ROCKY MOUNTAIN REGION DISASTER MENTAL HEALTH NEWSLETTER
Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT
October 26, 2001
"A good plan executed right now is far better than a perfect plan executed next week."
- George S. Patton
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INFORMATION FROM THE AMERICAN PSYCHOLOGICAL ASSOCIATION on coping with
traumatic events:
http://www.apa.org/psychnet/coverage.html
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CRITICAL INCIDENT STRESS WORKSHOP sponsored by The University of Wyoming Counseling Center
and The Rocky Mountain Region Disaster Mental Health Institute will be held in Laramie, WY
on November 16, 17, 2001. There will be two workshops. One will be in Basic Critical Incident
Stress Management (CISM) on 11/16-11/17 and will be a certification course taught by
International Critical Incident Stress Foundation (ICISF) certified trainers. The Advanced
Issues in Critical Incident Stress Debriefing will be taught by U.S. Navy Psychologist
CDR Bryce Lefever, PhD, ABPP. Enrollment in both workshops is limited. There is an early bird
registration period. If you wish to receive a printed brochure, please email:
GeorgeDoherty@callatherapist.com with your name and mailing address.
Online Brochure can be accessed at: https://www.angelfire.com/biz3/news/cismuw.html
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Join discussion about Borderline Personality Disorder
http://groups.yahoo.com/group/wtoprofessionals
Clinician moderated, this listserv is available for mental health professionals who wish to
share information and gain support for treating clients with borderline personality disorder.
It was started by Randi Kreger, coauthor of "Stop Walking on Eggshells," a popular book for
people who have a family member with the Axis II disorder.
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December 17-20: Southeast Asia Regional Conference on Scientific and Applied Psychology:
Enhancing Human Potential, Mumbai.
The conference is hosted by the Bombay Psychological Association (BPA) and is sponsored by the
International Association of Applied Psychology, the International Union of Psychological
Sciences and the International Association for Cross Cultural Psychology. Registration is
$200 on or before Sept. 15 and $250 thereafter. Contact: B.L. Barnes, BPA president and
conference co-president; SNDT Women's University, Mumbai 400020; Phone: 2072484, 3873838;
email: bpapsyindia@rediffmail.com.
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NEW DEMOCRACIES CAN BE UNDERMINED BY ELITES
Nations with socioeconomic and political elements that
sometime retard or disrupt full democratization might
benefit from the lessons of Germany during the 1920s,
according to a Penn State expert. A study by Michael H.
Bernhard, associate professor of political science,
shows that an initial brave attempt at democratization
was ultimately brought down by the voting power of
entrenched elites who preferred Hitler to the rule of
law. Bernhard coded each electoral district depending
on whether it became part of West Germany, pro-Soviet
East Germany, Poland or the Lithuanian or Russian
Soviet Republics after World War II. He then tabulated
votes for all eight of the Weimar Republic elections
between 1920 and 1933, comparing votes cast in the
western and eastern parts of pre-World War II Germany.
The study appeared in a recent issue of the journal
Comparative Politics. For the full story by Paul Blaum,
visit
http://www.psu.edu/ur/2001/newdemocracies.html.
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ROLE OF MENTAL HEALTH IN EMERGENCY RESPONSE AND RECOVERY
Disasters are complex human, bureaucratic, and political events. Routine resources and procedures
are not adequate for managing changes caused by disasters. The number and type of responding
groups, agencies, and jurisdictions increase tremendously. Relationships among organizations
change. Alterations in traditional divisions of labor and resources increase needs for multi-
organizational and multi-disciplinary coordination among all the participants. Without such
coordination, it is difficult to share resources and distribute them to fulfill needs.
Communication, command and control may be insufficient, essential tasks may be omitted,
duplication of effort may occur and activities may become counterproductive.
A disaster differs from routine emergencies in that it cannot be adequately managed by merely
mobilizing more personnel, equipment and supplies. A disaster often creates demands that exceed
the capacities of single organizations. This requires them to share tasks and resources with
other organizations that use unfamiliar procedures. Disasters may also cross jurisdictional
boundaries (Auf der Heide, 1989). They change the number and structure of responding
organizations and can result in the creation of new ones. They create new tasks, and engage
participants who are not ordinarily disaster responders. Disasters also disable routine
equipment and facilities needed for emergency responses.
Organizations inexperienced in disasters often respond by continuing their independent roles.
They fail to see how their function fits into the big picture and the total response effort
(Auf der Heide, 1989). This isolation occurs not just in response, but also in planning. All
too often, private sector groups and different levels of government may not have plans that
realistically consider the roles and resources of other groups.
Key factors in an organization's effectiveness are flexibility and the ability to improvise.
It is critical for responding agencies to educate themselves about the roles and responsibilities
of other local, state, and federal agencies in time of disaster. They must plan for disaster
response based on a solid knowledge of the organizational environment.
PLANNING FOR MENTAL HEALTH'S ROLE IN EMERGENCY RESPONSE AND RECOVERY
A mental health disaster plan is essential to coordinating the mental health emergency response
efforts with other emergency response organizations in time of disaster. It is strongly
recommended that each state department of mental health have a mental health disaster plan
which is a component of the state emergency management plan. In many states, the governor
mandates a mental health disaster plan by executive order. In a similar manner, each department
of mental health, city, county, or regional, should have a mental health disaster plan. This
plan should be a well-integrated component of the comprehensive emergency management plan for
that jurisdiction. Some states have mandated this by legislation.
The purpose of a mental health plan is to ensure an efficient, coordinated, effective response
to the mental health needs of the affected population in times of disaster. It will enable
mental health to maximize the use of structural facilities, personnel, and other resources
in providing mental health assistance to disaster survivors, emergency response personnel,
and the community (California Department of Mental Health, 1989; New Jersey Department of
Human Resources, 1991). The mental health disaster plan should specify the roles,
responsibilities and relationships of the agency to federal, state, and local entities with
responsibility for disaster planning, response and recovery.
The mental health disaster plan should also specify roles, responsibilities and relationships
within the mental health agency in responding to disasters (South Carolina Department of
Mental Health, 1991). The plan needs to be organized so that it reaches each level and each
component of the agency. It should also identify the respective individuals (by position) who
are responsible for carrying out the functions. Individuals should all have back-ups, preferably
three deep.
Mental health services are provided to disaster survivors in community locations where survivors
congregate. These include but should not be limited to shelters and meal sites. These sites are
often operated by the Red Cross in cooperation with social services or other organizations.
In long-term recovery, mental health efforts should be integrated with other human services
offered to survivors. Because close collaboration with these agencies is necessary, the mental
health disaster plan is often a component of, or an attachment to the social services/shelter
plan. In some areas, mental health agencies have found it beneficial to include in their plan
a Memorandum of Understanding (MOU) with the Red Cross, delineating roles and responsibilities
of the two agencies. Mental health services to survivors may also be provided at hospitals,
first aid sites, and the coroner's office. Consequently, the mental health plan requires
coordination and integration with the emergency medical plan, the public health plan, and the
coroner's plan.
VOLUNTARY AGENCIES RESPONSE
There are often many volunteer organizations that respond to disasters. Their responses are
not mandated by law. However, many individual organizations include disaster response in their
charters. Moany are members of the National Voluntary Organizations Active in Disaster (NVOAD).
Additionally, existing local groups like volunteer centers may provide specific responses to
a local disaster. Mental health should be alert to and familiar with voluntary groups'
responses in disasters. These groups often provide human services not otherwise available to
survivors.
CRISIS COUNSELING PROGRAMS FOR VICTIMS OF PRESIDENTIALLY
DECLARED DISASTERS
Section 416 of the Stafford Act authorizes funding for mental health services following a
presidentially declared disaster:
Sec. 416. The President is authorized to provide professional counseling services,
including financial assistance to state or local agencies or private mental health
organizations to provide such services or training of disaster workers, to victims of
major disasters in order to relieve mental health problems caused or aggravated by such
major disaster or its aftermath. (FEMA/CMHS, 1992).
Purpose and Objectives
The crisis counseling program for survivors of major disasters provides support for direct
services to disaster survivors. A training component in disaster crisis counseling for direct
services staff of the project and for training of other disaster services workers may be
included. This program has been developed in cooperation with FEMA and the Center for Mental
Health Services (CMHS) within the Substance Abuse and Mental Health Services Administration
(SAMHSA).
The law was enacted and the program developed in response to the recognition that disasters
produce a variety of emotional and mental disturbances that, if untreated, may become long
term and debilitating. Such problems as phobias, sleep disturbances, depression, irritability,
and family discord occur following a disaster. Programs funded under Section 416 are designed
to provide timely relief and to prevent long-term problems from developing.
Assistance under this program is limited to presidentially declared major disasters. Moreover,
the program is designed to supplement the available resources and services of state and local
governments. Therefore, support for crisis counseling services to disaster victims may be
granted if these services cannot be provided by existing agency programs. The support is not
automatically provided.
Conditions and Terms of Support
For any assistance, an assessment of the need for crisis counseling must be initiated by a state
within 10 days of the date of the presidential disaster declaration. There are two types of
support: Immediate Services Grants and Regular Services Grants. Monies for both types of support
come from FEMA.
Support for Immediate Services must be requested within 14 days of the date of the disaster
declaration. Support may be provided for up to 60 days after the date of the major disaster
declaration. This decision is made by the regional director of FEMA or his/her on-site designee,
the disaster recovery manager (DRM), after consultation with the Emergency Services and Disaster
Relief Branch, Center for Mental Health Services (CMHS) within the Substance Abuse and Mental
Health Services Administration (SAMHSA).
Regular Services funding must be requested within 60 days of the date of the disaster declaration.
Support may be provided by the assistant associate director of FEMA through SAMHSA, based upon
the recommendations of the FEMA regional director and the CMHS Emergency Services and Disaster
Relief Branch. The Regular Program is limited to nine months except in extenuating circumstances
when an extension of up to three months may be requested.
Eligibility Requirements
The law provides that financial assistance may be provided to state, local, or private mental
health organizations. A state agency official is appointed by the governor to make all requests
for federal disaster assistance (i.e., the state is the official applicant). This official is
the governor's authorized representative (GAR). Requests for funds under both the Immediate and
Regular Program must be made by the GAR. The recipient of support may be a state agency or its
designee.
Special Concerns
When developing a request for assistance, the applicant should be aware of special concerns,
such as:
* Specific attention should be given to high-risk groups such as children, the frail elderly,
and the disadvantages;
* Prolonged psychotherapy measures are inappropriate for this program;
* Maximum use should be made of available local resources and personnel; and
* Programs should be adapted to local needs, including special cultural, geographic, or
political constraints.
Disaster survivors are eligible for crisis counseling services if they are residents of the
designated major disaster area or were located in the area at the time of the disaster.
Additionally, they must (1) have a mental health problem which was caused or aggravated by
the disaster or its aftermath, or (2) they may benefit from preventive care techniques (Federal
Register, 1989).
Crisis counseling project staff or consultants to the project are eligible for training that
may be required to enable them to provide professional disaster mental health services to
eligible individuals. In addition, all federal, state, and local disaster workers responsible
for assisting disaster victims are eligible for training designed to enable them to deal
effectively and humanely with disaster survivors (Federal Register, 1989).
APPLYING FOR IMMEDIATE SERVICES
For Immediate Services, an application for funding in the form of a letter of request should be
submitted not later than 14 days following the disaster declaration by the GAR to the FEMA
disaster recovery manager (DRM). An additional copy will be submitted to the Emergency Services
and Disaster Relief Branch, CMHS, by FEMA for consultation in evaluating the need for Immediate
Services and the state's capability for providing services.
The application for Immediate Services must include the state's assessment of need, initiated
within 10 days of the disaster declaration. An estimate of the size and cost of the proposed
program is required. Specifically, the state mental health authority should address each of
the following issues, for each jurisdiction that is requesting funds:
Extent of Need: To justify initiation of a special mental health program, the state must
demonstrate that disaster-precipitated mental health needs exist.
State Resources: A description of current capabilities and additional disaster needs is
required.
Program Plan: Plans for outreach, crisis counseling, referral, consultation, and education
should be outlined briefly. Staff qualifications and training needs should also be included.
Whereas the Immediate Services application is expected to address the above issues, it is
anticipated that requests will be brief - only a few pages. A more comprehensive statement is
expected for applications for the Regular Services.
APPLYING FOR REGULAR SERVICES
For Regular Services, a grant application must be submitted with Standard Form 424 not later
than 60 days following the disaster declaration. The GAR must submit the application to the FEMA
assistant associate director, through the FEMA regional director, and simultaneously to the
Emergency Services and Disaster Relief Branch, CMHS.
The application for Regular Services must include:
1. Public Health Service Grant Application Form SF 424.
2. The disaster description including the type of disaster, and its time, place, and duration.
3. Needs Assessment: Estimates of the total number of individuals in need of direct services
and the total number of individuals in need of outreach and consultation and education, for
each service provider group. Population demographics.
4. Program Plan: Description of the manner in which the needs of the affected populations
will be met, types of services to be offered and a rationale for each. The plan must reflect
attention to cultural, ethnic, or geographic needs or other special factors indigenous to
the area.
5. Staffing and Training: Delineation of the number and kinds of staff required as well as specific
training programs for staff.
6. Resource Needs and Budget: Explanation of the extent to which existing resources are unable
to meet the needs of the disaster affected population. The budget must be clearly tied to the
program and contain both dollars requested and a justification for individual budget items.
A Workbook for Development of a Grant Application for the Regular Program, other technical
assistance materials, and information and guidance on either of the two types of application
can be obtained by contacting:
Emergency Services and Disaster Relief Branch
Division of Program Development,
Special Populations and Projects
Center for Mental Health Services
5600 Fishers Lane, Room 16C-26
Rockville, MD 20857 Phone: (301) 443-4735
Conclusion
It is essential that mental health agencies have an understanding of the basic roles,
responsibilities and resources of the private and public organizations and agencies involved
in disaster response. This is important in order to function effectively in the complex
organizational environment of a disaster. It is also important to have an understanding of
the funding available through Section 416 of the Stafford Act to assist local mental health
agencies in helping disaster survivors with their emotional and psychological recovery.
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REFERENCES
Auf der Heide, E. (1989). Disaster response: Principles of preparation and coordination. St. Louis,
MO: C.V. Mosby Co.
California Department of Mental Health (1989). Mental Health Disaster Plan. Sacramento, CA.
Federal Emergency Management Agency and Center for Mental Health Services. (1992). Crisis Counseling
for Victims of Presidentially Declared Disasters. Washington, D.C.
Federal Register (March 21,1989). 54(53): 11629.
New Jersey Department of Human Services, Division of Mental Health and Hospitals. (1991). Mental
Health/Emergency Disaster Plan. Newark, NJ.
South Carolina Department of Mental Health. (1901). State Mental Health Disaster Plan. Columbia, SC.
To search for books on disasters and disaster mental health topics and purchase them online,
go to the following url:
https://www.angelfire.com/biz/odochartaigh/searchbooks.html
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Contact your local Mental Health Center or
check the yellow pages for counselors, psychologists,
therapists, and other Mental health Professionals in
your area for further information.
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George W. Doherty
O'Dochartaigh Associates
Box 786
Laramie, WY 82073-0786
MENTAL HEALTH MOMENT Online: https://www.angelfire.com/biz3/news
