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Disaster Preparedness:
Mental Health & Substance Abuse

By Steve Herndon

New York firefighter Chris Agazzi at a 9/11 remembrance ceremony at Ground Zero, September 11, 2002. (Photo by Andrea Booher/Federal Emergency Management Agency (FEMA) News Photo.)

The tragic loss of life from the terrorist attacks on September 11, 2001, was but one outcome of that day's horrendous events. Many people close to the disaster experienced flashbacks, feelings of anxiety and depression, and even Post-Traumatic Stress Disorder. For the mental health and substance abuse treatment communities, and for SAMHSA, these events presented both a challenge and a call to action.

It was a challenge that SAMHSA answered many times before-in the aftermath of the Oklahoma City bombing and natural disasters such as floods and hurricanes-by organizing services to address mental health needs and prevent possible substance abuse in response to severe emotional stress.

But the events of September 11-and the anthrax incidents that followed-highlighted the need to be prepared to respond immediately, nationwide, to disasters of a nature and scale unprecedented in the United States.

The U.S. Department of Health and Human Services (HHS) responded swiftly with funding and staff support for states affected most by the September 11 attacks. HHS-assisted by SAMHSA-also hosted a national summit just 2 months after the attacks that sparked a dialogue on the unique planning needs of state mental health and substance abuse authorities related to these new, complex threats to communities and citizens.

It proved to be just the beginning of a series of initiatives by SAMHSA on planning for mental health needs as part of disaster preparedness.

"Emergency preparedness is central to everyone's health," said SAMHSA Administrator Charles G. Curie, M.A., A.C.S.W. "It's an area where SAMHSA will continue to invest financial, policy, and human resources. And we welcome the chance to help states focus on preparedness so they can tell the people they serve that, come what may, they'll be ready."

Strengthening States

The key to responding efficiently and effectively to disasters depends on the ability of each state, territory, and community of the United States to respond both individually and as part of a network.

Photo of April Naturale, NY; Dr. Kermit Crawford, VA; Shauna Spencer, Washington, DC; Stephen Crimando, NJ; Dr. Ruby Brown, VA. Not pictured: James Siemianowski, CT

Representatives from areas most affected by the events of September 11 presented at a conference panel, "Roads Traveled and Lessons Learned: Legacy of September 11, 2001." L to R: April Naturale, NY; Dr. Kermit Crawford, VA; Shauna Spencer, Washington, DC; Stephen Crimando, NJ; Dr. Ruby Brown, VA. Not pictured: James Siemianowski, CT.
(Photo by David Kasamatsu, for SAMHSA)

"SAMHSA is promoting a strategy of strengthening and coordinating planning efforts within and among state mental health and substance abuse authorities," said Gail Hutchings, M.P.A., Senior Advisor to the SAMHSA Administrator and former Acting Director of SAMHSA's Center for Mental Health Services (CMHS). "Federal agencies cannot and should not do the job alone. Through the states, we can leverage existing resources, build on the knowledge gained from the experience of each, and achieve a more comprehensive response."

SAMHSA's commitment to this strategy recently crystallized with the announcement of new State Capacity Expansion Grant awards, which divided nearly $3.5 million among 35 inaugural recipients.

State mental health and substance abuse directors will use the grants-as well as assistance from SAMHSA's three Centers-over the next 2 years to create and enhance local disaster plans.

The funds will enable recipients to seek help from disaster planning experts, build infrastructure for disaster response, and establish new partnerships.

Team Planning

The 35 grant recipients were announced during another highly anticipated SAMHSA initiative-a conference held this June in Washington, DC, called "Creating a Road Map for Disaster Preparedness: Strengthening State Capacity for Disaster Mental Health and Substance Abuse Response." (See related article, SAMHSA News, Disaster Preparedness: Conference Strengthens State Efforts.)

Photo of Dr. Robert W. Glover, Executive Director, National Association for State Mental Health Program Directors; Dr. Lewis E. Gallant, Executive Director, National Association of State Alcohol and Drug Abuse Directors; and Dr. Bryan Flynn, Associate Director, Center for Studies of Traumatic Stress, Uniformed Services University of the Health Sciences

The conference included representatives from both the substance abuse and mental health fields. Shown here are (l to r) Dr. Robert W. Glover, Executive Director, National Association for State Mental Health Program Directors; Dr. Lewis E. Gallant, Executive Director, National Association of State Alcohol and Drug Abuse Directors; and Dr. Bryan Flynn, Associate Director, Center for Studies of Traumatic Stress, Uniformed Services University of the Health Sciences. (Photo by David Kasamatsu, for SAMHSA)

Approximately 250 professionals gathered from across the country and several U.S. territories to explore strategic solutions for bolstering their preparedness efforts. They represented local and state mental health and substance abuse agencies, plus emergency management, public health, interfaith, and other partner groups.

"There was a time when working on preparedness at the state level was a lonely experience," said Seth Hassett, M.S.W., Chief of the CMHS Emergency Mental Health and Traumatic Stress Services Branch. "It's easy to lose focus and energy. But events like these are reinvigorating. People hear new ideas and think about planning in different ways. And they realize they're not alone in their efforts and that they can turn to colleagues across the country for support."

Manual Provides Guidance

The conference provided the perfect platform to introduce Mental Health All-Hazards Disaster Planning Guidance, a new manual targeted to states, developed by the National Association of State Mental Health Program Directors under contract from the CMHS Emergency Mental Health and Traumatic Stress Services Branch.

The manual complements the Guide for All-Hazard Emergency Operations Planning published by the Federal Emergency Management Agency in 1996 and offers recommendations at every stage of planning.

The fundamental principle behind all-hazards planning is that successful disaster preparedness plans include several common elements. The SAMHSA guide outlines these elements, as well as other hazard-specific details. (See related article, Disaster Preparedness: Manual Provides Guidance.)

One-Stop Assistance

Valuable disaster-planning help is never more than a phone call away, thanks to the new SAMHSA Disaster Technical Assistance Center (DTAC) supported by all three SAMHSA Centers.

Photo of Kerio Walliby, of Micronesia Health Services and Theodore Iyechad of Guam

Professionals from across the Nation and several U.S. territories attended the conference. Pictured here (l to r) are Kerio Walliby, of Micronesia Health Services and Theodore Iyechad of Guam.
(Photo by David Kasamatsu, for SAMHSA)

DTAC helps public authorities in states and U.S. territories by answering questions, organizing on-site training events and workshops, coordinating logistics for meetings, maintaining a Web site with vast resources, and brokering knowledge gained by states with disaster-related experience. State mental health and substance abuse authorities and local providers can request assistance and information from DTAC. Call 1 (800) 308-3515; fax (240) 744-7006; e-mail DTAC@esi-dc.org; or send a written request to: DTAC, 7735 Old Georgetown Road, Suite 400, Bethesda, MD 20814.

Science-to-Service Projects

Despite the difficulties of conducting empirical studies on disaster response (e.g., lack of control samples, dangerous environments, and the need to attend immediately to serious physical injuries), readiness for future disasters demands constant efforts to build on the knowledge base. Research must inform service delivery, and vice versa.

To this end, SAMHSA recently initiated an interagency agreement with the National Center for Post-Traumatic Stress Disorder (NCPTSD) within the U.S. Department of Veterans Affairs. The agreement will launch several projects designed to develop consensus among experts on best practices, produce guidance materials, and improve state and community needs-assessment processes after disasters. NCPTSD will also conduct a case study of New York's response to the September 11 World Trade Center attacks. The resulting information will help other planners nationwide improve preparedness.

"After September 11, SAMHSA's interstate forums brought together directors of the remarkable programs that emerged to serve the affected areas," said Mr. Hassett. "We learned a considerable amount about responding to terrorist events and how to help states prepare. Now we're concentrating on transferring this knowledge across the country."

SAMHSA is also collaborating on research case studies and expert panels with the National Institute of Mental Health, the National Institute on Drug Abuse, and the National Institute on Alcohol Abuse and Alcoholism-all from the National Institutes of Health.

"SAMHSA will serve states in both preparedness and response activities, while forging new partnerships everywhere we can," said Daniel Dodgen, Ph.D., SAMHSA's Emergency Coordinator. "It's a theme throughout disaster preparedness-bringing people together who need to work together but haven't yet. Because even though we can't address every issue or predict every event, we can train people, enhance capacity to respond, and build a foundation that promotes resilience when we need it most."