Hurricane Recovery Guides Preparedness Planning (Part 1)

"What we learned from Hurricane Katrina is not to wait until the water is up to our knees before we start figuring out what to do," said hurricane survivor Michael Patrick, a New Orleans native. Many survivors displaced by the storm, including Mr. Patrick, are now outreach workers in crisis counseling programs throughout the Gulf States.

To provide a forum for lessons learned from the 2005 hurricanes, SAMHSA convened a national summit in New Orleans in May: "The Spirit of Recovery: All-Hazards Behavioral Health Preparedness and Response—Building on the Lessons of Hurricanes Katrina, Wilma, and Rita."

More than 600 participants—state disaster management leaders, crisis counselors, researchers, first responders, consumers of mental health services, hurricane survivors, and others—gathered for the 3-day event to share ongoing challenges, take stock of last year's disaster response, and plan for the future.

"In the Gulf States and beyond, people have experienced profound change in this unprecedented disaster called Katrina," said SAMHSA Administrator Charles G. Curie, M.A., A.C.S.W. "To be prepared for future disasters, we need to reassess our priorities at the regional and national levels, and then we need to take the results back home to our communities and continue to build a plan."

SAMHSA convened the summit to review lessons learned from the 2005 hurricanes, to improve and consolidate ongoing efforts to respond to mental health and substance use needs, and to build better preparedness and response plans for future disasters of any kind.

The basic principle of all-hazards planning is that each state's response to any disaster, natural or human-made, shares certain core elements. The commonality of language and format allows for improved communications among potential regional partnerships (see Disaster Readiness Resources article).

"This summit is similar to the one SAMHSA held in New York City after the terrorist attacks of September 11," said conference emcee Kermit Crawford, Ph.D., Director, Center for Multicultural Mental Health, Boston University School of Medicine. "So we're moving forward by looking back." Dr. Crawford also participated in SAMHSA's disaster preparedness conference in 2003 (see SAMHSA News, summer 2003).

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Laying the Groundwork

Effective disaster response planning begins with understanding human behavior. When drafting emergency plans, especially evacuation plans, officials must consider in advance how people are going to behave.

For example, in Texas during Hurricane Rita, "The state planned for an 'orderly evacuation,' with people leaving town in stages," said Dave Wanser, Ph.D., Deputy Commissioner, Behavioral and Community Health, Texas Department of State Health Services. "But everybody left all at once." Misreading the public's intentions could cost lives, Dr. Wanser said.

Furthermore, within jurisdictional lines, disaster response leaders should plan to establish social and health resources along probable evacuation and transportation routes. One mental health counselor in Shreveport, LA, described an unexpected challenge among evacuees from Hurricane Katrina. "We were able to offer food, clothing, and clinical assistance when survivors were staying in the emergency shelters," she noted. "But as evacuees were relocated to hotels or trailers, especially those that were not on bus lines, it was difficult to provide services. People couldn't get to us. Even worse, when we got to them, there was no privacy, no place to sit down and talk."

H. Westley Clark, M.D., J.D., M.P.H., Director of SAMHSA's Center for Substance Abuse Treatment, urged participants to consider substance abuse in their disaster planning. "There are people in recovery who may relapse, and people with no prior history of substance abuse who may turn to substances of abuse to cope," he said.

To make emergency shelters work at optimum levels, disaster planners should identify qualified counselors in the pre-disaster phase, well before disaster strikes. "We are hearing again and again that the day of a disaster, the phone rings off the hook with volunteers," said A. Kathryn Power, M.Ed., Director of SAMHSA's Center for Mental Health Services. "But 2 weeks into the crisis, it's difficult to find people to help."

In addition, participants recommended the establishment of a central cross-state repository of qualified behavioral health service providers for deployment. This would necessitate cross-state credentialing, standardized trainings, mutual assistance systems, and other regional cooperative efforts.

Culture and heritage can affect levels of trust and attitudes toward authority, among other factors. For effective behavioral health planning, understanding local cultures is important in predicting how a disaster may affect a particular community. "For example, if we have a lack of sensitivity about the community or if we're not aware," said Dr. Clark, "then we open shelters, but nobody arrives; we establish evacuation routes and pathways, but nobody follows them." Among issues requiring sensitivity, Dr. Clark included age, ethnicity, sexual orientation, disability, and HIV/AIDS status.

"With each new disaster, we learn more about the breadth of reactions and emotional responses that we must respect and incorporate into our work," said Ms. Power.

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