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Disaster Behavioral Health Planning
Prepared by the Substance Abuse and Mental Health Services Administration (SAMHSA) Disaster Technical Assistance Center (DTAC), ESI, under contract with the Emergency Mental Health and Traumatic Stress Services Branch, Center for Mental Health Services, SAMHSA.
Peer-Reviewed Journal Articles
Bailey, B.E., Hallinan, M.M., Contreras, R.J., and Hernandez, A.G.
(1985). Disaster response: The need for community mental health center (CMHC)
preparedness. Journal of Mental Health Administration. 12(1):42-6.
This article discusses the importance of planning at the local community
level, and includes a literature review and a checklist for before, during,
and after a disaster for mental health coordinators, as well as a list of
necessary supplies.
Barton, G.M. (1985). Disaster preparedness from an emergency psychiatric
perspective. Emergency Health Services Review. 3(2-3):313-23.
This article focuses on disaster planning for psychiatric emergency
care personnel, and discusses planning objectives for the type of disaster,
suggestions for interagency collaboration, and references from the Vermont
and Michigan State disaster plans.
Becker, S.M. (2001). Are the psychosocial aspects of weapons of mass
destruction incidents addressed in the Federal Response Plan: Summary of an
expert panel. Military Medicine. 166(12 Suppl):66-8.
A panel made up of representatives from federal agencies, the armed
services, and the academic community, addressed the extent to which psychosocial
issues are integrated into the Federal Response Plan. The panel also recommended
areas where further assessment is necessary to maximize efforts in consequence
management.
Becker, S.M. (2001). Meeting the threat of weapons of mass destruction
terrorism: Toward a broader conception of consequence management. Military
Medicine. 166(12 Suppl):13-6.
The article outlines six limitations of current practices in dealing
with the psychosocial issues surrounding weapons of mass destruction. These
limitations include a minimal focus on long-term recovery issues, a lack of
attention to social issues, no consideration for scenarios with primarily
psychosocial effects, limited incorporation of social and behavioral science
research, a non-integrated general response, and insufficient attention to
fundamental issues such as the re-establishment of trust after a disaster.
Benedek, D.M., Holloway, H.C., and Becker, S.M. (2002). Emergency
mental health management in bioterrorism events. Emergency Medical Clinics
of North America. 20(2):393-407.
The article provides recommendations for communities in planning
to respond to a bioterrorism threat. Training, public communication, and regular
practice could alleviate the chaos that could accompany a bioterrorist attack.
The authors stress the importance of training and preparation for emergency
medical responders because they will identify the attack, and they must distinguish
the medically unaffected, who might display similar symptoms due to fear of
exposure, from the medically affected.
Bowencamp, C. (2000). Coordination of mental health and community
agencies in disaster response. International Journal of Emergency Mental Health.
2(3):159-65.
This article discusses the curriculum, disaster experience, and terrorist
attack response of the American Red Cross (ARC) over the past 10 years. The
collaboration of community mental health centers and the ARC has facilitated
efforts in treating traumatic stress responses.
Bradford, R. and John, A.M. (1991). The psychological effects of
disaster work: Implications for disaster planning. Journal of the Royal Society
of Health. 111(3):107-10.
Disaster mental health coordinators must plan to address the psychological
consequences of disaster work by identifying staff who may be vulnerable to
psychological distress. The authors discuss staff selection, training, use
of resources, supervision, debriefing, and counseling.
Call, J.A. and Pfefferbaum, B. (1999). Lessons from the first two
years of Project Heartland: Oklahoma’s mental health response to the 1995
bombing. Psychiatric Services. 50(7):953-5.
The authors detail the lessons learned in planning and service delivery
after the 1995 Oklahoma City bombing. The Project Heartland program was the
first community mental health program designed to work with survivors in the
short-term aftermath of a terrorist attack.
Cozza, S.J., Huleatt, W.J., and James, L.C. (2002). Walter Reed Army
Medical Center’s mental health response to the Pentagon attack. Military Medicine.
167(9 Suppl):12-6.
Following the 9/11 attack on the Pentagon, the Walter Reed Army Medical
Center provided complex mental health services in cooperation with civilian
medical, mental health, and relief agencies. The article describes how services
were provided to family members of victims, the roles and functions of the
mental health team members, and lessons learned from the mission for future
deployments.
Dailey, W.F. (2001). Planning for the unthinkable. Behavioral Healthcare
Tomorrow. 10(6):SR23-7.
This article discusses the preliminary and secondary responses of
the State of Connecticut in the hours after the 9/11 terrorist attacks. The
author outlines the State and Federal collaboration that took place in Connecticut,
and the lessons learned for future preparedness planning.
Darden, M.L. (2002). Wake of September 11th attacks: Implications
for research, policy and practice. Journal of the National Medical Association.
94(2):A24, A27-9.
The author provides an overview of the National Consortium for African-American
Children meeting on November 6, 2001 on bioterrorism and children. The post
9/11 heightened emotional atmosphere fostered collaborative preparedness planning
among leaders in child advocacy, health, mental health, insurance, economics,
law enforcement, and media technology, and evolved into an unprecedented model
for future coalition building.
Dodgen, D., LaDue, L.R., and Kaul, R.E. (2002). Coordinating a local
response to a national tragedy: Community mental health in Washington, DC
after the Pentagon attack. Military Medicine. 167(9 Suppl):87-9.
Post 9/11 community mental health in the Washington, D.C. area led
to the creation of the Mental Health Community Response Coalition, which offers
opportunities for networking among nonprofit, private, government, and military
relief organizations, as well as provides a model for other metropolitan communities.
Everly, Jr., G.S. (1999). Toward a model of psychological triage:
Who will most need assistance? International Journal of Emergency Mental Health.
1(3):151-4.
This paper offers a simple set of guidelines to create a system of
psychological triage for individuals in crisis. The author incorporated clinical
empiricism and applied physiological concepts in designing this program, and
such a program could facilitate efficient and valuable mental health services
in time of crisis.
Flynn, B.W. and Nelson, M.E. (1998). Understanding the needs of children
following large-scale disasters and the role of government. Child and Adolescent
Psychiatric Clinics of North America. 7(1):211-27.
The complex needs of children after a disaster are the responsibility
of families, schools, and health care providers. These needs are often not
met, and this literature review provides guidance and planning tools for mental
health professionals treating children after a disaster.
Fraser, J.R. and Spicka, D.A. (1981). Handling the emotional response
to disaster: The case for American Red Cross/community mental health collaboration.
Community Mental Health Journal. 17(4):255-64.
This paper discusses a collaborative approach for the Red Cross and
community mental health agencies for integrating professional resources and
early intervention skills to prevent long-term community distress after a
disaster. A working model is included.
Hoge, C.W., Orman, D.T., Robichaux, R.J., Crandell, E.O., Patterson,
V.J., Engel, C.C., Ritchie, E.C., and Milliken, C.S. (2002). Operation Solace:
Overview of the mental health intervention following the September 11, 2001
Pentagon attack. Military Medicine. 167(9 Suppl):44-7.
The Army created a proactive behavioral health response to the Pentagon
attack to minimize the short and long-term effects of mass casualty disasters.
This article addresses the goals, methods, and principles behind the plan.
Hyams, K.C., Murphy, F.M., and Wessely, S. (2002). Responding to
chemical, biological, or nuclear terrorism: The indirect and long-term health
effects may present the greatest challenge. Journal of Health Politics, Policy,
and Law. 27(2):273-91.
The authors advocate a greater emphasis on the indirect effects of
bioterrorism attacks, especially on the medical, social, economic, and legal
long-term consequences. The authors also recommend working toward a comprehensive
plan incorporating emergency response with health care, risk communication,
economic assistance, and government legislators.
Jacobs, G.A., Quevillon, R.P., and Stricherz, M. (1990). Lessons
from the aftermath of Flight 232. Practical considerations for the mental
health profession's response to air disasters. American Psychologist. 45(12):1329-35.
This article discusses the execution of a city disaster mental health
plan following the crash of Flight 232 at Sioux City, IA. The article details
the responsibilities and activities of the crisis counselors and provides
a checklist of planning criteria necessary for a competent disaster response.
Klitzman, S. and Freudenberg, N. (2003). Implications of the World
Trade Center attack for the public health and health care infrastructures.
American Journal of Public Health. 93(3):400-6.
The authors assessed the strengths and weaknesses of New York City’s
response to public health, occupational health, and mental health demands
following 9/11. The lessons learned can be applied to the evolution of social
services in urban environments.
Leonard, R.B. (1988). Role of pediatricians in disasters and mass
casualty incidents. Pediatric Emergency Care. 4(1):41-4.
The author discusses the role of a pediatrician before, during, and
after a disaster. Stressing the importance of active participation in community
public health planning, the pediatrician must counsel parents and children
on how to cope with stress and fear. An outline of suggested duty assignments
for hospital personnel during a disaster is included.
Lichterman, J.D. (2000). A “community as resource” strategy for disaster
response. Public Health Reports. 115(2-3):262-5.
This article assesses disaster planning at the community level, and
specifies hard and soft mitigation concerns specific to the type of disaster.
The author presents a “community as resource” model of community emergency
preparedness.
Mangelsdorff, A.D. (1985). Lessons learned and forgotten: The need
for prevention and mental health interventions in disaster preparedness. Journal
of Community Psychology. 13(3):239-57.
This is a literature review of legislation and disaster research
addressing combat stress reactions from wartime experiences. The author applies
treatment principles developed in war to concepts found in stress literature.
Examples of mental health services delivery are described.
McFarlane, A.C. (1986). Long-term psychiatric morbidity after a natural
disaster: Implications for disaster planners and emergency services. Medical
Journal of Australia. 145(11-12):561-3.
The researchers assessed 459 firefighters exposed to bushfires in
South Australia for posttraumatic stress disorder (PTSD). Twenty-one percent
of the firefighters were continuing to experience imagery of the fire twenty-nine
months after the fire, indicating the long-term nature of PTSD. Present disaster
mental health plans fail to recognize this long-term morbidity, and the author
urges the development of preventive mental health programs for PTSD.
Mitchell, J.T. (1999). Essential factors for effective psychological
response to disasters and other crises. International Journal of Emergency
Mental Health. 1(1):51-8.
This article presents guidelines for effective community crisis and
disaster response teams’ activities in a disaster. The author discusses resources
to enhance a psychological team’s response resulting in better crisis intervention
services.
Parkes, C.M. (1991). Planning for the aftermath. Journal of the Royal
Society of Medicine. 84(1):22-25.
This article evaluates the scientific justification for crisis intervention
through a literature review. Planning for disasters and assessment tools for
the impact and aftermath are discussed, and the long-term needs of an impacted
community are outlined.
Pynoos, R.S., Goenjian, A.K., and Steinburg, A.M. (1998). A public
mental health approach to the postdisaster treatment of children and adolescents.
Child and Adolescent Psychiatric Clinics of North America. 7(1):195-210.
This article extols the importance of mental health intervention
programs for children exposed to disaster and guides mental health officials
in implementing triage and treatment procedures.
Silver, T. and Goldstein, H. (1992). A collaborative model of a county
crisis intervention team: The Lake County experience. Community Mental Health
Journal. 28(3):249-56.
This is a collaborative model designed to deliver clinic-based, school-oriented,
integrative disaster services. It was created for rural populations to cope
with situations of suicide, accidental death, and natural disasters. A case
study of an adolescent suicide is outlined to present the elements of the
model in a school setting.
Summers, G.M. and Cowan, M.L. (1991). Mental health issues related
to the development of a national disaster response system. Military Medicine.
156(1):30-2.
The author presents the rationale for adding a comprehensive mental health
component to the National Disaster Medical System to serve both disaster survivors
and first responders.
Weisaeth, L., Knudsen, Jr., O., and Tonnessen, A. (2002). Technological
disasters, crisis management and leadership stress. Journal of Hazardous Material.
93(1):33-45.
In this study, researchers assessed 246 employees exposed to an industrial
disaster in the acute aftermath. Psychological resistance is discussed and
documented as 42 percent of those who received a diagnosis of posttraumatic
stress disorder (PTSD) were extremely reluctant to seek treatment. The author
argues that primary and secondary prevention outreach must be very active.
SAMHSA and Other Publications
Substance Abuse and Mental Health Administration
Center for Mental Health Services
Mental Health All-Hazards Disaster Planning Guidance
American Red Cross
Your Family Disaster Plan
American Red Cross
Disaster Preparedness for People with Disabilities
Federal Emergency Management Agency
Are You Ready? A Guide to Citizen Preparedness
Federal Emergency Management Agency
State and Local Guide (SLG) 101: Guide for All-Hazard Emergency Operations
Planning
Federal Emergency Management Agency
Introduction to State and Local EOP Planning Guidance
Federal Emergency Management Agency
Federal Response Plan
State Program Materials
David Wee, Disaster Mental Health Coordinator
Mobile Crisis Team, City of Berkeley Mental Health, Berkeley, CA
Mental Health Impacts
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Assistance and Training 
