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Supporting mental health after flooding

Researchers from three NIHR Health Protection Research Units have found that flooding can have a significant negative impact on the mental health of people whose homes are flooded, as well as those whose lives are disrupted by flooding events. Their research has informed guidance for local authorities, policy makers and public health practitioners on planning for and dealing with the aftermath of a flood.

Published: 29 September 2022

Flooding is an increasing risk

Researchers from three NIHR Health Protection Research Units have found that flooding can have a significant negative impact on the mental health of people whose homes are flooded, as well as those whose lives are disrupted by flooding events. Their research has informed guidance for local authorities, policy makers and public health practitioners on planning for and dealing with the aftermath of a flood. 

Flooding is one of the most common environmental emergencies and is becoming more frequent in the UK. While short-term health risks - such as injuries, infections and disruption to healthcare - are well understood, there is little evidence on the impact of repeat flooding on mental health or health-related quality of life (HRQoL). 

In recognition of the ongoing and increasing risk of flooding, researchers from three NIHR Health Protection Research Units (HPRUs) collaborated with Public Health England to establish the English National Study of Flooding and Health. In this study Professor Isabel Oliver, co-director of the HPRU in Behavioural Science and Evaluation and Visiting Professor at the University of Bristol, worked alongside colleagues at the HPRUs in Emergency Preparedness and Response and Environmental Change and Health to lead the investigation. 

Professor Oliver said: “The aims of the English National Flooding and Health study      were to investigate the medium- and longer-term impact of flooding and flooding-related disruption on mental health and wellbeing, and to provide a cohort to support future studies in this area. We anticipated this would help direct preventive and follow-up actions and reduce harm from future floods.”



Flooding linked to mental health difficulties

The researchers contacted 8,700 people in the south of England impacted by the winter 2013/14 floods - the wettest winter to England in 250 years - and people affected by the flood in Cumbria in 2015.  Data on their exposure to floods, mental health and quality of life were collected via questionnaire at approximately one, two and three years after the floods.

The one-year follow-up study found that people whose homes had been flooded were approximately six times more likely to experience mental health problems than those who were unaffected by flooding, with the prevalence of probable depression at 20.1%, anxiety 28.3% and post-traumatic stress disorder (PTSD) 36.2%.

In some cases people continued to experience mental health problems at two years and three years after being flooded, with PTSD in particular continuing long after the flooding event. 

Certain factors affected the likelihood of poor mental health after flooding, such as depth of flood water in the home, persistent flood-related damage, having to evacuate, and losing gas, electricity or water to the home.

The researchers also wanted to look into how flooding had affected people’s wellbeing more generally and their ability to live a fulfilling life. They found that health-related quality of life significantly lower in people who were exposed to or disrupted by flooding, and one, two and three years after flooding. 

Dr Clare French, who worked on the study at the NIHR HPRU in Evaluation of Interventions at the University of Bristol, noted: “The association between flooding and mental health at six months is striking.” 

“Our findings highlight the need for the provision of mental health services and support following flooding, irrespective of prior flooding experience."

Dr Clare French, co-investigator at the NIHR HPRU in Evaluation of Interventions

The researchers suggested that providing people with approaches to reduce the impact of flooding, such as increased community cohesion and support networks, prior to an event may help to protect their mental health afterwards.

Recommendations to protect mental health

The analysis by the HPRU researchers identified a set of clear recommendations that have informed the development of guidance by Public Health England for local authorities. The recommendations include: ensuring that the appropriate healthcare services are in place prior to flooding; anticipating an increased demand for mental health services afterwards; and minimising the ingress of water into houses. 

Their briefing for policy makers and practitioners outlines steps that health and public service providers can take when planning for and dealing with the aftermath of a flood. These recommendations have since been adopted by the directors of public health in Cumbria and Newcastle. Commenting on how the recommendations are being used in Cumbria, Colin Cox, Director of Public Health at Cumbria County Council, said:

“This report is extremely helpful in identifying key risk factors for poor mental health associated with flooding.” 

 

He continued, “It supports the planning that we are doing both within public health and with the community resilience groups around what we need to put in place to support people in future flooding events, enabling us to think about targeting support more accurately.”

The recommendations are also helping to inform the work of Department for Environment, Food and Rural Affairs and the Environment Agency (Defra), contributing to changes to the formula for allocating funding for flood and coastal defences, which included updated payments based on the overall impacts of flooding, such as mental health. They have also helped shape Defra’s call for evidence on whether funding rules should be changed to better take account of local factors, such as frequent flooding and its associated mental health impacts.

The research was cited by Baroness Walmsley in the opening speech for the House of Lords debate on the health impacts of climate change and in the Committee on Climate Change’s 2017 Report to Parliament

 

 “Our research will help inform agencies to plan and provide services in flood-affected areas, both in the immediate aftermath of flooding and longer-term, to help mitigate the effect of flooding on mental health and health-related quality of life.”

Professor Oliver

 

The study was funded by NIHR’s HPRUs in Behavioural Science and Evaluation at the University of Bristol, Emergency Preparedness and Response at King’s College London and Environmental Change and Health at the London School of Hygiene and Tropical Medicine, in partnership with Public Health England.

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