{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T18:07:02Z","timestamp":1775239622771,"version":"3.50.1"},"reference-count":57,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T00:00:00Z","timestamp":1775174400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Academies of Science, Engineering and Medicine"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Extreme weather events are increasing in frequency and severity, disproportionately affecting marginalized and under\u2011resourced communities. In Houston, Texas, where insurance coverage and mental health access remain limited, successive disasters compound existing inequities, leaving residents with unmet psychological needs. Yet little is known about how chronically impacted communities conceptualize their mental health experiences, barriers to accessing care, and priorities for support following repeated disaster events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a qualitative study using town hall\u2013style community conversations in three historically underserved Houston communities (Kashmere Gardens, Third Ward, Fifth Ward). A total of 145 residents participated between March and October 2024. Discussions followed a semi\u2011structured guide and were captured through trained note\u2011takers using a standardized template, supplemented by graphic recording. Reflexive thematic analysis, employing an inductive approach and an audit\u2011trailed consensus process, was used to identify themes. Researcher triangulation, persistent observation, and reflexivity were used to enhance trustworthiness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Three themes emerged. (1) Living in \u201csurvival mode\u201d: residents described cumulative emotional exhaustion driven by repeated disasters, including persistent anxiety, hypervigilance, grief, caregiving burdens, and limited capacity for self\u2011care. (2) Navigating stigma, mistrust, and limited access: participants highlighted cultural stigma, confusing and costly pathways to care, and mistrust stemming from unfulfilled institutional promises and inaccessible services. (3) Building a path forward: residents emphasized the need for mental health literacy, community\u2011embedded services, improved communication with city officials, and sustained funding for affordable, accessible, and culturally responsive mental health support.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Successive disasters create chronic psychological strain in high\u2011vulnerability communities while simultaneously limiting access to care. Findings underscore the need for disaster mental health strategies that move beyond the acute response period to include community\u2011embedded supports, continuity of care, and investments in mental health literacy and affordability. Centering community voices is critical for developing equitable, sustainable, and culturally attuned disaster mental health systems.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0345216","type":"journal-article","created":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T17:35:13Z","timestamp":1775237713000},"page":"e0345216","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond the emergency: Centering mental health in community disaster preparedness and recovery"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5585-7146","authenticated-orcid":true,"given":"Omolola E.","family":"Adepoju","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashley M.","family":"Smith","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura A.","family":"de la Roche","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Curtis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,4,3]]},"reference":[{"key":"pone.0345216.ref001","volume-title":"The State of Mental Health in America 2024","author":"M Reinert","year":"2024"},{"issue":"6","key":"pone.0345216.ref002","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1093\/jmp\/jhab032","article-title":"Mental Health Without Well-being","volume":"46","author":"S Wren-Lewis","year":"2021","journal-title":"J Med Philos"},{"issue":"5","key":"pone.0345216.ref003","article-title":"Understanding and Addressing Mental Health Stigma Across Cultures for Improving Psychiatric Care: A Narrative Review","volume":"15","author":"AA Ahad","year":"2023","journal-title":"Cureus"},{"issue":"8","key":"pone.0345216.ref004","first-page":"117","article-title":"The Effects of Climate Change on Mental Health","volume":"120","author":"A Walinski","year":"2023","journal-title":"Dtsch Arzteblatt Int"},{"key":"pone.0345216.ref005","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1002\/ajcp.12091","article-title":"Why does disaster recovery work influence mental health?: Pathways through physical health and household income","volume":"58","author":"S Lowe","year":"2016","journal-title":"Am J Community Psychol"},{"issue":"2","key":"pone.0345216.ref006","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1093\/gerona\/62.2.191","article-title":"Perception of unmet basic needs as a predictor of depressive symptoms among community-dwelling older adults","volume":"62","author":"DG Blazer","year":"2007","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"pone.0345216.ref007","doi-asserted-by":"crossref","first-page":"373","DOI":"10.3389\/fpubh.2018.00373","article-title":"Enhancing Disaster Resilience by Reducing Stress-Associated Health Impacts","volume":"6","author":"PA Sandifer","year":"2018","journal-title":"Front Public Health"},{"key":"pone.0345216.ref008","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3389\/fpsyt.2020.00001","article-title":"Ecological disasters and mental health: causes, consequences, and interventions","volume":"11","author":"JC Morganstein","year":"2020","journal-title":"Front Psychiatry"},{"key":"pone.0345216.ref009","unstructured":"City of Houston Planning & Development Department. 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