Healing for Health Workers: Building Mental Health Capacity in Post-Maria Puerto Rico

Commitment by Americares Foundation, Inc.

In 2018, Americares committed to support health workers, emergency responders, and social service providers in Puerto Rico to address mental health challenges in the wake of Hurricane Maria. Mental health has emerged as a serious unaddressed need following Hurricane Maria, and individuals in these professions are at an increased risk for psychosocial issues due to their dual role as care providers and survivors of the hurricane. Working with partners, Americares will train these workers to increase their own resiliency and coping skills in order to avoid job burnout and manage stress effectively. Americares will also train these individuals to better understand, identify, and respond to the mental health and psychosocial needs of their patients and clients and will equip them with skills including Psychological First Aid, identifying the signs of trauma, and suicide prevention. Over the next 18 months, Americares will extend this training to 5,000 health workers, emergency responders, and social service providers across the island.



Healing for Health Workers: Building Mental Health Capacity in Post-Maria Puerto Rico



Est. Duration

1 Year

Estimated Total Value



Latin America & Caribbean



Commitment by

Americares Foundation, Inc.

Partner(s) of the Commitment Maker(s)

Johnson & Johnson

This initiative is focused on addressing the mental health needs of healthcare and social service providers and the emergency response community in Puerto Rico by integrating psychosocial services into ongoing health system and emergency response initiatives. Americares will officially launch the program in April 2018 with a concrete strategy for staffing, training, implementation and data collection over the following 18 months across eight Department of Health Regions. Mental health programming will reach 5,000 participants. Starting in April 2018, Americares and partners will identify 20 local mental health staff and equip staff with the skills needed to effectively deliver the menu of programming. Simultaneously, staff and partners will identify health institutions, government partners and community organizations, to host sessions to engage participants in the selected regions. Americares Resilience and Coping for the Healthcare Community workshops will be delivered throughout the project period, starting in April and building to an estimated total of 400 workshops. June 2018- October 2019: The full array of mental health and psychosocial training, along with individual sessions, will ramp up in June of 2018 and continue through the commitment period. Partner selection will be ongoing, and Americares and partners will continue to coordinate service delivery and cultivate new partnerships with national and local associations, continuing to identify organizations and participants to receive mental health and psychosocial programming. Data will be collected through the duration of the project. Information will be used to inform new content creation to address common thematic concerns, as well as inform mental health needs that will persist past the commitment period.n \n\n Americares plans to train 5,000 health and social service providers and emergency responders over 18 months using a tiered approach that will reduce stress, depression, PTSD and burnout, and build capacity. To increase resiliency, coping skills and wellbeing of healthcare and social service providers and first responders, Americares will offer their signature Resilience and Coping for Healthcare Community (RCHC) workshops. These three-hour psychoeducational workshops define types and dimensions of stress; identify stress responses commonly experienced after a traumatic event; recognize signs of job burnout and compassion fatigue; identify healthy coping strategies and devise strategies to support each other in the workplace. Within the resilience building activities, Americares will provide focused support groups tailored to meet specific themes such as grief, stress management, and caregiving. Additionally, providers and responders in need of additional support are eligible to receive up to six individual solution focused sessions with referral to longer term care as needed. Americares will also offer a variety of training to increase the capacity of healthcare and social service providers and emergency responders to identify, treat, and/or refer patients with mental health and psychosocial needs. Educational workshops cover topics such as Psychological First Aid (PFA), General Signs of Stress and Trauma, Suicide Warning Signs Detection and Prevention, the Brain’s Reaction to Trauma, and Coping with Difficult Patients. Over the 18-month period, Americares will rapidly hire 20 local mental health professionals to achieve the outlined menu of training, individual sessions, data collection and coordination activities. Americares staff will be based in San Juan and across eight health regions of Puerto Rico. Americares staff will work alongside multi-sector partners to reach 5,000 participants, leveraging resources and ensuring efforts are not duplicated. Americares brings years of expertise in mental health and psychosocial support programming and will hire qualified mental health professionals who bring the necessary skills and experience required to achieve goals. Americares partners are committed to mobilizing resources – funding, staff, networks – and promoting available mental health and psychosocial services to healthcare and social service providers and emergency responders across Puerto Rico.


Prior to Hurricane Maria, Puerto Rico was already struggling with an emerging mental health crisis amid a 10-year recession that brought soaring unemployment, poverty, and family separation caused by migration. The most recent (2017) epidemiological study found that 7.3% of Puerto Rican adults suffer from a serious mental illness, two in 10 report a psychiatric ailment of some kind, and one in 10 suffer a severe depressive disorder, often without treatment. Since the storm, mental health issues have only intensified, emerging as a serious unaddressed need. Despite massive telecommunications interruptions, in the initial aftermath of the storm Puerto Rican health officials report that more than 2,000 calls quickly overwhelmed an emergency hotline for psychiatric crises maintained by the health department — double the normal number for that period. Officials also report that suicides have increased — more than 100 people have committed suicide in the aftermath of Hurricane Maria, a 15% spike compared to the same timeframe last year — and many more people than normal have been hospitalized after being deemed dangerous to themselves or others. Disasters impact an individual on many levels. Loss of a home, devastation of a community, changes to the workplace or injuries and deaths of family and friends are all common in the wake of a major disaster. It can take months, even years to recover, which can lead to sustained chronic stress during the recovery process. Caregivers in particular are in need of sustained, systematic mental health training and support. Health workers, social service professionals and emergency responders from affected communities play a dual role: They provide support to others in the disaster recovery process while also attending to their own and their families’ needs. Studies indicate that health workers are at a higher risk for increased alcohol consumption, anxiety, depressive symptoms, job burnout, compassion fatigue, secondary traumatic stress, and vicarious traumatization.

Partnership Opportunities

Americares is seeking partners that are committed to addressing the post-disaster mental health needs of Hurricane Maria survivors. Resources required to achieve the outlined commitment include incremental funding, support in recruitment of qualified mental health professionals, mobilizing networks to promote available mental health and psychosocial services to healthcare and social service providers and emergency responders across Puerto Rico.

Progress Reports

December 2018

Americares has trained 2,020 care providers through 124 service partners across Puerto Rico in Americares signature psychoeducational workshop, Resilience and Coping for the Healthcare Community or Psychological First Aid. Of those trained, 74% are health care workers and 26% are first responders/emergency responders. Many of the participants have received multiple services as part of our tiered approach.

An additional 25 workshops are scheduled between now and the end of the year. Concurrent with program implementation, Americares is gathering data and conducting research to assess impact and inform future interventions. We have received NIH clinical trials registry acceptance at the end of October and baseline data collection is complete.

Looking ahead, two recent grants from the Center for Disaster Philanthropy and from the Robert Wood Johnson Foundation to support Americares Mental Health and Psychosocial Support program in Puerto Rico complete the funding needed to implement fully the proposed CGI commitment thus positioning Americares to meet commitment goals by October 2019.