“It is the policy of New River Behavioral HealthCare to ensure the safety of all consumers, other visitors and employees during emergencies or disasters. New River will make every effort to be effectively prepared to respond to emergency situations.” (NRBHC EMERGENCY PREPARENESS AND RESPONSE Policy)
There are several reasons to review and update the New River Behavioral Healthcare disaster response plan. These reasons are detailed below. In short, the current plan only addresses isolated critical events occurring on agency property, has not been reviewed in six years, does not meet the expectations that county emergency managers expect, and does not address the needs of responders—even when they are employees.
The simplest reason to review the NRBH disaster response plan is that it is out-dated and inadequate, and that a newly developed comprehensive template is available. The latest revisions to the plan--from August of 2000—were never adopted, although the disaster coordinator attempted to implement best practice and a variety of measures were put in place regarding prevention and response to critical events.
A newly developed disaster response template is available. The new template was developed with input from the DMH disaster response coordinator & funded through a federal grant. Additional input from a wide variety of LME’s including both urban and rural environments. This template includes a partial plan template that addresses some unique features of the provider network. The new template is comprehensive, based on the SAMHSA disaster response checklist and contains additional references from established plans extant around the nation.
When NRBH relinquishes its LME functions, it will remain a public community health center. Until that time, NRBH is a 5-county LME and responsible for the psychological well-being of all citizens. As a service provider, NRBH senior managers have presented a desire to continue under a philosophy of community mental health—a one-stop shop for all citizens & responsive to the dynamic needs of the communities it serves.
In line with the one-stop shop philosophy and the relationships NRBH has built across the years it is not surprising that 4 of the 5 county plans expect NRBH to respond to disasters and work in shelters that are established by county governments. Becoming a 160A intergovernmental organization will only enhance this expectation. Below is a sampling of the language from those county emergency plans:
a) Alleghany County plan:--very similar to Ashe & Wilkes plans.
b) Ashe County plan: [Under Health Director]
“18. Mental Health Coordinator
a. Develop guidelines to provide mental health services during emergencies.
b. Provide sites as available for temporary clinics.
c. Assist ARC with inquiries and inform families on status of individuals injured or missing.
d. Maintain a 24 hour Crisis Line during periods of major disasters.
e. Identify evacuees in reception centers and shelters who have experienced mental stress and provide them with mental health services.
f. Arrange for debriefings or psychological support for emergency workers and disaster victims.”
c) Avery County plan:--currently not available
d) Watauga County plan:
“ C. Mental Health [Under Health Annex]
1. New River Mental Health Agency will coordinate activities with the Emergency Management Coordinator to provide services for the public and emergency workers.
2. Mental Health will be a support agency for coordination of Critical Incident Stress Debriefing Teams and any needed follow up. Request for debriefing teams will be directed to the Watauga County Emergency Management Office.”
e) Wilkes County plan:
Wilkes County Emergency Plan
Mental Health Services Provider
. Develop procedures to provide mental health services during emergencies.
. Develop a Disaster Training Guide for counseling personnel.
. Provide crisis intervention training for personnel assigned to Critical Incident Stress Debriefing Teams.
. Implement disaster plans for mental health facilities.
. Provide mental health professionals for treatment of disaster victims.
. Assist American Red Cross with inquiries and inform families on status of individuals injured or missing.
. Maintain a 24-hour Crisis Line during periods of evacuation.
. Identify evacuees in reception centers, shelters and Disaster Application Centers who have experienced mental stress and provide them with mental health services.
. Ensure continuity of mental health treatment and medication for persons in shelter, as necessary or requested.
. Provide crisis counseling to professionals and support staff working with the relocated population.
. Arrange for debriefings of psychological support for emergency workers and disaster victims.
. Coordinate with the Mental Health Coordinator and provide crisis counselors to shelters.
. Additional duties are also found in the various annexes and procedures.
Retrieved 06 Jan 2006 by rmcox from http://www.wilkescounty.net/emmgmt/eplan/basic.asp#Mental%20Health%20Services%20Provider
While attending shelters is usually thought of as a Red Cross function (with it’s own mental health staff), not every county has a Red Cross presence & not every shelter will be a Red Cross Shelter. The question of payment was raised during the development of the template; Red Cross mental health volunteers may be NRBH employees & who pays for their time during response must be answered. Some considerations include:
a) It is the responsibility of the Department of Social Services to insure that emergency shelters are available in an effected area.
b) In some counties the American Red Cross is poised to carry out this responsibility (Watauga).
c) In other areas (Ashe) Red Cross will play a supportive role, rather than a lead role.
d) Red Cross shelters are general public shelters where all residents are expected to take care of themselves. Those persons with greater need (Special Needs) are not eligible for Red Cross shelter services and must take refuge elsewhere.
e) Special Needs Shelters are the responsibility of the county where they are located.
Fortunately behavioral health response in disaster is expected. Experience taught that there are far more psychological survivors than those with strictly medical need. “Research has shown that 20% or more of people exposed to traumatic events typically develop clinically significant psychological problems” (retrieved 31 July 2006 by rmcox from http://www.istss.org/terrorism/professionals.htm). The DeWolfe Disaster Population Model is often used to visualize need in order to prepare for an individual response. However, “defining the victims is not an easy process, as many people who are exposed to most large-scale events are impacted. Even though people may be negatively affected, not all will need, accept, or necessarily benefit from various interventions. Definitions also may differ depending on the type of event - especially the difference between natural disasters and terrorist events (i.e. victims of terrorist events are crime victims and may therefore be eligible for services and resources not available in natural disasters). Some States have identified groups that represent primary populations who must be served (e.g., adults with severe mental illness; children and adolescents with severe emotional difficulties) and then identified other populations who can be served if possible or if additional resources are available.
“In the priority-setting process, both research and practical experience points to exposure as a prime predictor of the development of psychological sequelae. Figure 1 is an illustration of exposure categories. It generally is agreed that all who experience a disaster are somehow affected by it. However, a number of groups warrant specialized approaches and services, even if they're not at great risk, including, but not limited to, children, those with pre-existing mental disorders, disaster and emergency workers, the frail elderly, and racial and cultural minorities. An excellent summary of the empirical research, including a discussion of risk and status factors, can be found at http://www.ncptsd.org/facts/disasters/fs_range.html.” 20/80 Rule: expect 20% of survivors to have some physical casualty; 80% to be psychological casualties—of that 80%, half will have anxiety problems. (Everly Jr, George S PhD. Aug 2004 conference presentation.)
A Seriously injured victims • bereaved family members
B Victims with high exposure to trauma • victims evacuated from the disaster zone
C Bereaved extended family members and friends • rescue and recovery workers with prolonged exposure • medical examiner's office staff • service providers directly involved with death notification and bereaved families
D People who lost homes, jobs, pets, valued possessions • mental health providers • clergy, chaplains, spiritual leaders • emergency health care providers • school personnel involved with survivors, families, of victims • media personnel
E Government officials • groups that identify with target victim group • businesses with financial impacts
F Community-at-large
Researchers realized that a behavioral health response is for both survivors and for responders. Despite controversy about what to do, many responders report that cognitive-behavioral strategies for relieving distress are helpful. There are several models (one is CISM, a comprehensive continuum approach to building resiliency, enhancing response, and speeding recovery in an effected community—debriefing as a system) currently in use; although none have gained best practice status. One thing is clear: Responder care is community self-care & as such, integral to providing a response.
The purpose of planning is to be proactive in developing relationships & in preparing the public to respond to critical events. The SAMHSA All-Hazards Planning Guide: “There seems to be a consensus that the process of planning is nearly as important as the content of the plans” (retrieved on 31 July 2006 by rmcox from http://www.mentalhealth.samhsa.gov/publications/allpubs/SMA03-3829/part_two.asp). Building relationships prior to an event will enhance response because everyone knows what to do & how to do it. Of course, the worst time to develop and test a plan is during a critical event. Procrastination is a poor planning strategy.
For purposes of responding it is important to know what consumers are at elevated risk for direct effects through location and/or symptoms. “An adult's risk will increase linearly along with the number of these factors that are present:
• Female gender
• Age in the middle years of 40 to 60
• Little previous experience or training relevant to coping with the disaster
• Ethnic minority group membership
• Poverty or low socioeconomic status
• The presence of children in the home
• For women, the presence of a spouse especially if he is significantly distressed
• Psychiatric history
• Severe exposure to the disaster, especially injury, threat to life, and extreme loss
• Living in a highly disrupted or traumatized community
• Secondary stress and resource loss.
With a few modifications - primarily the deletion of age and minority group status -- this risk-factor model holds reasonably well for children and adolescents” (retrieved on 31 July 2006 by rmcox from http://www.istss.org/terrorism/victims_speak.htm) 50,000 Disaster Victims Speak: An Empirical Review of the Empirical Literature, 1981 – 2001. Prepared by: Fran H. Norris, Georgia State University. With the assistance of: Christopher M. Byrne and Eolia Diaz. Georgia State University and Krzysztof Kaniasty, Indiana University of Pennsylvania. For The National Center for PTSD And The Center for Mental Health Services (SAMHSA) September 2001. Lists created by various agencies outline the need for special needs shelters and for who to check on during a disaster.
NRBH should be part of every county Emergency Operations Center (EOC) to insure an adequate and appropriate behavioral health response. In fact, the NRBH INTRA-AGENCY DISASTER PLAN indicates such.
RESPONSIBLE PARTY
In the event of an external emergency, all New River Area Program employees will follow the plan set by the County Manager or the Emergency Management for the county. A copy of the Emergency Action Plan for each county that we service should be obtained by the Unit Director.
The Area Director, Unit Director, or Risk Management Nurse will act as Emergency Coordinator in the event of an internal emergency.
It quickly became apparent that New River would follow the lead of the County EOC & that the EOC would expect New River to know what to do. It also became apparent that neither has a plan should one be needed. Currently, In 4 of the 5 counties there is currently someone working with Emergency management regarding planning and response. NRBH does have resources to call on; there are trained and experienced responders in each county.
In conclusion, it appears that some thought was given to the response that New River would take should a disaster occur on the property of the agency. Plans are in place for coping with those events, if they are isolated and easily contained—any event requiring closure of a facility or multi-day response is not planned for. This is true also for the response of the counties—it is expected that NRBH will respond when called; although it is not clear who will be called and how they will respond. For these reasons, I request your permission to create a New River Behavioral Healthcare disaster response plan that addresses continuity of operations for the agency, care for our consumers, adequate and appropriate response to other emergency responders, and a working relationship with the county EOCs in our service region.
