Remarks by
A. Kathryn Power, M.Ed.
Director

Center for Mental Health Services
Substance Abuse and Mental Health Services Administration
U.S. Department of Health and Human Services

The Kent Center:
Annual Awards Breakfast

October 31, 2006
Warwick, RI

Good Morning. Thank you, Congressman, for that generous introduction…and thank you, David, for inviting me to join in this celebration honoring your community…a community that is striving to improve the quality of life for Rhode Islanders with mental illnesses and substance use disorders. You and the Kent Center are doing a remarkable job collaborating with businesses and community organizations to promote the recovery, rehabilitation, and rights of individuals with mental illness.

To each of you receiving awards today, I applaud you and your organizations for the outstanding work you are doing to support Rhode Island’s mental health community. Dr. Martin Luther King once said, "Life’s most persistent and urgent question is: What are you doing for others?" I think that he would find his answer right here in Warwick.

While a strong, vibrant, and caring community spirit is a vital ingredient in promoting the wellness of our country’s mental health, it is absolutely essential…in the event of a disaster—whether natural or man made. Disaster, much like physical or sexual abuse, is a traumatic and often violent event for those who experience it. The trauma that a disaster exacts on its victims…on their families…and the first responders… can be overwhelming to a community…and catastrophic, if the community is not well prepared.

I discovered that firsthand while I served here in Rhode Island as director of the Rhode Island Department of Mental Health, Retardation and Hospitals. When fire engulfed the West Warwick Station Nightclub in 2003 killing 100 people and injuring 190 others, I saw the widespread devastation it left among the residents of the entire State. Thousands of people were touched by this incident…whether at the scene or through media coverage. They experienced psychological pain…pain that was just as excruciating, just as debilitating, and just as enduring as physical pain.

Back then, my department was able to respond quickly to the trauma and behavioral health needs of those affected by the fire due in part to the Substance Abuse and Mental Health Services Administration (SAMHSA), under which I now serve. SAMHSA was instrumental in helping us prepare for the Station Nightclub disaster and address the ongoing needs of trauma victims. Rhode Island was one of nine States to receive a small grant from SAMHSA, after the 9/11 attacks, to help in planning for future disasters. Rhode Island had its mental health disaster plan in place the night of the fire and was ready to spring into action when the fire occurred. SAMHSA also provided technical assistance from the Emergency Services and Disaster Relief Branch and later awarded the State a grant to address the ongoing mental health and substance abuse needs of those affected by the fire.

My experience here in Rhode Island served me well when SAMHSA was called to respond to the devastation caused by Hurricane Katrina last year. SAMHSA mounted a response that encompassed the principles of collaborating with State and local officials as well as disaster relief organizations—both public and private. Our strategies promoted wellness and resilience, prevention of substance abuse and other harmful coping strategies, and help-seeking behavior. SAMHSA’s response efforts brought to the fore the importance of proactive and comprehensive mental health and substance abuse response as a vital and life-saving activity that significantly aids all aspects of disaster recovery.

Many of us working in the aftermath of Katrina saw the many faces of trauma up close. In one case in Mississippi, a crisis team thwarted 11-year-old Maggie’s suicide plan and arranged for an emergency appointment with the local mental health center.

In another instance, one of our volunteers found Joyce, suffering from paranoia, who was living in a tent on her destroyed property. She held a rifle in her arms to keep anyone from coming near her. Joyce refused treatment or her medications. But one of our clinicians was able to encourage her to disarm the weapon and go back on her medications again.

In Jefferson Parrish, Lousiana, one case specialist encountered Harry. In writing up her report about Harry, she said, “Harry had not slept for 5 days. Harry recalled the looting, the fires on the streets, and the snipers firing at helicopters overhead. Harry explained the terror he felt using his eyes and mouth and posture because it seemed that the word ‘terror’ itself was not enough to convey the largeness of his experience. There was a kind of panic in Harry’s body that mere memory provoked and made palpable around him.”

Helping people work through the initial trauma of disaster is critical, but it can be just the beginning of the psychological first aid needed by these individuals. Trauma is like a rock thrown in a pond. There is an area of immediate and high impact where the rock splits the water. But the effect of the rock hitting the water spreads out in ever-broadening circles. There is turbulence below the surface that we don’t see…turbulence that may not resurface for a long time to come. We know that many disaster survivors “recover” from grief and shock after a few months, but 25 percent to 30 percent of those directly affected may develop full-blown Post-traumatic Stress Disorder (PTSD).¹

One year after Katrina, The Hon. Calvin Johnson, Past Chief Judge, from Orleans Parish, LA says, “Even with our newly discovered coping skills, some days are just too much to bear. The accumulation of issues, from housing to displaced family members, to death and illness, are still overwhelming. The effect of what we have experienced remains with us to this day.”

The Judge describes what many victims of trauma experience…retraumatization, or the reliving of the trauma which often occurs when the person returns to the location of a tragedy, notes the anniversary of the trauma, or hears about a similar tragic event. Disaster mental health services need to provide on-going solace, support, and strength to help people who might experience renewed pain or grief. Disaster planning must include long term…as well as short term…care to continue the healing process.

We have learned much about addressing the needs of survivors in the aftermath of last year’s hurricanes along the Gulf Coast. To apply these lessons learned, the Center for Mental Health Services is supporting the National GAINS Center and the National Center for Trauma Informed Care in launching the After the Crisis (ATC) Initiative to improve technical assistance strategies and support networks for the long term trauma and mental health needs of disaster survivors. Representatives from the community, state and national levels are examining individual and community-level support strategies to increase community disaster response capacity.

The ATC consortium has determined that communities must have a disaster-ready network in place to help mobilize communities in the wake of a disaster. In the aftermath of a disaster, reweaving the social fabric of a community is just as important as rebuilding housing. One of the most important aspects of community life is the social networks individuals develop, whether it is through their neighborhoods, local businesses, or places of worship.

When a disaster occurs, these social networks can be severely disrupted. Still, it is critically important for community recovery that people stay connected. With a disaster-ready network plan in place to mobilize the community, individuals can stay connected and have access to the resources they need.

SAMHSA’s Center for Substance Abuse Treatment (CSAT) is further supporting this mobilization effort. It recently launched a multi-year project to develop a system that will help patients in treatment for opioid dependence obtain their medication in the midst of an emergency or other serious service disruption. The project, Digital Access to Medication (D-ATM), focuses on the retrieval of patient dosage information during or following emergencies that may cause a treatment program to close or make it difficult for patients to access care at their “home” programs.

A model that facilitates recovery among individuals and communities affected by traumatic events has been developed by the Mental Health Association of Southeastern Pennsylvania, in conjunction with the Center for Mental Health Policy and Services Research at the University of Pennsylvania. The Disaster Community Support Network (DCSN) model draws on local leadership—elected officials, the local business community, mental health and other human services agencies, or mental health advocates—to implement a solid community structure in response to a traumatic community-wide event. The DCSN model is currently available on the National GAINS Center Web site at http://gainscenter.samhsa.gov/atc.

Another recommendation resulting from the ATC initiative is the development of a strong peer support group within the community network. Peer support is a powerful force promoting community connection and hope in the lives of survivors of traumatic stress and retraumatization. With peer support programs across the country showing tremendous results in promoting recovery, the ATC initiative is supporting the development of a peer support/response training curriculum to help communities include peer support in the services offered during times of disaster.

Beth Filson, a Certified Peer Specialist in Georgia tells us, “Three things were reaffirmed for me about what peer support in my own life has meant: That bearing witness to another’s grief is a profound act, that people live in multiple contexts and we never really know them all, and, finally, that there is an insatiable need in all of us to be heard.”

It should come as no surprise that some of the most innovative and promising approaches to mental health disaster response have grown out of the lived experiences of consumers. The entire concept of recovery began with consumers. The genesis of the recovery movement is in the writings and experiences of consumers who have spoken with such eloquence, such knowledge, such truth and understanding about the ways in which trauma and mental illness can transform a life…and the personal struggle for hope that is involved in seeking recovery. Who better to take the lead in helping others overcome trauma?

But disaster-induced trauma represents only part of the trauma problem. We cannot forget the thousands of individuals traumatized by violence on a daily basis. Consider that…by the time I finish this sentence, another child in the United States will have been abused or neglected. Over the next 60 minutes, 78 rapes will have occurred. During the course of this breakfast meeting, over 500 assaults will have taken place. Many of these individuals eventually will need help dealing with the trauma that results from their violation.

The financial burden to society of undiagnosed and untreated trauma is staggering. Untreated trauma significantly increases the use of and further strains the financial resources of health care and behavioral health services, decreases productivity in the workplace, increases reliance on public welfare, and increases incarceration rates. The economic costs of untreated trauma-related alcohol and drug abuse alone were estimated at over $160 billion in 2000.²

As Director of SAMHSA’s Center for Mental Health Services, it is one of my personal priorities to help open the nation’s eyes to the impacts of trauma – whether it is trauma induced by criminal violence, disasters, terrorism, or wars – and to the importance of achieving emotional health and recovery for all adult men and women, and for children.

Trauma is a very serious public health problem, but it can be effectively confronted by a caring public involved in a public health solution. The public health approach has helped our Nation address problems as diverse as heart disease and automobile fatalities—it can also help us effectively address trauma.

The public health approach represents a rational and organized way to implement prevention efforts and ensure they are effective. Its framework for action, however, is built around the imperative that we fully engage both the public and private sector in its implementation.

This model embraces two concepts that should be the foundation of a new generation of trauma-informed actions. The first is the idea that the health of a community and the health of its residents are completely interwoven. Thus, communities that work to protect the health of individuals are, in effect, protecting the health and well-being of the entire community.

The second public health concept that is particularly relevant is this: protecting public health is a continuum that extends from promoting health and preventing illness through treatment and recovery. Protecting mental health, therefore, means community-wide action to prevent trauma from occurring. It also means engaging the entire community in caring for the mental health of those who have experienced trauma. Protecting the health of the community as a whole is a very strong incentive for community organizations to join together to reduce the incidence of violence among individuals. An effective continuum to eliminate trauma and reduce its impact will involve every community-based organization that touches our lives.

There is so much we need to do, and so much we still need to learn, about trauma. We don’t completely understand the consequences of trauma, nor do we know enough about protective factors that make some individuals more resilient against its long-term effects. In fact, the President’s New Freedom Commission on Mental Health singled out trauma as a key understudied area in its report called Achieving the Promise: Transforming Mental Health Care in America.

Achieving the Promise specifically states that we must develop the knowledge base for trauma. The report underscores this point by adding that "research in [this] understudied area is essential to ultimately improve the quality of mental health treatment and services."

Addressing trauma is increasingly recognized as essential for recovery! To fully address the needs of survivors of trauma within the public mental health service system, we must adopt a systemic approach...an approach characterized both by trauma-specific diagnostic and treatment services and a “trauma-informed” environment capable of sustaining these services.

This change to a trauma-informed service system environment represents a profound cultural shift in which consumers and their conditions and behaviors are viewed differently. Effective systems for service delivery must embrace policies and practices that create emotionally safe and personally empowering conditions and choices for trauma survivors and staff.

One of our caseworkers helping Katrina survivors in a crisis relief center saw how assumptions made about people with mental illness during a catastrophe can rob them of their self-efficacy. A woman arrived at the center in four-point restraints wearing a large tag on her chest that read “SCHIZOPHRENIA.” She showed no indication of psychosis. She was conspicuously calm…despite the fact she just had been airlifted to safety. Yet, someone had indiscriminately restrained her for transport to the State mental facility. Knowing the woman’s circumstances, our caseworker intervened and summoned a physician. The physician reassessed her state of mind, reviewed her history of mental illness and her ongoing medication regimen, and withdrew the orders for commitment.

There are millions of individuals who require care that recognizes and responds to their underlying trauma. They need our help. They need us to develop trauma informed systems of care. SAMHSA/CMHS is making a major investment of resources in the issue of trauma. We are committed to helping States respond with trauma-integrated, community-based solutions.

To again quote Dr. Martin Luther King, “The time is always right to do what is right.”

It is time for each of us to do something more about the consequences of trauma. It’s time for all of us…at the community, State, and national level…to advocate for the comprehensive, trauma-coordinated, consumer-centered mental health system that will give women and men …and all Americans… access to the full range of services they need to recover.

An unprecedented window of opportunity is opening…right now …and, we must do what is right.

Thank you.

¹ North, C.S. (2001). The course of post-traumatic stress disorder after the Oklahoma City bombing. Mil Med, 166 (12 Suppl): 51-2

² The Economic Costs of Drug Abuse in the United States 1992-1998. Report prepared by The Lewin Group.