Mental Health All-Hazards Disaster Planning Guidance

Introduction

Nearly three decades ago, the Robert T. Stafford Disaster Relief and Emergency Assistance Act was enacted by Congress to help State and local governments prepare for disasters. Since its enactment, which also established the Crisis Counseling Program (CCP), States have been required to have a plan to focus on the mental health aspects of disasters. Unfortunately, this portion of the legislation has not achieved the type of in-depth, comprehensive, and integrated planning hoped for — and, that in the current environment has become essential.

In some cases, insufficient planning at the State level has delayed Federal funding to meet the mental health needs of disaster victims and survivors. In other cases, the planning requirement has been technically met with only skeletal planning documents. The need to enhance State mental health disaster plans has become apparent to all involved as disaster and emergency planning has evolved through the years. The increased focus on mental health, as exemplified by the President's New Freedom Commission on Mental Health, and the increasing complexity of both the traditional and potential roles played by State Mental Health Agencies (SMHAs) and the disaster situations they face has made this clear.

Better planning can help make available appropriate interventions to those in need, and help promote resiliency and recovery. It also provides an opportunity for a more efficient mental health response. It is possible, with sound, integrated planning, to fill the new, complex roles of identifying disease outbreaks, integrating health and mental health response, and conducting epidemiological surveillance-all of which are necessary in the new age of bioterrorism threats.

To that end, the Center for Mental Health Services (CMHS), within the Substance Abuse and Mental Health Services Administration (SAMHSA), collaborated with the National Association for State Mental Health Program Directors (NASMHPD) to assess the status of disaster mental health plans in the country, and provide guidance to States regarding important components in the planning process as well as potential content and organization of viable plans.

This document is the result of that process. Along with the comprehensive matrix for planners found in Appendix A, this document is intended to help guide State and local mental health agencies create or revise plans for response to human or natural disasters and emergencies. It is a companion document to the Guide for All-Hazard Emergency Operations Planning, which was published by the Federal Emergency Management Agency (FEMA) in 1996. While this Mental Health All-Hazards Disaster Planning Guidance is full of helpful information and applicable resources for State and local mental health entities, it is strictly a guide and does not establish any requirements.

The document draws heavily on a number of sources, including:

Content review of State disaster mental health plans;
In-depth, structured interviews of individuals with long and diverse histories in disaster mental health as well as in State and/or Federal emergency management;
The results of a focus group that included representatives from the SMHAs, Federal disaster health and mental health leaders, and key health and mental health organizations (a list of participants can be found in Appendix B;
Guidance to SEMAs by FEMA; and
The experience of many contributors with relevant knowledge and background.

The guidance is based upon the "all-hazards" model of emergency preparedness. This model has been promoted by FEMA and is used, nearly universally, by SEMAs as they formulate and implement State plans. In addition to being based on a sound planning model for disasters, this document can help improve integration of the SMHA's roles and activities into the overall State emergency management and operations.

In recent years, FEMA has placed growing emphasis on moving States toward an all-hazards model of disaster preparedness. Historically, States often had separate plans for different types of events. As mentioned earlier, the primary document used to guide this planning has been the Guide for All-Hazards Emergency Operations Planning (FEMA, 1996).

The goals of a comprehensive all-hazards plan, as described in that guide, are to—

Serve as the basis for effective response to any hazard that threatens a jurisdiction;
Facilitate the integration of mitigation into response and recovery activities; and
Facilitate coordination with the Federal government during catastrophic disaster situations.

The FEMA guide describes a comprehensive all-hazards plan as one that:

Assigns responsibility to carry out actions in emergencies that exceed existing capacity;
Sets forth lines of authority and organizational relationships;
Describes how people and property will be protected in emergencies;
Identifies personnel, equipment, facilities, supplies, and other resources available; and
Identifies steps to address mitigation.

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