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Delivering Behavioral Health Services After a Disaster

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People who experience homelessness are especially vulnerable during a natural or human-caused disaster. SAMHSA held a webinar in fall 2013 to help grantees and interested community stakeholders understand how to coordinate services during a disaster and provide post-disaster medical and behavioral health services for people who experience homelessness.

“Disaster Preparedness” was moderated by LCDR Stephanie Felder, LCSW, BCD, U.S. Public Health Service, with SAMHSA’s Center for Mental Health Services (CMHS). Presenters were Sabrina Edgington, M.S.S.W., program and policy specialist, National Health Care for the Homeless Council, and Nancy Heller, LMHP, program specialist, Nebraska Department of Health and Human Services. Heller is also a state contact for the Projects for Assistance in Transition from Homelessness (PATH) grant program.

“Disaster behavioral health is the provision of mental health, substance abuse, and stress management services to disaster survivors and responders,” the presenters noted. They acknowledged that providing these services to people who are experiencing homelessness presents a unique set of challenges, given the fact that these people are transient and often have co-occurring mental and substance use disorders.

Disaster response must begin locally, the presenters said, and then, if the local jurisdiction is overwhelmed, the state steps in. If the state is unable to do enough, then a Presidential declaration must be made. Regular trainings and preparedness campaigns at the local level, however, are a sound first step.

All communications and emergency management planning meetings must include representatives from area homeless service agencies to ensure that they are fully prepared. For example, in 2010, some 120 people found themselves washed out of their encampment in Nashville after it was flooded by a storm-swollen river. The 2003 SARS outbreak in Toronto, with the potential for significant numbers of individuals experiencing homelessness to be infected, led to a call for an outbreak preparedness plan.

The “Disaster Preparedness” webinar also addressed crisis counseling. Heller noted that it differs from traditional counseling in a number of ways. Among other distinctions, crisis counseling:

  • Looks at strengths and coping skills, as opposed to diagnosing and treating mental illness
  • Focuses on a psychoeducational, rather than psychotherapeutic, approach
  • Validates common experiences and reactions instead of exploring past experiences
  • Provides support for disaster-related issues instead of being concerned with personality and functioning

Most important, in office-based clinical therapy, a mental health condition is assumed to be present until it is ruled out. In disaster behavioral health response, a mental health condition is assumed not to be present until it is confirmed.

Providing “injured survivors, bereaved family members and friends, survivors with high exposure to disaster trauma or evacuated from disaster zones, and first responders” with psychological first aid is essential, Heller said. People who have lost homes, jobs, and possessions; people with pre-existing trauma and dysfunction; at-risk groups; other disaster responders; and affected people from the larger community will benefit from education, outreach, and risk communication.

The entire community must be part of disaster preparation. Edgington noted that “Focus groups with people experiencing homelessness may help inform more effective strategies for communication of disaster information.”

Email the presenters with questions or request additional information: Stephanie Felder,; Sabrina Edgington,; Nancy Heller,

SAMHSA’s Disaster Distress Helpline, 1-800-985-5990, provides people experiencing emotional distress related to natural or human-caused disasters with crisis counseling and support.

Learn more about psychological first aid at the SAMHSA-funded National Child Traumatic Stress Network (NCTSN).

This article was originally published to highlight the December 2014 theme of Housing and Emergency Preparedness.

Access more behavioral health and homelessness resources.

Last Updated

Last Updated: 01/20/2017