Disaster Mental Health Response Research Articles

Lessons Learned From the New York State Mental Health Response to the September 11, 2001, Attacks

Objective: In the aftermath of the September 11, 2001, attacks on the World Trade Center, the public mental health system in New York City mounted the largest mental health disaster response in history, called Project Liberty. The successes and challenges of Project Liberty are evaluated. Methods: The development of Project Liberty is summarized and analyzed from the perspective of the New York State and New York City officials and scientists who led the disaster response. Lessons learned that have implications for mental health support in future disaster responses are offered. Results: A high level of interagency collaboration, engagement of nongovernmental organizations to provide services, media education efforts, and ongoing program evaluation all contributed to the program's successes. Mental health professionals' limited experiences with trauma, options for funding treatment, duration of clinical program, and existing needs assessments methodologies all proved challenging. Conclusions: Project Liberty was a massive and invaluable resource during the years of rebuilding in New York City in the wake of the attacks. Challenges faced have led to lessons of generalizable import for other mental health responses to large-scale events. (Psychiatric Services 62:1085–1089, 2011)

Federal Disaster Mental Health Response and Compliance with Best Practices

This study investigated the comprehensiveness of disaster mental health state plans and their adherence to published best practices in three states that experienced post-9/11 federally-declared disasters. There were 59 disaster mental health best practices used in this study to assess each state disaster mental plan's compliance with best practices; the states demonstrated a range of adherence to the best practices. This research may serve as a guide for those developing disaster mental health plans and encourage further considerations in disaster mental health response.

Mental Health in the Aftermath of Hurricane Katrina: Problems & Policy

When Hurricane Katrina swept through the Gulf Coast in 2005, it left in its wake more than just the physical destruction of homes and businesses. Extensive post-Katrina research reveals that – like other large natural disasters – the hurricane greatly affected the mental health of its victim population. The overall national governmental response to Katrina has been heavily criticized, specifically by the mental health community. This paper seeks to articulate some of these inadequacies and offer some policy lessons that may be learned from Katrina. First, the nature of the problems associated with disaster mental health and the unmet needs of those affected by Katrina will be discussed. This will be followed by a review of the empirical research on the prevalence of mental illness and the inadequacy of treatment following the storm. Potential policy alternatives – and the available research on the efficacy of such reforms – will then be examined, followed by concluding recommendations for future disasters. Although there may never be another event identical to Hurricane Katrina, the lessons it provides are essential to the improvement of disaster mental health response policy in the future.

China–Australia Training on Psychosocial Crisis Intervention: Response to the Earthquake Disaster in Sichuan

This paper describes the AusAID-funded psychosocial training program conducted jointly by Chinese and Australian mental health facilitators in the wake of the devastating earthquake disaster in Sichuan. A total of 280 professional and volunteer leaders in disaster mental health response from across China took part in the national disaster mental health training program. A comprehensive, evidence-based and practical program was collaboratively developed and delivered to meet the needs of the medical professionals and volunteer mental health workers working in the field. Results of the training evaluation indicated high levels of uptake and usefulness for the participants. Further outcome assessments will be utilized at the service delivery and community levels. The training program has contributed significantly to the building of national and local capacity to deliver psychological first-aid and psychosocial response management to assist the populations who have been affected by disaster.

Cognitive-Behavioral Psychology: Implications for Disaster and Terrorism Response

Given the personal and societal costs associated with acute impairment and enduring post-traumatic stress disorder (PTSD), the mental health response to disasters is an integral component of disaster response planning. The purpose of this paper is to explore the compatibility between cognitive-behavioral psychology and the disaster mental health model, and explicate how cognitive-behavioral perspectives and intervention methods can enhance the effectiveness of disaster mental health services. It is argued that cognitive-behavioral methods, if matched to the contexts of the disaster and the needs of individuals, will improve efforts to prevent the development of PTSD and other trauma-related problems in survivors of disaster or terrorist events. First, the similarities between models of care underlying both disaster mental health services and cognitive-behavioral therapies are described. Second, examples of prior cognitive-behavioral therapy-informed work with persons exposed to disaster and terrorism are provided, potential cognitive-behavioral therapy applications to disaster and terrorism are explored, and implications of cognitive-behavioral therapy for common challenges in disaster mental health is discussed. Finally, steps that can be taken to integrate cognitive-behavioral therapy into disaster mental health are outlined. The aim is to prompt disaster mental health agencies and workers to consider using cognitive-behavioral therapy to improve services and training, and to motivate cognitive-behavioral researchers and practitioners to develop and support disaster mental health response.

Occupational Therapists’ Role on U.S. Army and U.S. Public Health Service Commissioned Corps Disaster Mental Health Response Teams

Occupational Therapists’ Role on U.S. Army and U.S. Public Health Service Commissioned Corps Disaster Mental Health Response Teams

Transgenerational Trauma and Resilience: Improving Mental Health Counseling for Survivors of Hurricane Katrina

As disasters increase worldwide, there is greater need for effective and expedient disaster mental health response. The purpose of this paper is to present the etiology of transgenerational trauma to advance mental health counselors’ understanding of the complex issues associated with trauma and disaster. The authors have woven literature from the field of trauma counseling with their own clinical experiences during deployment in post-Katrina New Orleans. The authors assert that mental health counselors can enhance clinical practice by using transgenerational trauma assessment and interventions as well as historical and contextual knowledge. A case example and recommendations are provided to demonstrate how to incorporate transgenerational trauma and resilience into clinical practice when working with disaster survivors.

Effective Mental Health Response to Catastrophic Events

This article describes how a mental health disaster response plan, which resulted from a collaborative effort between the Arkansas Department of Health and the Arkansas Chapter of the National Association of Social Workers, was used successfully to meet the needs of more than 1,000 displaced survivors of Hurricane Katrina. Included is a discussion of how the components of established disaster response protocols can be integrated with evolving theory on the psychological effect of catastrophic events on micro-, mezzo-, and macro-level systems to advance the field of disaster mental health response.

Disaster Response and the Mental Health Counselor

The events of September 11, 2001, the Asian Tsunami of 2004 resulting from the Sumatra-Andaman earthquake, and the devastation resulting from Hurricane Katrina in 2005 have increased our awareness of the need for trained mental health counselors able to respond within days and weeks of mass disaster events. In conjunction with the traditionally identified first responders (i.e., firefighters, law enforcement officers, and emergency medical personnel), the importance of maintaining a trained cadre of early mental health responders has become increasingly evident (National Institute of Mental Health [NIMH], 2002; U.S. Department of Health and Human Services [DHHS], 2004). In fact, in the months following the terrorist attacks of September 11, a group of experts in the field of mental health and mass violence was convened to identify best practices related to early psychological intervention following large scale disasters either from natural causes or those caused by human agency. While the working group identified a number of general principles related to early psychological intervention in the aftermath of disaster (NIMH, 2002), it, likewise, recognized the need to develop more systematic training approaches to mental health disaster response and called for an increased focus on outcome research in this critical area. What has been identified clearly through the work reflected in these governmental documents (DHHS, 2004; NIMH) is that psychological intervention provided within days to the first few weeks following mass disasters is qualitatively different from the services mental health counselors provide in their day-to-day professional work. My personal experience providing support for first responders, construction workers, and support volunteers at ground zero following the attack on the World Trade Center taught me that lesson first hand (Rogers & Soyka, 2004). Believing that my experience in emergency psychiatric evaluation and intervention and my work in the field of Suicidology would translate easily into the disaster response setting, I became a local New York City Red Cross mental health volunteer assigned to ground zero shortly following the attacks. What I discovered was a need to step back from my advanced training and return to the basic principles of human connection and compassion. Fortunately, I was able to learn that lesson within the first few hours of my volunteer work at the World Trade Center site. The lessons I learned related to early mental health response to mass disaster events are similarly reflected in two articles in this issue of the JMHC. The first article, written by Alise Bartley titled Confronting the Realities of Volunteering for a National Disaster (Bartley, this issue), provides a first-had account of her experience as a volunteer following hurricane Katrina. In this article, Dr. Bartley shares her experience of both adjusting to the challenges and demands of disaster mental health work and the struggles that can accompany returning home following a disaster response deployment. …

Project Liberty: New York's Crisis Counseling Program Created in the Aftermath of September 11, 2001

Project Liberty: New York's Crisis Counseling Program Created in the Aftermath of September 11, 2001

Clients' Satisfaction With Project Liberty Counseling Services

Clients' Satisfaction With Project Liberty Counseling Services

Cognitive behavioral therapy for prolonged postdisaster distress

In this article, we present and illustrate cognitive-behavioral therapy for postdisaster distress. The treatment is for individuals who show more than normal transient stress after disaster and functions as an intermediate step between traditional crisis counseling and longer-term mental health treatments. Thus, it is one part of a larger mental health disaster response and is designed to be implemented no sooner than 60 days post disaster. A clinical case demonstrates its process and technique in a community practice setting.

Challenges of Urban Mental Health Disaster Planning

Summary Establishing disaster preparedness is an urgent matter, particularly with regard to mental health. This article examines the challenges of mental health disaster planning in the context of an urban setting, which may differ from those pertaining to rural areas. The need to better integrate public health disaster planning and mental health disaster planning is critical. This document particularly focuses on the challenges involved in leading, coordinating, and convening an urban mental health disaster response. With time, dedication, resources, and creation of effective policy, successful mental health response capability will evolve and endure.

Can We Influence the Trajectory of Psychological Consequences to Terrorism?

This article makes two significant contributions to the field of disaster and emergency mental health. First, it contributes to the existing knowledge regarding response to, and recovery from, events involving large-scale trauma. It does so by confirming previous findings as well as adding new information. Second, the findings of the study raise both puzzling and intriguing challenges to the profession and the country as we struggle to expand our knowledge and come to grips with the “new normal” faced by the United States. In a field where research is not nearly as extensive and complete as it needs to be and where we are far too dependent on extrapolation from other types of traumatic events, any and all research directly on disasters and terrorism is welcome. Longitudinal studies, even with rather short periods between samples, are especially needed. This study contributes by replication earlier findings regarding such factors as exposure, the impact of status factors such as gender, and the importance of social support. Other findings are tantalizing in both what they tell us and what they do not. We learn for example that a significant number of people turn to alcohol, medications, or drugs to feel better. What we cannot know from the study is the extent to which this coping strategy is nonproblematic use or abuse. To what extent is the drug use licit or illicit? These distinctions are important not only from a scientific and intervention perspective but also from a public policy, program development, and funding perspective. The study also demonstrates a significant gap in the existing models of understanding and intervening with the largest of catastrophic events. The science, practice, and appreciation for the importance of emergency and disaster mental health response has, and continues, to grow. However, most of our models are based on events that are far more limited in scope than the psychosocial sequelae that this study tells us attend the events of September 11, 2001. We have models for natural disaster. We have models for smaller-scale violent events. We do not have models for understanding and providing response and recovery from national disasters. This study documents the national nature of fear, distress, and changed behavior brought on by these types of events. While we may Psychiatry 67(2) Summer 2004 164

Moving Forward From September 11: A Stress/Crisis/Trauma Response Model

placed in the perspective of a Stress/Crisis/Trauma Response Model that covers (a) the categories of predisposing factors contributing to the individual’s level of resiliency (hardiness factor), (b) the nature, scope, and potential outcome of the actual event(s), (c) the immediate and, hopefully, transient responses (acute stress disorder), and (d) the potential long-term outcomes (e.g., physical illness, post-traumatic stress disorder, and other forms of psychopathology). Prevention activities, early interventions including emergency services, crisis intervention strategies, and treatment programs for serious mental disorders are incorporated into the model. The early intervention disaster response efforts directed towards both families and first responders following the events of September 11 are discussed. There is also a critique of the present state of mental health disaster response policy and our level of preparedness as well as a reply to that critique. [Brief Treatment and Crisis Intervention 2:55–74 (2002)]

Mental health disaster response: nursing interventions across the life span.

In the aftermath of a natural disaster, adult survivors often move through the following phases of disaster response: Heroic Phase, Honeymoon Phase, Disillusionment Phase, and Reconstruction Phase. Understanding age-related responses to traumatic events such as a tornado enables mental health clinicians to individualize appropriate interventions and prevent or diminish emotional sequelae such as post-traumatic stress disorders. Psychiatric-mental health nurses are encouraged to attend local Red Cross disaster training to be prepared should the need arise for mobilization of mental health disaster response teams in your community.