We often hear that natural disasters are stressful and, in public health, we recognize that people may have difficulty coping. It’s easy to see why. Homes, businesses, daycares, healthcare facilities and doctors’ offices are physically destroyed. Impacts on the local economy and personal financial stability are visible. What we don’t often consider is that disease outbreaks can be just as stressful and that coping may be just as difficult. The unknown or unfamiliar nature of diseases breeds fear and concern that hold very real consequences for our communities. Distress and concern, if unaddressed, can lead to unneeded quarantine directives and income loss, as well as unnecessary medication purchases or surges in emergency room visits.

After the emergence of Severe Acute Respiratory Syndrome (SARS) in 2005 and of the H1N1 flu in 2009, researchers and practitioners examined the psychological impacts on patients who were quarantined. These patients expressed feelings of anger, sadness, guilt, loneliness, and fear for the welfare of friends and family. In addition, patients worried that they would lose income due to quarantine and that their contacts, families, and friends would be stigmatized. These concerns are now being expressed by health professionals working on the front lines to combat Ebola.

These emotions and their consequences must be considered as public health agencies and health care professionals talk about a new or emerging disease. Leveraging risk communication can help. Risk communication research demonstrates the importance and effectiveness of addressing fear and concern. The research shows that unless we address the emotions tied to the situation, the scientific facts will be ignored.

During the 2009, H1N1 outbreak, the National Preparedness and Response Science Board (formerly the National Biodefense Science Board) provided guidance and recommendations for public health agencies on how to integrate behavioral health into interventions and how to address communication and messaging around pandemic flu for the public. These recommendations aligned with decades of research into the practice of risk communication and remain relevant today.

The board’s recommendations included:

• Provide messaging to reduce stigmatization of groups as needed, and utilize trusted community and faith-based leaders to help promote healthy behaviors
• Take into account factors such as culture and ethnicity, age, disability, and medical conditions (including serious mental illness and pharmacologically dependent)
• Maintain sensitivity to terminology and need for actionable guidance
• Discourage use of imprecise term “worried well”
• Provide a short explanation of why people are being asked to refrain from usual behavior and tell them what action to take instead

Public health and healthcare professionals can move risk communication principles and this advisory board’s expert recommendations into practice not only by informing and advising the public on protecting health, but also by acknowledging and normalizing the emotional response to the situation, including an infectious disease outbreak. When we are anxious, worried, or scared, our bodies and thought processes don’t perform optimally; we’re less able to process instructions, follow directions, or even remember that we received information on what to do.

When our fears and concerns are acknowledged, we immediately want to know what our community leaders are doing to protect us now and in the future and – just as important – what we can do to protect ourselves, have a voice in decisions that impact us, and feel in control of the situation. This information, too, helps support the behavioral health of our patients, family, friends, the community and the nation.

Among the most important elements in helping people “get the message” is listening. Incorporating what we learn through psychological first aid into our communications can help. The World Health Organization provided recommendations based on the principles of Psychological First Aid which reflects the emerging science on how to support people in the immediate aftermath of extremely stressful events.

Offering psychological first aid means that we look to check for serious distress reactions; ask about needs and concerns; actively listen; help people address basic needs and access services; give actionable information, and connect people with loved ones and social support.

By identifying the behavioral health concerns of disease outbreaks and acknowledging and addressing these concerns in the way we communicate, public health and health care professionals can make an important impact on the way the community copes with the situation. We can help community members make sound decisions, protect health and, overall, boost our community’s resilience.

Want to know more addressing the psychological impacts of diseases? Check out this video webcast on the Psychological Impact of Pandemics made during the H1N1 pandemic.

Are people in your community stressed about Ebola? Refer them to the Disaster Distress Helpline, 1-800-985-5990. The HHS Substance Abuse and Mental Health Services Agency offers a wealth of other resources, too, from tips to training to a cell phone app.