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30 was an internal need to be more prepared and connect with incident site. This, too, will cause emotions to resurface sur- the fire department. rounding the trauma. Careful consideration and planning will The airport manager connected with the fire chief and began need to be taken to have the appropriate resources in place to training with the fire department, thus building self- and com- deal with requests of the family and possible mental health munal efficacy. This provided an atmosphere of connectedness, implications for employees. and after working with the fire fighters on non-airport fire department calls, the manager found peaceful resolutions and 6. Example Mental Health an ability to cope with the after effects of a traumatic event. All Recovery Plan of these elements combined provide a safe and calm atmo- sphere in the midst of chaos. This Mental Health Planning Document was retrieved from The State of New York's Office of Mental Health. It provides a comprehensive review of the planning and resources needed Lessons Learned to develop a mental health response guide. While it is not an 1. Determine who will handle the media for "airport-specific" plan it illustrates many different facets to the airport during the event. consider while developing an organizations individual plan. It is available at http://www.omh.state.ny.us/omhweb/countyguide/. The airport manager was on scene as an official, but also as a city fire fighter. This made the response activity go quite smoothly; however, upon return to the office the media, and The New York State County Disaster others barraged the terminal and phone lines for informa- Mental Health Planning and Response tion. Who is to give out fatal information? When building Guide: A Guide for County Directors of scenarios and training events for traumatic events, make con- Mental Health and Community Services tact with the department or person that will handle the media The County Disaster Mental Health Planning and Response and notifications on behalf of the airport. If the airport is Guide provides specific information and resources to assist small (1 employee) then someone from the local jurisdiction the county Director of Community Services (DCS) in the may be delegated to handle this duty. development of a comprehensive county mental health dis- aster plan. The Guide follows the disaster management con- 2. Determine who will handle victims' tinuum and takes into consideration the important aspects of assistance activities. Planning and Preparedness, Mitigation, Response, Recovery, and Evaluation. Victims' families may want to visit the area and be brought It is recommended that the DCS review the community's to the site of the incident to aid in their grief process. While plan routinely so new information in the field of disaster men- this is an important step for families it is not a comfortable tal health may be integrated into the plan in a timely manner. position to put the airport sponsor in. At the point of initial Key contact information for vendors, volunteers, employees, investigation, the airport has no idea of the NTSB outcome and others should be reviewed every 6 months and the plan and there may be liability, so careful planning should ensue. updated accordingly. There should be a determination of what neutral party in the response effort should handle the victims' family members. 1. General Overview If the scene is on the airport property, then accommodations 1.1 Planning/Preparedness for access will need to be considered. Make direct contact with Convene a county Disaster Mental Health Advisory the American Red Cross for your region. Committee. Review the county's Emergency Management Disaster Plan. 3. Be cognizant of anniversary dates Review the disaster mental health plan of your local and memorial requests. American Red Cross and other disaster mental health It is not uncommon for family members to want to visit response agencies in your community. the site of the incident in the preceding years on the anniver- Develop a comprehensive county disaster mental health sary of the event. This will trigger phone calls and emotions response and recovery plan. surfacing, or reliving the event for the airport worker. Also, Develop county disaster mental health response teams. there have been several airports around the country that have Establish county MOU with community partners. been asked to put a permanent marker or memorial on the Participate in county disaster drills and exercises.

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31 1.2 Mitigation tion and diversity of participants involved in its development. Identify high risk areas and populations within the county Effort should be made to invite participants from multidisci- and its contiguous borders. plinary backgrounds and experiences. Representatives from Develop disaster-related educational brochures (i.e., the following list of public and private agencies and organi- psychological impact of disasters and how to seek zations might be invited to serve on the overall advisory com- help, recover, etc.) and distribute to high risk areas and mittee or its topic specific task groups: populations. 2.1.1 County/City Stakeholders 1.3 Response Office of Emergency Preparedness. Activate response protocols for County disaster mental Department of Health/Public Health. health teams. Office of the Medical Examiner. Coordinate resource deployment and service provi- Department of Health and Human Services. sion with other community-based disaster mental health Department of Human Resources Management. teams. Department of Information Technology. Assess mental health needs of the affected community. Department of Legal Affairs/Risk Management. Initiate early phase supportive interventions. Law Enforcement, Fire, and Emergency Medical Services. Identify high risk populations and implement the appro- Business Community. priate early phase interventions. School Districts/Universities/Colleges. Distribute public mental health educational materials. Correctional Facilities. Collaborate with county government about risk Airport Administration Officials. communication. Re-assess and evaluate mental health needs of the affected 2.1.2 Regional/State/Federal Stakeholders New York State Office of Mental Health (Field Office). community. New York State Department of Health (Regional Office). 1.4 Recovery Regional Resource Center/Hospital Bioterrorism Pre- Assess and evaluate the intermediate and long-term men- paredness Program. tal health needs of the affected community. New York State Office of Alcohol and Substance Abuse Identify community resources to provide intermedi- Services (Regional Office). ate and long-term mental health and substance abuse New York State Office of Mental Retardation/Develop- treatment. mental Disabilities (Regional Office). Train mental health/health practitioners in long-term New York State Emergency Management Office (Regional mental health and substance abuse treatment inter- Office). ventions. New York State Office of Mental Health Psychiatric Implement supportive interventions for DMH teams Centers. and other disaster personnel U.S. Department of Corrections (Federal Prisons). 1.5 Evaluation U.S. Veterans Affairs. Conduct periodic disaster drills and tabletop exercises. U.S. Military Installations. Following a disaster or a drill or exercise, convene an 2.1.3 Other Public/Private Agencies and Organizations "after action" committee to review preparedness, miti- American Red Cross. gation, response, and recovery issues and activities, and Salvation Army. make necessary updates and changes. Academic Medical Centers. 2. Planning and Preparedness Community Hospitals and Healthcare Facilities. 2.1 Convene a Disaster Mental Health Advisory Committee Mental Health Associations. The involvement of and collaboration with a wide variety Home Health Agencies. of public and private agencies and organizations is strongly Tribal Nations. encouraged. Planners may find it useful to sort the planning Nuclear Power Facilities. process into "topic" specific task groups or subcommittees Faith Organizations. addressing such areas as legal issues, recruitment and train- Transportation Companies (rail, bus, air). ing issues, operational and deployment protocols, "special Private Schools/Universities/Colleges. incidents" planning, etc. A vibrant and comprehensive men- Business and Industrial Community. tal health disaster plan is highly correlated with the collabora- Veterinary Associations.

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32 Special populations (those agencies or advocates repre- aster related needs of a community during times of disaster. senting children, elders, individuals with emotional and A community may also have other organizations that have physical challenges, various ethnic/cultural populations disaster-related service missions. Identify such agencies and such as Hispanic, African American, Asian, Mennonite, request and review copies of their respective disaster plans. deaf/hard of hearing, etc.). Identify opportunities to collaborate and reduce redundancies Private Residential Care Facilities. in service provision, where appropriate. 2.2 Review Your County Disaster Plan 2.4 Develop a Comprehensive Mental Health Disaster Plan The county's mental health disaster plan is one compo- Preparing for, responding to, and recovering from disaster nent of each county's overall community-wide disaster plan. is predicated on a comprehensive disaster mental health plan. To obtain a copy of the County Disaster Plan, contact the Development of this plan should include representatives from County Emergency Manager or Director of Emergency Pre- across professional disciplines as well as those from the pub- paredness. Each county plan should include a general overview lic and private sectors. Once the plan is completed, it should of the authority of the County Department of Mental Health be shared with and reviewed by a wide audience, especially during the event of a disaster. In reviewing the county's dis- those who have direct responsibility for carrying out specific aster plan, pay particular attention to the following issues in tasks and roles identified in the plan. Listed below are key a county: elements of a mental health disaster plan. Further informa- Potential disaster hazards and risks. tion regarding these key elements may be found in the U.S. Disaster history. Department of Health and Human Services, Substance Abuse Special plans (or Annexes) which identify specific roles, and Mental Health Services Administration (SAMHSA), responsibilities, or procedures the County will engage Mental Health All-Hazards Guidance Document, 2003 [see in related to the type of disaster. For example, many coun- Comprehensive Literature Review, Appendix A]. ties have elected to develop special plans in the event of the following: 2.4.1 Mental Health Disaster Plan-Key Elements Aviation or other transportation accidents. Statement of Purpose Weapons of Mass Destruction incidents. A statement of the general purpose of the plan and Radiological/Nuclear incidents. how it is intended to be used. Hazardous Materials (HazMat) incidents. General Assumptions Public health emergencies (such as SARS, Influenza, This information should include an overview of the and other communicable diseases). responsibilities of the County Department of Mental Review data on the geographical and population demo- Health, highest probability scenarios, as well as special graphics of the county as well as data on the risk groups considerations having significant impact on planning, below. The DCS may also want to collaborate with the including vulnerable populations, special facilities, etc. county's Geographic Information Systems (GIS) group Concept of Operation to map out specific risk groups: Include the County DCS's approach to an emergency Rural vs. urban communities. situation: jurisdictional responsibilities; sequence of Individuals living in flood plains. action before, during and following an event; requests Individuals living on earthquake fault lines. for aid, etc. This section is intended to be relatively Children, elderly, deaf/hard of hearing. brief, providing only the most general overview, pri- Schools, colleges, and universities. marily for readers of the plan who will not need the Ethnic/cultural populations. level of detail contained in the remainder of the plan. Religious communities. Citation of legal authorities and reference documents Group homes or assisted living facilities (mental health, Reference the specific legal authorities that enable the substance abuse treatment, MR/DD). County Department of Mental Health to fulfill the Nuclear power and other energy facilities. elements of the plan or to maintain existing services. Business and industry, especially those which may be In the event the County Department of Mental Health high risk targets for acts of terrorism. mobilizes and deploys paid staff and volunteers to pro- Disaster/emergency relief personnel. vide disaster mental health services on behalf of the 2.3 Review Disaster Plans for Local Disaster County, reference should be made in the plan as to Response Agencies what legal authority authorizes such deployment and A county's local chapter of the American Red Cross is how employee or volunteer liability will be covered in responsible for meeting the short-term or immediate dis- the event of a disaster-related accident or injury.

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33 Organization and Assignment of Responsibilities Identify a process for distributing educational and Identify tasks (within the County Department of Men- other materials to mental health service sites. tal Health, other County Departments, outside agen- Identify experts and resources outside the County cies) to be performed and positions and organizations Department of Mental Health that may be utilized as responsible for carrying out these tasks. consultants or advisors during times of disaster. Identify who is responsible for modifying and updat- Evacuation ing the disaster mental health plan and how often. Develop evacuation procedures for county mental Identify the level of integration of preparedness and health offices and facilities. coordination of operations with other important com- Identify alternate sites and facilities. ponents of local government (i.e., health/public health Collaboration with Other Agencies departments, substance abuse agencies, criminal jus- Coordinate with American Red Cross Disaster Mental tice agencies, mental retardation/developmental dis- Health Services. abilities agencies, etc.). Coordinate with community hospitals, mental health Administration, Logistics, Legal Issues centers and other mental health service providers. Policies and procedures regarding releasing personnel Resource Management home, holding personnel in place, recalling essen- Identify how the County Department of Mental Health tial personnel, and facilities evacuation (for County will find, obtain, allocate, and distribute necessary Department of Mental Health personnel and facilities). resources (i.e., personnel, transportation, communi- Procedures for record keeping of program activities, cations equipment, mutual aid, management of spon- expenditures and obligations, human resource utiliza- taneous volunteers, etc.). tion and situational reports. Special Response Plans Procedures for the management of both pre-identified Develop special response plans for high risk events and spontaneous volunteers. or incidents in which the County Department of Men- Procedures for feeding, sheltering, transporting, and tal Health or its facilities has special jurisdiction or supervising personnel. responsibility (i.e., aviation disasters, nuclear power Procedures for the repair/replacement of essential facility accidents, weapons of mass destruction events). equipment (radios, computers, cell phones). Continuity of Operations Arrange for personnel to have identification badges Describe how the County Department of Mental and address and resolve potential access issues with law Health will maintain or re-establish vital functions enforcement or other related agencies. (those services mandated by State or county regu- Address issues of licensing, personal, professional and lations) of the department during the first 72 hours organization liability, patient records management, following an event that seriously compromises or dis- informed consent, confidentiality, emergency evalua- rupts normal operations. tion or commitment laws, and duty to report laws. Identify and address procedures for restoring vital Communications records and data management within 72 hours. Procedures and methods for notifying county men- Procedures for the identification of essential person- tal health personnel, facilities, services providers, and nel, staff notification, staff and family support, and appropriate others. staff transportation. Alternative plans in the event of failed communication Identify alternate locations for essential operations. capability. Identify alternate sites for vital records (e.g., dupli- Identify the availability of technical consultation. cate copies of the disaster plan, personnel rosters, Public Information etc., should be located off site should existing sites Identify policies and responsibilities for dissemination be destroyed or are inaccessible). of public mental health information. Other Planning Considerations Identify external populations that may need special Identify a plan to prepare and support County Depart- warning and procedures for implementing such warn- ment of Mental Health personnel during and follow- ings (i.e., deaf and hard of hearing populations). ing deployment (i.e., physical health, mental health, Describe the relationship with the county Public Infor- family support). mation Officer. Ensure the County Department of Mental Health's Identify the availability of public information material role in disaster training, drills and exercises. (fact sheets, guides, multiple languages, access to Collaborate with county's GIS department to map high services, etc.). risk geographical areas and populations.

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34 Develop a list of federal, state and local mental health intervention skills and response protocols should be pro- and substance abuse treatment facilities, contact vided for disaster mental health workers prior to join- names, and telephone numbers (including alternate ing the team. Team members should be provided with modes of contact). ongoing training and education to maintain and enhance their disaster mental health response skills as well as to 2.5 Develop Disaster Mental Health Response Teams keep abreast of changes in the field. The following train- A county disaster mental health response team provides ings are recommended and encouraged: a significant resource to the community. Following a dis- Disaster Mental Health: A Critical Response curricu- aster, the majority of those affected will experience a range lum (UR/NYS OMH/DOH) of reactions that can be both stressful and impact personal Disaster Mental Health Services curriculum (American functioning. Disaster mental health response teams provide Red Cross) important supportive mental health interventions that may Risk Communication (NYS DOH) mitigate both the acute and long-term psychological conse- Incident Command System (FEMA) quences of disaster. Consideration must be given to the key Other Supplemental Training issues listed below in the development of a county disaster First Aid, CPR, Disaster Health Services, Disaster mental health response team: Casework (American Red Cross). Risk Management: If utilizing volunteers, address pro- Training to enhance skills in crisis intervention, fessional liability issues such as malpractice, work- grief counseling, death notification, mass casualty/ place injury, etc. If utilizing County Department of fatality, and special populations Mental Health personnel, address how employees will Training spontaneous volunteers in disaster mental be compensated for time worked as well as limitations health or in mental health interventions with special on employee number of work hours/days. populations may need to be offered during the disas- Selection Criteria: Team members should meet minimum ter relief operation so that spontaneous volunteers educational standards as well as possess documented may be utilized to augment insufficient or depleted experience in providing disaster mental health or other human resources. trauma-related support services. Position Descriptions: All team members should be pro- Application and Review Process: Team members should vided with a position description clearly outlining their complete an application highlighting his/her education roles and responsibilities on the response team. Descrip- and clinical experience. Requiring letters of reference is tions should be developed for the following positions: highly encouraged. A thorough review process should County Mental Health Director be conducted and include the identification of any crim- Response Team Coordinator inal or legal history as well as a review of the member's Response Team Leader professional license for any professional misconduct Response Team Member or sanctions. Other positions as determined. Recruitment: Teams should be representative of the Credentialing: Team members should be credentialed community in which they are deployed. Teams should prior to joining the team. This involves verifying the be comprised of members from various cultural/ethnic professional license of the individual and the clinical backgrounds, represent a range of academic mental training necessary to work with those impacted by dis- health disciplines, and possess rich clinical and practical aster. Once verified, team members should be provided experience. Below is a list of potential recruitment sites: with identification badges. A process for routinely veri- Local public/private mental health and substance fying and credentialing volunteers, especially sponta- abuse treatment facilities. neous volunteers, should also be developed. It is advis- Community-based private practitioners. able not to deploy spontaneous volunteers unless their Professional associations--State/local branches (i.e., educational and clinical backgrounds can be verified. American Psychiatric Association, American Psycho- Tracking: Monitoring the availability of team resources logical Association, American Counselors Association, is imperative to effective disaster response. Methods National Association of Social Workers, American should be developed for tracking the recruitment and Psychiatric Nurses Association). training of team members. Tracking should also include Training: The skills required by disaster mental health a mechanism for identifying members who may volun- response team members are not typically offered through teer with more than one response team in an effort to traditional clinical graduate mental health programs. A reduce redundancies in available disaster mental health rigorous training protocol highlighting the necessary response resources across agencies. It is important to

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35 clarify deployment priorities and expectations for those gests the following populations may be at heightened risk for members who do volunteer with multiple relief agencies. developing significant stress reactions or psychiatric illness Mobilization and Deployment Process: The county following disaster: mental disaster health plan should include a compre- Children hensive mobilization and deployment process so men- Female gender, especially married women tal health interventions may be offered "to the right Adults in their middle years, especially parents, pregnant people at the right time." These processes should ensure mothers that team members are deployed to safe environments Frail elders, especially those with physical health and their activities monitored from a risk management complications perspective. Spontaneous or "self" deployment should Ethnic minorities be discouraged. It is highly recommended that team Individuals with pre-existing psychiatric or substance members be deployed to a separate, off-site volunteer abuse disorders processing center prior to deployment to their work First responders, especially law enforcement, fire- assignments. fighters, emergency services with insufficient training and experience. 2.6 Establish Memorandum of Understanding with Poverty, lower socioeconomic status (SES). Community Partners A Memorandum of Understanding (MOU) should be devel- 3.2 Develop Disaster-Related Informational oped between the County Department of Mental Health and and Educational Brochures any agency or vendor identified in the plan that provides Providing information to individuals about disaster pre- disaster mental health services or human and/or material paredness and the anticipated psychological consequences fol- resources to carry out the activities of the plan. These MOUs lowing disaster may be an important preventative approach to should clearly articulate the roles and responsibilities of the mitigating such reactions. Informational brochures address- partner agencies and the mechanisms and procedures for car- ing personal, family and work life disaster planning, common rying out such duties. MOUs should be reviewed and cleared post-disaster stress reactions and community resources avail- by the County's legal and risk management department. able to meet the disaster related-needs of those impacted by disaster are important areas to highlight prior to disaster. These 2.7 Participate in County Disaster Drills and Exercises materials should be available in multiple languages specific to Counties are often required to hold community wide drills the population-based needs of your County. or exercises on a yearly or biyearly basis as required by the State Emergency Management Office. Other county or com- 3.3 Develop Operational Protocols to Manage munity agencies may also be required to hold similar drills Spontaneous Volunteers and exercises (i.e., County airport, nuclear power facilities, Disaster history and experience suggests that a significant hospitals, etc.). The County Department of Mental Health number of individuals will spontaneously present as volunteers should take the opportunity to participate in these drills and following large scale disasters. Establishing protocols to screen, exercises with the goal of evaluating the operational aspects train, and deploy these spontaneous volunteers is critical to the of their plan in addition to building relationships with com- disaster mental health operation. Counties must also address munity and county partners. risk and liability issues inherent in volunteer management. 3. Mitigation 4. Response 3.1 Identify High Risk Areas and Populations 4.1 Activate Response Protocols for Disaster Mental The County Department of Mental Health must work in Health Team(s) collaboration with the County Office of Emergency Prepared- An effective response protocol is predicated on the clear ness to identify potential high risk disaster areas or popula- and concise descriptions of the roles and responsibilities of tions within the county or its contiguous borders. These areas those involved in the response. It is highly advised that the should be mapped and routinely reviewed by disaster mental County's disaster plan incorporate a process by which the health team members. Individuals from these high risk areas County DCS is notified and advised of local disaster events. and populations can face significant psychological stressors This communication allows for the timely assessment and in the aftermath of disaster. Efforts should be made to reach provision of immediate mental health interventions that can out to high risk groups and areas and provide pre-disaster potentially mitigate acute, intermediate and long-term stress education which has been found to be successful in potentially reactions in the community. The mental health disaster plan mitigating acute and long-term psychological consequences of should include response protocols for a limited-team versus disaster. Disaster mental health research, though limited, sug- a full-team deployment. Team members should be advised

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36 as to the nature of the event, where they will report for their needs such as receiving first aid for injuries suffered in the dis- briefing and work assignment, and other issues that poten- aster, locating lost or missing family members, obtaining food, tially impact their safety and security. water, and clothing and seeking shelter. While not all disaster To maintain resource and scene management mental health victims will require extensive mental health intervention, some response teams should be deployed according to the circum- individuals, based upon the circumstances of the disaster as stances of the incident, availability of service sites, and num- well as their own individual characteristics (see page 10), may ber of victims involved. Many times, the "sense of immediacy require more focused mental health support. Early phase sup- to respond" and the response chaos inherent in disaster results portive interventions usually involve providing basic comfort in mass deployment. Care should be taken to provide service care while assessing the individuals for stress reactions that across the disaster response and recovery timeline and only might signal future psychological complications. Pre-disaster once the need is assessed, verified and logistical arrangements training for response team members should include orien- have been addressed. Staggering team member deployment tation and skill development in approved disaster mental will also prevent exhausting your resource pool prematurely. health interventions as those indicated below. Interventions Prior to service site deployment, team members should be that exceed the provision of basic supportive care may in fact provided with appropriate identification and oriented to what be harmful. is known about the event at that point in time. Specific infor- Early Phase Supportive Interventions mation regarding victim demographics, safety and security Psychological First Aid issues, the service delivery plan, and other pertinent details Crisis Intervention of the incident or response should be provided. Team mem- Bereavement Counseling bers should also be advised and provided with the names of 4.5 Identify High Risk Populations and Implement their administrative (work site) and technical (clinical) super- Appropriate Early Phase Interventions visors and clear expectations and protocols regarding the use While the majority of individuals impacted by disaster are of such supervisors. Expectations regarding telephone con- likely to experience some stress reactions, many of these re- tact and periodic updates with county disaster mental health actions are usually transitory and typically resolve within a administrative leaders should also be addressed. short period of time. There are, however, some disaster sur- 4.2 Coordination with Other Community Disaster Mental vivors who will go on to develop more significant psychiatric Health Teams complications. Previous disaster research has suggested cer- As mentioned earlier in the planning and preparedness sec- tain disaster characteristics or those of certain individuals tion, efforts should be made to identify other disaster mental could place someone more at risk for developing severe stress health teams or resources located in your county. Further effort reactions (see page 10). Efforts should be made to identify should be made to coordinate response to avoid duplication of high risk populations and provide them with supportive in- services, or more importantly, disruption or absence of such terventions that could mitigate long-term psychological con- service. At times, disaster mental health teams from outside sequences. Reach out to individuals who may represent such the community may self deploy or be requested to augment risk groups and work collaboratively to address these issues. local county teams. In these situations, coordination and clar- 4.6 Distribute Public Mental Health Educational Materials ification of roles and responsibilities is also important to address Research suggests that mental health resiliency following and resolve. disaster may be enhanced through the provision of educa- 4.3 Assess the Mental Health Needs of tional materials that describe the common stress reactions the Impacted Population and the methods and services available to respond to such re- Information concerning the psychological impact the dis- actions. Efforts should be made to release this information as aster has had on a community and the potential long-term soon as possible after disaster strikes. These educational ma- effects should be gathered as expeditiously as possible. In col- terials may need to be translated into languages other than laboration with emergency response officials, selected team English depending upon the needs of your County and be re- members may be deployed to gather information from com- leased repeatedly over a period of time following disaster. munity representatives regarding the impact the disaster has 4.7 Collaborate with County Government had on "at-risk" populations previously identified. in Risk Communication 4.4 Initiate Early Phase Supportive Interventions In the event of a disaster, local county government must In the initial aftermath of a disaster individuals will be pri- provide periodic information and updates regarding the marily focused on addressing their immediate disaster-related county's disaster response and recovery plan. The content

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37 of such information should be reviewed by disaster mental term mental health treatment may be available. County men- health risk communications experts in an effort to mitigate tal health officials should utilize their regional and state office any adverse psychological reactions by the community. The of mental health representatives to explore such options. County DCS or other disaster mental health expert should be 5.3 Train Mental Health Professionals in Intermediate consulted when preparing these disaster bulletins or updates. and Long-Term Mental Health Treatment Interventions Mental health consultants in these roles should be provided In the event of a large scale disaster, the County Department with the appropriate Risk Communications training prior of Mental Health must project the long-term mental health to disaster. implications on the community. Training opportunities in 4.8 Implement Supportive Interventions for Disaster Mental intermediate and long-term mental health interventions Health Teams will be required. Below is a list of mental health treatment Meeting the mental health needs of a community follow- modalities commonly used for those individuals suffering ing disaster can be considerably stressful to those mental health significant post-disaster psychological consequences. These professionals providing such aid. It is highly suggested that modalities have varying levels of scientific evidence support- protocols and resources be developed and offered to meet ing their efficacy. the mental health needs of disaster mental health teams and Intermediate/Long-Term Treatment Approaches others administering care to disaster survivors. Resources and Cognitive-behavioral therapy ideas for providing mental health support to mental health Phase-oriented treatment professionals can be found in the Comprehensive Literature Brief dynamic therapy Review, Appendix A of this guide. Psychopharmacology/pharmacotherapy 5. Recovery 5.1 Evaluate the Intermediate and Long-Term Mental Health Efforts should be made to train mental health professionals Needs of the Community in these treatment approaches prior to or shortly after disaster Disaster mental health research suggests that while most strikes the community. of a disaster-impacted community will experience a range of 5.4 Implement Supportive Interventions for DMH Teams stress reactions, these reactions are usually mild and transitory. and Other Disaster Personnel It has also been found that a minority of individuals may As mentioned previously, providing mental health sup- develop more moderate to severe psychological reactions port to disaster survivors, in and of itself can be stressful. that over time, if untreated, may develop into such psychiatric Because mental health professionals are not immune to stress disorders as Acute Stress Disorder, Major Depression, Post- reactions in the context of their work, it is highly suggested Traumatic Stress Disorder, or Generalized Anxiety Disorder. that ongoing support services are offered to mental health Pre-disaster substance abuse and dependence disorders were response team members and other disaster relief workers, also found to be exacerbated by disaster. With this in mind especially in the long-term recovery phase of disaster. Spe- it is highly recommended that counties use systematic screen- cial care should be taken to administer only those support- ing approaches to prioritize the delivery of more intensive ive interventions that are recognized as efficacious by the mental health services. Outreach efforts must be implemented disaster mental health field. in the impacted community in a timely fashion so that a better understanding of the long-term mental health needs can be 6. Evaluation evaluated. 6.1 Conduct Periodic Disaster Drills and Tabletop Exercises 5.2 Identify Community Resources to Provide Mental Health Reviewing and evaluating the county's mental health disas- and Substance Abuse Services ter plan can ensure an effective response that meets or exceeds As indicated earlier in the Planning and Preparedness sec- the mental health needs of a community. A successful plan will tion, a county mental health disaster plan should include a include an evaluation component where specific protocols listing of local mental health and substance abuse treatment and processes are reviewed, tested, and evaluated for their facilities and individual providers willing to treat disaster sur- efficacy and result. State and County emergency management vivors. Providers should possess the requisite education and practices often include periodic drills and exercises. It is highly training experience to evaluate and assess the range of inter- suggested that components of the disaster mental health plan mediate and long-term psychological symptoms and psychi- be included in these drills and exercises. Such drills might atric and substance abuse disorders in survivors resulting include a periodic call down of mental health team members from disaster. Depending on the size and scope of the disas- to evaluate availability and response times; tabletop exercises ter, financial assistance to provide intermediate and long- which evaluate the Department's ability to coordinate and

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38 deploy multiple internal and external agencies providing National Memorial Institute for the Prevention of Terrorism mental health resources; and special drills which might involve http://www.mipt.org establishing a community family assistance center following New York State Education Department, Office of the a mass casualty incident or Point of Dispensing clinic typi- Professions, Online Verification cally used in responding to public health emergencies. http://www.op.nysed.gov/opsearches.htm New York Office of Alcoholism and Substance Abuse Services 6.2 Convene an "After Action" Committee Following http://www.oasas.state.ny.us/www/home.cfm the Implementation of the Mental Health Disaster Plan In the event that the Disaster Mental Health Plan is acti- State Mental Health Authorities' Response to Terrorism, vated, arrangements should be made as soon as possible to 2004 review the results of the activation. Special attention should National Association of State Mental Health Directors be given to specific response and recovery activities associated http://www.nasmhpd.org/general_files/publications/med_ with the plan. Opportunities to identify and revise specific directors_pubs/Med%20Dir%20Terrorism%20Rpt%20-% planning, preparedness and mitigation efforts should also 20final.pdf be addressed. 7.2 Risk Communication 7. References and Resources Communicating in a Crisis: Risk Communication Guidelines 7.1 Planning Tools and Technical Resources for Public Officials CDC Public Health Emergency Response Guide for State, U.S. Department of Health and Human Services, Substance Local, and Tribal Public Health Directors, 2004 Abuse and Mental Health Services Administration (SAMHSA), Department of Health and Human Services, Centers for Dis- 2002 ease Control and Prevention http://www.riskcommunication.samhsa.gov/index.htm http://www.bt.cdc.gov/planning/pdf/cdcresponseguide.pdf Community Guidelines for Developing a Spontaneous 7.3 Disaster-Related Agencies and Programs Volunteer Plan American Red Cross Illinois Terrorism Task Force Committee on Volunteers http://www.redcross.org and Donations Department of Homeland Security http://www.state.il.us/iema/spontvol.PDF http://www.dhs.gov Disaster Technical Assistance Center Federal Emergency Management Agency (FEMA) U.S. Department of Health and Human Services, Substance http://www.fema.gov Abuse and Mental Health Services Administration (SAMHSA), National Voluntary Organizations Active in Disaster Center for Mental Health Services (VOAD) http://www.mentalhealth.samhsa.gov/dtac/ http://www.nvoad.org Early Intervention for Trauma in Adults: A Framework for New York State Emergency Management Office (SEMO) First Aid and Secondary Prevention http://www.nysemo.state.ny.us/ Litz, B.T. and Gray, M.J., In "Early Intervention for Trauma Project Liberty and Traumatic Loss." Edited by Brett T. Litz. The Guilford New York State Office of Mental Health (OMH) Press, 2004. Pp 87111 http://www.projectliberty.state.ny.us/ Mental Health All-Hazards Guidance Document, 2003 U.S. Department of Health and Human Services, Substance 7.4 Special Populations Abuse and Mental Health Services Administration (SAMHSA), American Academy of Child & Adolescent Psychiatry Center for Mental Health Services http://www.aacap.org/publications/factsfam/disaster.htm http://media.shs.net/ken/pdf/SMA03-3829/All-HazGuide.pdf U.S. Department of Health and Human Services, Substance Mental Health and Mass Violence: Evidence-Based Early Abuse and Mental Health Services Administration (SAMHSA), Psychological Intervention for Victims/Survivors of Mass Center for Mental Health Services. Violence http://www.mentalhealth.samhsa.gov/publications/allpubs/ National Institute of Mental Health (2002) SMA03-3828/default.asp http://www.nimh.nih.gov/publicat/massviolence.pdf Disaster Mental Health: Crisis Counseling Programs for the National Center for Post Traumatic Stress Disorder Rural Community (1999) http://www.ncptsd.org U.S. Department of Health and Human Services, Substance National Institute of Mental Health Abuse and Mental Health Services Administration (SAMHSA), http://www.nimh.gov Center for Mental Health Services.

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39 http://www.mentalhealth.org/publications/allpubs/sma99- Mental Health Intervention for Disaster 3378/default.asp National Center for Post-Traumatic Stress Disorders Psychosocial Issues for Older Adults in Disasters (1999) (NCPTSD) U.S. Department of Health and Human Services, Substance http://www.ncptsd.org/facts/disasters/fs_treatment_disaster. Abuse and Mental Health Services Administration (SAMHSA), html Center for Mental Health Services. 7.6 Training Resources http://media.shs.net/ken/pdf/SMA99-3323/99-821.pdf Disaster Mental Health: A Critical Response Responding to the Needs of People with Serious and Persis- University of Rochester Center for Disaster Medicine and tent Mental Illness in Times of Major Disaster (1996) Emergency Preparedness U.S. Department of Health and Human Services, Substance http://www.centerfordisastermedicine.org Abuse and Mental Health Services Administration (SAMHSA), Field Manual for Mental Health and Human Service Workers Center for Mental Health Services. in Major Disasters http://www.mentalhealth.org/publications/allpubs/SMA96- U.S. Department of Health and Human Services, Substance 3077/default.asp Abuse and Mental Health Services Administration (SAMHSA), Tips for Talking About Traumatic Events Center for Mental Health Services (2000) U.S. Department of Health and Human Services, Substance http://www.mentalhealth.samhsa.gov/publications/allpubs/ Abuse and Mental Health Services Administration (SAMHSA), ADM90-537/Default.asp Center for Mental Health Services. Mental Health Response to Mass Violence and Terrorism: http://www.mentalhealth.samhsa.gov/cmhs/TraumaticEvents/ A Training Manual tips.asp U.S. Department of Health and Human Services, Substance The National Child Traumatic Stress Network Abuse and Mental Health Services Administration (SAMHSA), http://www.nctsnet.org/ Center for Mental Health Services 7.5 Intervention Resources http://www.samhsa.gov Early Intervention for Trauma in Adults: A Framework for National Disaster Mental Health Training Program First Aid and Secondary Prevention National Center for Post Traumatic Stress Disorder (NCPTSD) Litz, B.T. and Gray, M.J., In "Early Intervention for Trauma http://www.ncptsd.org/about/training/ndmh_training.html and Traumatic Loss." Edited by Brett T. Litz. The Guilford Triumph Over Tragedy: A Community Response to Manag- Press, 2004. Pp 87111 ing Trauma in Times of Disaster and Terrorism Grief Counseling Resource Guide Edited by Evans, G.D., Wiens, B.A., The National Rural Behav- New York State Office of Mental Health ioral Health Center, 2004. http://www.omh.state.ny.us/omhweb/grief/ http://www.nrbhc.org/news_detail.asp?ID=11