Emergency planners and responders recognize that disaster behavioral health (DBH) is an integral part of the overall public health and medical response to any emergency event. DBH addresses the psychological, emotional, cognitive, developmental, and social impacts that disasters have on survivors and responders as they respond and recover. Even knowing this, not everyone understands the federal role in DBH. The majority of DBH activities are accomplished by state, local, tribal, and territorial (SLTT) entities, and voluntary organizations active in disaster (VOADs). Therefore, the federal role, largely carried out by the U.S. Department of Health and Human Services (HHS), includes providing preparedness, response, and recovery support to SLTT communities. Federal behavioral health support typically includes the provision of technical assistance, educational resources, grant assistance, deployment of trained behavioral health responders, actions to support federal responders manage stress and maintain resilience, and participation in response and recovery planning and coordination efforts at the SLTT and national levels. Although behavioral health activities occur across HHS, the primary agencies that engage in activities specifically related to disasters are the Office of the Assistant Secretary for Preparedness and Response (ASPR) and the Substance Abuse and Mental Health Services Administration (SAMHSA).
Assistant Secretary for Preparedness and Response (ASPR)
The ASPR works on behalf of the HHS Secretary to direct and coordinate all federal public health and medical assistance—including behavioral health assistance. Within ASPR, the Office of Emergency Management (OEM) and the Office of Policy and Planning (OPP) work closely together to carry out the activities directed toward overall public health and medical coordination for the ASPR.
OPP, Division for At-Risk Individuals, Behavioral Health, and Community Resilience (ABC)
Within ASPR OPP, the Division for At-Risk Individuals, Behavioral Health, and Community Resilience (ABC) is responsible for ensuring effective coordination and providing subject matter expertise so that DBH needs are identified and addressed as part of federal public health and medical response efforts. The primary mechanism by which this is accomplished is through convening the Federal Disaster Behavioral Health Group (FDBHG).
Coordination and Technical Assistance
The FDBHG includes participants from across HHS as well as national, state, and local stakeholders typically engaged in DBH, such as SAMHSA, the Administration for Children and Families , the Health Resources and Services Administration , the Centers for Disease Control, the American Red Cross, state mental health authorities, and HHS regional staff. After mass violence or terrorisim events, the FDBHG will also include partners such as the Department of Justice, the Federal Bureau of Investigation, and the Department of Education. The goal of the group is to implement a coordinated approach so that outreach to state and local behavioral health stakeholders is targeted, appropriate, and unnecessarily duplicative. The FDBHG also establishes bi-directional communication through relevant agency programs and grants to identify needs, share governmental information, gather essential elements of information, and develop a common operating picture regarding behavioral health. It allows the broad range of participants to analyze information and identify capabilities and gaps to make response recommendations. Often the group identifies informational and psycho-educational resources related to the disaster event and mobilizes access to this information through public information systems or generates information and conducts analysis to inform transition to recovery, long-term recovery, and after-action/lessons-learned activities. ABC and key partners of the FDBHG, such as SAMHSA, work closely with ASPR’s OEM to ensure that information and recommendations are captured and provided to decision makers, response and regional staff, and responders.
Resource and Guidance Development
ASPR ABC engages in preparedness activities when not supporting response efforts. ABC works closely with ASPR’s Technical Resources, Assistance Center, and Information Exchange (TRACIE) to address specific information requests. ABC also creates tools to help with the coordination and understanding of federal behavioral health activities as well as to assist SLTT planners enhance their ability to provide behavioral health services during and after emergency events. Examples include:
- HHS Disaster Behavioral Health CONOPS which outlines how federal and SLTT collaboration utilizes the strength of the existing health and behavioral health structures to achieve success in both response and recovery.
- Disaster Behavioral Health Coalition Guidance that provides a rationale, guidance, and suggestions for forming successful disaster behavioral health coalitions
- Capacity Assessment Tool to help state and local agencies as well as provider organizations assess disaster behavioral health capacity and its integration into all planning, preparedness, response and recovery efforts
Office of Emergency Management (OEM)
ASPR OEM carries out the administration and functional activities of public health and medical response and recovery, including behavioral health, and ensures ASPR has the systems, logistical support, and procedures necessary to coordinate the Department’s operational response to threats and emergencies. Within ASPR OEM, there are several components that work in close collaboration with ABC to ensure that federal behavioral health preparedness, response, and recovery activities are provided and appropriate. These include the Emergency Management Group (EMG), the Secretary’s Operations Center (SOC), the Regional Emergency Coordinators (REC), the Incident Response Team (IRCT), specifically assigned behavioral health liaison officers from the Public Health Service, and the Division of Recovery. OEM oversees the assessment of needs, the provision of technical assistance and resources, as well as the deployment of behavioral health personnel when necessary.
Substance Abuse and Mental Health Services Administration (SAMHSA)
SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities and support SLTT and voluntary organizations as they prepare for, respond to, and recover from disasters. SAMHSA oversees and administers the vast majority of day-to-day mental health and substance abuse programs and also uses several mechanisms to coordinate behavioral health resources to help responders and communities.
Communication & Coordination
One of the main ways SAMHSA coordinates behavioral health resources is through the SAMHSA Emergency Coordinator, who maintains contact and with SAMHSA grantees and other response partners (e.g., state departments of mental health/behavioral health, substance abuse/addiction services). This coordination involves communicating with the State Disaster Behavioral Health Coordinator and stakeholders in any affected region to assess whether there are unmet behavioral health needs and, if so, SAMHSA offers applicable technical assistance and resources. Examples of relevant projects and grants include the National Child Traumatic Stress Network, Suicide Prevention, block grants, tribal programs, and mental health and substance abuse prevention and treatment programs.
SAMHSA also helps VOADs and professional guilds that provide behavioral health services, such as the American Psychological Association, the National Association of Social Workers and the American Counseling Association, to coordinate and integrate their activities with federal and SLTT efforts.
Technical Assistance and Provision of Resources
SAMHSA provides technical assistance and administers the FEMA Crisis Counseling Assistance and Training Program, (CCP; a Stafford Act program) and the SAMHSA Emergency Response Grant (SERG) program, which can help SLTT entities meet survivors’ DBH needs. CCP assists individuals and communities in recovering from the challenging effects of disasters through the provision of community-based outreach and psychoeducational services. Services are typically provided by behavioral health organizations through contracts with a state’s department of mental health. SAMHSA’s role in disaster behavioral health also includes dissemination of resource materials via the SAMHSA website and SAMHSA’s Disaster Technical Assistance Center.
In addition, the SAMHSA Disaster Distress Helpline connects those experiencing emotional distress related to a disaster with crisis center counselors who can provide support and referrals to local resources by calling SAMHSA’s 24/7 Disaster Distress Helpline at 1-800-985-5990 or texting TalkWithUs to 66746. “SAMHSA GO2AID--The Field Resources for Aiding Disaster Survivors App,” allows responders to access critical, disaster-related behavioral health resources from their phone.
Interdependent Efforts
It is important to understand that DBH activities require interagency efforts, as well as coordination between the federal government, SLTT governments, and non-government stakeholders. During and after emergency events, the behavioral health scope of care must be based on an assessment of behavioral health needs with SLTT officials in consultation with SAMHSA, the EMG, the IRCT, ASPR-ABC, and local VOADs. It is only through building and leveraging partnerships between all of these stakeholders that the essential element of overall health – behavioral health – is recognized, assessed, supported, and strengthened.
