Disaster Mental Health Services Research Articles

School-based disaster mental health services: Clinical, policy, and community challenges.

The consequences of Hurricane Katrina have far-reaching implications for the mental health system in the Gulf Coast region, with some of the most vulnerable survivors being children and adolescents.

Pandemic Policy and Planning Considerations for Universities: Findings from a Tabletop Exercise

The potential for a novel influenza virus to cause a pandemic represents a significant threat to global health. Planning for pandemic flu, as compared to planning for other types of hazards, presents some unique challenges to businesses, communities, and education institutions. To identify and address the challenges that may be faced by major metropolitan universities during a flu pandemic, a tabletop exercise was developed, offered, and evaluated. Its purpose was to assess existing University of Washington (UW) plans and policies for responding to an influenza pandemic. On May 31, 2006, more than 50 participants, including UW administrators and unit leaders and a number of key external partners, participated in a tabletop exercise designed to simulate all phases of an influenza pandemic. This exercise revealed existing gaps in university pandemic influenza plans and policies, including issues related to isolation and quarantine, continuity of operations, disaster mental health services, integration of volunteers into a disaster response, tracking travel of university students and personnel, communication problems, and ways to meet the needs of resident and foreign students and faculty during an outbreak. Policy and planning recommendations are offered that address each of these challenges faced by UW as well as other major research universities and colleges.

A Sound Blueprint for Building a Stronger Home

A Sound Blueprint for Building a Stronger HomeBrian W. FlynnBrian W. FlynnRetired Rear Admiral/Assistant Surgeon General in the U.S. Public Health Service where he directed, or supervised the direction of, the federal government's domestic disaster mental health service programs for many years. He is Adjunct Professor of Psychiatry and an Associate Director of the Center for the Study of Traumatic Stress at the Uniformed Services University of the Health Sciences.Address correspondence to Brian W. Flynn, EdD, P.O. Box 1205, Severna Park, MD 21146; e-mail: [email protected]Search for more papers by this authorPublished Online:January 2008https://doi.org/10.1521/psyc.2007.70.4.366PDFPDF PLUS ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations About Previous article Next article FiguresReferencesRelatedDetails Cited byCited by1. Psychosoziales Belastungs- und Handlungsverständnis für Interventionen nach Notfallereignissen und für belastenden EinsatzsituationenOnline publication date: 21 April 2015. Go to citation Crossref Google Scholar2. What is Psychopathology after Disasters? Considerations about the Nature of the Psychological and Behavioral Consequences of DisastersOnline publication date: Go to citation Crossref Google Scholar Volume 70Issue 4Dec 2007 Information© Guilford Publications Inc.PDF download

Affected Parents' and Other Stakeholders' Perception of a Fire Disaster Management in India: A Situational Analysis

Fires that result in a large number of deaths and injuries are quite common in India, presenting many complex emergency management challenges. While significant improvement in disaster management has been noted in recent years, full integration of government emergency management initiatives at the provincial level is still in its infancy. This article presents the findings of a study of a school fire in India that resulted in the deaths of 93 children. The effective provincial level management of this fire, in the absence of a well-defined disaster management plan, was quite encouraging and provides guidance for other disaster managers in the country. The purpose of the study was to analyze the factors leading to the tragedy, the response of the stakeholders, the relief and rehabilitation support provided to the affected families, and the perceptions of the affected parents regarding their level of satisfaction with the management of this disaster. Extensive visits were made to the damaged school, schools where the rescued and evacuated children were relocated, affected households, injured children, various stakeholders and institutions playing a significant role in managing the incident, and nongovernment organizations working in the field. The study methodology included structured interviews to determine the parents' level of satisfaction with the different elements of the response, participant observations, intensive interaction with the members of the affected families, and focused group discussion with different relevant government officials. The findings indicate a high level of parent and stakeholder satisfaction in the majority of response and relief efforts associated with the disaster. Also reinforced were the importance of adherence to school safety regulations; the role of effective relief and rehabilitation; public-private partnership in disaster management; and the importance of media management, humanitarian assistance during crisis management and response, gender sensitivity in relief and rehabilitation, and services provided to reduce mental health risks for the injured children and families who lost their children in the incident. While the participants in the study perceived the management of the disaster as highly satisfactory, several disaster management elements, particularly disaster mental health services, require further attention at all levels.

An Evidence-Informed Model of Human Resistance, Resilience, and Recovery: The Johns Hopkins' Outcome-Driven Paradigm for Disaster Mental Health Services

In the past, psychological intervention subsequent to mass disasters/acts of terrorism has been characterized by reactive, event-specific practices that all too often overlook the variability inherent in the temporal trajectory of the human response to such events. In essence, these so-called univariate crisis intervention models can trace their origins back to community mental health initiatives (Decker & Stubblebine, 1972; Langsley, Machotka, & Flomenhaft, 1971; Parad & Parad, 1968), the outpatient community psychiatry movements (Caplan, 1961, 1964), as well as the ‘‘forward psychiatry’’ initiatives of the great World Wars (Artiss, 1963; Kardiner, 1941; Salmon, 1919). Given the original intent and design of these models, it is not surprising that they are not easily transferable to the disaster mental health field. Although mass disasters and terrorism affect whole communities of individuals, all individuals in the community do not react the same to such events. Stated another way, some (but not all) individuals exposed to a disaster will need assistance and not everyone will benefit from the same type of assistance (National Institute of Mental Health [NIMH], 2002). In fact, only the minority of individuals exposed to traumatic events will require formalized intervention beyond perhaps information and reassurance (NIMH, 2002; United States Department of Health and Human Services, 1999). The challenge, therefore, becomes identifying those who require more structured intervention from those who do not. This observation has recently pushed ‘‘interventionists,’’ sometimes reluctantly, to now consider adding the skills of assessment and strategic planning to their therapies. The emerging model must therefore be one of a continuum of care in order to accommodate the varied aspects and challenges of disaster response. One potential framework that may assist disaster mental health interventionists to plan and structure such a revised therapeutic program is a framework that engages the concepts of resistance, resilience, and recovery. The impetus and foundation of this framework are based on a presentation to the Johns Hopkins Conference on Mental Health by Kaminsky (2003). In that conference, Dr. Kaminsky discussed the need for a paradigmatic shift away from previous disaster mental health practices that were (a) void of adequate assessment; (b) reactionary From the Johns Hopkins University School of Medicine. Contact author: Alan M. Langlieb, Assistant Professor. E-mail: alanglie@jhmi.edu.

Comparative Analysis of Three Crisis Intervention Models Applied to Law Enforcement First Responders During 9/11 and Hurricane Katrina

Two distinct fields, crisis intervention (which targets civilian populations) and disaster mental health services (which targets first responders), have emerged in response to natural and man-made disasters. As a consequence of 9/11 and Hurricane Katrina, questions have been raised whether the occupational ecology of first responders has significantly changed. Two new concepts, the high-risk rescuer and the rescuer-victim, are identified. Using three field cases, this paper describes and analyzes the application of three different crisis intervention models for law enforcement first responders during 9/11 and Hurricane Katrina: (a) psychological first aid, (b) critical incident stress management, and (c) the Federal Emergency Management Association/Substance Abuse Crisis Counseling Program. Implications for meeting the mental health needs of first responders post-9/11 and -Hurricane Katrina are discussed.

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

Disasters in the 21st Century: Lessons From Project Liberty

Back to table of contents Next article Taking IssueFull AccessDisasters in the 21st Century: Lessons From Project LibertyBetty Pfefferbaum M.D., J.D.,Betty Pfefferbaum M.D., J.D.Search for more papers by this author,Published Online:1 Sep 2006AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The reports from Project Liberty in this special issue of Psychiatric Services attest to the wealth of experience and the explosion of knowledge and understanding gained in work associated with the September 11, 2001, terrorist attacks five years ago. More than $137 million was spent on Project Liberty to serve approximately 1.5 million people, making it the largest federal disaster mental health program in history. Additional attention and resources were focused on the response at the Pentagon and in Shanksville, Pennsylvania. Noteworthy is the maturation of federal mental health services in recognizing the needs of affected populations by offering enhanced services and an intervention for complicated grief and in enhancing accountability by assessing the delivery and impact of services. Historically, federally funded crisis counseling programs have not supported traditional treatment, focusing instead on the needs of persons whose reactions do not reach the level of psychopathology. Those needing traditional psychiatric care are referred to providers in the existing mental health system. After a disaster, the potential for serious and enduring pathology is great, and the costs of providing traditional care may be substantial. Some of the Project Liberty articles report information about the approximately 10 percent of counseling recipients who were referred to professional mental health services. More systematic information is needed, however, to understand the care provided to these individuals. Disaster mental health care has evolved, and its growth is reflected in the ability to respond to succeeding disasters of increased dimensions in the context of more complex and devastated environments. Research is likewise advancing. Gone is the concern voiced after the 1995 Oklahoma City bombing that conducting evaluation and services research was somehow antithetical to providing high-quality care. The articles in this issue of Psychiatric Services demonstrate how a partnership of providers, administrators, and researchers using relatively simple quality assurance approaches can greatly enhance what we know about the disaster mental health services that are provided. Incorporating such quality assurance approaches in future disaster responses is an important step in continuing the process of improving services while enriching the evidence base about the best approaches. It is also vital that journals like Psychiatric Services spotlight the successes and failures of the disaster mental health system so that the larger professional audience and policy makers can make informed choices about needs and priorities. University of Oklahoma Health Sciences Center, Oklahoma City, and Bradley D. Stein, M.D., Ph.D., Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine FiguresReferencesCited byDetailsCited ByNone Volume 57Issue 9 September, 2006Pages 1251-1251PSYCHIATRIC SERVICES September 2006 Volume 57 Number 9 Metrics PDF download History Published online 1 September 2006 Published in print 1 September 2006

Disasters in the 21st Century: Lessons From Project Liberty

Back to table of contents Next article Taking IssueFull AccessDisasters in the 21st Century: Lessons From Project LibertyBetty Pfefferbaum M.D., J.D.,Betty Pfefferbaum M.D., J.D.Search for more papers by this author,Published Online:1 Sep 2006AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The reports from Project Liberty in this special issue of Psychiatric Services attest to the wealth of experience and the explosion of knowledge and understanding gained in work associated with the September 11, 2001, terrorist attacks five years ago. More than $137 million was spent on Project Liberty to serve approximately 1.5 million people, making it the largest federal disaster mental health program in history. Additional attention and resources were focused on the response at the Pentagon and in Shanksville, Pennsylvania. Noteworthy is the maturation of federal mental health services in recognizing the needs of affected populations by offering enhanced services and an intervention for complicated grief and in enhancing accountability by assessing the delivery and impact of services. Historically, federally funded crisis counseling programs have not supported traditional treatment, focusing instead on the needs of persons whose reactions do not reach the level of psychopathology. Those needing traditional psychiatric care are referred to providers in the existing mental health system. After a disaster, the potential for serious and enduring pathology is great, and the costs of providing traditional care may be substantial. Some of the Project Liberty articles report information about the approximately 10 percent of counseling recipients who were referred to professional mental health services. More systematic information is needed, however, to understand the care provided to these individuals. Disaster mental health care has evolved, and its growth is reflected in the ability to respond to succeeding disasters of increased dimensions in the context of more complex and devastated environments. Research is likewise advancing. Gone is the concern voiced after the 1995 Oklahoma City bombing that conducting evaluation and services research was somehow antithetical to providing high-quality care. The articles in this issue of Psychiatric Services demonstrate how a partnership of providers, administrators, and researchers using relatively simple quality assurance approaches can greatly enhance what we know about the disaster mental health services that are provided. Incorporating such quality assurance approaches in future disaster responses is an important step in continuing the process of improving services while enriching the evidence base about the best approaches. It is also vital that journals like Psychiatric Services spotlight the successes and failures of the disaster mental health system so that the larger professional audience and policy makers can make informed choices about needs and priorities. University of Oklahoma Health Sciences Center, Oklahoma City, and Bradley D. Stein, M.D., Ph.D., Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine FiguresReferencesCited byDetailsCited ByThe Oklahoma City Bombing Volume 57Issue 9 September, 2006Pages 1251-1251PSYCHIATRIC SERVICES September 2006 Volume 57 Number 9 Metrics PDF download History Published online 1 September 2006 Published in print 1 September 2006

Impact of a Media Campaign for Disaster Mental Health Counseling in Post-September 11 New York

After the September 11, 2001, terrorist attacks on the World Trade Center, the New York State Office of Mental Health (NYOMH) initiated a three-phase multifaceted, multilingual media campaign that advertised the availability of counseling services. This study evaluated the association between patterns of spending within this campaign and the volume of calls received and referred to a counseling program. Spending on television, radio, print, and other advertising was examined, as was the corresponding volume of calls to the NetLife hotline seeking referrals to counseling services. From September 2001 to December 2002, $9.38 million was spent on Project Liberty media campaigns. Call volumes increased during months when total monthly expenditures peaked. Initially, flyers, billboards, and other material items accounted for most monthly expenses. Over time, spending for television and radio advertisements increased, whereas other advertising declined. Temporal patterns show that in periods after an increase in media spending, call volumes increased independently of other sentinel events such as the one-year anniversary of the attacks. Sustained advertising through multiple media outlets appeared to be effective in encouraging individuals to seek mental health services.

Clients' Satisfaction With Project Liberty Counseling Services

Clients' Satisfaction With Project Liberty Counseling Services

Outcomes of Enhanced Counseling Services Provided to Adults Through Project Liberty

Project Liberty provided brief crisis counseling to 753,015 residents of New York City and surrounding counties after the attacks on the World Trade Center. Most regained predisaster functioning after counseling. For those who did not, Project Liberty provided enhanced services by specially trained, licensed mental health professionals. Individuals receiving crisis counseling and enhanced services responded to confidential telephone interviews about 18 and 24 months, respectively, after the attacks. Impairment was compared between groups to determine whether enhanced services recipients reported improved functioning and fewer symptoms of depression, posttraumatic stress, and complicated grief. Crisis counseling recipients (N=153) were interviewed once and enhanced services recipients (N=76) were interviewed twice about symptomatology and daily functioning. The samples did not differ in age or gender. Significantly greater proportions of enhanced services recipients reported knowing someone who died as a result of the attacks, having been involved in rescue efforts, or having lost their job because of the attacks. Compared with crisis counseling respondents, enhanced services recipients at their first interview reported significantly more symptoms of depression, grief, and traumatic stress and significantly poorer daily functioning in five life areas. At follow-up, enhanced services respondents reported significant improvement in three of five functioning domains, significantly fewer symptoms of depression and grief, and marginally less traumatic stress. Recipients of enhanced services were more impaired than people who received only crisis counseling. On the basis of reports from service recipients, meaningful improvements in functioning and symptoms may be associated with the receipt of enhanced services.

Provider Perspectives on Disaster Mental Health Services in Oklahoma City

Seven years after the bombing of the Murrah Federal Building in Oklahoma City, 34 individuals affiliated with various organizations were interviewed about their experiences in providing disaster mental health services to victims and the community. Their perspectives elucidated the importance of preparedness, training and education, local control, interagency cooperation, and psychosocial support for providers. Significant conflicts emerged among providers about credentials, referrals, the quality of services provided, and the appropriateness, in this context, of basing services solely on a crisis counseling model. The lack of ongoing needs assessment or evaluation data further fueled the debates. On the basis of the findings, the authors outline several recommendations for planning mental health responses to future terrorist attacks.

The Social Context of Recovery

The findings of Stein et al.’s two-month longitudinal study regarding reactions, impairment and help-seeking following the terrorist attacks of September 11th, 2001, compel further exploration of the ways in which communal social functioning and individual social networking may serve either to reintegrate and reconnect community members or to pose complex challenges to the recovery process. Our commentary reflects our experience providing crisis intervention and disaster mental health services in the District of Columbia in the aftermath of September 11th, 2001, the anthrax contaminations of October, 2001, and the sniper shootings of October, 2002. For the District of Columbia, the impact of these tragedies must be considered in a social context whose characteristics include vast economic and educational disparity and chronic neighborhood violence. Social capital theory describes the phenomenon of bonding of like groups—social bonding that occurs at the family, neighborhood, and close friend level and among people who share demographic characteristics (Cullen and Whiteford 2001). These likenesses may create an “affinity group,” which we define as the phenomenon in which commonalities afford a mutually felt sense of belonging and may inform the interpretation of events for those within the group. Social capital theory also posits that bonding networks are key in information dissemination and the establishment of social and cultural norms. Thus, the concepts of bonding and affinity are determinants of trust that suggest mechanisms that should not be overlooked by preparedness planners and in the crafting of recovery interventions. With initial evidence of substantial distress in the New York City area following the September 11th attacks, Wave 2 of Stein et al.’s study (60-days post-event) found acute and localized distress to have substantially abated and to have become more evenly distributed across both rural and urban regions of the country. This study lends credibility to evidence of what the field has broadly termed the “new normal.” While initial shock and distress levels have subsided, there remains persistent, widespread distress that, while not diagnostically significant, is significant in terms of social functioning and adaptation (North and Pfefferbaum 2002). Psychiatry 67(2) Summer 2004 158

Integration of disaster mental health services with emergency medicine.

Despite limited resources, emergency medical settings will be called upon to play many roles in the context of disasters and terrorist attacks that are related to preparedness, surveillance, mental health services delivery, and staff care. Such settings are a central capture site for those individuals likely to be at highest risk for developing mental health and functional problems. Because much of the potential harm to survivors of disaster or terrorism (and their families) will be related to their mental health and role functioning, preparedness requires the active integration of behavioral health into emergency medicine in every component of disaster response. There are many challenges of doing this including: (1) finding ways to integrate activities of the medical care, emergency response, and public health systems; (2) determining whether an incident has actually occurred; (3) making differential diagnoses and managing other aspects of initial medical needs; and (4) coping with the risks associated with system overload and failure. Delivery of direct mental health care must include: (1) survivor and family education; (2) identification and referral of those requiring immediate care and follow-up; (3) group education and support services; and (4) individual counseling. In order for effective response to occur, the integration of psychosocial care into disaster response must occur prior to the disaster itself, and will depend on effective collaboration between medical and mental health care providers. At workplaces, emergency medical care centers must ensure that staff and their families are properly trained and supported with regard to their disaster functions and encouraged to develop personal/family disaster plans.

Psychiatrists Repair Damage Isabel Left in Its Wake

Psychiatrists Repair Damage Isabel Left in Its Wake

Reflections on 9/11: Vulnerability and strength in the “new world order”

One year after the tragedy and horror of the events of September 11, 2001, many still struggle to understand their meaning and long‐term impact. This article provides a brief overview of critical stress debriefings and describes the author's work offering disaster mental health services to survivors of the World Trade Center attacks in the immediate aftermath of the 9/11 disaster. The essay considers gaps in mental health services and the toll that such relief work can take on mental health responders. Implications for healing are considered in the context of the government's crackdown on civil liberties and its plans for war with Iraq.

Disaster mental health services following the 1995 Oklahoma City bombing: modifying approaches to address terrorism.

How did the 1995 Oklahoma City bombing differ from prior disasters and what implications did it have for disaster mental health services and service delivery? The federal disaster mental health approach in this country developed largely out of experiences with natural disasters. The 1995 Oklahoma City bombing differed in several important ways, including the large number of human casualties, higher rates of psychopathology, and an extended period of concern due to the criminal investigation and trials, which suggested the need to consider modifications in the program. Outreach was extensive, but psychiatric morbidity of direct victims was greater than that of victims of natural disasters, emphasizing the need for attention to the triage and referral process. Other concerns that warrant consideration include practices related to record keeping and program evaluation.

The American Red Cross Disaster Mental Health Services: Development of a cooperative, single function, multidisciplinary service model

Not until 1989 did the Red Cross officially recognize a need for a systematic and organized plan for the mental health needs of disaster survivors. Over the next decade, the Red Cross Disaster Mental Health Services program has developed and evolved to assist both disaster victims and the Red Cross workers who serve them to cope with the overwhelming stresses encountered by both groups in the aftermath of disasters. The Red Cross now coordinates a large and diverse group of mental health professionals from fields of psychology, psychiatry, nursing, social work, marriage and family therapy, and counseling who work together cooperatively. Cross-disciplinary conflicts are minimized by the Red Cross' generic approach to the various mental health professional specialties as functionally interchangeable in performing Red Cross duties. This article reviews the development of this process and describes one local Red Cross chapter's early experience as part of this effort.

Disaster Mental Health Services

Disaster Mental Health Services