Disaster Mental Health Government Response

Kathy Clark, MFTDisaster Assistance CoordinatorCA Department of Mental Health(916) 654-3598 or kathy.clark@dmh.ca.gov

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Goals for PresentationGain familiarity with:

The government levels involved in a disaster mental health response

County, State, Federal Government roles

What a disaster mental health response entails

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Disaster Cycle

Disaster mental health: includes response, but mainly recovery

DISASTER

Planning

Response

Recovery

Mitigation 90%

10%

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Mental Health Disaster Response Infrastructure

County Level (Operational Area):County Mental Health Department

State Level:California Department of Mental Health (CDMH)

Federal Level:Federal Emergency Management Agency (FEMA)Center for Mental Health Services (CMHS)

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What Prompts a Combined Federal, State and County Disaster Mental Health Response?

State of Emergency: county mental health and CA Department of Mental Health (CDMH)

Presidential declaration of disaster: county mental health, CDMH, FEMA and CMHS

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FEMA Crisis Counseling Program Established 1974Requires a Presidential declarationUsed following natural disasters and acts of terrorismFederal, state and county government partnership

County contract provider organizations (CBO’s) who ultimately deliver services

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FEMA CCP Grants

Immediate Services Program: Application due within 14 days of Presidential disaster declaration. Funds 60 – 120 days of services

Regular Services Program: Application due within 60 days of Presidential declaration. Funds nine (9-11) months of services

Typically lasts through first anniversary of disaster

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CDMH ResponseReport to OES & FEMA DFOProvide consultation & TA to counties

Plan a mental health responsePrepare application for federal funds

Assist in arranging mutual aidPrepare FEMA ISP grant application (14 days)Prepare FEMA RSP grant application (60 days)Administer FEMA CCP for following year

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County Mental Health ResponseParticipate in Op. Area Emergency Operations Assess need; develop response strategiesCoordinate with other response agencies (ARC)Mobilize and deploy crisis response personnelPrepare federal grant application(s)Organize and oversee mutual aid responseGet out onto the streets, into the shelters, neighborhoods, morgue facility, family assistance centers, hospitals, schools and other gathering placesPlan for and administer recovery services (grants)Launch FEMA CCP overnight

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County Mental Health Deployment

Emergency Operations CenterExtrication and morgue sitesCare and shelter sitesCommunity gathering placesNeighborhoods, homes, businesses

Town hall meetingsMedical/triage centersCounty/city administrative officesFamily assistance centersSchoolsDRC/LAC

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Disaster Mental Health GoalsAssist people in returning to a pre-disaster functioning levelProviding crisis intervention and stress management servicesListen and educateNormalize: typical reactions and emotionsTeach/reinforce positive, adaptive coping skills Assess needs and refer to resourcesFacilitate community recovery

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A Disaster Mental

Health Outreach Team

A Disaster Mental

Health Outreach Team

Team members include: clinicians, para professionals, indigenous personnel

Team members include: clinicians, para professionals, indigenous personnel

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FEMA CCP ActivitiesOutreachScreening and assessmentIndividual, family, group counselingInformation and referralPublic educationStress management

Provided by: mental health professionals paraprofessionals, indigenous people in the community

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Response: first 60 daysGoal: assessing needs and stabilizing affected victims (to the degree possible under a crisis situation)Activities:

Conduct an assessment of needProvide immediate crisis response services: outreach, counseling, education, diffusing/debriefing, referral to other services

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Door to door outreach: leaving resource materialsDoor to door outreach:

leaving resource materials

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Portable On-site ServicesPortable On-site Services

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Recovery: 9 – 11 MonthsAssisting disaster survivors to return to pre-disaster functioningPromote resiliencyConnect disaster survivors to long-term recovery services and programsBuild community capacity for recovery from effects of disaster

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FEMA CCPLess traditional than typical psychotherapyHome, neighborhood, community basedAssesses strengths, adaptation and coping skillsSeeks to restore pre-disaster functioningValidates appropriateness of reactions Normalizes experience: loss, fear, anxiety, anger, despair, depression, griefEducational focus

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Special PopulationsChildren, elderlyEthnicity & languageDisabledHomelessSeriously mentally illVarying socioeconomic statusMedically fragileDisaster responders

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ComparisonsTraditional Counseling

ServicesPrimarily office-basedFocus on diagnosis and treatmentAttempt to impact personality & functioningExamines contentEncourages insight into past experiences & influence on current problems

FEMA CCPHome and community basedAssessment of strengths, adaptation and coping skillsSeeks to restore pre-disaster functioningAccepts content at face valueValidates appropriateness of reactions and normalizes experiencePsycho-educational focus

Source: ESDRB Program Guidance, December, 1996

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Program LimitationsMedicationsHospitalizationFormalized treatment or long-term therapyProviding childcare or transportationFundraising activitiesAdvocacyCase management

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Children’s GroupChildren’s Group

Children love to be listened to, if given the opportunity.

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Example: 2003 CA Wildfires

Five counties declared; three applied for fundsFEMA Immediate Services Program:

10/26/03 – 3/22/04 (5 months)

Regular Services Program: 3/23/04 – 12/22/04 (9 months)

Three Wildfire Recovery Projects: San Bernardino Co., San Diego Co., Tri-City area of LA Co.

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Successful Project ActivitiesWidespread community outreach, educationLinking sponsors to affected communities:

1991 East Bay fire survivors offer supportAdopt a school program; school pen pals

Community events: health fairs, rebuilding seminars, picnics, fundraisers, sharing groups, memorials, anniversary events, community art projects and memorial effortsFacilitating the building of consortiums

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Big Bear Family

Counseling

Bilingual Family Counseling

Services

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County Fair Outreach 22 days and 1.2 million visitors

22 days and 1.2 million visitors

16 communities represented16 communities

represented

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Community “Story Boards”

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Partnering for Community Education and PreparednessPartnering for Community Education and Preparedness

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Benefits of the FEMA CCPThe Wildfire Recovery Project provided a safe way to engage in services:

No cost for servicesNo insurance claim/report for servicesNo employer involvement (Employee Assistance Program)No diagnosis, less stigma than “formalized” mental health services

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Wildfire Recovery Project Accomplishments

14 months of services (two months, past anniversary date)Written resource materials handed out: 112,000 Educational contacts; 63,000 Crisis counseling contacts: 24,000Crisis counseling group participants: 9,200

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No Federal Funding?County Mental Health attempts to deliver services based on available resources Response may be limited or none at all800 Access line exists in every countyIn-person participation versus leaving resource materials at Disaster Recovery Centers/Local Assistance Centers