When Hurricane Melissa struck Jamaica on 28 October with 185mph winds, destroying homes, hospitals and infrastructure, killing 32 people and affecting 1.5 million, Toni-Jan Ifill immediately realised it would leave many with long-term traumatic memories.
A month and a half after the storm, which also affected eastern Cuba, the clinical psychologist says recollections of the terrifying winds also haunt some of the staff at the University Hospital of the West Indies in Kingston. Even the sound of rain can cause trauma responses among people who lived through it.
“Simple things can trigger them,” Ifill says. “One woman mentioned a trolley we often push through the corridors, carrying bedding and other items, whose sound reminded her of cracking branches and the wind. She no longer wants to hear that sound.”
Hurricane Melissa, a category 5 storm, led to a package of up to $6.7bn over three years and an additional $150m (£112m) payout from Jamaica’s pioneering catastrophe bond for reconstruction, partially covering the estimated $9bn in economic losses. But the financial relief, experts warn, cannot cover the unseen cost: the widespread trauma – especially among those still recovering from Hurricane Beryl in 2024.
While most attention focuses on physical reconstruction, studies over the past three years show that post-traumatic stress disorder (PTSD) risks increase after hurricanes and displacement. Experts are calling for the integration of mental health into climate-disaster policy across Caribbean small island developing states.
Researchers emphasise how extended displacement, loss of livelihoods and inadequate services worsen mental health risks. A 2023 Caribbean-focused paper warned of a significant risk of PTSD, depression and anxiety after climate-related events. A qualitative study in Dominica this year also documented anxiety, fear and emotional distress among people displaced by Tropical Storm Erika and Hurricane Maria.
Dr Eamin Heanoy, a researcher at the University of Alberta, studied disaster survivors across a broad range of countries, including Mexico, India, Canada, Bangladesh, Germany, the US and Indonesia. Her qualitative review, published last year in the journal Healthcare, says that survivors could face three mental health challenges after a natural disaster: PTSD, depression and anxiety.
Dr Rose-Ann Smith, a lecturer in geography and disaster risk management at the University of the West Indies in Jamaica, agrees with this assessment. She notes that humans are generally resilient, but as the climate crisis worsens, mental health is becoming an increasingly significant issue – although prevalence surveys are lacking.
Smith and Heanoy found that women reported higher mental distress than men. “So it’s quite possible women are more psychologically vulnerable than males [in such catastrophes],” Smith says.
Heanoy says that while some initial improvement in mental health occurs within a year, long-term outcomes remain uncertain. Whether or to what extent disaster survivors who experience mental challenges recover will depend to a large extent on what triggered their illness.
The experts observe that during and in the immediate aftermath of a disaster, loss of homes and resources can intensify the mental struggle to rebuild. Smith calls housing loss “one of the primary stressors”, particularly when insurance or savings are lacking. “Rebuilding comes with its own mental burden,” she says.
Ifill observes the same among her patients: “People who had mental health challenges before have noticed it’s significantly worse in this short period of time.”
Hurricane Melissa destroyed two of Jamaica’s most prominent river water intakes, delaying the complete restoration of water supplies. Even if the catastrophe bond payout provides some relief, it cannot resolve all of Jamaica’s infrastructure problems in the aftermath.
And, as experts highlight, rebuilding alone cannot heal emotional wounds caused by permanent disabilities or the loss of loved ones. Heanoy reports that survivors consistently find community support to be more responsive than government assistance. Smith observes that communal ties strengthen resilience.
“The government’s role is essential,” Smith says. “In its absence, or when it is slow, communities keep each other whole.”
In times of disaster, Ifill says, mutual support from communities helps overcome challenges. She says she was “impressed by the sense of humour and relaxed manner” among strong communities in Jamaica. “Your house is gone, right? But if a community has more jovial people, they make jokes about the storm.”
Ifill also praises Jamaica’s government for encouraging citizens to look after their mental health after Melissa, but warns about the harms of doomscrolling. “I recommended [staff] limit social media, stick to reliable news, and use WhatsApp to connect with family.”
Mental health has garnered greater attention from international agencies over the past decade because of the climate crisis, as scientists have realised that the frequency of hurricanes and other extreme weather events is increasing.
The World Health Organization published a booklet on psychological first aid in 2011 to guide field workers when dealing with survivors of traumatic events. The Pan American Health Organization (Paho) has also published guidelines, with documents released in 2016 and 2019 on psychological coping strategies and psychosocial support in response to natural disasters in the region.
The Caribbean Development Bank has also taken steps to help deal with such psychological trauma. Its president, Daniel Best, says that feedback from communities and staff members on the ground led the bank to initiate a psychosocial support programme in 2018 in conjunction with Paho. The project was designed to build individual and social resilience in the event of a disaster by training mental health professionals, creating a regional expert roster for emergency response, combating stigma and encouraging the use of mental health services.
Mental health needs assessment and action plans for care and psychosocial support, Best says, adding that all of the bank’s borrowing member states can benefit from that project.
Support from international organisations is crucial, as mental health is often not the top priority in governments’ responses to climate disasters. Experts such as Heanoy say that when survivors cannot rebuild or restore their pre-disaster lives, research shows that the trauma could persist, reducing the chances of full recovery.
Kieron Chaboo, a farmer from Orange Grove, Trinidad and Tobago, who lost all the crops on his 30-acre (12-hectare) farm during massive floods in 2018, highlights the crucial role of financial resources in safeguarding mental health.
He says he has always saved money with flood loss in mind, as he does not rely on government assistance to rebuild his life. Seven years after the disaster, he feels frustrated as he has yet to hear from officials responsible for compensating farmers for their losses. “They came and did their investigation,” he says. “But up to this day, we never got compensation.”
Best notes that the region accounts for less than 1% of global emissions but bears disproportionate climate impacts, and says that a swift, well-funded recovery is critical to prevent such prolonged suffering.
“Our reality and our infrastructure do not match the climate conditions that we are facing. Attempting to rebuild an entire country to make it climate resilient is going to take time,” he says, adding that winds of 185mph (300km/h), as experienced in Jamaica, will inevitably cause significant destruction.
He says the money needs to be available to enable countries to access and develop at the appropriate level. “If we can have structures that can withstand [major hurricanes], that means we will lose fewer people, and we will lose fewer of our possessions,” Best says. “If we can reduce loss, then it gives us a fighting chance to be mentally and psychosocially a bit more grounded.”
