Hurricane Recovery Guides Preparedness Planning (Part
By Meredith Hogan Pond
"What we learned from Hurricane Katrina is not to wait
until the water is up to our knees before we start figuring
out what to do," said hurricane survivor Michael Patrick,
a New Orleans native. Many survivors displaced by the
storm, including Mr. Patrick, are now outreach workers
in crisis counseling programs throughout the Gulf States.
To provide a forum for lessons learned from the 2005
hurricanes, SAMHSA convened a national summit in New
Orleans in May: "The Spirit of Recovery: All-Hazards
Behavioral Health Preparedness and Response—Building
on the Lessons of Hurricanes Katrina, Wilma, and Rita."
More than 600 participants—state disaster management
leaders, crisis counselors, researchers, first responders,
consumers of mental health services, hurricane survivors,
and others—gathered for the 3-day event to share
ongoing challenges, take stock of last year's disaster
response, and plan for the future.
"In the Gulf States and beyond, people have experienced
profound change in this unprecedented disaster called
Katrina," said SAMHSA Administrator Charles G.
Curie, M.A., A.C.S.W. "To be prepared for future
disasters, we need to reassess our priorities at the
regional and national levels, and then we need to take
the results back home to our communities and continue
to build a plan."
SAMHSA convened the summit to review lessons learned
from the 2005 hurricanes, to improve and consolidate
ongoing efforts to respond to mental health and substance
use needs, and to build better preparedness and response
plans for future disasters of any kind.
The basic principle of all-hazards planning is that
each state's response to any disaster, natural or human-made,
shares certain core elements. The commonality of language
and format allows for improved communications among potential
regional partnerships (see Disaster
Readiness Resources article).
"This summit is similar to the one SAMHSA held in New
York City after the terrorist attacks of September 11,"
said conference emcee Kermit Crawford, Ph.D., Director,
Center for Multicultural Mental Health, Boston University
School of Medicine. "So we're moving forward by looking
back." Dr. Crawford also participated in SAMHSA's disaster
preparedness conference in 2003 (see
SAMHSA News, summer 2003).
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Laying the Groundwork
Effective disaster response planning begins with understanding
human behavior. When drafting emergency plans, especially
evacuation plans, officials must consider in advance how
people are going to behave.
For example, in Texas during Hurricane Rita, "The state
planned for an 'orderly evacuation,' with people leaving
town in stages," said Dave Wanser, Ph.D., Deputy Commissioner,
Behavioral and Community Health, Texas Department of
State Health Services. "But everybody left all at once."
Misreading the public's intentions could cost lives,
Dr. Wanser said.
Furthermore, within jurisdictional lines, disaster response
leaders should plan to establish social and health resources
along probable evacuation and transportation routes.
One mental health counselor in Shreveport, LA, described
an unexpected challenge among evacuees from Hurricane
Katrina. "We were able to offer food, clothing,
and clinical assistance when survivors were staying in
the emergency shelters," she noted. "But
as evacuees were relocated to hotels or trailers, especially
those that were not on bus lines, it was difficult to
provide services. People couldn't get to us. Even
worse, when we got to them, there was no privacy, no
place to sit down and talk."
H. Westley Clark, M.D., J.D., M.P.H., Director of SAMHSA's
Center for Substance Abuse Treatment, urged participants
to consider substance abuse in their disaster planning.
"There are people in recovery who may relapse,
and people with no prior history of substance abuse who
may turn to substances of abuse to cope," he said.
To make emergency shelters work at optimum levels, disaster
planners should identify qualified counselors in the
pre-disaster phase, well before disaster strikes. "We
are hearing again and again that the day of a disaster,
the phone rings off the hook with volunteers,"
said A. Kathryn Power, M.Ed., Director of SAMHSA's
Center for Mental Health Services. "But 2 weeks
into the crisis, it's difficult to find people
In addition, participants recommended the establishment
of a central cross-state repository of qualified behavioral
health service providers for deployment. This would necessitate
cross-state credentialing, standardized trainings, mutual
assistance systems, and other regional cooperative efforts.
Culture and heritage can affect levels of trust and
attitudes toward authority, among other factors. For
effective behavioral health planning, understanding local
cultures is important in predicting how a disaster may
affect a particular community. "For example, if
we have a lack of sensitivity about the community or
if we're not aware," said Dr. Clark, "then
we open shelters, but nobody arrives; we establish evacuation
routes and pathways, but nobody follows them."
Among issues requiring sensitivity, Dr. Clark included
age, ethnicity, sexual orientation, disability, and HIV/AIDS
"With each new disaster, we learn more about the
breadth of reactions and emotional responses that we
must respect and incorporate into our work," said
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