approach. For example, Phases of Disaster Model (below) is a single path over time, addressing one event. It still resonates, but as disasters are expected to become more frequent, more is required.

MARCCD, on the other hand, revises the phases of a disaster; 2) identifies key groups of people involved (the "Faces of Disaster"); and 3) discusses how to manage stress when crisis hits. It also addresses handling community resources needed at any single point in time, plus managing resources over longer periods when many problems may be occurring at once.

Phases of Disaster

Four phases of disaster are identified and viewed as interconnected stages: Anticipation, Impact, Adaptation, and Growth & Recovery. Depending on circumstances, disasters can cycle back to earlier phases.

For example, during COVID-19, the impact of one wave informed anticipation of the next. Those less cautious who became ill took more precautions the next time to avoid getting sick, and they experienced a corresponding shift in feelings and expectations. The Impact phase loops back to Anticipation, illustrating how MARCCD captures cyclical and overlapping phases.

Anticipation Phase

Anticipation phase involves expecting disaster is about to hit.

Key actions during this phase:

• Risk Communication: Conveying potential risks to all stakeholders.
• Resource Readiness: Ensuring essential supplies and systems are in place.
• Community Engagement: Educating and involving community members in preparedness efforts.
• Leadership: Educating leaders in risk communications, disaster response, and disaster behavioral response.

Impact Phase

The impact phase begins when disaster strikes. It may be brief, as in an earthquake, though with aftershocks, or prolonged, like storms or wildfires. The immediate focus is survival, mitigating damage, providing basic resources and Psychological First Aid (PFA).

Key considerations:

• Immediate Response: Mobilizing first responders and ensuring basic needs of food, water, and shelter are met.
• Communication: Providing accurate, timely information to prevent panic and confusion.
• Safety and Stability: Protecting vulnerable populations and restoring a sense of order.

Adaptation Phase

Once the initial shock subsides, communities transition into the Adaptation phase, which involves adjusting to a new normal, whether temporary or long-term.

Key actions:

• Stabilization: Re-establishing basic infrastructure and services.
• Community Support: Offering mental health resources and social support to those affected.
• Long-Term Planning: Addressing systemic changes to reduce future vulnerabilities.

Growth & Recovery Phase

The focus shifts to healing and rebuilding, not only returning to baseline functionality but also striving for post-traumatic growth (PTG).

Key elements:

• Restoration: Rebuilding physical infrastructure and restoring services.
• Reflection: Learning from the disaster to improve future preparedness.
• Empowerment: Encouraging individuals and communities to find meaning and strength in their experiences.

Faces of Disaster

MARCCD emphasizes the importance of recognizing diverse groups affected by disasters:

• Survivors: Individuals and communities directly affected by disaster.
• Community Leaders: Local leaders play critical roles in resource allocation, communication, and rebuilding efforts.
• Responders: Emergency personnel and volunteers, first to face the disaster’s challenges.

Healthy Stress Regulation

Effective disaster response hinges on regulating stress at individual, community, and systemic levels. MARCCD adopts a dynamic model to illustrate the importance of maintaining equilibrium within a window of operating parameters (homeorhesis model), rather than a fixed (homeostasis) state, to preserve and bolster function, and know when to pause and rest.

Key concepts:

• Optimal Stress Zone: Balancing under-regulation (chaos) and over-regulation (paralysis). Paying attention to self-care, helping colleagues stay regulated together.
• Autonomic Nervous System: Understanding how stress affects biological and emotional responses.
• Sustainable Coping: Encouraging self-care, community support, and resource-sharing to manage prolonged stress.

Community Balance Sheet

Community Balance Sheet provides a snapshot of community resources and vulnerabilities before, during, and after a disaster. A township, for example, needs to keep stock of emergency supplies, populations with particular needs, and consider how different types of disasters strain resources, planning accordingly.

Key features:

• Inventory of Resources: Identifying what is available, what is needed.
• Time Course: Understanding how resources fluctuate throughout a disaster.
• Strategic Planning: Using the balance sheet to inform decision-making and improve resilience.

Stress Load Threshold

Stress Load Threshold highlights the cumulative impact of disasters on a community’s capacity to cope. This visualizes how chronic stressors, foundational issues, and new disasters interact, straining resources and community resilience.

Key insights:

• Chronic Stressors: Long-standing challenges, such as poverty or inadequate infrastructure.
• Additive Effects: How existing stressors intensify the impact of new disasters.
• Protective Factors: Elements that bolster resilience, such as community cohesion or robust leadership.

MARCCD was developed to offer a high-level framework for understanding complex, overlapping factors that shape disaster response, with an emphasis on behavioral health. It highlights distinct phases of disaster, roles of key stakeholders, and how communities can process the impact of crises within historical, cultural, and socioeconomic contexts.

As development of the model continues—including a video series with the state of Missouri (below)—stakeholders are encouraged to explore how MARCCD can be applied in their own settings to guide preparedness, inform real-time decision-making, and support long-term recovery.

Special thanks to Vinh-Son Nguyen and April Naturale for their important contributions to this article.