Washington Psychological Aspects of Mental Health Disasters Discussion What do you think it takes to be a qualitatively effective Disaster Mental Health re

Washington Psychological Aspects of Mental Health Disasters Discussion What do you think it takes to be a qualitatively effective Disaster Mental Health responder?

1. What kinds of character traits and skills seem necessary?
2. What kinds of character traits and even skill sets might present barriers to being effective?
3. Now, consider if you were in this role. What traits or skills do you think you possess that would be helpful in it? Or, for what role do you see yourself better suited? Do you feel that there would be certain aspects of that role that might be especially challenging for you personally?

*Please put some effort into this, as it is actually one of two reflections for which you will be graded. This post will require more intensive consideration, effort, and even research. SPECIAL FOCUS
The Integration of Mental and Behavioral Health
Into Disaster Preparedness, Response, and Recovery
Betty Pfefferbaum, MD, JD; Brian W. Flynn, EdD; David Schonfeld, MD; Lisa M. Brown, PhD;
Gerard A. Jacobs, PhD; Daniel Dodgen, PhD; Darrin Donato; Rachel E. Kaul, MSW;
Brook Stone, MFS; Ann E. Norwood, MD; Dori B. Reissman, MD, MPH; Jack Herrmann, MSEd;
Stevan E. Hobfoll, PhD; Russell T. Jones, PhD; Josef I. Ruzek, PhD; Robert J. Ursano, MD;
Robert J. Taylor, PhD; David Lindley, PhD
ABSTRACT
The close interplay between mental health and physical health makes it critical to integrate mental and behavioral health considerations into all aspects of public health and medical disaster management. Therefore, the
National Biodefense Science Board (NBSB) convened the Disaster Mental Health Subcommittee to assess the
progress of the US Department of Health and Human Services (HHS) in integrating mental and behavioral health
into disaster and emergency preparedness and response activities. One vital opportunity to improve integration
is the development of clear and directive national policy to firmly establish the role of mental and behavioral health
as part of a unified public health and medical response to disasters. Integration of mental and behavioral health
into disaster preparedness, response, and recovery requires it to be incorporated in assessments and services,
addressed in education and training, and founded on and advanced through research. Integration must be supported in underlying policies and administration with clear lines of responsibility for formulating and implementing policy and practice.
(Disaster Med Public Health Preparedness. 2012;6:60-66)
Key Words: disaster mental and behavioral health, disaster preparedness, response, recovery, emergency
management, federal and state disaster plans
R
ecently, substantial efforts have been made toward enhancing the US public health and medical infrastructure to ensure it is appropriate and
expeditious to the full spectrum of disasters and public
health crises. Nevertheless, gaps persist in the nation’s
ability to respond effectively to the mental and behavioral health effects of these events. The mental and behavioral health consequences of disasters can manifest
as physical symptoms, exacerbate existing physical illnesses, undermine compliance with public health directives and warnings, contribute to difficulties in individual functioning and interpersonal relationships,
increase work and school absenteeism, and adversely
affect survivors’ quality of life. These problems can be
both debilitating and persistent, resulting in considerable individual, community, and societal costs. Timely
mental and behavioral health interventions can improve response efficiency, prevent secondary adversities due to inappropriate or inadequate response, help
affected populations recover and adjust to changed circumstances, improve adherence to future recommendations and directives, and increase confidence in government. Therefore, concerted attention to mental and
behavioral health concerns is integral to success in preparedness, response, and recovery for disasters and public health emergencies.
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Recent federal efforts in disaster preparedness, response, and recovery recognize the importance of mental and behavioral health.1,2 Homeland Security Presidential Directive-21 (HSPD-21),3 which presented a
national strategy for public health and medical preparedness, included mental health as part of mass casualty care. Recognizing psychological support mechanisms as essential elements of “a prepared and responsive
health system,” the 2009 US Department of Health and
Human Services (HHS) National Health Security Strategy (NHSS)1(p11) promotes two goals: (1) building community resilience and (2) strengthening and sustaining health and emergency response systems. The Federal
Emergency Management Agency (FEMA) National Disaster Recovery Framework (NDRF)2 promotes emotional and behavioral health considerations as an essential component of recovery.
INTEGRATING MENTAL AND BEHAVIORAL HEALTH
INTO DISASTER PREPAREDNESS AND RESPONSE
The close interplay between mental health and physical health makes it critical to integrate mental and behavioral health considerations into all aspects of public health and medical disaster management. Successful
integration requires mental and behavioral health efforts to be (1) incorporated in assessments and services; (2) addressed in education and training; and (3)
Disaster Medicine and Public Health Preparedness
©2012 American Medical Association. All rights reserved.
VOL. 6/NO. 1
Mental and Behavioral Health in Disaster Preparedness
founded on and advanced through research. Integration must
be supported in underlying policies and administration.
Integration has the potential to
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promote compliance with public health directives;
enhance individual and community resilience;
augment prevention through education;
facilitate rapid identification of individuals in need of immediate care;
improve accuracy in diagnosis and treatment by health care
providers;
reduce the development of longer-term mental health problems;
facilitate adjustment to loss and coping with adverse circumstances;
further cost-effective and seamless care;
identify and minimize potential barriers to treatment adherence and compliance;
encourage mobilization and allocation of resources for atrisk and special needs groups;
support culturally informed and culturally responsive policies and services;
foster confidence and trust in government;
empower individuals to care for themselves more effectively; and
foster cohesion in the affected community to promote community resilience and facilitate the community’s timely return to normal.
THE CHARGE TO THE DISASTER MENTAL HEALTH
SUBCOMMITTEE
The National Biodefense Science Board (NBSB) was created
under the authority of the Pandemic and All-Hazards Preparedness Act, signed into law on December 19, 2006.4 The NBSB
was chartered to provide expert advice and guidance to the secretary of HHS on scientific, technical, and other matters of special interest to HHS regarding current and future chemical, biological, nuclear, and radiological incidents, whether naturally
occurring, accidental, or deliberate. As needed, the NBSB also
provides advice and guidance to the secretary of HHS and/or
the Office of the Assistant Secretary for Preparedness and Response (ASPR) on other matters related to public health emergency preparedness and response.5
The Disaster Mental Health Subcommittee, directed by HSPD213 and established under the NBSB, was charged with submitting recommendations to the NBSB for protecting, preserving, and restoring individual and community mental health in
catastrophic health event settings, including pre-, intra-, and
postevent education, messaging, and interventions. On November 18, 2008, the subcommittee submitted its initial report, Disaster Mental Health Recommendations6 (recommendations report), to the NBSB. Eight recommendations addressed
three areas related to disaster mental and behavioral health preparedness and response: (1) intervention; (2) education and
training; and (3) communication and messaging. The document included an extensive bibliography that provides scientific, clinical, and policy support for the content in this article.
The complete recommendations report is available on the NBSB
Web site.6 The NBSB unanimously approved the report and
voted to send the recommendations to the ASPR.7
On September 22, 2009, the ASPR asked the NBSB to convene the subcommittee to assess HHS’s progress in integrating
mental and behavioral health into disaster and emergency preparedness and response activities. On September 22, 2010, the
subcommittee presented a report to the NBSB, Integration of
Mental and Behavioral Health in Federal Disaster Preparedness, Response, and Recovery: Assessment and Recommendations (available on the NBSB Web site).8 Noting that successful integration requires meaningful metrics and accountability, the
integration report focused on policy and the organizational and
structural elements necessary to translate policy into action. The
NBSB voted to adopt the report and send its five recommendations to the secretary of HHS.9 This report describes the importance and context of the integration of mental and behavioral health and provides details of the subcommittee’s assessment
of integration and its recommendations for integration.
Approach and Analysis
The subcommittee assessed progress toward the integration of
mental and behavioral health within HHS by holding teleconferences in which ex officio members (or their designees) were
first asked to identify gaps in integration efforts within their agencies, identify strategies to address these gaps, and provide a timeline for this process. Second, they were asked to identify changes
in interaction with other federal agencies that would improve
the agency’s progress toward integration. Finally, they were asked
to identify impediments to enhancing integration and ways to
reduce such obstacles. A complete list of agencies is included
in the integration report.8
Although the subcommittee was not charged with assessing integration at the state and local levels, a true status assessment
requires an understanding of issues at these levels. Therefore,
the subcommittee asked representatives from the Multi-state
Disaster Behavioral Health Consortium to (1) identify some
best-practice examples of successful integration as well as challenges and barriers at the state and local levels; (2) describe current linkages between federal and state agencies and activities
that support integration as well as challenges and barriers; and
(3) identify federal activities that could be initiated or adjusted to improve integration at the state and local levels.
The subcommittee reviewed the recommendations provided to
the NBSB in its 2008 report, considered the need for integration and a functional definition, and analyzed the information
provided by federal agency representatives.
Disaster Medicine and Public Health Preparedness
©2012 American Medical Association. All rights reserved.
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Mental and Behavioral Health in Disaster Preparedness
Reflecting on the Subcommittee’s 2008
Recommendations Report
In preparing its 2008 recommendations report,6 the subcommittee conducted a literature review and used expert consensus to
generate a set of recommendations for disaster mental and behavioral health. In brief, the 2008 recommendations were to
• integrate mental and behavioral health into all public health
and medical preparedness and response activities (eg,
develop a disaster mental health concept of operations
[CONOPS]);
• advance the research agenda for disaster mental and behavioral health;
• enhance assessment and surveillance of mental and behavioral health needs during emergencies;
• enhance disaster mental and behavioral health training for
professionals and paraprofessionals;
• promote the population’s psychological resilience;
• ensure that the needs of at-risk individuals and issues of cultural responsiveness are addressed in all NBSB efforts;
• develop a disaster mental and behavioral health communication strategy; and
• prepare an Internet-based communication toolkit with, for
example, coordinated access to messaging and educational
materials.
The subcommittee concluded that, while some progress had
been made toward implementing the 2008 recommendations, persistent gaps warranted attention. These gaps
existed, in part, because the scope of the recommendations
was broad and because advances in disaster mental and
behavioral health have been limited. Thus, the first recommendation in the integration report8 was to fully implement
the 2008 recommendations. The subcommittee noted that
some of the action steps in the recommendations report were
too specific to reflect evolving concerns, current conditions,
and changed structures; thus, other approaches may be more
appropriate for implementation in the present environment.
Six cross-cutting principles were identified in the recommendations report6: (1) define disaster mental and behavioral
health “comprehensively to include the highly interconnected
psychological, emotional, cognitive, and social influences on
behavior and mental health” in the context of disaster preparedness, response, and recovery6(p4); (2) encourage “practical, flexible, empowering, compassionate, and respectful”
disaster mental and behavioral health interventions6(p4); (3)
advocate responsiveness to culture and diversity; (4) promote
attention to vulnerable, at-risk populations; (5) discourage
additional burdens on states/territories, federally recognized
tribes, and local entities without appropriate funding and
resources; and (6) advance collaboration and integration of
effort among “non-traditional” government, academic, and
private sector partners as well as federal, state/territory, tribal,
and local partners.6(p5)
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The subcommittee considered integration of disaster mental and
behavioral health in its first recommendation in the 2008 recommendations report.6 Recommendation 1b focused squarely
on integration in proposing (1) the inclusion of language on
mental health, substance abuse, and behavioral health in all
appropriate legislation, regulations, and grants; and (2) the inclusion of disaster mental and behavioral health planning and
exercises in performance benchmarks of new or existing federally funded emergency management programs or grants. The
first recommendation also noted the importance of coordinating mental and behavioral health services through a unified
CONOPS across pre-, intra-, and postevent phases. A mental
and behavioral health CONOPS would identify roles and responsibilities, procedures, and processes to be used when incidents occur and would create a structure that could facilitate
integration.10 Work toward this recommendation has advanced significantly in the last two years with the publication
of a Disaster Behavioral Health CONOPS by HHS11 that will
inform, and be integrated with, the nation’s Emergency Support Function (ESF) #8–Public Health and Medical Services
Annex.12
Recommendation 2 called for a national research agenda supported by federal agencies that fund research initiatives, a position echoed in the subcommittee’s integration report. This
recommendation proposed convening a working group of the
subcommittee to review research portfolios from various agencies to identify gaps in knowledge; areas of recent progress; and
priorities in program evaluation, early interventions, treatment, and dissemination of training in interventions.6
Integration was also promoted in recommendation 3, which advocated for enhanced assessment of mental and behavioral health
during emergencies. The subcommittee envisioned using existing surveillance systems to (1) establish a baseline; (2) assess status at critical points in time; and (3) monitor mental
and behavioral health reactions, needs, and recovery.6
Recommendations 4, 5, and 6 focused on education and training, emphasizing the importance of promoting psychological
resilience through education in disaster mental health and/or
training in psychological first aid and through a national strategy for the integration, dissemination, and evaluation of this
intervention. The report used the term “psychological first aid”
to describe supportive activities delivered by nonmental health
professionals to family, friends, neighbors, coworkers, and students as well as more sophisticated psychological support delivered by primary care providers to their patients.6 (p12) The report recognized the limited research on the benefits of
psychological first aid and called for the creation of a national
strategy for integrating, disseminating, and evaluating psychological first aid.6 Given the need to first establish an evidence
base for the effectiveness of psychological first aid, the subcommittee decided against promoting it in the integration report.
Disaster Medicine and Public Health Preparedness
©2012 American Medical Association. All rights reserved.
VOL. 6/NO. 1
Mental and Behavioral Health in Disaster Preparedness
The subcommittee endorsed the inclusion of mechanisms for
ensuring that the needs of at-risk individuals and cultural responsiveness are addressed in all NBSB efforts.6 This endorsement was covered in the integration report as well.
Recommendation 7 promoted the integration of communication strategies through education and training and through policies to coordinate communication efforts across federal components. The recommendation envisioned trained mental health
experts serving as consultants in developing communication
strategies. With respect to the content of messages, the recommendation specified the importance of psychoeducation and
information about available services and promoted a policy that
would require that messages and activities be informed by existing evidence.6
The eighth, and final, recommendation was the creation of a
federal Web site that might allow interaction with the public
as well as provide a conduit for both public and professional
information. This recommendation should not be interpreted
as support for a single federal Web site, which might carry with
it potential challenges on both sides of the communication equation. Obtaining consensus on what information to post may
prove problematic and time consuming. In addition, the public may prefer multiple Web sites, given individual preferences
and confidence in various information sources. The subcommittee recognized the need to stay abreast of rapidly emerging
and changing communication technologies and social networks for use in reaching appropriate audiences.
ity, accountability, and communication. The subcommittee clarified that the focus on integration does not mean that effective
existing programs specifically dedicated to disaster mental and
behavioral health should be eliminated. Nor does integration
mean that disaster mental health activities should be consolidated into a single agency or department, which could result
in attention to these issues being minimized within other agencies and departments or marginalized throughout the federal
system.8
ANALYSIS: THE INTEGRATION REPORT
The subcommittee concluded that, although the federal government has made progress toward integration in certain areas,
far more needs to be done. The most pressing and significant
opportunity to improve integration is the development of clear
and directive national policy to firmly establish the role of disaster mental and behavioral health as part of a unified public
health and medical response to disasters. Integration must be
modeled and supported in underlying policies and administration with clear lines of responsibility for formulating and implementing policy and practice.
The analysis of the status of integration was organized around
two themes: (1) policy and (2) the organizational and structural elements needed to transform policy into effective action. The subcommittee noted that success will require meaningful metrics and accountability so that policy achieves the
desired goals.
Policy
THE NEED FOR MENTAL AND BEHAVIORAL HEALTH
INTEGRATION AND A FUNCTIONAL DEFINITION
The subcommittee considered the need for integration and for
a functional definition of integration. Attention to the integration of mental and behavioral health is necessary because
mental health has not been addressed systematically or consistently in disaster preparedness, response, and recovery. Attempts at integration have commonly relied on interested individuals and organizational structures that are subject to change.
Moreover, where it exists, integration has not been comprehensive or universally eff…
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