Mental Health & Substance Abuse
By Steve Herndon
The tragic loss of life from the terrorist attacks on September 11, 2001, was but one outcome of that day's horrendous events. Many people close to the disaster experienced flashbacks, feelings of anxiety and depression, and even Post-Traumatic Stress Disorder. For the mental health and substance abuse treatment communities, and for SAMHSA, these events presented both a challenge and a call to action.
It was a challenge that SAMHSA answered many times before-in the aftermath of the Oklahoma City bombing and natural disasters such as floods and hurricanes-by organizing services to address mental health needs and prevent possible substance abuse in response to severe emotional stress.
But the events of September 11-and the anthrax incidents that followed-highlighted
the need to be prepared to respond immediately, nationwide, to disasters
of a nature and scale unprecedented in the United States.
The U.S. Department of Health and Human Services (HHS) responded
swiftly with funding and staff support for states affected most
by the September 11 attacks. HHS-assisted by SAMHSA-also hosted
a national summit just 2 months after the attacks that sparked a
dialogue on the unique planning needs of state mental health and
substance abuse authorities related to these new, complex threats
to communities and citizens.
It proved to be just the beginning of a series of initiatives by
SAMHSA on planning for mental health needs as part of disaster preparedness.
"Emergency preparedness is central to everyone's health," said
SAMHSA Administrator Charles G. Curie, M.A., A.C.S.W. "It's an area
where SAMHSA will continue to invest financial, policy, and human
resources. And we welcome the chance to help states focus on preparedness
so they can tell the people they serve that, come what may, they'll
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The key to responding efficiently and effectively to disasters
depends on the ability of each state, territory, and community of
the United States to respond both individually and as part of a
"SAMHSA is promoting a strategy of strengthening and coordinating
planning efforts within and among state mental health and substance
abuse authorities," said Gail Hutchings, M.P.A., Senior Advisor
to the SAMHSA Administrator and former Acting Director of SAMHSA's
Center for Mental Health Services (CMHS). "Federal agencies cannot
and should not do the job alone. Through the states, we can leverage
existing resources, build on the knowledge gained from the experience
of each, and achieve a more comprehensive response."
SAMHSA's commitment to this strategy recently crystallized with
the announcement of new State Capacity Expansion Grant awards, which
divided nearly $3.5 million among 35 inaugural recipients.
State mental health and substance abuse directors will use the
grants-as well as assistance from SAMHSA's three Centers-over the
next 2 years to create and enhance local disaster plans.
The funds will enable recipients to seek help from disaster planning
experts, build infrastructure for disaster response, and establish
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The 35 grant recipients were announced during another highly anticipated
SAMHSA initiative-a conference held this June in Washington, DC,
called "Creating a Road Map for Disaster Preparedness: Strengthening
State Capacity for Disaster Mental Health and Substance Abuse Response."
(See related article, SAMHSA News, Disaster
Preparedness: Conference Strengthens State Efforts.)
Approximately 250 professionals gathered from across the country
and several U.S. territories to explore strategic solutions for
bolstering their preparedness efforts. They represented local and
state mental health and substance abuse agencies, plus emergency
management, public health, interfaith, and other partner groups.
"There was a time when working on preparedness at the state level
was a lonely experience," said Seth Hassett, M.S.W., Chief of the
CMHS Emergency Mental Health and Traumatic Stress Services Branch.
"It's easy to lose focus and energy. But events like these are reinvigorating.
People hear new ideas and think about planning in different ways.
And they realize they're not alone in their efforts and that they
can turn to colleagues across the country for support."
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Manual Provides Guidance
The conference provided the perfect platform to introduce Mental
Health All-Hazards Disaster Planning Guidance, a new manual
targeted to states, developed by the National Association of State
Mental Health Program Directors under contract from the CMHS Emergency
Mental Health and Traumatic Stress Services Branch.
The manual complements the Guide for All-Hazard Emergency Operations
Planning published by the Federal Emergency Management Agency
in 1996 and offers recommendations at every stage of planning.
The fundamental principle behind all-hazards planning is that successful
disaster preparedness plans include several common elements. The
SAMHSA guide outlines these elements, as well as other hazard-specific
details. (See related article, SAMHSA News, Disaster
Preparedness: Manual Provides Guidance.)
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Valuable disaster-planning help is never more than a phone call
away, thanks to the new SAMHSA Disaster Technical Assistance Center
(DTAC) supported by all three SAMHSA Centers.
DTAC helps public authorities in states and U.S. territories by
answering questions, organizing on-site training events and workshops,
coordinating logistics for meetings, maintaining a Web site with
vast resources, and brokering knowledge gained by states with disaster-related
experience. State mental health and substance abuse authorities
and local providers can request assistance and information from
DTAC. Call 1 (800) 308-3515; fax (240) 744-7006; e-mail DTAC@esi-dc.org;
or send a written request to: DTAC, 7735 Old Georgetown Road, Suite
400, Bethesda, MD 20814.
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Despite the difficulties of conducting empirical studies on disaster
response (e.g., lack of control samples, dangerous environments,
and the need to attend immediately to serious physical injuries),
readiness for future disasters demands constant efforts to build
on the knowledge base. Research must inform service delivery, and
To this end, SAMHSA recently initiated an interagency agreement
with the National Center for Post-Traumatic Stress Disorder (NCPTSD)
within the U.S. Department of Veterans Affairs. The agreement will
launch several projects designed to develop consensus among experts
on best practices, produce guidance materials, and improve state
and community needs-assessment processes after disasters. NCPTSD
will also conduct a case study of New York's response to the September
11 World Trade Center attacks. The resulting information will help
other planners nationwide improve preparedness.
"After September 11, SAMHSA's interstate forums brought together
directors of the remarkable programs that emerged to serve the affected
areas," said Mr. Hassett. "We learned a considerable amount about
responding to terrorist events and how to help states prepare. Now
we're concentrating on transferring this knowledge across the country."
SAMHSA is also collaborating on research case studies and expert
panels with the National Institute of Mental Health, the National
Institute on Drug Abuse, and the National Institute on Alcohol Abuse
and Alcoholism-all from the National Institutes of Health.
"SAMHSA will serve states in both preparedness and response activities,
while forging new partnerships everywhere we can," said Daniel Dodgen,
Ph.D., SAMHSA's Emergency Coordinator. "It's a theme throughout
disaster preparedness-bringing people together who need to work
together but haven't yet. Because even though we can't address every
issue or predict every event, we can train people, enhance capacity
to respond, and build a foundation that promotes resilience when
we need it most."
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