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Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT November 22, 2002 "Excellence can be attained if you CARE more than others think is wise, RISK more than others think is safe, DREAM more than others think is practical, and EXPECT more than others think is possible." - Anonymous
The Mental Health Moment will not be published next week due to the Thanksgiving Holiday. It will resume on December 6, 2002. BEST WISHES TO ALL FOR A HAPPY AND RELAXING THANKSGIVING
Short Subjects
LINKS Mental Health Moment Online CONFERENCES AND WORKSHOPS:
The Australasian Critical Incident
Stress Association Conference
The Right Response in the
21st Century
Location: Carlton Crest Hotel
Melbourne Australia
Friday October 3, 2003 thru
Sunday October 5, 2003
For further information
please contact the conference organisers
ammp@optushome.com.au Conference Website:
http://www.acisa.org.au/ conference2003/2002 BERLIN CONFERENCE ON
THE HUMAN DIMENSIONS
OF GLOBAL ENVIRONMENTAL CHANGE
December 6 - 7, 2002
Location: Berlin, GERMANY
Contact: Frank Biermann, Chair
DVPW Environmental Policy and
Global Change Section
biermann@pik-potsdam.de or
Sabine Campe, Manager
2002 Berlin Conference
sabine.campe@pik-potsdam.de
VIII European Conference
on
Traumatic Stress (ECOTS)
May 22 - 25 2003
Location: Berlin
GERMANY
Contact:
Scientific Secretariat
VIII ECOTS Berlin 2003
c/o Catholic University of
Applied Social Sciences
Koepenicker Allee 39-57
D-10318 Berlin
Tel: +49-30-50 10 10 54
Fax: +49-30-50 10 10 88
E-mail:
trauma-conference@kfb-berlin.de
Deadlines:
Abstract Submission
30 November 200227th Congress of the
World Federation for
Mental Health
February 21-26, 2003
Melbourne, AUSTRALIA
Contact: ICMS Pty Ltd
(Congress Secretariat)
84 Queensbridge Street
Southbank VIC 3006, Australia
Tel: 61 3 9682 0244
Fax: 61 3 9682 0288
E-mail: wfmh2003@icms.com.au
Annual Conference Society for
Industrial/Organizational Psychology (SIOP)
April 12 - 14, 2003
Location: Orlando, Florida
USA
Contact: lhakel@siop.bgsu.edu
AREA RESIDENTS SHOW SENIORS CAN SHARPEN MENTAL SKILLS
Results from the largest national study of mental ability training for older adults, which included more than 400 seniors from Lewistown, Huntingdon, Mount Union and Altoona, have shown that the over-65 crowd can make significant improvements in memory, concentration and problem solving with appropriate training. Sherry Willis, professor of human development, who led the Penn State study site based at University Park, says, "The results from our local seniors, along with data from seniors across the country, show that practice and training in memory, problem solving and concentration can lead to significant improvement in thinking and mental abilities in older people." Nearly 3,000 men and women, age 65 to 94, participated in the study conducted at senior housing, community centers, churches and hospital/clinics in Birmingham, Detroit, Boston, Baltimore and Indianapolis, as well as locally. The study results were published in the Nov. 13 issue of the Journal of the American Medical Association. For the full story by Barbara Hale, visit: http://www.psu.edu/ur/2002/seniortraining.html
President Declares Major Disaster For Mississippi Tornado Damage
The head of the Federal Emergency Management Agency (FEMA) announced today that President Bush has declared a major disaster for Mississippi, opening the way for the use of federal disaster funds to help meet the recovery needs of families and businesses devastated by last weekend’s swarm of deadly tornadoes. For further information, go to: http://www.fema.gov/diz02/hq02_219.shtm
Presidential Panel Finds US Mental Health System 'Dysfunctional'
America's system for treating and rehabilitating persons with mental illness is in financial and bureaucratic disarray and is plagued by complexities that make it nearly impossible for many patients to receive needed care, according to a report issued Friday by a presidential mental health commission. For the full article, go to: http://www.medscape.com/viewarticle/443908
NEWS ARTICLES ONLINE USA - Northcom sees imminent terrorist attack http://www.washtimes.com/national/20021115-9748711.htm
NEW YORK - New York Plague Cases: Not a Bioterror Attack, but a Good Trial Run for Health Care Providers http://ap.tbo.com/ap/breaking/MGARFK75L8D.html
ARIZONA - The Mother of All Bioterror Disaster Drills to take place http://www.voanews.com/article.cfm?objectID=8A46CBF1-3BB1-4B2A-B550E89C90E08A59
TEXAS/MEXICO Border - Brownsville wary of Dengue Fever outbreak across border - 63 cases reported so far http://www.thenewsmexico.com/noticia.asp?id=40003
See Also: http://www.chron.com/cs/CDA/story.hts/metropolitan/1664409
CALIFORNIA - Radioactive emergency simulated http://www.ukiahdailyjournal.com/Stories/0,1413,91%257E3089%257E993584,00.html
International AUSTRALIA - Australia tells citizens to 'be especially alert to their own security' http://www.theage.com.au/articles/2002/11/11/1036308630869.html
PAKISTAN - Bin Laden Alive - Congressional terrorism expert agrees al-Qaida leader in Pakistan http://www.worldnetdaily.com/news/article.asp?ARTICLE_ID=29624
LIBYA - Saddam pays Gaddafi $3 billion to give his family safe haven in Libya http://www.timesonline.co.uk/article/0,,3-481908,00.html
MEXICO - Mexican Navy purchases anti-aircraft missiles to guard against terrorist attacks http://www.thenewsmexico.com/noticia.asp?id=39995
CANADA - Terror list can't be found, U.S. says http://www.globeandmail.com/servlet/ ArticleNews/PEstory/TGAM/20021116/UTERRM/national/ national/national_temp/1/1/22/
USING VOLUNTEERS AND MUTUAL AID PERSONNEL IN THE MENTAL HEALTH RESPONSE TO DISASTERS - Part 1
PRE-DISASTER
The mental health agency which is charged with disaster response services will be faced with having to staff and maintain its standard mental health programs as well. Because most publicly funded mental health programs are limited in size and budget, it is likely that additional staffing will be necessary in order to manage both operations.
Because the local government has overall responsibility for disaster response activities, it is likely that the coordinating agency for disaster mental health response will be the county mental health agency. In some states the state department of mental health provides all mental health services in local jurisdictions, and will be in charge of disaster-related mental health services. In a few localities, there are city mental health agencies that assume responsibility for the mental health response within their boundaries following disasters.
Staffing can come from several sources. One option is for the mental health agency to hire additional personnel. Frequently, however, budget constraints do not allow this option without additional funding. In a presidentially declared disaster, an Immediate Services Counseling grant from the Federal Emergency Management Agency (FEMA) will pay for the hiring of additional staff. However, the local agency will not know if its grant application is funded until several weeks following the disaster. Therefore, in most circumstances, mental health must augment staffing from two other sources:
1. volunteers orVolunteers are mental health professionals who have offered to help pro bono (without reimbursement). They may be in private practice or employed by other agencies. Mutual aid personnel are professionals from other agencies who have accepted voluntary assignment through their agency. These "volunteers" continue to receive pay from their agency during their disaster assignment.2. mutual aid personnel from other agencies or jurisdictions
Reimbursement for both volunteers and mutual aid personnel salaries may be recouped through the FEMA Crisis Immediate Counseling Services grant if those costs are specifically requested and approved in the grant. However, the local mental health agency needs to be careful to emphasize that they cannot guarantee such reimbursement at the outset. Volunteers and mutual aid entities should be prepared to assume responsibility for their own salaries and expenses.
Most states have a mutual aid system designed to ensure that additional resources are provided to local jurisdictions whenever their own resources are insufficient. The mutual aid system is usually adopted by all counties, and creates a formal structure for giving and receiving help. Cities and counties may request assistance from each other or may request assistance through the state Office of Emergency Services. This will help in the coordination of resources from other counties, the state, and the Federal Government.
Mutual aid agreements typically include assistance such as fire, rescue, law enforcement, medical services, coroners, public works, and engineering. Mental health may or may not be included, either as a separate entity or under medical services. Local mental health agencies should learn whether they are covered in the state mutual aid plan. If they are, it is critical to understand how to request assistance through the chain of command.
If mental health is not part of the state mutual aid system, mental health agencies will need to develop resources and systems for obtaining additional assistance in times of disasters.
Pre-planning can help diminish the disorganization and stress which can occur when attempting to meet disaster staffing requirements. The effort to find, select, mobilize, organize, orient, train, deploy, supervise, feed, shelter, debrief, disengage, and provide thanks and recognition to a cadres of unknown personnel can be a Herculean task. Because of this, law enforcement, fire and emergency medical service jurisdictions have developed mutual aid agreements as part of their normal operating procedures. In the midst of an emergency is not the preferred time to be thinking through the logistics involved.
Pre-disaster
The first step is for the local mental health agency to develop a disaster mental health plan. This plan should outline what disaster-related services would be provided under what circumstances. It is helpful to consider the different levels of emergency which may occur. Such levels would include minor involvement (a sit-specific incident, e.g., suicide at school), mid-level involvement (larger scale event, e.g., a plant explosion with many deaths), or large-scale involvement (e.g., a major disaster). Some mental health jurisdictions will not have the capability to respond to small or mid-level events, and will limit their disaster plan to mobilizing only in case of major disasters.
The mental health agency should integrate its disaster plan with the local emergency management plan. The local office of emergency management may help mental health in developing formal mutual aid or cooperative assistance agreements with other mental health jurisdictions or groups. The mental health disaster plan should have a predesignated position for coordinator of volunteer and mutual aid resources.
Identifying Potential Disaster Staffing Requirements
The mental health plan should identify which services would most likely be provided should a disaster occur, potential sites for mental health service delivery, and the degree and duration of staff involvement for each level of emergency.
It is equally important for mental health administrators to examine which day-to-day responsibilities can be suspended or curtailed in the time of a disaster, and which activities are essential. For example, some outpatients could conceivably be seen less frequently during the disaster response, assuming that they are fairly well-functioning and not immediately impacted by the disaster. This knowledge will help the mental health agency to make estimates about how much staffing can be provided to the disaster response and how much mutual aid may be needed in any given scenario.
Identifying Potential tasks for Mutual Aid Personnel
Mental health should identify which job tasks (both disaster-related and day-to-day) can be delegated to a volunteer or mutual aid worker. Potential jobs include:
1. Clerical support, record keeping and compilation of statistics, typing of the grant application, answering phones, etc.2. Development of educational materials (brochures, public service announcements, etc.).
3. Assistance with coordination of services and logistical support for mental health staff in the field. If possible, the mental health agency should bring in a consultant or mental health disaster coordinator who has managed a large-scale disaster operation. This individual can provide assistance to the local mental health disaster coordinator.
4. Assistance with grant writing.
5. Outreach and crisis counseling at community sites.
6. Community support groups and debriefing groups for survivors and disaster workers.
7. Training of mental health and other professionals in disaster mental health principles and interventions. Training should be provided by an individual with a thorough understanding of disaster mental health concepts and practices, and with experience in actual disasters.
Clearly Delineating The Responsibilities Of The Mental health Agency
The local mental health agency must maintain control and integral involvement in the field-based disaster response. There are several reasons for this "hands on" involvement. First, it's vitally important for ongoing needs assessment in the community. Secondly, and of equal importance, local mental health staff need to be visible and accessible to the locally impacted population. Some continuity of staffing is essential for the community's trust of the local mental health program. Otherwise, services are delivered by individuals who disappear at the end of the immediate emergency. Survivors feel "abandoned" and have to get to know a new cadre of workers. The local mental health program or its designee will most likely manage or provide the long-term recovery program if a FEMA Immediate Services and Regular Program grant is obtained following a presidentially declared disaster.
Local mental health staff know the demographics of the community, including ethnic populations, social and econo,mic age groups, community needs, and formal and informal community resources. Local mental health staff must make this knowledge available to volunteers. Both local staff and volunteers play a vital role in linking survivors with local resources.
Identification of Volunteer Resources
Prior to a disaster, mental health can assess the capabilities of potential volunteer groups. It is possible to survey professional associations (e.g., psychiatrists, psychologists, social workers, psychiatric nurses, clergy) and clinicians in private practice to learn their interest, capabilities, and availability. Ideally, a disaster mental health response should be multidisciplinsry, so as many groups as feasible should be contacted.
It is useful for mental health to have a ballpark estimate of what resources any given organization could mobilize, if needed.
Typically, recruiting enough bilingual staff is difficult. Special efforts need to be made predisaster to identify both local and out-of-county mental health personnel who can provide services in those languages present in the community. The mental health agency should identify personnel with signing capabilities for communicating with hearing impaired individuals.
it is recommended that mental health agencies consider precreening, selecting, and training a cadre of individual volunteers from the community who would be available for service during disasters. Potential volunteers can fill out an application that is reviewed predisaster. The mental health agency then makes a decision regarding acceptance of the individual for the disaster response team. The selected volunteers can then participate in regular training and drills with the predesignated disaster response staff from the mental health agency. Applications of those volunteers not immediately selected should not be discarded, but kept on file in case additional volunteers may be needed.
Once selected, it is suggested that volunteers sign a statement with wording such as "I understand that my time/service is volunteered and I will not receive compensation for such services" (Project COPE, 1983). Additionally, volunteers should sign any usual forms which mental health requires, e.g., an oath of confidentiality. If the mental health agency has a policy regarding self-referral to private practice (e.g., requiring review by a panel of clinicians or by the clinical director), volunteers should sign a statement of understanding of the policy. Volunteers can be issued official identification predisaster or at the time of mobilization.
Identifying Mutual Aid Resources
For mutual aid resources, mental health can contact public or private mental health agencies within the community. Examples might include Family Service agencies, Catholic Social Services, Jewish Family Service, and public or private hospitals with mental health resources and expertise.
Some communities may have a critical incident stress debriefing (CISD) team in place. A CISD team is a collaborative effort between mental health professionals and trained peers from emergency service agencies (police, fire, emergency medical services). The purpose of the team is to provide support services to emergency workers in dealing with the traumatic or critical incident stress associated eith their jobs. A team can provide a variety of postincident interventions, including critical incident stress debriefing. Debriefing is a group intervention that helps workers in coping with the intense thoughts, feelings, and reactions that are common following a critical incident. Teams are highly specialized to allow members to understand and intervene appropriately with emergency personnel.
If a CISD team exists in the community, the local mental health agency should meet the team leader predisaster to clarify roles and responsibilities during a disaster. Because there is not always consistency on a national level regarding amount and type of training of CISD teams, the mental health agency should clarify the exact capabilities of the CISD team. The CISD team will likely be the logical resource for providing postdisaster assistance to disaster responders, so that mental health does not have to duplicate the effort. If the CISD team wishes to provide services to the civilian survivor population, however, they must obtain additional training in disaster mental health interventions with non-responder populations.
The American Red Cross has developed its own cadre of mental health professional volunteers. The intention is to provide services primarily to Red Cross workers, but service may be provided to survivors as well in some situations. Disaster Mental Health Services policies and procedures, and a Disaster Mental Health Provider's Course have been developed by the Red Cross. This course helps local Red Cross chapters to train volunteer mental health providers who are assigned to a variety of roles at Red Cross disaster service sites, including shelters.
Local mental health agencies should establish collaborative relationships with the local Red Cross chapter predisaster. Local mental health may also undertake mental health activities in the shelters, in which case roles and responsibilities of the mental health agency volunteers and Red Cross mental health volunteers should be spelled out prior to a disaster. The local mental health agency should also develop a referral procedure with the Red Cross team. This will ensure the continuity of services to survivors after the shelter operations close down and Red Cross volunteers are no longer active. A fortmal Memorandum of Understanding between the local Red Cross chapter and the local mental health agency is recommended.
In areas where Red Cross mental health services have been established, they are designed to supplement the local community mental health delivery system in times of emergency. In communities where local mental health services are limited, the Red Cross may take a more active role in providing disaster mental health services. Red Cross mental health assistance does not extend beyond assessment of mental health status and needs, stress reduction, brief counseling, crisis intervention, referral, and follow-up recommendations. The responsibility for services to individuals requiring more intensive or long-term care will rest with oublic or private sector mental health resources. Rapport and trust between mental health and disaster survivors are best established in the early phases of disasters. Therefore, local community mental health staff should be present in the disaster shelters even if the Red Cross has its own cadre of volunteers.
In the event of a large-scale disaster, adjacent counties will likely be affected. In such a case, mutual aid may be needed from outlying counties or jurisdictions. In such a scenario, it will be extremely useful if the state mental health agency has conducted a predisaster assessment of mutual aid resources and procedures for procurement should be updated annually and distributed to all county mental health disaster coordinators.
Developing A Volunteer/mutual Aid Resource List AND Formal Mutual Aid Agreements
After volunteer and mutual aid resources have been assessed, the mental health agency should develop and annually update a directory of resources. The resource directory should include the name, address, and telephone number of contact persons and their alternates. An additional copy of the list should be kept at the local Emergency Operations Center.
The local office of emergency management is responsible for establishing mutual aid or cooperative assistance agreements with jurisdictions that can provide needed services, equipment, or resources in case of an emergency. They can help mental health in developing formal mutual aid agreements with the resources that have been identified. In times of emergency, these mutual aid resources can be formally activated through the Emergency Operations Center at the local level.
Developing An Integrated Public/volunteer Response Team
Some mental health jurisdictions have a formal cadre of volunteer and mutual aid responders whom they recognize as part of the agency's disaster response team. The mental health disaster plan includes policies and procedures for the volunteer as well as the agency components of the team. Through the process of periodic meetings, training, and exercising of the response plan, team building takes place. When a disaster occurs, individual team members are not total strangers to each other. They have a common base of knowledge and skills, and have an accurate, realistic understanding of roles, responsibilities, and chain of command.
The cost associated with predisaster team involvement may be an issue for some volunteers or potential mutual aid groups. Private practice clinicians and agencies alike may have to forfeit income-generating activities to attend disaster training and drills. Additionally, agencies will usually be paying their staff's salaries during their participation. The benefit to these agencies, however, is that their staffs are receiving valuable training that is applicable to many crises, not just large-scale disasters. Training is usually provided at the expense of the mental health agency sponsoring the team. Additionally, disaster work is exciting and rewarding. For many mental health professionals, predisaster involvement in disaster training and exercises add a new and interesting facet to their work, with a boost in staff morale as an immediate result.
Legalities and Liabilities
Local mental health agencies should work closely with their risk management officers to develop plans for using volunteers and mutual aid personnel. It should be clearly understood by both the mental health agency and volunteers who is responsible for workers' compensation or disability coverage if a worker is injured on the job. Additionally, it should be clear who is responsible for general and professional liability coverage. Some jurisdictions deal with these issues by having volunteers sign a volunteer contract, which then formally brings them under the umbrella of the agency and its insurance coverage. After the Coalinga, California earthquake of 1983, the seismic Safety Commission recommended formal registration of volunteers as civil defense workers so they would be covered by workers' compensation policies (Seismic Safety Commission, 1983). Formalized mutual aid agreements can help to avoid legal and liability questions between agencies and jurisdictions.
Training and Exercises
For a mental health disaster response to be appropriate and effective, training is essential. It is recommended that mental health agency personnel be trained conjointly with individuals identified in the community who are likely to be volunteer or mutual aid responders. An essential component of the training should be the mental health disaster plan, including activation of the disaster response team; when and where to report; types of services to be provided; sites of service delivery; and roles, responsibilities, and chain of command. Besides training, regular exercises for practicing response actions and skills are critical.
REFERENCES Auf der Heide, E. (1989). Disaster response: Principles of preparation and coordination. St. Louis: The C.V. Mosby Company.
California Disaster and Civil Defense Mutual Aid Agreement (1980).
"Establishing a volunteer force of mental health professionals in the case of a disaster." (1983). In Project VOPE: A community-based mental health response to disaster. Final Report: FEMA Crisis Counseling Project. County of Santa Cruz Community Mental health Services.
Herman, R.E. (1982). Disaster planning for local government New York: Universe Books.
Quarantelli, E.L. (1965). Mass behavior and governmental breakdown in major disasters: Viewpoint of a researcher. Police Yearbook, p. 105.
Quarantelli, E.L. and Dynes, R.R. (January/February, 1970). Introduction: Special issue on organizational and group behavior in disaster. American Behavioral Scientist, 13(3): 325.
Seismic Safety Commission: Preliminary Reports Submitted to the Seismic Safety Commission on the May 2, 1983, Coalinga, California Earthquake. Publication No. SSC 83-08, Sacramento, CA.
To search for books on disasters and disaster mental
health topics, leaders, leadership, orgainizations,
crisis intervention, leaders and crises, and related
topics and purchase them online, go to the following url:
https://www.angelfire.com/biz/odochartaigh/searchbooks.html
RECOMMENDED READING
Disaster Response: GIS for Public Safety
by Gary Amdahl
Book Description
Local, state, and federal government units and the private sector need to learn how to best use the GIS technology now in the hands of those on the front lines fighting fires, managing evacuations, and cleaning toxic spills. These case studies illustrate the best new strategies for mitigation, response, and recovery from both natural and human disasters. A wide variety of disasters and scenarios are represented, including a lethal mudslide and wildfires.
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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
Rocky Mountain Region
Disaster Mental Health Institute
Box 786
Laramie, WY 82073-0786
MENTAL HEALTH MOMENT Online: https://www.angelfire.com/biz3/news
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