After a disaster, a major network of disaster counselors and mental health professional spring into action. Their task? Aid people with the sometimes long and invisible recovery that takes place following a traumatic event.

It could be after a natural disaster, like a hurricane or wildfire. Or a tragedy, like a mass shooting or crime. Either way, there's an important personal recovery that needs to take place — and people whose job it is to help.

Psychologist James Halpern was a first responder at both 9/11 and the Sandy Hook school shooting, which left 20 children dead. He's co-author of the book "Disaster Mental Health Interventions: Core Principles and Practices." He's also a professor emeritus and founding director of the Institute for Disaster Mental Health at SUNY New Paltz.

Halpern joined Marketplace Weekend host Lizzie O'Leary to talk about the role of mental health professionals following a disaster.Below is an edited transcript of the conversation.

Lizzie O’Leary: We are reflecting on the five year anniversary of the Sandy Hook shooting. That's something you responded to. Can you walk us through what happens as a mental health first responder? You know, in that case what do you do?

James Halpern: I was with the families on the second day of the event. There was considerable fear and considerable chaos. We tried to provide some calm and safety. But they also asked us questions like, “How could this have happened to me? How could this have happened to my wonderful child?” And those are not real questions for us counselors. Those are cries or laments. What we can do is offer kindness and compassion and support. But some of the questions they asked, which had to do with how they supported their other children, were real questions. About whether or not the kids could watch these events on TV. And the answer is no. Whether or not it was good for those young children to be interviewed by the press. The answer is no. So, some combination of what might be considered crisis counseling and compassion and support.

O’Leary: What sort of disasters have you responded to and do people like you respond to?

Halpern: Sorry I'm laughing, but yeah, I mean disasters are so common and getting more common, it seems. You know, the United States, people don't appreciate, has the most extreme weather in the world. So in addition to the kind of floods and fires that are most typical, we have a hurricane season. We have a tornado season. We have a wildfire season that seems to be expanding. Of course, we've got earthquakes, explosions, transportation accidents, plane crashes, epidemics, anything that involves considerable human suffering beyond a person.

O’Leary: Listening to the breadth of what you're talking about, what does it cost to provide mental health care for so many people in such a variety of situations? And who pays for that? 

Halpern: In the early stages of disaster, crisis counseling is typically free. There are 5,000 mental health professionals deployed around the country by the Red Cross. These are psychologists, social workers, mental health counselors, who give up their time and energy to provide that kind of pro bono service. There's also county, state, federal workers who, similarly, can be at shelters or family assistance centers. Now, over time some significant minority can develop long-term symptoms. And those folks are treated by professionals with health care, Medicare, Medicaid, private insurance. And depending on the nature of the disaster it can be supported by the federal government. For instance, if the disaster was a crime, like the Las Vegas shooting or 9/11, then there’s support from crime victims services for long-term care.

O’Leary: You know, I'm thinking about Puerto Rico. I just came back from a trip reporting on the island and that’s a place with significant devastation. I would imagine that the kinds of mental health services required over time change dramatically as we move farther out from the event itself.

Halpern: Most folks experience significant but transient symptoms. They're OK and don't need that long-term help. On the other hand, there's some considerable research from the gulf oil spill where it leads to long-term economic dislocation, job loss. You see significant depression that needs to be addressed.

O’Leary: There’s a study from the National Institute of Mental Health that says it would have cost about $12.5 billion to provide what they call “comprehensive mental health care for 24 months” to the people affected by Hurricanes Katrina and Rita. Make the economic argument for me, the cost benefit analysis, of why that money is worth spending on mental health.

Halpern: These are disaster survivors who certainly bear no blame for being in the middle of these kinds of events. They are suffering. There is job loss. And those treatments work. We can reduce, then, long-term problems in substance abuse, in family violence, and family conflict, and individual suffering. There's enormous benefit that we get when people are functioning effectively.

O’Leary: Do you think as a country we have made any collective strides in understanding that mental health is something worth spending money on?

Halpern: I think there is much less stigma now. It can be a struggle to find resources to cover those invisible wounds. I think easier, probably, to find resources for injuries and illnesses than for those invisible scars.

O’Leary: Is it hard to find the people who need help, after all a disaster can scatter survivors all over the place?

Halpern: Yes. I think that we could do better at providing more comprehensive screening, which would not be very costly. And there are, in fact, check lists where we can identify folks who are likely to have serious mental health problems.

O’Leary: What's the impact on the people who do this work? I would imagine this is not easy.

Halpern: There are of course the obvious physical hazards. But for all responders, including mental health counselors, there's listening to stories of trauma repeatedly, which can result in compassion fatigue. Or burnout. Or vicarious trauma, that you can begin to feel traumatized yourself just by hearing those stories secondhand. And, again, I think that that puts all responders at risk, and why it's so important for all of those responders, and all of us as counselors to have very careful self care plans.

For many countries impacted by the negative impacts of climate change, much more money is leaving in debt payments than they receive in grants to cope with climate impacts (Theresa May: It’s Britain’s duty to help nations hit by climate change, 12 December).

Even before this autumn’s devastating hurricanes, Caribbean countries were suffering under unsustainable debts caused by the legacy of colonialism, unjust trade rules, harsh austerity measures imposed in return for bailouts, and past disasters. Now countries such as Antigua and Barbuda, and Dominica, are expected to keep paying debts while struggling to rebuild.

One of the main “solutions” proposed to this cycle of climate-induced disasters and indebtedness is climate risk insurance. This fundamentally unjust measure places the financial burden of climate impacts on people who have done the least to cause the problem of climate change, while ensuring that creditors keep being paid in the event of climate disasters. Instead, debt cancellation is needed to make debts sustainable, and all assistance to adapt to – and rebuild from – climate disasters must be in the form of grants, not loans.
Sarah-Jayne Clifton
Director, Jubilee Debt Campaign

• Theresa May’s article failed to explain how the fight to limit climate change is helped by fracking, by the building of Hinckley Point with its absurd overpricing of the cost of each unit of electricity (another example of Conservatives milking citizens to benefit commerce), by the third runway at Heathrow or by her government’s refusal to include environmental costs in the calculation of the value of gross national product, another example of said welfare state.

Her stock answer to demands for more being spent on (for example) the NHS is that increased interest payments on borrowing cannot be borne because they will prejudice future generations, yet the threat to future generations from the effects of climate change is immeasurably greater. Moreover, May has no qualms in leaving future generations with the burden of guarding spent nuclear fuel for hundreds of years. The inadequacy of her policies is plain.
Ian Tysh
Wealden Green party, East Sussex

Floods persist in seven southern provinces, with more than 900,000 people affected by inundations that have resulted in 22 deaths over the past 15 days.

The northeastern monsoon that began on Nov 25 has brought flooding to 11 southern provinces: Pattani, Yala, Songkhla, Phatthalung, Trang, Satun, Chumphon, Narathiwat, Nakhon Sri Thammarat, Surat Thani and Krabi, 

The floods, which have claimed 22 lives so far, still persist in seven provinces, with 903,603 people from 3,077 villages in 56 districts enduring hardship, Chayapol Thitisak, director-general of the Department of Disaster Prevention and Mitigation, said on Saturday.

The seven provinces are Pattani, Songkhla, Phatthalung, Trang, Chumphon, Nakhon Sri Thammarat and Surat Thani, he said.

In Pattani, Nong Chik and Muang districts are still inundated. In Songkhla, the affected areas are Sathing Phra, Khuan Niang, Singha Nakhon, Krasae Srin, Bang Klam and Ranot districts. In Phatthalung, Khuan Khanun, Sri Banphot, Sri Nakharin, Kong Ra, Pak Phayun, Pa Phayom, Pa Bon, Khao Chaison, Bang Kaew and Tamot are affected.

In Trang, Muang, Na Yong, Wang Wiset, and Kantang districts are still inundated. In Chumphon, flooding remains in Lamae, Muang, Thung Tako, Pathiu, Phato, Sawi and Lang Suan.

In Nakhon Sri Thammarat, water levels remain high in eight districts: Cha-uat, Bang Khan, Chian Yai, Chulabhorn, Thung Song, Pak Phanang, Sichon, Na Bon, Chawang, Nop Phi Tham, Hua Sai, Chalerm Prakiat, Phommakhiri, Thung Yai, Chang Klang, Ron Phibun, Tha Sala and Tham Phannara.

In Surat Thani, seven districts -- Phrasaeng, Wiang Sa, Khian Sa, Ban Na San, Ban Na Doem, Phunphin and Don Sak -- are flooded.

CARPINTERIA, Calif. — Fire continued to tear across Southern California on Thursday, surrounding communities and shrouding much of the region in searing flame and thick, choking smoke.

And where there was no fire, there was fear.

Fear of what could come next as wildfires ravaged the state for a fourth day. Fear of what could happen if the winds shifted, if the flames moved, if new blazes erupted and were strengthened by the powerful gusts already fueling the infernos burning across the region.

Tens of thousands of people fled their homes, running from fires without any idea of when they could return or what they might find when they do. They grabbed pets, clothes and mementos before hurrying off in search of shelter.

Veteran firefighters described the blazes as unlike anything they had ever encountered. Thousands of firefighters and other first responders fanned out to save lives, protect homes and shepherd people to safety, joined by reinforcements that flocked in from other parts of the country.

Authorities had not reported any deaths due to the blazes by Thursday, but they spoke bluntly about the danger that remained through week’s end. While the most severe winds are forecast to slacken Friday and Saturday, lessening the fire danger some, the National Weather Service cautions the risk of fires will remain elevated through Sunday as conditions remain abnormally dry and breezy.

“We are a long way from being out of this weather event,” Ken Pimlott, director of Cal Fire, said at a briefing Thursday. “In some cases, the worst could be yet to come in terms of the wind.”

The National Weather Service warned that if new fires do begin, “very rapid spread and extreme fire behavior is likely.” Blazes began Thursday across Southern California, including one in San Diego County, where the Lilac Fire grew to 1,000 acres in just a few hours and prompted mandatory evacuations. Officials warned it was growing dangerously fast and said it threatened 1,000 structures and had damaged some others.

The massive Thomas Fire, the state’s biggest active blaze, burned across 150 square miles in Ventura County on Thursday. The blaze “continues to burn actively with extreme rates of spread,” authorities warned.

Flames from that fire surrounded Ojai, the popular winter retreat that is home to about 8,000 people, on Thursday morning, officials said. Most of the Ojai Valley had been placed under a mandatory evacuation order.

More than 100 firetrucks from several states had parked at the Ventura County Fairgrounds, firefighters standing or sitting aside their equipment as they took breaks from battling fires in nearby Ojai the night before, winds whipping in off the ocean as they rested.

“This breeze is nothing,” said Shane Nollsch, who had traveled from Lyon County, Nev., arriving at 3 a.m. Wednesday. “Yesterday, you had to chew the air before you breathed it.”

Chris Mason, a firefighter from Carson City, Nev., said those who came to help had to adjust to different terrain and a new environment. Different winds. Different fuels.

“It’s a sharp learning curve,” Mason said. “Fire is coming down the mountain at you, especially at night, when it’s hard to see and you don’t know where the streets are.”

La Conchita, a tiny town hard against coastal Highway 101 northwest of Ventura, was threatened by flames early Thursday. The town most commonly faces danger from mudslides, but those same cliffs that give way with rain are now a rich “fuel bed” for the wildfires. Fire crews managed to keep the blaze from the town’s edge, but new lines, fanned by off-shore winds, remained a peril.

That blaze — the Thomas Fire — extended dozens of miles from near Santa Paula in Ventura County to the edge of Carpinteria, a city of 13,000 people, a stiffening wind posing the most threat. Gusts picked up flames low on coastal mountain slopes and drove them up and over hills toward several towns along the Pacific Ocean.

Santa Barbara County began urging evacuations, ordering hundreds of people to leave areas along the Pacific Ocean between the larger cities of Santa Barbara and Ventura.

Along Rincon Mountain Road a few miles south of Carpinteria, fire crews fought several lines of flames overnight Wednesday and throughout Thursday, focused on protecting homes and ranches. A dozen Ventura County fire engines staged along the road near midday, the fire burning in the avocado and citrus orchards along the ridge-line above.

Tall stands of eucalyptus shook with the strengthening wind, which was driving the flames toward several multimillion-dollar homes, a brewery and a small vineyard. Two helicopters buzzed overhead, tailing “bambi buckets” beneath. The buckets open from the bottom, scooping up loads of water from the Pacific and Lake Casitas to drop near threatened homes and buildings. In all, about 30 homes were in immediate danger.

Fred Burris, a Ventura County Fire Department battalion chief, was finishing a 24-hour shift that included helping to protect La Conchita. Only one outbuilding was lost early Thursday, he said, but new fire lines were popping up along a 15-mile stretch of Highway 150 between Ojai and Carpinteria.

“We’re basically defending an area with homes and ranch infrastructure, seeing a new fire emerge along this stretch, then splitting off resources to send there – that’s the strategy,” said Burris, a 36-year veteran of the department. “Everyone says, ‘Yeah, this is the worst,’ but it really is the high-water mark for me. We’ve never seen a fire with this much speed and range.”

The California National Guard said it had mobilized more than 1,300 personnel to help confront the wildfires.

In Los Angeles County, firefighters responded to threats on multiple fronts. The Rye and Creek fires continued burning through a combined 29 square miles north of Los Angeles, while the Skirball Fire’s smaller reach forced evacuations in ritzy Bel Air and caused the University of California Los Angeles to cancel classes on Thursday, just two days before final exams.

Los Angeles Mayor Eric Garcetti (D) said the “erratic and unpredictable” wind gusts will continue through Saturday, warning that the winds could whip through with speeds as high as 70 mph.

“These conditions, combined with the heat that is now … coming to the area, the dryness, the amount of vegetation in some of the areas still that have not burned, makes this still a very threatening environment,” he said.

In the Sunland area of Los Angeles near the Creek Fire, Ken Villegas, a horse farm owner, said earlier in the week he saw the flames jump from across the street and enter his property, burning some of his foliage but no structures.

“It was crazy,” the 56-year-old said with a laugh. “The wind was blowing so hard it would’ve knocked you over.”

Warning of “extreme” fire behavior, authorities said those fighting the Creek Fire were facing multiple difficulties because of the winds, poor access to the fire, and steep, rugged terrain.

To the southwest, the Skirball Fire’s continued impact could be seen traveling down Interstate 405, the famously congested roadway shut down by the flames a day earlier. Mountains to the east of the 405 that had been swathed in flame were charred, while those on the freeway’s west side were spared.

About 10 miles south of Carpinteria, Richard Floyd watched flames burn down a steep hillside toward his aunt’s 32-acre avocado orchard, flaring with the wind gusts. For hours, the fire was close enough to his cabin, set in a bowl between hills, that you could hear it crackle and pop.

Helicopters dropped water on the hillside above the orchard for more than an hour, two working in tandem: As one dropped a load and swung south to refill in Lake Casitas, the second could be seen in the near distance.

The crews were “doing great, just great,” Floyd said. But the flames persisted and he remained uneasy.

Berman reported from Washington. Noah Smith in Los Angeles; Soo Youn in Ventura, Calif.; and Travis Andrews, J. Freedom du Lac, Jason Samenow and Dan Lamothe in Washington contributed to this report.