Disaster relief shelter experience during Hurricane Sandy: A preliminary phenomenological inquiry

Journal Pre-proof Disaster relief shelter experience during Hurricane Sandy: A preliminary phenomenological inquiry Alyssa L. Basile PII:

S2212-4209(19)30341-3

DOI:

https://doi.org/10.1016/j.ijdrr.2019.101466

Reference:

IJDRR 101466

To appear in:

International Journal of Disaster Risk Reduction

Received Date: 19 April 2019 Revised Date:

14 December 2019

Accepted Date: 30 December 2019

Please cite this article as: A.L. Basile, Disaster relief shelter experience during Hurricane Sandy: A preliminary phenomenological inquiry, International Journal of Disaster Risk Reduction (2020), doi: https://doi.org/10.1016/j.ijdrr.2019.101466. This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2019 Published by Elsevier Ltd.

Running head: DISASTER RELIEF SHELTER EXPERIENCE

Disaster Relief Shelter Experience During Hurricane Sandy: A Preliminary Phenomenological Inquiry Alyssa L. Basile1 Monmouth University, 400 Cedar Avenue, West Long Branch, NJ 07764 [email protected] Declaration of Interest: None

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Address: 728 Greens Avenue, Apt 7, Long Branch, NJ 07740

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DISASTER RELIEF SHELTER EXPERIENCE Abstract There is limited research on the psychological experience of residing in a disaster relief shelter during a natural disaster, especially during Hurricane Sandy. To better understand and improve occupants’ and staff members’ experiences in disaster relief shelters, preliminary phenomenological research was conducted on the shelter experience. Three former staff members at a disaster relief shelter during Hurricane Sandy in 2012 were interviewed on their experience working in a disaster relief shelter, their perception of shelter occupants’ psychological challenges, the beneficial aspects of the shelter, and their recommendations to improve future shelters. Participants discussed their perception of shelter occupants’ intensified feelings of anxiety, depression, and frustration while in the shelter. Participants discussed their view of occupants feeling overwhelmed, exhausted, and frustrated. Participants reported occupants and staff experiencing additional health complications in the shelter. While beneficial aspects of the shelter were reported, participants highlighted the importance of future shelters having a wider range of medical resources, more therapeutic services for adolescents, enhanced procedures to transition occupants out of shelters, and stronger psychological support for staff. Keywords: Hurricane Sandy, disaster relief shelter, lived experience, challenges

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Disaster Relief Shelter Experience During Hurricane Sandy: A Preliminary Phenomenological Inquiry 1. Introduction Millions of people are affected by natural disasters per year (Guha-Sapir, Vos, & Below, 2012). Disaster victims are at greater risk for experiencing mental health challenges, especially those who have resided in a disaster relief shelter (Kun, Han, Chen, & Yao, 2009). Considering the prevalence of natural disasters and the mental health risks associated with experiencing a disaster and residing in a disaster relief shelter, this study was intended to better understand staff members’ experiences in shelters to improve future shelter experiences. Previous research cites the psychological challenges of natural disasters, risk factors for having difficulty in coping with disasters, and protective factors for coping with disasters. Psychological challenges refer to negative feelings that were experienced such as anxiety or depression. While research identifies disaster victims’ psychological challenges, there is little research to date on the psychological challenges specifically for disaster victims who resided in disaster relief shelters. Current research on the risk factors and protective factors for disaster victims is also not specific to people who resided in disaster relief shelters. This study will expand previous research by reporting staffs’ experience and their view of occupants’ lived experience of residing in a disaster relief shelter during a natural disaster, mainly focusing on psychological challenges. The lived experience consists of a detailed explanation of a given issue from people who have lived through the experience, which is intended to better understand an issue (Hopkins, Regehr, & Pratt, 2017). Since there is little research to date on disaster victims’ psychological challenges from Hurricane Sandy, this study was completed on the aftermath of Sandy.

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1.1.Hurricane Sandy Hurricane Sandy was a tropical cyclone (10/22/2012-11/2/2012) that became a Category Three storm that especially impacted the Tri-State area (New York, New Jersey, and Connecticut) (Blake, Kimberlain, Berg, Cangialosi, & Beven II, 2013). In the United States, there were 159 reported deaths from Sandy (Blake et al., 2013). More than 650,000 homes were damaged or destroyed (HUD, 2013), 8.5 million people lost power (Blake et al., 2013), and millions of people became homeless (Hurricane Sandy Rebuilding Task Force, 2013). Hundreds of businesses were damaged or forced to close at least temporarily (HUD, 2013). The storm caused 65 billion dollars’ worth of damages and economic losses (Blake et al., 2013). In New Jersey, 2 hospitals were evacuated, 12 residential facilities closed, and 1,408 patients were evacuated (Hurricane Sandy Rebuilding Task Force, 2013). In New York, 6 hospitals and 26 residential facilities closed, 10 hospitals stayed open despite flooding and/or power outages, and 8% of hospital beds were unavailable after Sandy (Hurricane Sandy Rebuilding Task Force, 2013). 1.2. Psychological Challenges Numerous psychological challenges may be experienced after natural disasters (e.g., Briere & Elliott, 2000). Some commonly reported challenges are: doubting one’s safety in their community (Prewitt Diaz & Dayal, 2008), suicidality, vocational difficulties, physiological changes (American Psychological Association [APA], 2015), and physical symptoms (APA, 2015; Norris, Friedman, & Watson, 2002). It is also common to experience difficulty in making decisions, concentrating, eating, and/or sleeping after disasters (APA, 2015). Victims may experience these challenges long after disasters have occurred.

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Following disasters, victims are more at risk for developing psychological disorders. Post-Traumatic Stress Disorder (PTSD) is the most common diagnosis among victims after disasters (Norris et al., 2002). Depression is the second most commonly diagnosed disorder, followed by anxiety (Norris et al., 2002). Victims are also of greater risk for developing substance abuse problems and psychological adjustment disorders (Norris et al., 2002). Most victims’ symptoms decline over time following disasters (Pietrzak et al., 2012). 1.3. Risk Factors The more traumatic a disaster, the greater the mental health risks for victims. The following experiences are associated with greater post-disaster symptoms: displacement from one’s home or lack of resources for over a week, loss or damage to personal property or sentimental possessions, personal or household members’ health problems, financial loss, increased relationship demands (Lowe, Tracy, Cerdá, Norris, & Galea, 2013), incurring an injury, having a threat to one’s life, experiencing a loss, living in a disrupted or traumatized neighborhood, or other severe causes of stress (Norris et al., 2002). Some victims are more resilient than others. Older adults are more at risk than younger adults (Parker et al., 2016). Children are more likely to struggle than adults (Lieberman & Knorr, 2007), although adolescents have fewer depressive and/or PTSD symptoms than adults (Jacobs & Harville, 2015). Children who have more psychological stress prior to disasters (e.g., history of trauma, limited social support [Tang, Liu, Liu, Xue, & Zhang, 2014], homelessness, or experiences with violence, foster care, special needs, or lower socioeconomic status) have a harder time coping with disasters than other children (Madrid, Grant, Reilly, & Redlener, 2006; Vernberg & Vogel, 1993).

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For adults, there are greater mental health risks for those who are female, unmarried, religious, fearful (Tang et al. 2014), an ethnic minority (Kun et al., 2009; Norris et al., 2002), divorced (Hunt, Al-Awadi, & Johnson, 2008), a cigarette smoker (Velden, Grievink, Gersons, & Kleber, 2007), and/or who are impoverished (Kun et al., 2009; Norris et al., 2002; Pollack, Weiss, & Trung, 2016). Additional adult risk factors include: prior exposure to trauma, limited education (Tang et al., 2014), prior psychiatric history, lacking a supportive home environment, lacking social resources, and living with a spouse or children. People who believe that they have limited control over their lives (Norris et al., 2002) or believe that their lives are more in danger after a disaster also experience more mental health implications (Jacobs & Harville, 2015). Tang et al. (2014) reported that having religious beliefs is a risk factor; however, Putman et al. (2012) identified religious faith as a protective factor. Participants in Tang et al. (2014)’s study may have believed that natural disasters are considered to be a punishment from God, which may have intensified negative feelings (Chen & Koening, 2006). Victims residing in a disaster relief shelter or temporary home experience greater mental health risks, especially for developing PTSD (Kun et al., 2009). Disaster relief shelters are temporary housing facilities for people who do not have safe and/or stable housing during a disaster (Bashawri, Garrity, & Moodley, 2014). Victims residing in shelters may have greater risks because they may experience more distress since shelters do not always have enough food and water (Brodie, Weltzien, Altman, Blendon, & Benson, 2006) or accommodations for pregnant women or people with dietary restrictions (Callaghan et al., 2007). Shelter occupants have also complained about crowding and limited privacy in shelters (Warchal & Graham, 2011). Shelter occupants likely have less support and/or financial resources than disaster victims who did not reside in a shelter as occupants did not have any other temporary housing options.

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Poor support (Tang et al., 2014) and financial distress are mental health risk factors (e.g., Pollack et al. 2016). Therefore, occupants may be more psychologically vulnerable. 1.4. Protective Factors Protective factors reduce victims’ mental health risks (e.g., McGuire et al., 2018). Some protective factors include: being married, having advanced education (Hunt et al., 2008), having religious faith (Putman et al., 2012), strong social support (McGuire et al., 2018), less media exposure, fewer negative worldviews, less emotional suppression, less denial, less self-blame, strong coping strategies, and willingness to seek out emotional support (Butler et al., 2009). Utilization of relationship building activities (Prewitt Diaz & Dayal, 2008), animal-related activities (Thompson et al., 2014), psychological first aid (PFA) (Fox et al., 2012), eye movement desensitization and reprocessing (EMDR) (Natha & Daiches, 2014), faith-based exercises (Putman et al., 2012), and mental health counseling are also protective factors (Boulanger, 2013). Therapy is a significant resource for disaster victims; however, counseling challenges may arise during disasters. Therapists tend to live in close proximity to their clients; thus, therapists could also be affected by disasters, which could compromise their objectivity (Boulanger, 2013). Shared traumas may occur, where “both therapist and patient are involved in the process of mourning at the same time over the same loss” (Tosone et al., 2003, p. 75). Therapists’ offices may have been damaged or destroyed, making it challenging to find a safe, private location for therapy, especially for shelter occupants. Therefore, therapists have used temporary spaces, seen clients in multiple offices, and held sessions over the phone. Therapists have reached out to their more vulnerable clients to assure their safety, whereas their clients usually reach out to them (Boulanger, 2013). Therapists have also taken personal phone calls

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during sessions to ensure confirmation of crucial consultations such as insurance companies, contractors, and/or roofers (Boulanger, 2013). Therapists have disclosed more personal information after disasters to inform clients of their safety (Boulanger, 2013). Despite these efforts, some clients reported that these changes in the dynamic complicated their treatment (Boulanger, 2013). Thus, therapy may be less of a protective factor during natural disasters. 2. Present Study Existing research reports the potential impact of disasters, risk factors, and protective factors in coping with natural disasters; however, there is limited research on the experience of residing in disaster relief shelters. This study will assess: What was shelter staff members’ psychological experience when residing in a disaster relief shelter during Hurricane Sandy? What was shelter staff members’ perception of the shelter and ways to improve it? Hurricane Sandy, was analyzed because there is limited research on this storm. Hurricane Sandy is also a recent, severe disaster; therefore, it is predicted that analyzing this disaster will provide relative, current information on disaster relief shelters. It was predicted that staff members experienced several psychological challenges such as intensified anxiety, depression, and feeling overwhelmed and exhausted. This preliminary study is explorative in nature with limitations that are discussed. 3. Methodology Husserl’s (1962) phenomenological method was used for analysis and collection of data. The author conducted semi-structured interviews, in which the participants were asked standard questions as well as questions that were specific to them as based on the participants’ responses (Semrau, Evans-Lacko, Koschorke, Ashenafi, & Thornicroft, 2015). Phenomenological

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interviews are typically relatively unstructured to provide the freedom to explore emerging concepts and allow interviewees to take the lead when appropriate (Brinkmann & Kvale, 2005). The participants were former staff members at a disaster relief shelter at a medium-sized private university in the Northeast United States during Hurricane Sandy. Participants were recruited through purposive sampling. They were selected because they played a large, widely divergent, professional role in the shelter. By having these roles, participants were expected to provide diverse insight of the shelter experience. Participants included a security guard who upheld the role of a shelter manager, a nurse, and a Disaster Response Crisis Counselor (DRCC)2. There was one male participant and two female participants, who were all EuropeanAmerican. The participants ranged in age from 55 to 60 years, with a mean age of 56.67. While there is a small participant pool, saturation was considered reached because participants provided insight that addressed the goal of the study. The participants received an email with a brief overview of this study, requesting their participation in a one-hour interview, offering no financial incentive. Participants arranged an individual interview in a classroom at a private university in the Northeast United States. The researcher, having no pre-existing relationships to the participants, conducted the interviews. Prior to the interviews, participants were informed that their names and the shelter in which they worked would not be disclosed to protect their anonymity. Participants were informed that their participation was voluntary, they would be digitally audio-recorded, and that the interview could

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DRCC- A volunteer for the Emergency Response Network, who helps communities affected by

disasters (NJ Department of Human Services, 2015).

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provoke any unresolved feelings regarding the shelter experience. They were given mental health resources to mitigate the risk of psychological distress if provoked by the interviews. After informed consent was obtained, participants were asked to describe their experience in the shelter and their psychological challenges. They were also asked to describe their perception of occupants’ shelter experience and their psychological challenges. Participants were also to report their recommendations to improve future shelters. Some standard interview questions were used and some interview questions were modified in the interview based on participants’ responses. For example, the shelter manager answered some of the interview questions before he was asked them; therefore, he was not asked those questions. The researcher probed with further questions throughout the interviews to clarify responses and obtain more information on the experience. Following the interviews, the participants completed a demographic form and were debriefed on the rationale for the study. Interviews lasted between forty-five minutes to an hour and four minutes (See Table 1 for interview questions). Participants’ interviews were transcribed verbatim, grouped thematically, and direct quotes were utilized to illustrate staff members’ report of their shelter experience and their perception of shelter occupants’ experiences. Participants’ reports were grouped thematically, meaning categorized based on psychological associations (Tinkham, 1997). The categories include: staff members’ psychological challenges, occupants’ perceived psychological challenges, occupants’ observed individual differences in coping, perceived beneficial aspects of the shelter, and overall view of the shelter. Interviewees’ recommendations to improve future shelters were also reported. To try to prevent bias, the researcher reported potential alternative explanations for results in the discussion section. 4. Results

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Based on participants’ interviews, staff members’ experiences in the shelter and their perception of occupants’ shelter experience was discussed. Participants reported staff members’ psychological challenges (See Table 2) and their perception of shelter occupants’ psychological challenges (See Table 3). Some occupants reportedly coped better than others. Participants’ perception of occupants’ variations in coping abilities were identified (See Table 4). Beneficial aspects of the experience for staff members (See Table 5) and perceived beneficial aspects of the experience for occupants (See Table 6) were discussed. While the participants reported that the shelter was successful, participants provided suggestions to improve staff members’ (See Table 7) and occupants’ (See Table 8) future shelter experiences. These reports are discussed in greater detail below. 4.1. Staff Members’ Reported Psychological Challenges Participants described the shelter population as a diverse, vulnerable group of people. The nurse stated, “A lot of psychological issues for these folks. A large part of the population that comes in is our population that is seeing counselors regularly. We have our drug addicted population, we had seniors who were extremely depressed, so we had a large variety.” This description depicts occupants’ as having psychological vulnerability, which may mean that the staff had a challenging role to try to support and stabilize the occupants. The DRCC depicted the shelter experience as overwhelming for staff to try to meet occupants’ needs, stating: When you go to the shelter for the first time as a responder, I was going to tell my friends or just new kids, interns, people that are new to the field, you are going into ‘shelter shock.’ I call it that because it’s like so overwhelming; it’s like a mass of people who are

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the disenfranchised. Folks in the shelter are the elderly population, are people with special needs, mental illness, addiction. It’s the ones that don’t have social supports. The DRCC later reported, “I had one [staff member] who just totally melted down on me, she was just ‘I can’t do this, I can’t do this.’” The nurse also described staff members feeling overwhelmed, in addition to feeling exhausted: At the beginning, overwhelmed, the first bus that filled up and you realize that it’s not just a couple people on a bus; it’s really overwhelming, exhausted, and overwhelmed, again a different kind, just with the amount of problems that everyone had. You realize how many people are at home really not making it, I mean they are doing the best that they can, but how many seniors had no support system or how many of our disabled have very little support system. It was real[ly] hard for our staff, with the folks that were transferred out of the shelter and that started to flood. . .[the] beach because everyone came wet. That was a reality check for all of us that something was going on out there because we weren’t able to see TV or anything. The shelter manager discussed staff members’ frustration, stating: I don’t think any of us understood the FEMA side of it, or how to connect them the right way, or what would happen next. So, as folks asked about—That was a big frustration, they asked us questions, we were clueless to give them information. Shelter staff seemed to feel exhausted, overwhelmed, and frustrated with the challenges encountered to try to meet the shelter populations’ needs. 4.2. Occupants’ Perceived Reported Psychological Challenges In addition to the distress of experiencing natural disasters, participants reported that they believed that occupants experienced intensified psychological distress while in the shelter. Two

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participants reported that occupants underwent intensified feelings of anxiety, and one participant identified occupants as having stronger feelings of depression and frustration while in the shelter. Two participants stated that occupants tended to hoard donated items at the shelter. The nurse reported that occupants “. . .were anxious,” and the security guard stated that occupants: …Get anxious, some wanted to get out of there, they had things to do and you almost had to counsel people by saying, “I’m supposed to go do this, supposed to bring my granddaughter to this recital.” “It’s—school has no power, there is no recital, so you’re not missing anything.” The nurse described occupants as having intensified depressive symptoms at the shelter, by stating: Definitely some more depression. Our seniors who have Sundown Syndrome, it definitely exasperated. There was no sense of time for them, or day. That was one of [the] things that people were smart enough to put up every day, what day and time it was, but that was definitely a big thing; no one know[s] what day or time it was. It was very hard to ensure that they knew day from night because we had to keep enough lights on to be able to get through. So, we definitely broke up their cycles, which created a lot of psychological issues. They didn’t sleep well; they didn’t have enough sleep. The DRCC described her view of occupants experiencing frustration, stating: I would say, like anything else, you put 2,000 people together in a room, and you tell them for a week that “call FEMA to register,” and a lot of these folks didn’t have cellphones, so they set up landlines. So, they had to register, but then they said with housing “you have to call back the next day, and the best time to call is between 1 and 4

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in the morning.” So okay, you’re going to now have the shelter be all disrupted to get people to stand on line, and then okay, after that, then “you need to call the hotels to see if they are accepting FEMA vouchers.” Well, where are they going to get—we don’t have internet for them. Then, they need to get transportation to the hotel, and also, “oh bring a credit card,” well if they had a credit card, they would have done it. So, of course, the frustration mounted over time. The shelter manager also acknowledged occupants’ frustration, stating, “When they were getting to that area in . . . [the other shelter], I think that became more of a frustration, more people upset, in that respect. But again, what can you do? . . . The DRCC described occupants’ hoarding tendencies, stating: You kind of see people, almost like, go into basic instinct mood, you know the Maslow’s hierarchy of basic instincts; . . .it’s like food, shelter clothing, and you would see people kind of hoarding, they would be like hoarding Gatorade cases under their cots. We had a lot of clothing donated, and . . .we were trying to ration the socks because folks were coming in with no shoes, and so then they would have wet socks, which then, their feet would be getting wet, especially if they had cellulitis or diabetes. I mean it was a mess. And we had the AmeriCorps, the kids, the volunteers and be like, “Oh gosh, I found a new box of socks,” and so they would walk around giving socks out. And then we had these folks that really didn’t need them, but they were grabbing at them and it was sort of like the masses were like, I found myself getting pissed off, I was like you don’t need that, save it for someone who needs it. So, you sort of saw people regress in a way, kind of into like basic survival mode.

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The nurse also recognized occupants’ hoarding tendencies, as she mentioned: “At some point, folks actually became hoarders as well. They felt the need to hold on to anything that they got, we gotten some things donated, and they had created their own space with the stuff.” Occupants’ observed psychological challenges may have been provoked by feeling a lack of stability and security while in the shelter. 4.3. Reported Perceived Individual Differences in Occupants’ Experiences Some occupants were perceived to reportedly cope better than others. Participants reported that senior citizens struggled the most in the shelter. When the nurse was asked who she thought encountered the most challenges, she responded: I think our seniors. These were folks who are living on the edge at home. They manage, but they struggled to manage. By far, I think those folks struggled the most in a shelter situation. For nothing else, just the distance to a bathroom, no one they felt secure with, and this is horrible, but some felt that their families abandoned them. They were hard for me, and we did have families drop people off at the door. The DRCC also described senior citizens struggling when stating, “…The geriatrics had the biggest problem. Geriatric folks that were out of their element, they were the ones who had the most difficulty, the older population.” Thus, senior citizens may need more accommodations in future shelters. Children and families were reportedly perceived as having coped the best with the experience. The DRCC mentioned: “. . .Probably the most resilient were the kids, because they were just ‘this is fun, this is exciting, this is new.’” The nurse also conveyed that she viewed children as being less impacted by the storm than older occupants, stating, “They had play groups and stuff. It wasn’t real to them while they were here at all, there wasn’t that impact. We

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didn’t have television, so there was absolutely no—they were in this big place with all of these people and that was kind of it.” The nurse also reported observing families as coping better than other occupants, stating, “I would say family units coped the best because they already have an established support system among themselves at home.” Families may be able to provide more assistance to vulnerable populations such as senior citizens in future shelters. The participants reported contradictory perceptions of homeless people’s experiences in the shelter. When the DRCC was asked who coped the best in the shelter, she responded: “I would say my homeless people. They are the survivors; they do this all of the time, they are like ‘ok fine, I’m not homeless, . . .so folks like that live on. . . nothing.” After discussing another topic, the DRCC reported, “. . .But yeah, the homeless people, the addicts, if they had their methadone, they were okay. They’re like ‘yeah we’re homeless, but now we’re not. This is cool, I get some warm clothes, I get some warm socks, I don’t have to worry about it, I have a place to put my head.’” In contrast, the security guard reported that homeless people: “. . . just don’t like the change again, even the homeless, they don’t like that change, they come here and, in the beginning, it was great because you know food, but then they don’t like that because they don’t have their normalcy, their freedom.” Homeless people may struggle more than other occupants to adapt to the shelter environment as they may not be used to living with others, much less hundreds of people in a shelter. Considering the contradictory perceptions of homeless people’s experiences, further research on the shelter experience would be especially helpful with this population. 4.4. Reported Health Problems Participants reportedly perceived that occupants’ and staff members’ health deteriorated in the shelter. The DRCC reported:

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The elderly population, within a short period of time, being out of their natural habitat, environment, started getting a little disoriented, confused. Plus, . . .you’re an elderly person. . .sleeping on a cot. . .with fifteen hundred people around, . . .you’re eventually going to have aches and pains and inability to ambulate. Further into the interview, the DRCC stated: For our mentally ill folks, which were a lot of them, we call SPMI, severely persistent mental illness, that live in group homes or boarding homes, a lot of them were on antipsychotic medication and many came without that. So, you may have some people starting to have their psychosis come to be . . .in the forefront, . . .any stress will bring on a little psychiatric or psychological . . .break in a way. . .Then, you had our addicts which. . .a lot of them were on, methadone programs, which. . .they didn’t bring their methadone. . . The nurse also reported health complications, stating, “We had one nurse who had to go to the hospital. We had actually thrown off her circadian rhythms with the night and day thing, and it affected her heart. We had another staff member who didn’t sleep for months.” These health problems may have intensified staffs’ and occupants’ psychological distress. 4.5. Reported Beneficial Aspects of Shelter for Staff Members There were beneficial aspects of the shelter that likely mitigated feelings of distress. For example, the nurse discussed the benefits of staff taking breaks, stating: “One of the really positive things about here was that staff were able to get away from everything. It was a separate floor for staff to rest, as well as staff able to use a separate cafeteria, so actually totally unengaged for a time.” The importance of breaks was also emphasized by the DRCC, stating: “. . . Like anything else, you kind of have to find that boundary and the way that you find boundaries

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is always when you find yourself on the other side. You’re like ‘oh crap, this is really starting to impact me,’ so you just need to know when to stop and take a breath. . .” Thus, staff seemed to recognize breaks as valuable to their self-care. The DRCC reported other aspects of the shelter that benefitted staff, stating: “My coworkers, and the fact that I knew that every day, I was able to go back to my house, although I didn’t have power, but I could still sleep in my bed. I had hot water and so I just, I knew that I had a place to go, I can leave, so that helped with stress.” She also reported that staff members utilized the support of one another: “Staff, we just made sure we kept an eye on each other and just checked in. . .We had a lot of laughter. . .you know you kind of get, you have to just let go sometimes, . . .maybe sick shelter humor, but that is what you do.” These aspects that helped staff to relax are likely imperative for future staff as well. 4.6. Reported Perceived Beneficial Aspects of Shelter for Occupants Similar to staff members, social interaction and support were perceived as important for occupants. For example, the nurse reported: As we went along, we realized how important [it was] to group folks more, we moved folks with younger children together, they needed a similarity to be grouped, and you could actually see the difference in their interactions. They just needed that support and they also just needed that support continually from staff. The nurse later stated that occupants: “. . .needed downtime.” Further into the interview, the nurse described occupants’ experiences in groups, stating: They went from strangers to forming groups. Folks with children went to folks with children, single older folks grouped together, actually single older women tended to

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group, and single older men tended to group. It was kind of like the eighth-grade dance if you looked at them. Occupants may have felt more comfortable by having familiarity within their social groups. The DRCC reported other beneficial aspects for occupants, stating: Just relying on each other, relying on information being. . .up to date and I think the shelter staff did that as much as they could as soon as they got any type of information. . . They were just trying to keep themselves busy. We had a lot of agencies that came in over the first week. . .so we had activities for the kids and things like that. Obtaining information and being involved in activities may have also helped occupants to feel more comfortable in the shelter as they may normally be involved in these activities. These aspects that were perceived to be beneficial would likely be helpful in future shelters. 4.7. Reported View of the Shelter Participants reported that the shelter was successful. The security guard reported no security issues, stating: “There were no arrests, no thefts, no incidents that I was aware of anything being stolen, no assaults, no sexual assaults, no gang issues even though we had gangs.” He later emphasized, “There were no issues in this facility, nothing.” The DRCC also recognized the facility as successful, stating: “When I hear about other shelters, . . . [this shelter] did great.” The nurse also spoke positively of the shelter. She stated, “We were very fortunate to be here. It was immaculately clean. Everyone who came to work really had a commitment. I don’t feel like there was a soul who didn’t walk through the door that just didn’t embrace everybody. That was probably just a tremendous part of it.” The nurse later reported that the shelter was “. . . Overwhelming, but rewarding, it gave us all a sense of the real needs in the

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communities and made us aware of where we fit into our community.” Thus, staff appeared grateful to be involved in the shelter. Participants reportedly perceived staff and occupants as feeling a sense of community in the shelter. To describe her view of occupants’ shelter experiences, the nurse stated, “Although they were anxious, they were actually pretty excited. A lot of folks lived alone, so it actually gave them a community initially.” Further into the interview, the nurse also mentioned, “. . .It brought a whole new bond between us—I mean we shared socks at some point,” regarding the shared experience between occupants and staff. The DRCC also acknowledged the sense of community in the shelter. She stated, “. . .[We] came together as a huge family, regardless of if it was the president or if it was the person in charge of the housekeeping. It was just amazing, there were like no titles, everyone just dug in.” This sense of community seemed to mitigate some of the challenges in the shelter. 4.8. Reported Suggestions to Improve Staff Members’ Experiences While the participants perceived the shelter as successful, they made suggestions to improve future experiences in shelters. For staff, the nurse reported that staff lacked psychological support, stating: We didn’t provide enough psychological support for staff. Right after, we should have really spent the time to see what they thought was important, what their needs were, and how we were going to meet them. We had one nurse who had to go to the hospital, we had actually thrown off her circadian rhythms with the night and day thing and it affected her heart. We had another staff member who didn’t sleep for months. So, we really felt that we probably really missed the boat right after because everyone was so burned out

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that it was kind of like, just go home and rest, but should have found out where they were at and what their needs were at that point in time. Psychological services for staff are likely important in future shelters. 4.9. Reported Suggestions to Improve Occupants’ Experiences Several suggestions were also made to improve occupants’ experiences in future shelters. The nurse reported, “. . .Folks going home were nervous, it was something that we didn’t prepare enough for, they needed to start transitioning them back out. What were they going to do? How were they going to manage?” Further into the interview, the nurse stated: “The teen group was probably the most neglected group across the board.” When prompted for more information, the nurse stated, “I just don’t think that we provided anything. I know we didn’t have any groups for teens and I know the other shelter did not have any groups for teens, nor did we have any much for them in the community youth that were disturbed.” The DRCC discussed the need for improved medical care in the shelter: . . .The need for medication. . . so having some kind of natural directory, which I think we kind of do about. . .what meds people are on. . .It took us forever to try to get a pharmacy that would be willing to accept a voucher from the county, finally. . .[a pharmacy] did it for us. . .Having special needs, we had no wheelchairs,. . .we had a patient on hospice. . . in. . . [a] room, the man was dying. . .and it’s just he was in the middle of chaos of everyone coming in. [He was] . . .like, “I need my Xanax,” things like that. So just, specific areas, for. . .special needs. We needed better food, . . .in the

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beginning, everyone ate the same MREs3. . .the preparation wasn’t there, but I think the medical equipment was the number one thing that we needed. The nurse also reported that medication was a problem in the shelter, stating, “. . . Medication[s] were a big issue for a lot of them, especially like our methadone, which we had a big problem with getting.” Therefore, a wider range of psychological and medical resources are needed in future shelters; however, it may be challenging to obtain these resources. 5. Discussion Previous research reports post-disaster mental health symptoms, risk factors, and protective factors for coping with natural disasters. This study expands upon previous research by reporting the commonly experienced psychological challenges for shelter staff, perceived psychological challenges for shelter occupants, beneficial aspects in shelters, and recommendations to improve future disaster relief shelter experiences. Participants’ reports of shelter staff members’ and occupants’ psychological challenges validate previous research findings of disaster victims’ psychological challenges. This insight can be utilized to improve future disaster relief shelters to enhance shelter occupants’ and staff members’ shelter experiences. As per participants’ reports, staff members felt overwhelmed, exhausted, and frustrated, and they had trouble with sleeping at the shelter. These challenges may have been provoked by living with strangers, being short staffed, having limited privacy, constant light and noise, and by

3

MRES- Meals, Ready to Eat- packaging of pre-prepared foods, designed for individuals

engaged in heavy activities such as the military, where normal food service is not available (Defense Logistics Agency, 2018).

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being around people in distress. Considering that the staff lived in close proximity to the shelter, they were likely also affected by the disaster. Thus, they may have experienced similar feelings of distress as the occupants. Sleep trouble is common for all disaster victims (APA, 2015), and residing in a shelter may contribute to this challenge. If shelter staff lived in further proximity and were not affected by disaster, they may have experienced less psychological challenges when working in the shelter. However, staff may be less likely to work in far shelters since it is likely less convenient and they may care more about helping their own communities. Participants perceived occupants as experiencing intensified anxiety, depression, and frustration in the shelter, and struggling to sleep. Further research is needed on occupants’ shelter experience as they did not directly report these challenges; however, it is important to note that occupants’ perceived challenges were also noted in previous research on disaster victims (Norris et al., 2002). Depression is the second most commonly diagnosed psychological disorder, anxiety is the third most common (Norris et al., 2002), and sleep trouble is common for all disaster victims (APA, 2015). If occupants experienced these perceived challenges, it may have been due to similar reasons that staff members reported feeling overwhelmed and exhausted: living with strangers, limited privacy, constant lights and noise, and by being around people in distress. Depressive symptoms may have intensified because there were limited opportunities to be active at the shelter, since there was limited space for exercise and few activities. It is also possible that staff members projected their feelings onto the occupants, expecting that occupants experienced the same feelings that they experienced. Occupants were reportedly observed to commonly hoard donated items. As the DRCC mentioned, disaster victims may have regressed in Maslow’s hierarchy (Maslow, 1943) to the physiological stage of functioning, focusing solely on meeting their basic physiological needs

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such as consuming food and water. Shelter occupants may be more likely to regress in their stage of functioning than disaster victims who did not reside in shelters, as most shelter occupants have less support and resources than the rest of the population. Vulnerable populations are important to identify as these people likely need additional support in future shelters. Geriatrics, people who did not have their medications, people who had mental illnesses, and/or substance addictions reportedly experienced additional challenges in this shelter. Previous research also identified geriatrics (Parker et al., 2016) and people with mental illnesses as having greater mental health risks during disasters (Norris et al., 2002). In future shelters, group therapy may be especially beneficial for these vulnerable populations. There were contradictory reports of homeless people’s experience in this shelter. The security guard stated that homeless people struggled more than other occupants because they struggled to adapt to change. Conversely, the DRCC mentioned that homeless people fared the experience the best since they had better access to resources than usual. Inconsistent with these reports, the nurse reported that no homeless people resided in this shelter. The security guard’s report may have been the most accurate since he reported knowing most of the homeless people in the shelter. The DRCC and the nurse may have had less experience interacting with the homeless occupants. Further research is needed; however, homeless people likely need additional support in shelters. The reported positive aspects of this shelter and coping mechanisms are important to discuss since these factors are likely critical for future shelter experiences. The following aspects reportedly benefited occupants: forming groups based on similarities, obtaining information about the storm, having better food than was available at this shelter during Hurricane Irene, staying occupied, and obtaining support from one another and staff. For staff members, taking

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time away from the occupants, utilizing staff support, trying to relax, and being humorous enabled them to reportedly best cope with the situation. Support was understandably beneficial, as social support is a protective factor in coping with disasters (McGuire et al., 2018). The reported positive aspects of the shelter and coping activities are recommended for future shelters. Participants made recommendations for future disaster relief shelters. For example, it was recommended that staff have a wider range of medical resources, stronger psychological support, and more follow-up procedures after leaving the shelter. For occupants, it was reported that they could benefit from having a wider range of medical resources especially opiate-assisted therapy medication, more therapeutic resources for adolescents, and services to transition occupants out of the shelter. Mental health therapists could strengthen shelters by providing occupants and staff with additional support. Therapy tends to have beneficial outcomes, in spite of barriers to the counseling relationship during disasters (Boulanger, 2013). In addition to participants’ suggestions, the author recommends that future shelters utilize dimmed lights and provide noiseblocking headphones, and eye masks to block out light to improve occupants and staffs’ ability to sleep. While these recommendations are important to note, it may not be realistic for all these aspects to be improved upon in future shelters. 5.1. Strengths and Limitations This study provides a basis of the shelter experience, which is important because it is a limited area of research. The researcher obtained detailed information from participants about the shelter experience by asking broad, open-ended questions and probing for further information based on participants’ responses. Important points about the psychological experience, specifically psychological challenges were discussed in detail. The participants held widely divergent roles; therefore, they provided diverse perspectives.

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There were limitations to this study as it was explorative in nature and further research is needed to make the results generalizable to the public. The generalizability of the study is limited by the small participant pool. Participants were all European-American, which limits the generalizability among different cultures. As with all phenomenological research, this study was based on self-report. Participants may have been inaccurate in their reports to try to make themselves sound more appealing. Participants may have also had inaccurate perceptions of shelter occupants’ experiences. The participants’ descriptions of occupants’ and staffs’ experiences could also be bias considering that they also resided in the shelter and were affected by the storm. The author conducted the interviews, which allows for potential bias in interpreting the results. However, the author noted potential alternate explanations for findings, some standard interview questions were used, and participants’ direct reports are cited to improve the objectivity of the study. 5.2. Further Direction For future research, the phenomenological method could be utilized to further explore the lived experience of residing in a disaster relief shelter. A large, diverse population of shelter occupants and staff members could complete semi-structured interviews, describing their shelter experiences. Future research could further explore the shelter experience for the reported vulnerable populations such as geriatrics, people with substance addictions, and homeless people. Future studies could test the effectiveness of various approaches to help these people to feel more comfortable and be better accommodated in shelters. Homeless people’s shelter experiences may be especially helpful to explore as there were contrasting perspectives on their experience and there is limited research on their experience with disasters. 6. Conclusion

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From this study, insight was obtained on shelter staffs’ psychological challenges, perception of occupants’ psychological challenges, and recommendations for future shelters. Staff described feeling more overwhelmed and exhausted in the shelter. Observations of occupants’ exacerbated feelings of anxiety, depression, and frustration were depicted, as well as occupants’ struggle to sleep and tendency to hoard donated items. Variations in occupants’ ability to cope were described. To enhance coping, staff highlighted the value of taking breaks and obtaining support from other staff members. For occupants, it was observed that forming groups, obtaining information on the storm, involvement in moderate activity, and receiving support was beneficial. Participants emphasized the importance of future shelters having a wider range of medical resources, more therapeutic services for adolescents, enhanced procedures to transition occupants out of the shelter, and stronger psychological support for staff members. This insight is intended to prompt further research and enhance knowledge of staff members’ and occupants’ psychological experiences when residing in a shelter. Acknowledgements The author wishes to thank Professor Robert Kelly, Dr. Nicole Jackson, Dr. Michael Sikes, Dr. Alan Cavaiola, Dr. George Kapalka, Dr. Thomson Ling, Professor Corinne Cavallo, Professor Traci Bitondo, Professor Daphne Keller, Debbie Basile, Greg Silber, Andrew Galicki, and Anthony Mellone for their feedback and support on this research. The author also would like to thank the participants for providing detailed accounts of their experiences. Funding This work was supported by Monmouth University’s Summer Research Program. Program faculty members, Dr. Michael Palladino, Professor Jamie Kretsch, Professor Jay Wang, and Professor Robert Kelly are thankfully acknowledged. The funding agency did not have any

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Table 1 Interview Questions Shelter Manager’s Interview Questions: What was your role in the shelter? What adjectives would you use to summarize the whole set up procedure? How would you describe the psychological state of shelter occupants when they were admitted? How would describe shelter occupant’s psychological state throughout the process? How would you describe the psychological state of people when they left? Nurse’s Interview Questions: What was your role in the shelter? Please explain your typical day at work. What do you feel helped you prepare for the shelter? What psychological skills do you feel are important for possessing in this type of shelter? Please explain the psychological state of occupants when they were first admitted How do you think it moved to over time? What would you say that their primary source of stress during the shelter? What would you say would promote their happiness? Please describe the characteristics of the people you feel struggled the most with the experience. How would you describe the characteristics of the people who coped best? What type of methods were used to maintain their physical health? What type of accommodations were made for pregnant women, children, or people with dietary restrictions?

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Would you say occupant’s level of faith in God or a higher power grow or decreased over the time? How do you feel that the shelter was able to help people to follow their traditions? How did strangers interact with each other? Did you notice hostility among people? Were there any mental health outbursts? What was done in reaction to their outbursts? What would you say were some strengths of the shelter? How would you say staffs’ psychological state at the beginning? What do you think that would have been helpful [for staff]? Is there anything that you wish would have been changed in terms of shelter occupants’ experiences that could improve it? What do you think is an important area to focus on in this type of research? What would you say your biggest challenge was? What would you say was the scariest experience that you noticed there? What would you say was the most meaningful experience that you noticed there? Were there any conflicts between staff members? How many occupants would you say were depressed? Did any staff members struggle with depression? Were there any. . .follow-up calls. . .with occupants? What adjectives would you use to describe the overall experience? If you were able to give advice for someone before they are encountering a storm? What type of advice would you give them?

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Would you say a fair amount of people struggled with sleeping? Do you feel like this issue got better or worse over time? Would you say that occupants complained often? What type of complaints were made by staff members? Is there anything else that you think is important in terms of psychological challenges or mental health that you think is important to note? How do you think homeless people fared the experience? DRCC’s Interview Questions: What was your role? What do you feel helped you prepare for this? Can you explain shelter occupants’ psychological state when they were admitted? How do you feel like their psychological state progressed over time? How do you feel like staff overall interacted with each other? How do you feel like shelter occupants’ psychological state progressed over time? How about when they were leaving? How would you say that their mood was? How would you describe their level of faith when they were admitted? What would you say was like your biggest challenge with your job? What would you say was like the most rewarding part of your job? How do you feel strangers interacted with each other? Did you notice any hostility? What would you say were some things that you would like to improve about the shelter? What would you say were like their main coping mechanisms? For occupants and for the staff?

DISASTER RELIEF SHELTER EXPERIENCE What would you say were characteristics of occupants who like reacted the best to the shelter? Who had the best coping? Were there any like mental health outbursts? . . . fears of staff? What would you say helped you work through your stress? What type of advice would you give to someone who is going to enter a storm, someone who would be an occupant? How do you feel the follow-up plan was effective? What would you say is an important area of research to focus on within mental health in this field? What do you think were some abnormal behaviors? What would you say were occupants’ primary source of happiness? What else do you think was an important thing to note from the experience? How well would you say that occupants kept up with their hygiene? How do you think that impacted their mental health? Is there anything else that you think it is important?

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DISASTER RELIEF SHELTER EXPERIENCE Table 2 Staff Members’ Reported Psychological Challenges Feeling overwhelmed (the DRCC & the nurse) Feeling exhausted (the nurse) Feeling frustrated (shelter manager)

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DISASTER RELIEF SHELTER EXPERIENCE Table 3 Occupants’ Perceived Reported Psychological Challenges Feeling anxiety (the security guard & the nurse) Feeling of depression (the nurse) Feeling frustrated (the DRCC) Tendency to hoard donated items (the DRCC & the nurse) Intensified health problems (the DRCC & the nurse)

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DISASTER RELIEF SHELTER EXPERIENCE Table 4 Reported Perceived Individual Differences in Occupants’ Experiences Senior citizens had the worst experience (the DRCC & the nurse) Children fared better than others (the DRCC & the nurse) Homeless people fared better than others (the DRCC) Family units fared better than others (the nurse)

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DISASTER RELIEF SHELTER EXPERIENCE Table 5 Reported Beneficial Aspects of Shelter for Staff Members Taking breaks from the occupants (the DRCC & the nurse) Remembering that they could leave the shelter (the DRCC) Obtaining support from other staff members (the DRCC)

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DISASTER RELIEF SHELTER EXPERIENCE Table 6 Reported Perceived Beneficial Aspects of Shelter for Occupants Forming groups with people who have similarities (the nurse) Obtaining support from staff members (the nurse) Having downtime (the nurse) Staying busy (the DRCC) Obtaining support from other occupants (the DRCC) Receiving information on the disaster (the DRCC) Higher quality food in the shelter than during Hurricane Irene (the DRCC)

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DISASTER RELIEF SHELTER EXPERIENCE Table 7 Reported Suggestions to Improve Staff Members’ Experiences Wider range of medical resources (the DRCC & the nurse) Stronger psychological support for staff members (the nurse) More follow-up procedures for staff after they leave the shelter (the nurse)

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DISASTER RELIEF SHELTER EXPERIENCE Table 8 Reported Suggestions to Improve Occupants’ Experiences Wider range of medical resources (DRCC & the nurse) More therapeutic services for adolescents (the nurse) Better procedures to transition occupants out of the shelter (the nurse)

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Declaration of interests X The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. ☐The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: