Mental Health

All-Hazards

Disaster Planning

Guidance

Disaster

Response

Disaster

Planning

Mental Health

All-Hazards 

Disaster Planning

Guidance 

2003

U.S. Department of Health and Human Services

Substance Abuse and Mental Health Services Administration

Center for Mental Health Services
II

ACKNOWLEDGMENTS

This report was produced by the National Association of State Mental Health Program Directors

(NASMHPD) and the National Technical Assistance Center for State Mental Health Planning (NTAC)

and is supported under Cooperative Agreement #01M0088201D from the Center for Mental Health

Services (CMHS), Substance Abuse and Mental Health Services Administration (SAMHSA). The

document was written by Brian W. Flynn, Ed.D., reviewed by a group of experts on mental health

response to disasters, and edited, designed, published, and distributed by the National Technical

Assistance Center (NTAC) of NASMHPD. The SAMHSA Disaster Technical Assistance Center, ESI,

under contract with ESDRB/CMHS, prepared the resource list, edited the document, and designed

the cover and layout for this publication.

DISCLAIMER

The content in this publication, is solely the responsibility of the author and does not necessarily

represent the views, policies or opinions of the Department of Health and Human Services (HHS),

SAMHSA, or its centers.

PUBLIC DOMAIN NOTICE

All material appearing in this report is in the public domain and may be reproduced or copied

without permission from SAMHSA or CMHS. Citation of the source is appreciated. However, this

publication may not be reproduced or distributed for a fee without the specific, written 

authorization of the Office of Communications, SAMHSA, DHHS.

ELECTRONIC ACCESS AND 

COPIES OF PUBLICATION

This publication can be accessed electronically through the following Internet connection:

www.samhsa.gov. For additional free copies of this document, please contact SAMHSA’s National

Mental Health Information Center at 1-800-789-2647 or 1-866-889-2647 (TDD).

RECOMMENDED CITATION

U.S. Department of Health and Human Services. Mental Health All-Hazards Disaster Planning

Guidance. DHHS Pub. No. SMA 3829. Rockville, MD: Center for Mental Health Services, Substance

Abuse and Mental Health Services Administration, 2003.

ORIGINATING OFFICE

Substance Abuse and Mental Health Services Administration

5600 Fishers Lane, Rockville, Maryland 20857

DHHS Publication No. SMA 3829

Printed 2003
III

T ABLE OF CONTENTS

FOREWORD .........................................................................................................................1

INTRODUCTION ........................................................................................................2

P A R T ONE: THE STATE OF THE STATES .............4

Plan Revisions Currently in Process ............................................................................................5

P A R T TWO: THE PLANNING PROCESS .......................6

Benefits of the Planning Process .................................................................................................7

Limitations, Barriers, and Challenges in Developing and Implementing Plans........................7

Getting the Planning Process Started..........................................................................................8

Recommendations from the Focus Group ..................................................................................9

P A R T THREE: PLAN CONTENT .................................................18

Basic Plan Elements ...................................................................................................................19

Integrating with the State Plan ..................................................................................................23

Functional Annex Content .........................................................................................................24

Hazard-Specific Planning...........................................................................................................28

Special Planning Concerns for Mental Health ..........................................................................30

Standard Operating Procedures and Checklists .......................................................................32

Glossary of Terms .......................................................................................................................32

P A R T FOUR: RESOURCES ...................................................................34

Organizations .............................................................................................................................34

Publications.................................................................................................................................35

References...................................................................................................................................37

APPENDICES

Appendix A: Elements of an All-Hazards State Disaster Mental Health Plan ......................A-1

Appendix B: Listing of Focus Group Members........................................................................B-1

Appendix C: Common Acronyms and Definitions ..................................................................C-1

FIGURE

Figure 1: Population Exposure Model .......................................................................................12

T ABLES

Table 1: Sample Comparison of Eligibility and Services ..........................................................10

Table 2: Examples of State Legislation Geared Toward Disaster Response Planning............14

Table 3: Recommended Planning Participants .........................................................................15

Table 4: Texas Department of Mental Health and Mental Retardation Disaster Matrix.........20

Table 5: CMHS Needs Assessment Formula .............................................................................23

1

FOREWORD

Prior to the publication of the Federal Emergency Management Agency’s Guide for 

All-Hazard Emergency Operations Planning (FEMA, 1996), State and local emergency 

management leaders did not have sufficient, nationally accepted guidance to help them

respond to natural and man-made disasters. FEMA’s publication, also known as State and

Local Guide (SLG) 101, provided a geographically diverse group of planners and decision

makers with a comprehensive “toolbox” of best practices, suggested collaborations, ideas,

and advice on how to adequately prepare for worst-case scenarios of all kinds.

While the SLG serves as an effective resource for emergency management leaders, it does

not focus on guidance for State mental health leadership. This document, the Mental Health

All-Hazards Disaster Planning Guidance, is intended to serve as a companion piece to the

SLG by providing direction and support tailored specifically for State and local mental

health leaders as they create and/or revise all-hazards response plans. In particular, the

document provides counsel to States on considerations for the planning process, and for

actual plan content.

The tragic loss of life that occurred on September 11, 2001 was one outcome of the day’s

horrendous events. While most Americans were resilient in the face of this tragedy, some

experienced depression, grief, and Post-Traumatic Stress Disorder. Thus, the events of that

day were both a challenge and a call to action for all those responsible for the organization

and provision of mental health services. The feelings of loss of our security and wellbeing—arguably the most crucial abstract ingredients for leading a happy, healthy life—

dramatically affected the citizens of this country. Looking to the future, we believe this 

document can be used to lessen the blow—especially the behavioral health consequences

delivered by subsequent disasters. 

The Mental Health All-Hazards Disaster Planning Guidance was created through collaboration

between Substance Abuse and Mental Health Services Administration and the National

Association of State Mental Health Program Directors. It uses a concise, yet comprehensive

format to offer policy makers practical, experience-driven advice on a complex and 

important topic. We invite State and local planners to use this document to help alleviate

the pain and suffering that all too often accompanies large-scale tragedies of every type.

Charles G. Curie, M.A., A.C.S.W.

Administrator

Substance Abuse and Mental Health 

Services Administration

Robert W. Glover, Ph.D.

Executive Director

National Association of State Mental

Health Program Directors
2

Nearly three decades ago, the

Robert T. Stafford Disaster Relief

and Emergency Assistance Act

was enacted by Congress to help

State and local governments

prepare for disasters. Since its

enactment, which also established

the Crisis Counseling program

(CCP), States have been required

to have a plan to focus on the

mental health aspects of

disasters. Unfortunately, this

portion of the legislation has not

achieved the type of in-depth,

comprehensive, and integrated

planning hoped for—and, that in

the current environment has

become essential.

In some cases, insufficient

planning at the State level has

delayed Federal funding to meet

the mental health needs of

disaster victims and survivors. In

other cases, the planning

requirement has been technically

met with only skeletal planning

documents. The need to enhance

State mental health disaster plans

has become apparent to all

involved as disaster and

emergency planning has evolved

through the years. The increased

focus on mental health, as

exemplified by the President's

New Freedom Commission on

Mental Health, and the increasing

complexity of both the traditional

and potential roles played by

State Mental Health Agencies

(SMHAs) and the disaster

situations they face has made this

clear.

Introduction
3

Better planning can help make

available appropriate

interventions to those in need,

and help promote resiliency and

recovery. It also provides an

opportunity for a more efficient

mental health response. It is

possible, with sound, integrated

planning, to fill the new, complex

roles of identifying disease

outbreaks, integrating health and

mental health response, and

conducting epidemiological

surveillance—all of which are

necessary in the new age of

bioterrorism threats.

To that end, the Center for Mental

Health Services (CMHS), within

the Substance Abuse and Mental

Health Services Administration

(SAMHSA), collaborated with the

National Association for State

Mental Health Program Directors

(NASMHPD) to assess the status

of disaster mental health plans in

the country, and provide guidance

to States regarding important

components in the planning

process as well as potential

content and organization of viable

plans. 

This document is the result of that

process. Along with the comprehensive matrix for planners found

in Appendix A, this document is

intended to help guide State and

local mental health agencies

create or revise plans for

response to human or natural

disasters and emergencies. It is a

companion document to the

Guide for All-Hazard Emergency

Operations Planning, which was

published by the Federal

Emergency Management Agency

(FEMA) in 1996. While this Mental

Health All-Hazards Disaster

Planning Guidance is full of

helpful information and

applicable resources for State and

local mental health entities, it is

strictly a guide and does not

establish any requirements.

The document draws heavily on a

number of sources, including:

■ Content review of State disaster

mental health plans;

■ In-depth, structured interviews

of individuals with long and

diverse histories in disaster

mental health as well as in State

and/or Federal emergency

management;

■ The results of a focus group 

that included representatives

from the SMHAs, Federal disaster

health and mental health leaders,

and key health and mental 

health organizations (a list of

participants can be found in

Appendix B);

■ Guidance to SEMAs by FEMA;

and

■ The experience of many

contributors with relevant

knowledge and background.

The guidance is based upon the

“all-hazards” model of emergency

preparedness. This model has

been promoted by FEMA and is

used, nearly universally, by

SEMAs as they formulate and

implement State plans. In

addition to being based on a

sound planning model for

disasters, this document can help

improve integration of the

SMHA’s roles and activities into

the overall State emergency

management and operations. 

In recent years, FEMA has placed

growing emphasis on moving

States toward an all-hazards

model of disaster preparedness.

Historically, States often had

separate plans for different types

of events. As mentioned earlier,

the primary document used to

guide this planning has been the

Guide for All-Hazards Emergency

Operations Planning (FEMA, 1996). 

The goals of a comprehensive 

all-hazards plan, as described in that

guide, are to—

■ Serve as the basis for effective

response to any hazard that

threatens a jurisdiction;

■ Facilitate the integration of

mitigation into response and

recovery activities; and

■ Facilitate coordination with the

federal government during

catastrophic disaster situations.

The FEMA guide describes a 

comprehensive all-hazards plan as

one that:

■ Assigns responsibility to carry

out actions in emergencies that

exceed existing capacity;

■ Sets forth lines of authority and

organizational relationships;

■ Describes how people and

property will be protected in

emergencies;

■ Identifies personnel, equipment,

facilities, supplies, and other

resources available; and

■ Identifies steps to address

mitigation.
4

It became clear in the development

of this document that resources—

both human and financial—are key

elements to successful planning

and implementation. Few States,

however, have even a single

person whose full-time responsibility is disaster and emergency

mental health. Most States rely on

leadership from a single person

who devotes 5 percent to 

50 percent of his or her time to 

this type of activity.

While funding for disaster mental

health planning often is limited

and must compete with other

SMHA priorities, it was dramatic to

see what could be accomplished in

States with full-time staff and even

small amounts of funding. The

Massachusetts plan, for example,

demonstrates what can be

accomplished with an infusion of a

relatively small amount of funding

(provided by SAMHSA following

the terrorist attacks of September 11,

2001). Another example of this is

Texas, which has been able to

4

P ART

ONE

tates and Territories were asked

for their existing plans to assess

both the status of disaster mental

health response planning and the

best reference point for this

publication. Thirty-one plans were

submitted and analyzed, using a

matrix similar to the one found in

Appendix A of this document.

Although it employed an

admittedly high standard, the

matrix provided a way to look at

specific areas in the plans in

which key content was included or

missing. In general, the status of

the disaster mental health plans

submitted was both variable and

incomplete.

Virtually all of the reviewed plans

lacked key elements that a

comprehensive and viable allhazards plan should contain, and

format and content varied among

States. However, several plans had

elements that were especially well

done, and a few plans, while not

in the all-hazards format, were

comprehensive and creative.

The State

of the

States

S
5

accomplish a great deal by having

full-time staff jointly funded by

SEMA and SMHA.

Most States indicated they are in

the process of plan revision. This

interest in plan revision is

primarily a result of a broad,

renewed interest in disaster

preparedness—sparked by the

events of September 11, 2001—

and the recognition that existing

plans often fall far short of being

current and having maximum

utility.

PLAN REVISIONS

CURRENTLY IN

PROCESS

Some of the areas in which States

are focusing their revisions include:

■ Enhancing the use of a

consistent planning template

compliant with the Joint

Commission on Accreditation of

Healthcare Organizations

(JCAHO);

■ Considering the use of the

Incident Command System (ICS)

because the SMHA must operate

within the ICS to respond to a

Federally declared emergency;

■ Addressing regional disasters;

■ Increasing attention to terrorism

and bioterrorism;

■ Enhancing training for SMHA

staff in incident command;

■ Addressing storage and

maintenance of plans in multiple

locations as well as in computer

file format and notebook format;

■ Expanding integration of

regional mental health planning

with regional and community

emergency management;

■ Addressing the evacuation of

SMHA facilities and development

of surge capacity in facilities;

■ Revising long-standing CCP

training to add or expand on the

topics of terrorism, child and

adolescent issues, multicultural

components, and post-disaster

substance abuse treatment and

prevention needs;

■ Expanding training to others

(including SEMAs), and refining

databases on specific and/or

specialized skills existing within

the State;

■ Modifying State emergency

plans to ensure mental healthrelated responsibilities are

included under the SMHA and not

(inappropriately) under other State

agencies;

■ Revising the State mental health

plan to include more content on

health, substance abuse, 

bioterrorism, the President’s

Homeland Security Advisory

System, the State Department of

Education, spiritual community

involvement; racial and cultural

competence; outreach to nonState organizations involved in

disaster mental health; and State

planning and advisory bodies; and

■ Revising existing systems to

include more standard forms and

to incorporate biennial review and

updating of the plan.

It became clear in the

development of this document

that resources—both human and

financial—are key elements to

successful planning and

implementation. Few States,

however, have even a single

person whose full-time 

responsibility is disaster and

emergency mental health. Most

States rely on leadership from

a single person who devotes 

5 percent to 50 percent of his

or her time to this type of

activity.
6

keep plans current require

resources and ongoing

commitment. Few organizations

will have the resources to

accomplish everything they desire,

but most will be able to delineate

at least the basic elements of a

plan.

In addition, the scope of a State’s

disaster mental health response

will have an impact on financial

and human resources as well as

on existing programs. These

considerations should be

incorporated into the planning

process. For example, intensive

outreach and case finding will

result in the identification of more

individuals in need of assistance,

necessitating additional funding

and personnel. Some victims,

while typically in the minority, will

develop significant mental health

problems. Planning should include

an assessment of the ability of the

State mental health infrastructure

to absorb additional individuals in

need of services.

P ART

TWO

ccording to Albert Ashwood,

Director of the Oklahoma

Department of Civil Emergency

Management, all-hazards planning

can be summed up in two points,

“The process is where the real

plan comes through,” and, “Until

mental health, health, and

emergency management make

[coordinated planning] a priority,

little will happen.”

There seems to be a consensus

that the process of planning is

nearly as important as the content

of the plans. Individual and

organizational relationships

among interested parties are

formed and solidified, planning

responsibilities of the SMHA and

others are established, and

multiple plans are integrated

during the process.

States benefit from an honest

assessment of the resources

available to them to establish and

maintain a plan at the beginning

of the planning process. Sound

planning and the effort needed to

The

Planning

Process

A
7

Effective plans are exercised,

modified, and updated regularly. If

a plan is developed and not kept

alive and vital, it will have limited

value. For that reason, it is

important to develop a plan that

is meaningful but also fairly basic,

so that it can be maintained and

updated regularly.

BENEFITS OF THE

PLANNING PROCESS

Nearly all reviewed States identified

positive outcomes for the process of

developing and implementing disaster mental health plans. Some of

these outcomes are listed below.

■ Having plans in place and

having a good working

relationship with the SEMA make

it easy to modify the plans

because there is an established

structure and mutual trust.

■ A strong commitment from the

Commissioner resulted in positive

planning and plan outcomes.

■ The planning process enhanced

relationships with the Red Cross

and resulted in the development

of crisis response teams, which

assist emergency personnel in

times of emotional instability.

■ The planning process enhanced

collaborations with other State

and county agencies.

■ The process allowed and

facilitated completion of a

Statewide needs assessment,

increased information available

online, and garnered support of

the SEMA.

■ The process resulted in the

establishment of full-time

positions in the SMHA devoted to

disaster preparedness, response,

and recovery.

LIMITATIONS,

BARRIERS, AND

CHALLENGES IN

DEVELOPING AND

IMPLEMENTING PLANS

Some of the systemic limitations

and barriers to adequate planning

(identified through phone interviews) include:

■ Lack of human and financial

resources to do the work;

■ The “back burner” status of

disaster mental health planning

when the public mental health

system struggles with inadequate

staff and funding for basic mental

health services;

■ Little political will to focus on

disaster mental health over many

years, once a disaster passes;

■ Mental health being overlooked

in favor of safety and security

concerns;

■ Less than optimal mental health

planning because of the barriers

to ensuring that mental health

concerns are reflected in the

policies, practices, and planning

of public safety, disease control,

and law enforcement officials.

These barriers may include lack of

state mental health agency

resources, organizational

separation, and lack of knowledge

about and appreciation for the

importance of behavioral health

issues and impacts;

■ Emerging local and regional

mental health groups (e.g., new

There seems to be a

consensus that the process

of planning is nearly as

important as the content of

the plans. Individual and

organizational relationships

among interested parties

are formed and solidified,

planning responsibilities of

the SMHA and others are

established, and multiple

plans are integrated during

the process.
8

diplomatic process sensitive to

strengths, challenges, and other

priorities.

The Context of 

Planning

■ Secure support for planning at

the highest possible level of State

government (e.g., the Governor’s

Office or at the Cabinet level).

■ Plan developers should know

the culture of the State

government and the major players

before starting. (Table 3 contains

a listing of some suggested major

players). For example, will making

changes and establishing new

collaborations be easy and/or

valued? Are the major agencies/

organizations involved seeking

change, or are they likely to try to

maintain the status quo? Is this

planning taking place in the

context of fiscal expansion or

contraction? The SMHA is

typically part of a larger State

response and recovery effort and

it often functions under SEMA’s

authority. It is important to know

who is responsible and/or in

charge of the larger operation.

■ Exactly how planning occurs—

considering the variables

delineated above—is not well

documented at the national level.

It is anticipated that as plans

emerge and as the process

becomes documented more

completely by the State Disaster

Mental Health Coordinators, more

State-specific guidance will be

developed and disseminated.

Process Guidance

■ Try to anticipate problems from

the start.

advocacy groups, local and State

critical incident management

groups, etc.), as well as local and

regional safety and security

groups (e.g., groups organizing for

community security, groups

marketing security equipment,

and plans for individuals and

businesses, etc.), with little

knowledge of State disaster and

disaster mental health

infrastructure;

■ The lack of collaboration and

consistency among federal

departments and agencies and

corresponding State departments

and agencies receiving disaster

and terrorism funding—

SAMHSA/CMHS, the Department

of Justice, the Centers for Disease

Control and Prevention, and the

Health Resources and Services

Administration were specifically

mentioned; and

■ The lack of well-defined, studied

and easily implemented programs

in disaster mental health that can

be adopted widely.

GETTING THE

PLANNING PROCESS

STARTED

It will be helpful to keep in mind

the following contextual and

fundamental guidelines before

formal planning begins.

Remember that each State differs

from others in its planning and

disaster history, its structure, and

its resources for preparedness

activities. States will need to

adapt the following guidelines to

their unique situations and may

find it useful to prioritize these

elements. The unifying essential

characteristics of these guidelines

are good preparation and a

Err on the side of overinclusion rather than

leaving some portion of the

system out. If key players

are left out, the value of

their contribution could be

lost and valuable time and

human resources may be

expended to mend fences

and/or cope with resistance

to the process or product.
9

■ Err on the side of over-inclusion

rather than leaving some portion

of the system out. If key players

are left out, the value of their

contribution could be lost and

valuable time and human

resources may be expended to

mend fences and/or cope with

resistance to the process or

product.

■ Have a leader, but share the

work. Without someone to guide

and oversee this process it

frequently becomes the victim of

other emerging priorities. At the

same time, workload and differential expertise and authorities

demand that the work be shared.

■ Keep reminding participants of

the benefits of the effort.

■ Appreciate and acknowledge the

concerns/constraints/expertise of

others.

■ Involve representatives who can

make decisions for their agencies/

departments/organizations.

Enormous amounts of time and

energy can be wasted when

decisions must wait for clearance,

which can be lengthy, or if

decisions or components are later

changed because the planning

participant lacked authority.

■ Encourage agencies/departments/organizations to do what

they do best.

■ Keep expectations and timelines

realistic.

■ Understand that in many ways

the process is as valuable as the

product. The teamwork developed

in the planning process will be the

teamwork you depend on in the

disaster response efforts.

RECOMMENDATIONS

FROM THE FOCUS

GROUP

When the focus group for this

project convened, members

identified several parts of the

planning process they felt were

important to successful outcomes.

They offered the following

suggestions and observations

about the process of developing

plans.

The Preplanning and

Early Planning Stages

■ Much information already exists

and is readily available. While

comprehensive, all-hazards plans

are scarce, most States have

existing and emerging plans that

can be very helpful. Officials

should review the plans of other

States with an eye toward

identifying those elements that

might be applicable in their State.

Some examples of elements

derived from States’ plans are

included throughout this

document.

■ Literature, available through a

wide variety of sources commonly

known to State emergency

coordinators, should be utilized to

support and assist the planning

process. For example, numerous

preparedness publications are

available from FEMA (See Part IV

for contact information). Meeting

with the SEMA at the beginning of

the planning process can be

useful in a variety of ways,

including gaining access to

preparedness aids/documents

that the SEMA has found helpful

in the past. The SMHA will likely

find some of these resources more

helpful than others.

Understand that, in many

ways, the process is as

valuable as the product.

The teamwork developed in

the planning process will

be the teamwork you

depend on in the disaster

response efforts.
10

■ In addition, different providers of

services have different definitions

of services, as well as who is

eligible for these services—

specifically in regard to mental

health interventions. For example,

three major national providers/

AGENCY

FEMA/CMHS

Crisis

Counseling

Red Cross

Mental 

Health

Services

Office for

Victims of

Crime

TYPE OF EVENT

•Natural or human

caused disaster

•Must have 

Presidential 

declaration

•Any emergency

•Special authorities 

in transportation 

emergencies

•Criminal acts

only (including 

terrorism)

WHO IS ELIGIBLE?

•Anyone living,

working, or in the

declared area at

the time of the 

disaster

•Anyone in affected

areas 

• Can provide services

to families outside

disaster area

•Crime victim’s 

location not 

critical

WHAT IS PROVIDED

•Outreach, shortterm counseling,

referral, and 

psychoeducational

activities provided

by mix of professionals and trained

paraprofessionals

•Counseling and 

referral by licensed

mental health 

professionals

•Variety of advocacy

and other services

including support

for short- and longterm mental health

services

WHEN PROVIDED

•Typically for about

a year following a

disaster 

•Does not provide

long-term treatment

•Typically only for 

a few days/week 

following the 

event

•As long as 

necessary

T ABLE 1:

SAMPLE COMPARISON OF ELIGIBILITY AND SERVICES

The information in Table 1 is an example

of how definitions of eligibility vary as a

function of the type of event and funding

source in the mental health arena. Each

State will want to consider carefully the

types of events that may occur, what

definitions apply, and who will provide the

relevant services to the various victims. In

addition to the groups listed in the table

above, other potential providers/

supporters of post-disaster mental health

services may include health insurance

programs, employee assistance programs,

and faith-based services.

supporters of disaster mental

health services include CMHS

(operating this program for

FEMA), the American Red Cross,

and the Office for Victims of

Crime (See Part IV for contact

information). The information in

Table 1 may be useful in

understanding service provider

similarities and differences.

■ It is important to acknowledge

that other State departments and

agencies may be further along in

planning and preparedness than

the SMHA. Other State agencies
11

may be very helpful while the

mental health disaster plan is

being developed.

■ Along with understanding

organizational differences in

terms of eligibility and services,

as mentioned above, SMHAs will

enhance collaborations if they

make an effort to understand new

administrative and operational

terminology, especially from the

SEMA and FEMA, as they begin

the planning process. The

establishment of common

definitions is also important, and

each State will be able to

determine which of those

common definitions are

important to establish. Examples

may include shared incident

definitions, common command

and control definitions, and

administrative terms.

■ It is important to consider the

intended audience(s) for the plan

as the process begins. This may

vary from State to State and it

may be necessary for States to

prioritize their audiences, as it is

difficult for a plan to meet fully

the needs of everyone. Factors

affecting priority setting may

include financing, politics,

structure, extent, and nature of

operational responsibilities, etc.

Audiences may include the

SMHA, SEMA, other State

agencies and departments, the

governor, State legislature,

components of the larger mental

health system, State and local

Red Cross chapters, and the

Federal government. Planners

will want to consider how much

of the plan they want to make

available (on the SMHA’s Web

site, for instance) to the general

public. A wide distribution of

parts of the plan may be useful,

while other parts (i.e. portions

identifying potential targets for

terrorism) may warrant a

narrower distribution.

■ SMHAs vary widely in their

flexibility and adaptability to

emergency and disaster

situations. A candid appraisal of

these characteristics can help

ensure that expectations of the

system in the wake of such an

event are realistic. The extent to

which a State engages in assertive

outreach, for example, will have a

significant impact upon the

number of people they find with

both disaster-related stress as

well as preexisting mental

disorders. It is important to

acknowledge this issue in the

preparedness stage in the context

of such factors as the State’s

ability to obtain and/or re-deploy

resources (and for how long),

absorb additional caseload, and

sustain expanded expectations.

■ It is far better to develop

relationships prior to an event

than attempting to forge them

during an event.

■ It is important to identify 

specifically who will have responsibility for putting the plan

together and to update this

information on a periodic basis.

This person must have a sound

understanding of the SMHA, the

legal responsibility for response

and recovery operations, and

knowledge of where this responsibility falls within the State

emergency plan.

■ Key partners in disaster

planning may already have

experience dealing with the

SMHA. That experience may have

been positive or negative, it may

have been general or specific to a

single issue, and it could have

occurred recently or in the distant

past. It is helpful to learn what

those experiences are and the

type of impression the person may

have left. One may identify

attitudes and perspectives through

this process that may be

important during the collaboration

process. Ask around to determine

if division and/or departmental

initiatives may have preceded the

current effort and existing plans

and relationships must be taken

into consideration.

■ Others will participate in the

planning process more readily if

they see some benefit to their

organization or operation

following an event. Mental health

planners should identify how

others will benefit from collaboration with the SMHA. As an

example, a local mental health

agency or school that does not

have staff trained in large-scale

crisis response may benefit by

having staff trained as part of the

preparation effort. In addition, the

planning process will enable these

organizations to better know and

understand each other, thereby

opening doors to collaborations

outside the disaster context.

■ It is important to identify the

mission of the planning process,

the purpose(s) of the plan, and the

legal obligations of the SMHA,

early on.

■ Viewing mental health concerns

in a public health context that is

broader than direct service

interventions (e.g., counseling,

debriefing, etc.) is one of many

benefits derived from approaching
12

the planning process and the plan

from a public health perspective.

Terrorist events have made public

health a national security issue

and few in the public health

sector have managed to see the

benefits of including mental/

behavioral health as part of this

system. Like mental health, public

health shares the same interest in

primary, secondary, and tertiary

prevention. So there is much to be

gained from a close collaboration

between the SMHA and the public

health agency in the areas of

preparedness and response. The

requirements of State health

agencies regarding smallpox

vaccination, as an example,

provide an opportunity for collaboration. Federal guidelines require

health departments to establish

plans for dealing with the mental

health consequences of an

outbreak. Some SMHAs have used

this requirement to engage the

public health authorities on a

variety of issues including consultation on risk communication.

■ 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,

A

F

E

D

C

B

FIGURE 1:

POPULATION EXPOSURE MODEL (DeWolfe)

Seriously injured victims • bereaved family members

Victims with high exposure to trauma • victims evacuated from the disaster zone

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

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

Government officials • groups that identify with target

victim group • businesses with financial impacts

Community-at-large

A

B

C

D

E

F
13

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.

■ Membership on a planning

group should be given careful

consideration. A State may opt to

establish a consistent team that

will develop the plan. Others may

opt for a “core team” that includes

all who are legally mandated to

be involved, and a larger “adjunct

team” that includes the core team

as well as representative of any

other agency that has an interest.

Texas has developed a unique

model of a Crisis Consortium

representing a number of State

agencies (See excerpt at right). 

Structural 

Considerations

■ Ideal plans identify a clear

decision making structure and

articulate the authority of each

plan participant.

■ Both State and local mental

health agencies can best exert

influence and respond to

changing events if they are

represented in State and local

Emergency Operations Centers.

■ The SMHA can play a valuable

“gate-keeping” role if the plans

incorporate it. These can include

distribution of mental health

provider resources and

management of research

interests.

AN EXCERPT FROM THE TEXAS MODEL 

[TEXAS DEPARTMENT OF MENTAL HEALTH AND MENTAL

RETARDATION, (TDMR, 2002)]

The role of the State Crisis Consortium is to coordinate,

manage, and ensure the credibility of services provided

and eliminate the duplication of services to victims

following a catastrophic event. The State Crisis Consortium

is a unique and innovative element in disaster response

and recovery and is comprised of the following core

programs: 

The Texas Department of Mental Health and Mental

Retardation’s Disaster Assistance and Crisis Response

Services program is the lead agency in the coordination of

the State Crisis Consortium and provides assessment and

evaluation of the immediate long-term mental health needs

of victims and responders, immediate crisis counseling and

mental health services to victims and responders, and

coordinates federal Crisis Counseling and Training

programs following federally declared disasters.

The Texas Department of Public Safety Psychological

Services Division provides peer support and victim

services to responders and their families including shortterm counseling and referral.

The Texas Department of Health Critical Incident Stress

Management Network provides for the pre- and postincident stress management and educational support to

emergency service workers and their primary support

systems, and provides support after any situation faced by

personnel that causes them to experience unusually strong

emotional reactions.

The Office of the Attorney General Crime Victim Services

Division provides for crime victim compensation services if

the event is criminal in nature. The Consumer Protection

Division provides support, protection and recovery from

consumer fraud and deceptive practices following disaster

or critical events.
14

■ In States with both regional and

central SMHA offices, identifying

the respective roles and responsibilities of each is a very important

part of the planning process.

■ Plans should include clear

documentation on how to access

Federal resources through State

structure. In the past, some

SMHAs have had a better

understanding of the Federal

administrative process to obtain

funding than of the State process

required to obtain and distribute

these funds. In some cases, this

has resulted in unnecessary

delays in funding. To reduce

delays and other setbacks, the

following questions should be

considered: Under what circumstances can a State apply for the

Federal Crisis Counseling

program? Through which internal

State processes and paths do

these decisions and processes

flow? How do Federal funds flow

from the Governor’s Office to the

SEMA, to the SMHA, and on to

vendors?

T ABLE 2:

EXAMPLES OF STATE LEGISLATION GEARED TOWARD

DISASTER RESPONSE PLANNING

LOUISIANA

R.S. 39:1494.1 SOCIAL

SERVICE CONTRACTS

A. Contracts for social 

services may be awarded

without the necessity of

competitive bidding or competitive negotiation only if

director of the office of contractual review determines

that any one of the following

conditions is present. The

using agency shall document

the condition present and

such documentation shall be

part of the contract record

submitted to the office of

contractual review.

(6) An emergency exists

which will not permit the

delay in procurement necessitated by the request for

proposal procedure given in

R.S. 39:1503. Such emergency shall be determined

by the director of the office

of contractual review.

MINNESOTA

9575.0670 EMERGENCY

APPOINTMENT

Whenever an emergency

exists that requires the

immediate services of one or

more persons and it is not

possible to obtain such 

persons from appropriate

registers, the appointing

authority may appoint a 

person or persons without

consideration of other 

provisions of this chapter

governing appointment,

except as provided in parts

9575.1410 to 9575.1450.

Such appointments normally

shall be limited to no more

than 45 working days during

any calendar year for the

same person; however, such

appointment of the same

person can be extended to

67 working days.

STAT AUTH: MS s 256.012

HIST: 12 SR 458 ; 22 SR 45

SMHAs may find it useful to

review their individual State laws

with an eye toward needs (such

as speedy hiring, rapid

contracting, and the ability to

reprogram funds) that are

common in disaster situations. In

some cases, States may consider

policy changes, either themselves,

or in concert with other State

disaster response entities, that

will allow for these urgent

activities. Table 2 contains

examples of relevant legislation

from Louisiana and Minnesota.

■ The important relationship

between the SMHA and the

health agency can benefit from

the creation of a formal

Memorandum of Understanding

(a legal document which details

the two agency’s potential collaboration) established during the

planning process. 

Recommended Planning

Participants

Involvement of, and collaboration

with, a wide variety of both public

and private agencies and organizations is strongly encouraged.

Partnering with some or all of the

organizations listed in Table 3 is

recommended.

Planners may find it useful to sort

groups into categories such as

those having legal responsibility

for planning, those whose

responsibilities are primarily

response, and those who might

serve best as advisors. In

addition, as noted earlier, most

States will want to prioritize these

groups based on factors such as

centrality to the SMHA disaster

mission and a State’s political,

structural, and financial context.
15

T ABLE 3:

RECOMMENDED PLANNING PARTICIPANTS

As noted earlier in this document,

the scope and depth of a given

SMHA’s investment in this

planning process will vary

depending on a number of factors,

especially human and fiscal

resources. The scope of the above

list may seem beyond the

resources of some. Each SMHA is

encouraged to be realistic about

its resources and assess priority

linkages in their State. Some of

the entities on the above list may

not be involved in initial planning,

but may be incorporated at a later

date if time and resources are not

available to accommodate all.

However, the following list of

entities includes core organizations that must be involved in

any planning effort.

Essential Planning

Participants

■ Involve local mental health

agencies in planning from the

beginning.

■ Seek the collaboration between

the SMHA and the SEMA—

perhaps the most important

collaboration within State

government. Planners should note

that SEMA plans are already in

place and that SMHA planning

should be integrated into those

existing plans. 

■ Establish a relationship with the

largest employers in the State.

These employers may have special

needs following a disaster,

resources that could be helpful

following a disaster, and plans

that should be coordinated with

the State plan. In some cases,

these large employers may be

potential targets for terrorism.

■ Identify potential mental health

resources. Sources might include:

• Veterans Administration

hospitals and clinics—often

have significant numbers of

mental health professionals

well-trained in trauma work;

• Academic institutions—faculty

and student health services may

have resources;

• Professional associations—

State chapters may be

able/willing to identify/train

their members to serve; 

• State-operated services—State

mental health provider

institutions/agencies in

unaffected areas may be able to

deploy staff to areas of need; and

Most disaster responses utilize

mental health professionals 

as well as trained paraprofessionals. The mix of

responders may vary depending

on the type of incident, source of

funding, availability of professionals, and duration of the

recovery. It is important to

identify potential resources and

to consider the initial and

ongoing training needs of

everyone. A list of resources is

included in Part IV of this

publication. 

■ Agencies serving the elderly

■ Agencies serving people with disabilities

■ CISM teams

■ Community systems (all responsible agencies)

■ Crime victim advocates

■ Daycare

■ Department of Education

■ Department of Veterans Affairs

■ Faith community

■ Head Start 

■ Health authority

■ Hospital systems

■ Large employer

■ Law enforcement

■ Local and State military resources

■ Managed behavioral health care companies

■ Managed care organizations

■ Media conduits

■ Medical provider communities

■ National Guard and other military

■ Public safety agencies

■ Red Cross

■ Salvation Army

■ School systems 

■ Social services

■ Substance abuse professionals

■ Unions

■ V ocational rehabilitation services
16

■ The Red Cross is active in nearly

all emergencies and disasters,

providing general post-disaster

services and specialized mental

health services. Through a

partnership with the National

Highway Traffic Safety Administration, the Red Cross has taken

the lead in serving families of

victims in transportation

emergencies and disasters. The

development of coordinated

planning with the Red Cross is

essential. Without such

agreements, the potential for

misunderstandings, inefficient use

of mental health resources, and

organizational conflict is

increased. SAMHSA’s recently

established Disaster Technical

Assistance Center (DTAC) is

collecting helpful examples of

these agreements for State

planners to utilize (See Part IV for

contact information). The Red

Cross has chapters in counties

and cities throughout the United

States. In addition, each State has

a lead chapter responsible for

developing mental health

planning. A copy of each State’s

plan is on file at the Red Cross

national office. The Red Cross

trains mental health professionals

with appropriate licenses and

credentials in basic Red Cross

procedure, and these individuals

are promoted commensurate with

their experience. By the time a

major disaster happens, they

should have a clear idea of how

to work with State and local

representatives.

■ As noted earlier, one of the most

significant relationships is the one

between the SMHA and the State

health agency. This link is

especially critical in the areas of

terrorism involving chemical,

nuclear, or biological weapons. 

■ A relationship based on

expertise and trust should exist

between SMHA public

information staff and their

counterparts in emergency

management.

■ Most SEMAs have established

links with other State departments as well as interstate collaboration for events that cross

borders or might activate mutual

aid agreements. SMHAs might

explore opportunities to build

upon those existing emergency

management relationships as they

plan. Specific suggestions include:

learning about the existence of

SEMA interstate collaborations;

assessing the relevance of

existing collaborative arrangements for disaster mental health

response; identifying opportunities for the SMHA to

collaborate; contacting SMHA

counterparts in other jurisdictions; and sharing relevant

portions of the SMHA plan or

planning process to promote

coordination/collaboration

following an event. Participation

in multi-jurisdictional exercises

also can be very beneficial.

Contact the SEMA Individual

Assistance Officer to discuss

existing partnerships and to

create a Memorandum of

Understanding (MOU) or other

mutual aid agreement that could

serve as a starting point for

similar agreements benefiting the

SMHA plan.

■ Most SMHAs work closely with

consumers and family members

in their routine activities. These

groups can contribute an

A response is only as good

as the responders. A plan

must be in place to ensure

physical and psychological

support for mental health

workers as well as staffing

depth to ensure ongoing

operational capacity.
17

important perspective to disaster

planning and response as well.

Representatives from other

vulnerable populations such as

children, the aged/geriatric

population, and those who are

hard of hearing or deaf can also

contribute. It is known from years

of disaster mental health

experience that these groups have

special needs following disasters

(although they may not be at

higher risk for development of

mental disorders). In addition,

they may be receiving services

through multiple organizations

that may be part of the planning

process for the SMHA plan (e.g.,

schools, health care facilities,

etc.). Including representatives

from these groups in the planning

process can help ensure that

planning proceeds in a manner

that incorporates their particular

needs.

Response Logistics

■ Establish a system for notification and call-up of key response

staff as events occur.

■ Ensure access to areas where

staff is needed by issuing proper

identification and establishing a

method to easily identify mental

health workers (e.g., baseball

caps, labeled T-shirts). In some

States, the SEMA has issued

SEMA badges to SMHA

employees.

■ Prior to an event, establish a

plan for deployment of mental

health personnel. Mutual aid

agreements for deploying mental

health personnel from one

jurisdiction to another should be

considered. A Statewide

deployment plan should detail the

specific agencies involved as well

as the method of deployment for

these agencies. Careful consideration should be given to the

availability of resources and the

backfilling of temporary

vacancies, as well as

transportation, communication,

and safety issues. In particular,

communication systems (cell

phones, “ham” radios, etc.) should

provide redundancy to ensure

capability if infrastructure has

been destroyed. Do not

oversimplify this critical

procedural element of the plan.

■ Be sure that SMHA leadership

understands the incident

command system and establishes

plans for immediate mental health

activities as part of unified

incident command.

■ Clarify how communications

will take place and the reporting

expectations. The use of

preexisting forms is

recommended.

Planning for Post-event

Issues

■ It would be helpful to have a

common and nationally

consistent definition of what

constitutes the responsibility of

the SMHA for mental health

response and recovery after a

disaster. It is a challenge for key

State leaders outside the SMHA to

understand the nature of disaster

mental health services and how

these services differ from

traditional mental health services,

because most SMHAs focus

primarily (sometimes exclusively)

on those with the most serious

mental health disorders.

■ Public education following an

event is critical. Many victims will

require nothing more than

information that reassures and

provides anticipatory guidance

and meaningful advice about

what can be done to reduce

and/or manage disaster-related

stress. Consistency in these

messages is critical.

■ A response is only as good as

the responders. A plan must be in

place to ensure physical and

psychological support for mental

health workers as well as staffing

depth to ensure ongoing

operational capacity.

■ There often is significant lag

time between the decision to

implement services and the actual

implementation. States should

develop a mechanism to expedite

the implantation of services so

the process is unencumbered by

procedural delays.
18

It also should be noted that SMHAs

vary considerably in the programs

that are included in the agency, as

well as how they are organized

internally. For example, in some

SMHAs the tasks of disaster and

emergency preparedness and risk

management are organizationally

separate. This document was

developed on the assumption that

these two functions are combined.

Responsibility for developing

various parts of the plan will fall to

different parts of the organization

in those States where these

functions are separate. In all cases,

the content should be integrated

regardless of which part of the

organization has the lead.

There are several basic elements to

an all-hazards disaster mental

health plan. This section will

describe the suggested contents of

each element. Appendix A contains

a comprehensive matrix to help

planners in ensuring that they have

included all the relevant information in the plan. In reviewing this

matrix, States may find items that

4

P ART

THREE

n creating this document,

extensive consideration was given

to whether States should be

encouraged to follow a common

approach or to create their own

design and content. No current

authority requires States to adopt

a single, uniform conceptual

model; there is merit to unique

approaches. However, there was

consensus that States should be

encouraged to follow a consistent

content format and conceptual

model based on the FEMAsupported all-hazards approach,

which is being universally utilized

by SEMAs. It was agreed this

common approach will enhance

the integration of SEMA planning

and operations as well as crossState collaboration—both

important values in this endeavor.

However, within this common

model there is significant

opportunity for States to devise

and implement plans reflecting

their particular needs, characteristics, and unique and creative

approaches.

Plan

Content

I
19

do not apply to their particular

situation.

It is worth noting again that not

all States will have the resources

to develop or sustain a plan that

contains all of these elements.

This information is meant to serve

as a guide—a comprehensive

menu for choosing initiatives

when formulating an all-hazards

disaster mental health plan.

BASIC PLAN 

ELEMENTS

Several boilerplate elements should

be in the introduction of the plan

including material such as those 

listed below:

■ A signature page to assure

readers that the plan is official;

■ A dated title page with a record

of changes. It will assure readers

that they are reviewing the

current version;

■ A record of the plan’s distribution to ensure that those who

need to review and access the

plan have done so;

■ A table of contents; and

■ An optional executive summary

may be helpful to those who do

not have the time or need to

review the entire plan.

To set the stage and context for

the more detailed portions of the

plan early on, the following

elements should be included:

■ A statement of the general

purpose of the plan;

■ General situations and

assumptions inherent in the plan.

This information should include

basic assumptions, such as limits

of the SMHA’s responsibilities and

highest probability scenarios as

well as special considerations

having significant impact on

planning, including vulnerable

populations, special facilities, and

low probability/high impact

events. A matrix capturing some

of this type of information has

been developed by the Texas

Department of Mental Health and

Mental Retardation and is

included in Table 4. Some States

may find it helpful to differentiate

hazards into two categories:

physical events or damage that is

easily identifiable (e.g., flood,

school shooting), and events not

easily identifiable (e.g., bioterrorism, epidemics, reaction to

perceived risk);

■ A general concept of operations,

including the SMHA’s overall

approach to an emergency

situation; jurisdictional responsibilities; the general sequence of

action before, during and

following an event; requests for

aid, etc. While this section should

cover many topics, it is intended

to be relatively brief, providing

only the most general overview,

primarily for readers of the plan

who will not need the level of

detail contained in the remainder

of the plan and for those who may

be unfamiliar with the SMHA and

its function in disasters. As a

broader topic, establishing and

implementing a concept of

operations is complex and will

vary considerably among States.

Hopefully, States will share this

information with each other and

additional discussion and

guidance can be provided as more

plans are developed and

implemented; and

It is worth noting again

that not all States will have

the resources to develop

or sustain a plan that

contains all of these

elements. This information

is meant to serve as a

guide—a comprehensive

menu for choosing

initiatives when formulating

an all-hazards disaster

mental health plan.
20

T ABLE 4: 

TEXAS DEPARTMENT OF MENTAL HEALTH AND MENTAL RETARDATION 

DISASTER MATRIX (TDMHMR, 2002)

LOCAL DISASTERS

A local disaster is any event,

real and/or perceived, which

threatens the well-being (life or

property) of citizens in one 

municipality. A local disaster is

manageable by local officials

without a need for outside

resources.

Response is by local government, such as a police or fire

chief, mayor, or county judge

and/or other legal authority of

local government.

A response by a Community

Mental Health and Mental

Retardation Center is not

required by the State Authority.

The Local Authority may choose

to respond if a request is made

by local officials and/or a need

is evident.

There is no set time duration

for response to a local 

disaster.

This type of disaster is not

reimbursable.

STATE DECLARED DISASTERS

A State disaster is any event, real and/or

perceived, which threatens the well-being

of citizens in multiple cities, counties,

regions and/or overwhelms a local 

jurisdiction’s ability to respond, or affects

a State-owned property or interest.

A State-declared emergency can only be

designated by the Governor or his/her

designee. Response and recovery is the

responsibility of the Texas Department of

Public Safety and the Governor’s Division

of Emergency Management.

A response may be required depending

upon the magnitude, nature, and duration

of the emergency or disastrous event. The

State Authority may also supplement local

resources with State Facility staff and/or

other staffing opportunities.

The duration of response for this category

of disaster is generally for the duration of

the event or until it is jointly determined by

the State Authority and the Governor’s

Division of Emergency Management that a

response is no longer necessary and/or

appropriate.

This type of disaster is not reimbursable.

Only under highly unusual circumstances

would the State Authority be allowed to

apply for contingency funds from the

Governor’s office.

FEDERALLY DECLARED DISASTERS

A Federally declared disaster is any event,

real and/or perceived, which threatens the

well-being of citizens, overwhelms the local

and State ability to respond and/or recover,

or the event affects Federally owned 

property or interests.

A Federally declared disaster can only be

designated by the President of the United

States. The Governor of a State must

request a Presidential declaration of 

disaster.

A response will be required and the level of

response will be according to actual or 

perceived need.

The duration of response for this type of

disaster will be for the duration of the

event or until it is jointly determined by the

State Authority and the Governor’s Division

of Emergency Management that a response

is no longer necessary and/or appropriate;

for the duration of the grant period, if a

Federal Crisis Counseling Program is

obtained.

This type of disaster will be reimbursable

only upon request and approval by the

State and Federal authorities. If a disaster

is approved for “Public Assistance,” a

municipality may apply for reimbursement.

Also, if the State Authority seeks a Federal

Crisis Counseling Program grant through

the Governor's office, funds for these 

services will be reimbursable.

Reimbursable? Duration of Response Response Required Ownership Disaster Definition
21

■ References to specific legal

authorities that enable the SMHA

to fulfill the elements of the plan

or to maintain existing services.

Organization and assignment of

responsibilities in times of 

emergencies relate to the following

components:

■ Identification of tasks (both

within the SMHA and outside) to

be performed and positions and

organizations responsible for

carrying out these tasks.

Documentation of tasks may use

the FEMA-suggested format

(defines objectives, characterization of the situation, general

plan of action, delegation of

responsibilities, information on

resources, and administrative

support necessary to accomplish

tasks including descriptions of

treatment responsibilities).

Additionally, one of the most

important assignments to clarify is

responsibility for modifying and

updating the disaster mental

health plan;

■ Tasks related to other

departments and agencies, such

as FEMA, SAMHSA/CMHS, and

the Justice Department (victim

rights and assistance);

■ Integration of preparedness and

coordination of operations with

other important components of

State and local government, such

as health agencies, substance

abuse agency, criminal justice

agencies, law enforcement, fire

and rescue, and agriculture

(including the extension service

and veterinary services); and

■ Connection with State

emergency plan and Federal

response plan (the SMHA’s plan

must be consistent with the

expectations of these two

important plans in the likely event

that an incident that activates the

SMHA plan also activates other

State and Federal plans).

An appropriate response may be

ensured by adequate preparation of

the following administrative issues

(using documentation expected from

FEMA and CMHS may help if funding

from these sources is anticipated):

■ Record keeping for program

activities (which services are

being provided to whom, and by

whom);

■ Record keeping of expenditures

and obligations. In the course of a

response, the SMHA may incur

significant, atypical expenses,

such as car or generator rentals. It

is important before an incident to

have a means of documenting

these types of expenditures to

ensure that future problems are

minimized and reimbursable

expenses are accurately

documented;

■ Record keeping for human

resource utilization. This is

important not only for potential

reimbursement, but for planning

to ensure adequate staffing as

well;

■ Expected format, frequency, and

content of situation reports.

Again, this information is critical,

especially in the early parts of a

response, to justify resources and

to project service, fiscal, and

human resource needs. Situation

reports can also serve as

In the course of a

response, the SMHA may

incur significant, atypical

expenses, such as car or

generator rentals. It is

important before an

incident to have a means of

documenting these types of

expenditures to ensure that

future problems are

minimized and reimbursable

expenses are accurately

documented.
22

important political resources as

SMHA and other State leaders

present the status of response to

others; and

■ Management of volunteer

services. Development of a plan to

address use of volunteers prior to

an incident will help ensure that

human resource levels and skills

are appropriate to service needs.

Many States have learned difficult

lessons about the management of

well-intentioned but unneeded

and/or inappropriate volunteer

resources. The SMHA should

consider the use of a volunteer

coordinator position in large-scale

disasters/events. This position/

function would centralize decision

making and control of voluntary

mental health assistance. Predisaster, the plan should include a

decision tree for use by the

voluntary utilization function to

ensure consistency in the

selection and deployment of

unsolicited assistance.

During the preparation stages, it is

important to consider the following

key logistics issues:

■ Arrangement for support (food,

shelter, etc.) needed for the

mental health operation, including

the ability of the mental health

operation to be self-supporting for

at least 72 hours. Operations can

quickly be compromised if staff

must rely on others during this

critical and often chaotic period;

■ Arrangement to repair and/or

replace essential equipment (such

as radios, computers, phone

service); and

■ Arrangement for personnel to

access the areas where they are

needed. The most heavily

impacted areas are not accessible

without proper credentials and

transportation in the early hours

after a disaster. The SMHA should

work closely with the SEMA to

assure that essential mental

health staff members are able to

get to where they need to be. It is

important to ensure that these

credentialing arrangements are

included in both the SEMA and

SMHA plans. Transportation of

mental health workers may need

to be jointly planned in cases

where mental health staff need to

be transported by resources

outside the SMHA (e.g., the

National Guard). As noted earlier,

familiarity with the incident

command system (ICS) will make

planning for access and exit

easier.

A necessary but challenging activity

for content planning is ongoing

needs assessment. Critical questions

to consider are listed below:

■ How are needs to be assessed? Is

there a needs assessment tool?

Who is responsible for compiling

the assessment? What is the

process for implementing

recommendations?

■ Who will be served? Are original

assumptions still accurate? Is

information being collected with

respect to the extent of exposure,

degree of personal impact, and

demographic characteristics?

CMHS Crisis Counseling guidance

may be helpful in making this

assessment.

■ How will they be served? What

services are available; what are

needed? Are requests for services

A process to provide

continuous information flow

to planners and managers

is also critical because of

the rapidly changing

environment that characterizes large-scale

disasters.
23

being answered in a timely

manner?

■ How are needs changing? Are the

needs of some satisfied so that

resources can be redeployed? Are

there emerging groups? Are

geographical areas of need

emerging?

An assessment with these types

of questions is critical for

resource management,

establishing program priorities,

documentation of effort, and

long-range planning. A process to

provide continuous information

flow to planners and managers is

also critical because of the rapidly

changing environment that

characterizes large-scale

disasters. The CMHS needs

assessment formula is included in

Table 5.

INTEGRATING 

ACTIVITIES WITH THE

STATE PLAN

■ The availability of medications,

and where they need to be

located are special mental health

concerns. The plan should

address the transportation of

medications to where they are

needed, as well as the

safeguarding of their administration, recording, and storage.

■ When—in the assessment of the

local agency or the SMHA—the

requirements of events exceed

the service capacity of the

responsible jurisdiction, mutual

aid agreements with other

jurisdictions (e.g., counties,

States) can be very helpful and

are strongly encouraged. The plan

should document the existence

and scope of such agreements.

T ABLE 5:

CMHS NEEDS ASSESSMENT FORMULA (CMHS, 2000)

CMHS Needs Assessment Formula for

Estimating Disaster Mental Health Needs

This is an estimate for the following disaster area: _____________________________________

Date of Report: ___________________ Completed by: _______________________________________________

B. Needs Assessment Formula. Using the CMHS Needs Assessment

Formula (located below) estimate the number of persons you will serve in

each designated area (fourth column of the following table). Attach a CMHS

Needs Assessment Formula sheet for each designated area.

Total estimated persons in need of Crisis Counseling

services (add total column)

LOSS 

CATEGORIES

Type of 

Loss

Dead

Hospitalized

Nonhospitalized

injured

Homes

destroyed

Homes with

“major damage”

Homes with

“minor damage”

Disaster

unemployed

(Other loss—

specify)

NUMBER OF 

PERSONS

Number

ANH

Multiply 

by ANH1

RANGE 

ESTIMATED

At-Risk 

Multiplier

(Percent)

100

3 5

1 5

100

3 5

1 5

1 5

1 0

TOTAL

Number of

Persons Targeted

Per Loss Category

1ANH means Average Number of persons per Household. This figure can be obtained on a

county/parish/area basis from the Census Bureau. If the State is unable to determine the ANH

for an area, then use the average figure of 2.5.
24

To make the response and recovery

activities both more efficient and to

reduce vulnerability to litigation, the

plan should address the following

legal issues prior to the event:

■ Knowledge and understanding

of State licensing laws. Are there

waiver provisions during

emergencies for recognition of

those licensed in other

jurisdictions?

■ Informed consent, confidentiality

of conversations with victims, and

records kept by service providers;

and

■ Liability (How is personal,

professional, and organizational

liability addressed? In what ways

are service providers vulnerable?

Are there legal provisions for

waiving certain contracting/

procurement rules during

emergencies?).

FUNCTIONAL ANNEX

CONTENT

State emergency plans typically

contain a series of functional

annexes. Annexes are typically

parts of a plan that begin to

provide more detailed direction

and information. Planning in these

areas should focus on assignment

of responsibilities, key tasks, and

specific actions that should be

taken. The annexes described in

this section follow the FEMA allhazards annex components and

will be reflected in most SEMA

plans. They are general in nature

and apply to many, if not most,

types of events that would

activate the plan. Planning related

to specific types of events, also as

reflected in the FEMA all-hazards

approach, is discussed in the next

section. 

Communications

Functional and reliable communication is frequently a problem following major events. In some types of

disasters, the event itself may compromise communications, (i.e. cell

phone transmitters were located

atop the World Trade Center buildings) or they may become so over

utilized that they are of little use.

These issues can be a major concern

for SMHAs as they typically rely on

existing communications systems to

assess the status of existing programs and emerging needs, as well

as to deploy and track mental health

resources. During planning stages,

the following key elements of communication should be considered:

■ Identify situational assumptions

such as the types of situations that

might occur and the types of

communication necessary (e.g.,

telephone and data transmission).

Close integration with the SEMA

will be helpful in this activity;

■ Identify methods of communication among key sites such as

the SMHA and psychiatric

facilities, community treatment

facilities, State emergency

management, hospitals and

clinics, and sites where victims

may be sheltered and mental

health staff may be stationed. A

good communication plan begins

with the assurance that the SMHA

is on the notification list of the

Governor’s Office and State

emergency management when

emergencies occur;

■ Identify alternatives when

planned communications fail, as

well as the availability of

personnel with the technical

expertise to make and keep

communications functional. Plans

should include multiple options

for communications; and

■ Identify risk is communicated in

emergency situations has a

significant psychosocial impact.

While the primary responsibility

typically lies outside the SMHA,

the SMHA has much to contribute

to this process and therefore the

description of the SMHA role in

risk communication should be

clear.

Public Information

Communication with the public is

an important part of all

emergency responses. It ensures

that those affected by an event, or

at risk of being affected, take

appropriate action to mitigate

adverse effects. This function

assumes even greater significance

in mental health. Everything

communicated to the public, how

it is communicated, and by whom

it is communicated can exert a

significant effect on the

psychosocial experience of the

event. State and local SMHAs

should work closely with the

SEMA’s public information officer,

since this position is typically

responsible for this function

during State and federally

declared emergencies. Key

elements of an optimal public

information plan are listed below.

More detailed information is

available in Communicating in a

Crisis: Risk Communication

Guidelines for Public Officials (U.S.

Department of Health and Human

Services, 2002).
25

Identification of

Responsibility

■ It is important to identify key

roles and policies, such as the

designation of the SMHA liaison(s)

to the media and restricting media

access to other personnel.

■ Public information materials

should exist prior to an event (e.g.,

fact sheets, guidance on how to

access services, guides to coping).

These materials should be

available in a variety of languages.

■ Identification of experts in

trauma and disaster/emergency

mental health by the SMHA, prior

to an event, will significantly

reduce the likelihood that the

SMHA will have to locate and

assess expertise in the midst of a

response and will increase the

likelihood that the SMHA can

exercise some control of the

messages given.

■ Establishing relationships with

the local media prior to an event

will help ensure that mental health

is considered in coverage and may

reduce the potential for the media

to seek out or accept mental

health information from sources

unconnected with the response.

Existing SMHA media

relationships may be helpful.

Briefing the media on the planning

process and the importance of

accurate information about

behavioral sequelae may be an

opportunity for mental health

promotion and problem

prevention. Relationships with

reporters who cover health issues

may be especially productive.

W arning: Mobilization

Related to Internal

Mental Health Systems 

It is important that the SMHA

receive as much information as 

possible, as early as possible, when

an event occurs or is likely to occur.

The SMHA, therefore, must have

mechanisms in place to mobilize the

mental health response. Key 

elements in this process include:

■ The SMHA and local mental

health agencies should be linked

to the SEMA warning and notification system/process;

■ The plan should identify

methods and procedures for

notifying staff, facilities, service

providers, and others, as

appropriate in a given State;

■ The plan should include policies

and procedures for SMHA offices

and facilities, such as sending

staff home, holding staff in place,

recall of staff who are off duty,

and evacuating facilities. In some

States, these functions are

controlled by the SMHA risk

management unit rather than

those involved in disaster

preparedness. In those States, it is

important that these two parts of

the organization integrate their

plans; and

■ Warning and mobilization of

those outside the SMHA also are

important roles of the SMHA.

Plans should identify groups with

special needs (such as those who

have mental disorders who are

also deaf) and include plans to

notify the larger mental health

system (e.g., counties, contract

providers) as well as private

sector mental health resources.

It is important that the

SMHA receive as much

information as possible, as

early as possible, when an

event occurs or is likely to

occur. The SMHA,

therefore, must have

mechanisms in place to

mobilize the mental health

response. 
26

Evacuation

Events may cause evacuation of

large or small portions of a State. In

all cases, evacuations have had significant effects both on direct SMHA

operations as well as on potential

service sites. Integration with SEMA

planning is essential, as always. In

most cases, the SMHA will not have

direct responsibility, except in their

own facilities, but evacuation can

have significant impact on all

involved, including staff. Planning

considerations follow:

■ It is critical that SMHA

evacuation plans are integrated

with State emergency

management plans;

■ Clearly established plans are

needed for the evacuation of

SMHA offices and facilities.

Responding to the Needs of People

with Serious and Persistent Mental

Illness in Times of Disaster

(U.S. Department of Health and

Human Services, 1996) may

provide useful ideas in planning

for the needs of those in State

facilities;

■ Alternate sites should be

established to conduct vital SMHA

activities. Emergency managers

typically describe these sites in

terms unfamiliar to those in

mental health. Sites in place,

unused for any other purpose, and

capable of being fully functional

during emergencies, are called

“hot sites.” Those sites with some

functionality, but also used for

other functions in non-emergency

times are called “warm sites.” And

those existing sites that do not

become active until an event

occurs are called “cold sites;” and

■ The plan should include

provisions for mental health

services at shelters and mass care

facilities.

Mass Care

Caring for large numbers of 

displaced victims is a major, complex

part of disaster planning. While mental health does not have primary

responsibility in this area, it is 

common to find the SMHA playing a

secondary, supportive role. Typically,

the Red Cross has the lead in mass

care, but the SMHA may be asked to

provide support in terms of ongoing

needs assessment, staffing for 

shelters or places where families

await information on the status of

loved ones, and referral of those

identified as suffering from serious

psychological reactions. When planning ideas for the SMHA role in mass

care, be sure to confirm:

■ Documentation of coordination

with the SEMA mass care plan;

and

■ A description of linkages

between the SMHA, the Red Cross,

and National Voluntary

Organizations Active in Disasters

(See Part IV for contact information).

Many SMHAs have had experience

with mass care. States are

encouraged to utilize State-toState consultation regarding mass

care preparations. For example,

most of the Gulf States have wellestablished evacuation plans that

have significant mass care

components. The SAMHSA

Disaster Mental Health Technical

Assistance Center (DTAC) can

provide technical assistance on

this topic (See Part IV for contact

information).

Caring for large numbers of

displaced victims is a

major, complex part of

disaster planning. While

mental health does not

have primary responsibility

in this area, it is common

to find the SMHA playing a

secondary, supportive role.
27

Health and Medical

While health and medical response is

only part of the SEMA plan, it is the

heart of the SMHA plan. For this 

reason, SMHAs should pay particular

attention to the content of this annex

in the SEMA plan and ensure that

planning is integrated. The SMHA

plan will be far more comprehensive

and detailed with respect to behavioral health issues. It is important

that the SEMA be briefed on its content when the SMHA plan is complete

so that the SEMA is aware of the

scope, depth, and limitations of

SMHA responsibilities and resources.

When reference is made to the SMHA

in State emergency management

plans, it probably is included in the

Health and Medical Annex. Typically,

the emergency management plan will

task the SMHA with providing crisis

counseling services and/or caring for

people with serious mental illness

who are within the SMHA service 

system. Some State emergency management plans describe additional

functions. For the purposes of the

SMHA’s disaster plan, the following

points are suggestions for integration

with the emergency management

plan, as well as for other significant

roles the SMHA can play.

■ The plan should document

coordination with the State

emergency management plan,

especially in the areas of staffing,

logistics, costs, and availability of

pharmaceuticals.

■ The SMHA plan should include

mental health services and consultation as part of the State’s

emergency medical plan. Typically,

this part of the State’s emergency

management plan will reflect

utilization of Veterans

Administration resources (which

offer a considerable number of

mental health professionals

skilled in dealing with psychological trauma.) The State plan

also will use Emergency Support

Function Number 8 (ESF-8), an

item under the Health and

Medical Annex of the Federal

Response Plan. ESF-8 addresses

the availability of services

provided by the National Disaster

Medical System (NDMS), a joint

Federal-medical response

capability involving the U.S. Public

Health Service, the Veterans

Administration, the Department of

Defense, and FEMA (See Part IV

for contact information). ESF-8 also

mandates the provision of mobile

medical teams for deployment in

major emergencies. There are

several types of these ESF-8

specialty teams including mental

health professionals in addition to

general medical teams.

■ The plan should contain clearly

identified roles in the areas of

services and consultation to

primary victims, secondary

victims (those not directly

impacted by injury, death, and

destruction but who are

nevertheless experiencing disaster

related stress), response and

recovery workers (fire, police,

rescue, morgue), incident

command leadership and staff,

and to other State agencies and

departments (such as health

epidemiology, education, and

social services).

■ The plan should document

coordination with the Red Cross

disaster mental health services.

Resource Management

The purpose of the Resource

Management Annex is to ensure that

the SMHA documents the means,

organizational structure, and

process through which it will locate,

obtain, allocate, and distribute 

necessary resources during an

emergency. Several key considerations are listed below.

■ As noted earlier, a number of

issues arise related to personnel,

including how will personnel be

notified, mobilized, transported,

and deployed in the context of a

changing response environment?

■ The plan should describe how

communications and other

emergency equipment would be

obtained, distributed, and

maintained (including repairs).

■ The plan should describe the

mass care supplies needed to

sustain SMHA resources should

they be isolated or need to remain

at their service locations.

■ Mutual aid agreements within

the State should be described in

the event that local resources are

not sufficient.

■ As noted earlier, response

efforts can be made more efficient

and effective with a plan for

managing unsolicited offers of

assistance, as well as solicited

volunteers.

■ The Resources Management

Annex should describe the nature

of and process for obtaining

resources from other States and

the Federal government.

■ The plan should document

policies and procedures for

maintaining financial and legal

accountability.
28

HAZARD-SPECIFIC

PLANNING

There is a need to plan for the

specific and sometimes unique

aspects of different events in the

context of plan content applicable

to nearly all types of events.

Events may have unique characteristics with special resulting

psychosocial consequences that

have significant implications for

the SMHA (i.e. slow-rising, longstanding flooding may result in

delayed reconstruction or repair to

homes, which may further result

in victims spending longer periods

of time in shelters or with friends

and families. This can generate

additional individual and family

stress).

Some types of events are

accompanied by significant

government regulations that

directly affect response and

recovery, which may result in or

affect psychosocial sequelae. For

example, the locations in which

suspected terrorist events occur

are considered crime scenes. This

may result in delayed body

recovery and release of surviving

victims. It also may result in

recovery workers becoming

witnesses in criminal proceedings.

These special factors can have a

significant impact on the course

and timing of psychological

recovery.

Hazard-specific planning by the

SMHA also should occur in the

context of similar planning by the

SEMA. The SEMA workers will

have performed significant and

detailed risk assessments that can

be utilized by the SMHA. This

planning will also include identification of events when an agency

other than emergency

management (e.g., the FBI or

military) is in control of the

response. Plans should include

identification of types of risks, as

well as geographic areas that are

believed to be at risk. Not all

States are susceptible to the same

risks, and different portions of

States may be at greater or lesser

risk for different types of events. In

addition, the SMHA may have

facilities in high-risk areas or

facilities to be used as backup

facilities.

A detailed listing of the types of

risks a State may experience is

included in Appendix A.

T errorism

Planning for the consequences of 

terrorist acts presents numerous

challenges. The national experience

and the experience of most individual States is limited, and there are

many types of potential terrorist acts

to consider during planning. The 

scientific knowledge about the psychological and medical aspects of

some types of terrorist acts, especially bioterrorism, is not as precise

and complete as needed. Because so

much emphasis currently is being

placed on preparing for a wide 

variety of terrorist incidents, the

planning environment is changing

rapidly—with new laws, guidelines,

and key players emerging constantly.

In some cases the SMHA plan could

reference the SEMA plan. Consider

using excerpts from the SEMA plan

to add detailed context to situational

assumptions and HazMat considerations. There may also be reluctance

to put some material in a plan that is

posted on the Web or is otherwise

easily accessible to a very wide audience. Again, taking the SEMA’s lead

may be the best strategy. With these

factors in mind, the SMHA plan for

terrorism should be developed by

being informed of the following

issues.

■ An understanding of potential

hazards such as chemical,

biological, nuclear/radiological,

explosive, cyber, or combined

events. Many types of events

might stem from these overall

classifications. States with rural

areas and agribusiness industries

should also include Foreign

Animal Diseases (FADs) that may

be introduced accidentally or

criminally. Planning should reflect

the types of events that the SEMA

has included in their plans.

■ Identification of potential targets

that reflect or are consistent with

those identified by the SEMA (e.g.

chemical manufacturing plants or

nuclear power generating

facilities). This will not only ensure

that there has been SMHA and

SEMA communication on these

potential targets, but also that

planning between the two

agencies is consistent.

■ Situational assumptions of the

SEMA plan including environment

(e.g., prevailing winds),

populations and population

centers, urbanicity, infrastructure

(water, sewer), transport patterns

(roads, railways), airports (public,

private, military), trains/subways,

government facilities (nonmilitary), military installations,

recreation facilities, and facilities

containing hazardous materials, 

as well as other high-risk targets

such as financial institutions,

universities, hospitals, research
29

institutes, schools, and daycare

centers. By completing a

description of situational

assumptions, the SMHA will

ensure that planning is consistent

with the SEMA, while considering

where needs may arise, what

mental health resources may be at

risk, and where to place

preparedness priorities.

■ Description of the SMHA’s

terrorist incident management

protocol, with special attention to

aspects where incident

management may be different

than in other types of disasters.

■ Reflection of the State

emergency plan’s modeling of

potential releases of hazardous

materials or biological agents.

This again will increase the

potential for SEMA/SMHA plan

coordination, as the SMHA will be

able to identify specific scenarios

(e.g., evacuations, decontamination sites, etc.) that may

generate special mental health

needs, assess vulnerability of

mental health service sites,

identify alternative sites, evaluate

the deployment of mental health

resources, etc.

■ Documentation of how incident

management by the SMHA

reflects the roles of other State

and various Federal agencies and

resources.

■ Description of how the plan’s

consequence management

reflects the involvement of

various Federal components (such

as FEMA, SAMHSA/CMHS

resources, Office for Victims of

Crime in the Justice Department,

and Safe and Drug Free Schools

in the Department of Education). 

■ A description of the State

emergency plan in cases in which

terrorist events trigger different

response, authorities, and policies

within the functional annexes

described in the previous section.

■ Identification of links to health

and medical entities to assist in

screening potential victims for

mental disorders and psychogenic

symptoms, functional impairment,

substance abuse, etc. One of the

great concerns following a bioterrorist incident is the rapid

utilization of health and medical

resources not only by those who

have been exposed but also by

those who believe they have been

exposed. This is an area in which

close collaboration in the

planning and response phases

among the SMHA, the health

agency, local hospitals, and other

health care facilities is paramount.

■ Links with the health agency for

surveillance, screening, consultation, intervention planning, and

risk communication. In events

with major public health

implications, the State health

agency will have a lead role. The

valuable role that the SMHA can

and should play in the activities

described is often not understood

by the State health agency.

Collaboration in the planning

process can result in enhanced

response by both the SMHA and

the health agency.

■ A description of the SMHA’s

authority in risk communication

and response. As noted before,

this is an area in which collaboration between the SMHA, the

health agency, and the State

emergency management public

information structure is critical.

Planning for the

consequences of terrorist

acts presents numerous

challenges. The national

experience and the

experience of most

individual States is limited,

and there are many types

of potential terrorist acts

to consider during

planning. 
30

■ Plans should reflect the fact that

mental health providers typically

are not first responders to HazMat

incidents. When they are deployed

to the site and are present at the

site, their safety should be a prime

concern to planners and administrators. Adequate preparation

should be undertaken to ensure

safety, such as training on proper

use of safety equipment and

protective gear. Without

preparation mental health

providers quickly and easily can

become part of the population

needing health, medical, and

mental health services.

Continuity of Operations

for the State Mental

Health Agency

No organization can mount a

response to a disaster if the 

fundamental operations of that

organization are not functioning.

SMHAs are no exception. Additionally, preexisting and ongoing responsibilities of the SMHA do not stop,

even when disaster strikes. As a

result, part of a meaningful plan are

provisions that will enable the SMHA

to continue its essential functions

when disaster strikes through a

Continuity of Operations Plan

(COOP). In many States, these issues

will be addressed in documents 

separate from the SMHA’s disaster

plan. In some States, they will be

integrated as part of the disaster

plan. In any case, there is certainly a

role for disaster planners in preparing for worker stress issues inherent

in any situation that would activate a

COOP. To ensure continuity of

essential operations, the following

points should be addressed.

■ A statement of goals for the COOP

is necessary. The goal in most

States is to maintain or reestablish

vital functions of the SMHA during

the first 72 hours following any

event that would compromise or

halt normal operations.

■ As in other components, there

should be documentation of 

coordination with the overall State

Coop.

■ The plan should identify vital

functions, records, and data to 

be maintained within the first 

72 hours.

■ The plan should identify plans

related to human resources, such

as essential staff, staff notification,

and family support. Note that these

functions may be different from

those described earlier, which focus

on disaster-related services. In this

case, the concern is with

maintaining preexisting SMHA

functions and responsibilities.

■ The plan should identify alternate

locations for essential operations as

well as provide for transportation

and staff support (food,

rest/sleeping areas, etc.).

■ In case the primary records are

destroyed or inaccessible, it is

important that duplicate vital

records and documents be housed

prior to an event in at least one

alternate site. These types of

records might include the SMHA

disaster plan, staff rosters, and vital

patient medical records.

SPECIAL PLANNING

CONCERNS FOR MENTAL

HEALTH

The following list includes elements of

the SMHA disaster plan that represent

issues of special concern to SMHAs.

Plans should reflect the

fact that mental health

providers typically are not

first responders to HazMat

incidents. When they are

deployed to the site and

are present at the site,

their safety should be a

prime concern to planners

and administrators.
31

As States develop their plans, they

may want to personalize the list.

■ The description of the SMHA’s

presence and role in the State

emergency management structure.

As has been noted, this

relationship is central to effective

planning and plan implementation.

In many States in which this

positive relationship exists, it is

based upon personal relationships.

Committing these relationships to

writing can help ensure that the

relationship is sustained as key

people change.

■ Documentation of regional or

multi-State planning and coordination. The SMHA should not and

cannot plan alone. If a plan is to

be effective and support the

sharing and flexibility of human

and other resources, it must

involve other jurisdictions.

■ Descriptions of licensing issues

in disasters. A variety of licensingrelated issues for mental health

professionals come into play in

emergency and disaster situations.

SMHAs are advised to consult with

appropriate officials within the

State to explore issues including

licensing of out-of-State providers,

the appropriate scope of practice

guidance, and the clarity of the

types of disaster mental health

activities that require a license.

■ Documentation of plans to

prepare and support mental health

staff during and following

deployment under the plan. These

plans should include attention to

physical and psychological health,

special medical needs, and family

support. Unfortunately, the needs

of the providers frequently are

overlooked, or are secondary

considerations. Attention to these

issues in the planning process can

help assure that providers do not

become secondary victims in the

course of performing their

important work.

■ Documentation of public sector

links with private mental health

resources. When disasters occur,

the line between public and

private mental health concerns is

not as clear as in “normal” times.

SMHAs will be well-served by preevent planning and collaboration

that explore roles, skills, and

availability of mental health

resources as well as contract

planning.

■ Documentation of appropriate

links with businesses,

corporations, and other private

sector interests engaged in

planning for behavioral health

response and consequences.

Business and corporate

emergency planning has

expanded dramatically in recent

years. Some are incorporating

behavioral health issues into their

plans, though many are not. The

SMHA may improve outreach

capability and enhance

community support by reaching

out to these organizations during

the planning process.

■ Documentation of appropriate

planning links with institutions of

higher learning. Academic

departments may be able to

provide specialized expertise

helpful in planning and/or actual

resources when disasters occur.

In addition, their student health

services could benefit from

information, consultation, or

training related to disaster mental

health.

■ Assurance that SMHA facilities

meet the standards of the Joint

Commission on Accreditation of

Healthcare Organizations (JCAHO)

or other appropriate standards for

disaster and emergency

preparedness. Like other organizations, health care facilities have

increased their attention significantly to prepare for emergencies.

SMHAs should ensure that

facilities under their responsibility

are prepared. The Joint

Commission on Accreditation of

Healthcare Organizations

(www.jcaho.org) has disaster and

emergency guidance that may be

helpful. 

■ SMHA involvement in disaster

training and exercises. Short of

real disasters, disaster exercises

are among the best ways to test

plans. SEMAs routinely conduct

exercises involving differing event

scenarios. SMHAs are advised to

make certain that not only the

SMHA is involved in these

exercises, but also that content

related to psychosocial

consequences are built into

exercise scripts. With proper

involvement, the exercises will

become more realistic and the

SMHA will have the opportunity to

learn more from the experience.

Following drills, after-action

reviews should be conducted to

identify “lessons learned” for

incorporation into planning and

exercise development.

■ Description of roles in coordination of research. While not

often a common role, the SMHA

may play a very helpful and

valuable role in helping to

coordinate research following an

event. The balance between

services and research is often a
32

delicate one, especially when

balancing the need for increased

disaster mental health research

and the need to ensure that

government entities charged with

service provision protect the

importance of that mission. The

SMHA can play a central role in

helping to maintain that balance.

■ Plans for data collection and

evaluation of programs. The same

delicate balances described above

apply in the area of data

collection and the evaluation of

services. Potential problems can

be avoided to the extent that data

collection and evaluations can be

described and agreed upon prior

to an incident. SAMHSA currently

has seven FEMA/CMHS program

guidance documents “developed

to ensure consistency in

addressing key program issues” in

crisis counseling training,

including Recommended

Approaches to Evaluation of Crisis

Counseling Grant Projects. The

documents are listed on the Web

at www.samhsa.gov.

STANDARD OPERATING

PROCEDURES AND

CHECKLISTS

The response phase will certainly

be more efficient, and likely more

effective, if procedures can be

standardized and shared prior to

an event and used consistently

during an event. Developing these

procedures during an event is

time consuming and distracting to

the primary mission.

In the planning phase, SMHAs

should consider the types of

procedures and checklists (e.g.,

emergency contact numbers) that

could be helpful, and develop

them during the planning process.

The Texas Department of Mental

Health and Mental Retardation has

created a detailed procedural guide

for community mental health

centers to use in “pre-disaster

preparation and initial response.”

The guide is available online at

www.mhmr.state.tx.us.

GLOSSARY OF 

TERMS

Plans have large and diverse

audiences. Also, a major purpose

of a plan is to communicate

clearly. For these reasons, States

have found it helpful to include a

glossary of State-specific,

emergency management, mental

health, and public health terms as

a part of their plan. A sample

glossary of acronyms and

definitions is included in 

Appendix C.

The response phase will

certainly be more efficient,

and likely more effective, if

procedures can be

standardized and shared

prior to an event and used

consistently during an

event. Developing these

procedures during an event

is time consuming and

distracting to the primary

mission.

34

4

P ART

FOUR

Resources

ORGANIZATIONS

Sources for information

and assistance in 

planning are listed

below. The list does not

necessarily represent all

sources of information

nor is inclusion on the

list intended to imply an

endorsement by HHS or

SAMHSA.

FEDERAL

Centers for Disease Control and

Prevention

www.cdc.gov

888-246-2675

Federal Emergency Management

Agency 

www.fema.gov

800-621-FEMA

U.S. Department of Health and

Human Services

Substance Abuse and Mental

Health Services Administration 

Center for Mental Health Services 

www.samhsa.gov

800-789-2647

U.S. Department of Defense

www.defenselink.mil

U.S. Department of Education

www.ed.gov/index.jsp

1-800-USA-LEARN

U.S. Department of Justice

Office for Victims of Crime

www.ojp.usdoj.gov/ovc

800-627-6872

U.S. Department of Veterans Affairs

www.va.gov

U.S. Department of Health and

Human Services 

Office of Emergency Preparedness

National Disaster Medical System

800-USA-NDMS

www.ndms.dhhs.gov

PRIVATE 

American Psychiatric Association

www.psych.org

703-907-7300

American Psychological

Association

www.apa.org

800-374-2721
35

American Red Cross

www.redcross.org 

202-639-3520

Jane’s Information Group

www.janes.com

800-824-0768

Joint Commission on

Accreditation of Healthcare

Organizations

www.jcaho.org

630-792-5000

National Association of Social

Workers

www.socialworkers.org

202-408-8600

National Center for PostTraumatic Stress Disorder

www.ncptsd.org 

802-296-6300

The National Child Traumatic

Stress Network

www.nctsnet.org

National Emergency Management

Association

www.nemaweb.org/index.cfm

859-244-8000 

National Voluntary Organizations

Active in Disasters

www.nvoad.org

301-890-2119

SAMHSA Disaster Technical

Assistance Center (DTAC)

800-308-3515

(Under contract with CMHS/

ESDRB)

PUBLICATIONS

The following 

publications also may

contribute to a 

comprehensive planning

effort. Again, the list is

not exhaustive; inclusion

does not imply endorsement by HHS or SAMHSA.

Bailey, B. E., Hallinan, M. M.,

Contreras, R. J., and Hernandez,

A. G. (1985). Disaster response:

The need for community

mental health center (CMHC)

preparedness. Journal of Mental

Health Administration, 

12(1):42-6.

Barton, G. M. (1985). Disaster

preparedness from an

emergency psychiatric

perspective. Emergency Health

Services Review, 3(2-3):313-23.

Beaton, R., and Murphy, S. (2002,

April). Psychosocial responses

to biological and chemical

terrorist threats and events:

Implications for the workplace.

American Association of

Occupational Health Nurses

Journal, 50(4):182-9. Review.

Benedek, D. M., Holloway, H. C.,

and Becker, S. M. (2002, May).

Emergency mental health

management in bioterrorism

events. Emergency Medical

Clinics of North America,

20(2):393-407. Review.

Bowencamp, C. (2000, Fall).

Coordination of mental health

and community agencies in

disaster response. International

Journal of Emergency Mental

Health, 2(3):159-65.

Call, J. A., and Pfefferbaum, B.

(1999, July). Lessons from the

first two years of Project

Heartland: Oklahoma’s mental

health response to the 1995

bombing. Psychiatric Services,

50(7):953-5.

Cozza, S. J., Huleatt, W. J., and

James, L. C. (2002, September).

Walter Reed Army Medical

Center’s mental health

response to the Pentagon

attack. Military Medicine, 

167(9 Suppl):12-6.

Dailey, W. F. (2001, December).

Planning for the unthinkable.

Behavioral Healthcare

Tomorrow, 10(6):SR23-7.

Dodgen, D., LaDue, L. R., and

Kaul, R. E. (2002, September).

Coordinating a local response

to a national tragedy:

Community mental health in

Washington, DC after the

Pentagon attack. Military

Medicine, 167(9 Suppl):87-9.

Everly, G. S. (1999, Summer).

Toward a model of psychological triage: Who will most

need assistance? International

Journal of Emergency Mental

Health, 1(3):151-4.

Federal Emergency Management

Agency. Are You Ready? A Guide

To Citizen Preparedness. FEMA

publication H-34.

Flynn, B. W. (1995). Thoughts and

reflections following the

bombing of the Alfred P. Murrah

Federal Building in Oklahoma

City. Journal of the American

Association of Psychiatric

Nursing, 1(5), 166-170.
36

PUBLICATIONS, CONT.

Flynn, B. W., and Nelson, M. E.

(1998, January). Understanding

the needs of children following

large-scale disasters and the

role of government. Child and

Adolescent Psychiatric Clinics of

North America, 7(1):211-27.

Review.

Fraser, J. R., and Spicka, D. A.

(1981, Winter). Handling the

emotional response to disaster:

The case for American Red

Cross/community mental

health collaboration.

Community Mental Health

Journal, 17(4):255-64.

Hoge, C. W., Orman, D. T.,

Robichaux, R. J., Crandell, E. O.,

Patterson, V. J., Engel, C. C.,

Ritchie, E. C., and Milliken, C. S.

(2002, September). Operation

solace: Overview of the mental

health intervention following

the September 11, 2001

Pentagon attack. Military

Medicine, 167(9 Suppl):44-7.

Hyams, K. C., Murphy, F. M., and

Wessely, S. (2002, April).

Responding to chemical,

biological, or nuclear terrorism:

The indirect and long-term

health effects may present the

greatest challenge. Journal of

Health Politics, Policy, and Law,

27(2):273-91.

Lebedun, M., and Wilson, K. E.

(1989). Planning and integrating

disaster response. In R. Gist,

and B. Lubin (Eds.), Psychosocial Aspects of Disaster, 

268-279. New York, NY: Wiley.

Lichterman, J. D. (2000, MarchJune). A “community as

resource” strategy for disaster

response. Public Health Reports,

115(2-3):262-5.

Lindy, J. D., and Lindy, J. G. (1981).

Planning and delivery of mental

health services in disaster: The

Cincinnati experience. Urban

and Social Change Review,

14(2):16-21.

Loyd, C., Creson, D. L., and

D’Antonio, M. S. (1993). A

petrochemical plant disaster:

Lessons for the future. Journal

of Social Behavior and

Personality, 8:281-298.

Malilay, J. (2000, OctoberDecember). Public health

assessments in disaster

settings: Recommendations for

a multidisciplinary approach.

Prehospital and Disaster

Medicine, 15(4):167-72.

Mangelsdorff, A. D.(1985, July).

Lessons learned and forgotten:

The need for prevention and

mental health interventions in

disaster preparedness. Journal

of Community Psychology,

13(3):239-57. Review.

McCarrol, J. E., Ursano, R. J.,

Wright, K. M., and Fullerton, 

C. S. (1990). Psychiatric and

psychological aspects of the

management of catastrophic

incidents. Journal of the 

U.S. Army Medical Department, 

1:36-41.

McFarlane, A. C. (1986,

December). Long-term

psychiatric morbidity after a

natural disaster: Implications

for disaster planners and

emergency services. Medical

Journal of Australia, 1-15;

145(11-12):561-3.

National Institute of Mental

Health. (2002). Mental Health

and Mass Violence: Evidencebased Early Psychological

Intervention for Victims/

Survivors of Mass Violence. A

Workshop To Reach Consensus

on Best Practices. National

Institute of Health (Publication

No. 02-5138). Washington, DC:

U.S. Government Printing

Office.

Parker, S. G. (2001, March).

Establishing victim services

within a law enforcement

agency: The Austin experience.

OVC Bulletin. Washington, DC:

U.S. Department of Justice,

Office of Justice Programs,

Office for Victims of Crime. 

Parkes, C. M. (1991). Planning for

the aftermath. Journal of the

Royal Society of Medicine, 

84:22-25.

Pynoos, R. S., Goenjian, A. K., and

Steinburg, A. M. (1998,

January). A public mental

health approach to the

postdisaster treatment of

children and adolescents. Child

and Adolescent Psychiatric

Clinics of North America,

7(1):195-210. Review.
37

Shechet, A. L., and Jordan, C. E.

(1993). The Kentucky Post

Trauma Response Team:

Development of a statewide

crisis response capability.

Journal of Social Behavior and

Personality, 8:267-280.

Silver, T., and Goldstein, H. (1992,

June). A collaborative model of

a county crisis intervention

team: The Lake County

experience. Community Mental

Health Journal, 28(3):249-56.

Summers, G. M., and Cowan, M.

L. (1991, January). Mental

health issues related to the

development of a national

disaster response system.

Military Medicine, 156(1):30-2.

Tucker, P., Pfefferbaum, B.,

Vincent, R., Boehler, S. D., and

Nixon, S. J. (1998, February).

Oklahoma City: Disaster

challenges mental health and

medical administrators. Journal

of Behavioral Health Services

Research, 25(1):93-9.

U.S. Public Health Service. (1999).

The Surgeon General's Call To

Action To Prevent Suicide.

Washington, DC: Department of

Health and Human Services.

Weisaeth, L., Knudsen, O., and

Tonnessen, A. (2002, July 1).

Technological disasters, crisis

management and leadership

stress. Journal of Hazardous

Material, 93(1):33-45.

Winget, C. N., and Umbenhauer,

S. L. (1982, Winter). Disaster

planning: The mental health

worker as “victim–by–proxy.”

Journal of Health and Human

Resources Administration,

4(3):363-73.

REFERENCES

Center for Mental Health Services.

(Revised June, 2000). Needs

Assessment Formula (internal

document). Rockville, MD: 

U.S. Department of Health and

Human Services, Substance

Abuse and Mental Health

Services Administration, Center

for Mental Health Services.

DeWolfe, D. J. (unpublished

manuscript). Population

Exposure Model and text

excerpted from Mental Health

Interventions Following Major

Disasters: A Guide for

Administrators, Policy Makers,

Planners and Providers.

Rockville, MD: Substance

Abuse and Mental Health

Services Administration.

Federal Emergency Management

Agency. (1996). Guide for Allhazard Emergency Operations

Planning, State and Local Guide

(SLG) 101. Washington, DC:

FEMA. (Editor’s note: This guide,

including Chapter 6, Attachment

G, is available for download from

www.fema.gov) 

Texas Department of Mental

Health and Mental Retardation.

(2002, March). Interim Disaster

Plan. Austin, TX: Texas

Department of Mental Health

and Mental Retardation

Texas Department of Mental

Health and Mental Retardation.

(2003). Common Acronyms and

Definitions. Retrieved 

February 5, 2003, from

www.mhmr.state.tx.us 

U.S. Department of Health and

Human Services. (1996).

Responding to the Needs of

People with Serious and

Persistent Mental Illness in Times

of Disaster. Rockville, MD: 

U.S. Department of Health and

Human Services, Public Health

Service, Substance Abuse and

Mental Health Services

Administration, Center for

Mental Health Services.

U.S. Department of Health and

Human Services. (1999). Mental

Health: A Report of the Surgeon

General. Rockville, MD: 

U.S. Department of Health and

Human Services, Substance

Abuse and Mental Health

Services Administration, Center

for Mental Health Services,

National Institutes of Health,

National Institute of Mental

Health. 

U.S. Department of Health and

Human Services. (2002).

Communicating in a Crisis: Risk

Communication Guidelines for

Public Officials. Rockville, MD:

U.S. Department of Health and

Human Services, Public Health

Service.
38
APPENDIX A:

ELEMENTS OF AN ALL-HAZARDS STATE

DISASTER MENTAL HEALTH PLAN

APPENDIX B:

LISTING OF FOCUS GROUP MEMBERS 

APPENDIX C:

COMMON ACRONYMS AND DEFINITIONS

Appendices 
A-1

APPENDIX A:

ELEMENTS OF AN ALL-HAZARDS STATE DISASTER 

MENTAL HEALTH PLAN

1. Introductory Material Present Absent N/A

A. Signature page

B. Dated title page

C. Record of changes

D. Record of distribution

E. Table of contents

2. Executive Summary Present Absent N/A

Summary describing basic plan

3. Purpose Present Absent N/A

General statement of plan’s purpose

4. Situation and Assumptions-General Present Absent N/A

A. Assumptions (limits of mental health authority, highest probability 

scenarios, etc.) 

B. Situation (probable impact, vulnerable/special facilities and populations, 

include low probability/high impact events, etc.)

C. Include matrix of events if desired

5. Concept of Operations—General (sequence and scope of response) Present Absent N/A 

A. Overview of approach (what should happen, when, who directs?)

B. Division of responsibility (State, Local, Federal, etc.)

C. General sequence of actions before, during, after event

D. Who is authorized to request aid, and in which situations?
A-2

6. Authorities and References Present Absent N/A

Citation of legal authorities and reference documents as appropriate

7. Organization and Assignment of Responsibilities Present Absent N/A

A. Listing, by position and organization, of the types of tasks to be 

performed (matrix of primary/secondary/shared responsibilities?)

B. Documents tasks of SMHA in FEMA format: definition of objective, 

characterization of the situation, general plan of action, delegation of 

responsibilities, information on resources and administrative support 

necessary to accomplish tasks. Includes description of treatment 

responsibilities (internal/external)

C. Describes State tasks outside SMHA authority

D. Tasks related to other governmental levels and organizations 

(e.g., counties, cities, Red Cross, faith organizations, FEMA, 

SAMHSA/CMHS, Department of Justice, etc.)

E. Describes coordination with other components of State and 

local government health department, substance abuse agency, criminal 

justice, law enforcement, fire and rescue, agriculture (including extension 

service and veterinary services), parks and recreation, animal care and 

control, victims services, social services, education

F. Ensures connectivity to State emergency plan and federal 

response plan

8. Administration, Logistics, Legal Present Absent N/A

A. Administration—Recording and reporting program activities

B. Administration—Recording and reporting expenditures and obligations

C. Administration—Recording and reporting human resources utilization

D. Administration—Expectations of situation reports (format and frequency)

E. Administration—Recording and reporting of services provided by 

volunteer agencies

F. Administration—Management of volunteer offers/services

G. Logistics—Arrangements for support needs (food, water, fuel, etc.)

H. Logistics—Provision for self-support for at least 72 hours
A-3

8. Administration, Logistics, Legal (cont.) Present Absent N/A

I. Logistics—Replacement/repair of damaged/destroyed essential 

equipment

J. Logistics—Access of personnel to impacted area (criteria method, 

transportation)

K. Logistics—Availability, transport, administration, safeguarding, 

recording medications

L. Logistics—Existence and scope of mutual aid agreements 

M. Legal—Issues including licensing, informed consent, confidentiality, 

providers licensed in other jurisdictions, personal, professional, and 

organization liability, patient records management, waiver of contracting 

or other procurement rules during emergencies

9. Plan Development and Maintenance Present Absent N/A

Describes who is responsible for modifications and updating, ensuring 

coordination with other State emergency planning elements

10. Communications Present Absent N/A

A. Situation assumptions (types of situations likely to occur—should relate

to earlier assumptions, types of communications necessary such as 

telephone, data, etc.)

B. Methods of communication among SMHA, local mental health agencies, 

State psychiatric hospitals, other psychiatric facilities, community-based 

treatment facilities, State emergency management, regional or field offices, 

emergency medical services, hospitals and clinics, shelter facilities. 

Ensure SMHA is on notification list from Governor’s Office

C. Alternatives in the event of failed communication capacity

D. Availability of technical expertise

11. Public Information Present Absent N/A 

A. Communications strategy 

B. Identification of responsibility

C. Policies for public information (designation and authority of media 

liaison[s])
A-4

11. Public Information (cont.) Present Absent N/A 

D. Existence of public information material (fact sheets, guides, multiple 

languages, access to services, distribution of materials, etc.)

E. Relationship with State emergency office public information officer

F. Identified means of disseminating information

G. Identification of experts/resources outside SMHA

H. Pre-event relationships with media

12. Warning: Mobilization Related to Internal Mental Health Systems Present Absent N/A

A. Internal—Links with State emergency warning activities

B. Internal—Describes methods and procedures for notifying staff, facilities, 

service providers, others as appropriate (link to agency risk management 

as appropriate) 

C. Internal—Establishes policies and procedures (e.g., sending staff home, 

holding staff in place, recall of essential staff, facilities evacuation, etc.) for 

SMHA offices and facilities 

D. External—Identifies groups with special warning needs (e.g., persons 

who are deaf and have mental illness)

E. External—Notify mental health system (counties, providers, etc.)

F. External—Notification of private sector mental health resources

13. Evacuation Present Absent N/A

A. Plan for evacuation of SMHA offices and facilities

B. Plan for alternate sites ("hot,” "warm,” and "cold" sites as appropriate)

C. Clear linkage with State emergency management evacuation plans and 

operations

D. Plan for services at shelters/mass care facilities

14. Mass Care Present Absent N/A

A. Documentation of coordination with State emergency management 

mass care plan

B. Links with Red Cross special populations facilities and other National 

Voluntary Organizations Active in Disasters
A-5

15. Health and Medical Present Absent N/A

A. Documentation of coordination with State emergency management 

health and medical plan staffing, logistics, costs, availability of 

pharmaceuticals

B. Provision of mental health services/consultation as part of State's 

emergency medical plan (Emergency Support Function #8, VA 

resources, etc.)

C. Roles identified in areas of services/consultation to primary victims, 

secondary victims, response and recovery workers, incident command, 

public information, body identification and recovery, mortuary services, 

other State agencies and departments (e.g., health epidemiology, 

education, social services, etc.)

D. Documentation of coordination with Red Cross mental health services

E. Documentation of coordination with Red Cross health services

16. Resource Management Present Absent N/A

A. Purpose — Documents means, organization, and process by which 

SMHA will find, obtain, allocate, and distribute necessary resources

B. Personnel

C. Transportation for staff

D. Communications equipment

E. Emergency equipment as necessary

F. Mass care supplies for SMHA resources

G. Intrastate mutual aid

H. Management of offers of assistance and invited/uninvited volunteers

I. Availability of aid from other States and Federal government

J. Plan for maintaining financial and legal accountability

K. Resources for initial and ongoing needs assessment

17. All-Hazards Specific Planning Materials (Natural and Accidental) Present Absent N/A

A. Plan allows for accommodation of unique aspects of hazards

B. Identifies nature of hazard
A-6

17. All-Hazards Specific Planning Materials (cont.) Present Absent N/A

C. Identifies areas of high risk

D. Flooding (flash and slow rising) and dam failure 

E. Hazardous materials (including chemicals)

F. Hurricane/Tsunami

G. Fire

H. Earthquake

I. Military chemical agents and munitions

J. Radiological hazards (medical usage, educational institutions, military, 

manufacturing companies, transport of nuclear material)

K. Nuclear power plant(s)

L. Nuclear conflict (war) 

M. Snow/ice

N. Tornado

O. Civil unrest/community violence

P. Agricultural disasters/emergencies

Q. Immigration emergencies

R. Tidal wave

S. Other(s) (specify)

18. Terrorism Present Absent N/A 

A. Describes nature of potential hazards (chemical, biological, 

nuclear/radiological, explosive, cyber, combined)

B. Potential targets are identified and/or reflective of State emergency plan

C. Describes incident management for SMHA

D. Describes and/or reflects State emergency plan's situational 

assumptions (environment, populations, urbanicity, infrastructure, 

transport patterns, airports, trains/subways, government facilities, 

recreation facilities, military installations, HazMat facilities, other high risk 

targets such as financial institutions, universities, hospitals, research 

institutes, schools, daycare centers)
A-7

18. Terrorism (cont.) Present Absent N/A 

E. Reflects coordination with State emergency plan's modeling of 

potential release areas

F. Incident management reflects roles of other State and Federal roles 

and resources

G. Consequence management reflects involvement of various federal 

components

H. SMHA plan reflects knowledge of and integration with State emergency 

plan with respect to warning, communication, emergency public 

information, protective actions, mass care, health and medical annex, 

resource management

I. Describes links to health and medical entities for purposes of assisting 

in screening potential victims for mental disorders and psychogenic 

symptomatology, functional impairment, substance abuse, etc.

J. Describes links with State public health structure for surveillance, 

screening, consultation, intervention planning, risk communication

K. Describes SMHA role in risk communication planning and response

L. Describes SMHA participation in exercises and drills

19. Continuity of Operations- SMHA Present Absent N/A

A. Contains overview of goals of Continuity of Operations Plan (e.g., to 

maintain/reestablish vital functions of SMHA during the first 72 hours 

following an event that would seriously compromise or halt normal 

operations)

B. Documents coordination with overall State Continuity of Operations Plan

C. Identifies vital functions to be maintained within first 72 hours

D. Identifies vital records/data necessary to function within first 72 hours

E. Describes plans related to human resources (e.g., essential staff, staff 

notification, family support)

F. Describes alternate locations of essential operations

G. Describes transportation and staff support

H. Describes alternate vital record/document sites (e.g., assurance of 

access to disaster plan, staff rosters, patient vital medical records if 

existing sites are destroyed or inaccessible)
A-8

20. Other Special Planning Concerns Present Absent N/A

A. Description of SMHA’s presence and role in State emergency 

management structure

B. Documentation of regional or multi-State planning and coordination

C. Describes various issues around licensing within State, out-of-State 

providers, scope of practice, etc.

D. Documentation of plans to prepare and support SMHA staff during and 

following deployment under plan (physical, health, special medical needs, 

family support, psychological)

E. Documentation of plans to prepare and support emergency service 

responders (e.g., police, fire, hospital emergency department staff, 

mortuary workers) during and following deployment

F. Documentation of public sector links with private mental health 

resources

G. Documentation of coordination with business and corporations and 

other private sector interests in planning for behavioral health response 

and consequences

H. Documentation of appropriate planning links with institutions of higher 

learning (academic departments, student health services, etc.)

I. Provides assurance that all SMHA facilities meet JCAHO or other 

appropriate standards for disaster and emergency preparedness

J. Describes SMHA role in crisis and emergency risk communication

K. Ensures SMHA’s role in disaster training and exercises

L. Describes SMHA’s role in coordination of research

M. Describes SMHA’s role in data collection/evaluation/and gatekeeping 

to balance information needs with victims' needs

21. Standard Operating Procedures and Checklists Present Absent N/A

A. Contains applicable standard operating procedures

B. Contains applicable checklists (e.g., emergency contact numbers, 

lists of facilities, etc.)
A-9

22. Glossary of Terms Present Absent N/A

A. State specific terms

B. Emergency management terms

C. Public health terms

D. Mental health terms
B-1

APPENDIX B:

LISTING OF FOCUS GROUP MEMBERS

N A TIONAL A SSOCIATION OF

S TATE M ENTAL H EALTH P ROGRAM D IRECTORS

A L L - H AZARDS S TATE D ISASTER M ENTAL H EALTH P LANNING

E XPERTS F OCUS G ROUP M EETING

J une 3-4, 2002 • Alexandria, VA

SPONSORED BY:

Center for Mental Health Services,

Substance Abuse and Mental Health Services Administration 

National Association of State Mental Health Program Directors

P ARTICIPANTS

Bruce D. Emery, M.S.W. (facilitator)

Strategic Partnership Solutions, Inc.

709 Devonshire Road

Takoma Park, MD 20912

301-270-0530

Fax: 301-270-0531 

E-mail: emerybd@msn.com

Brian Flynn, Ed.D. (consultant)

P. O. Box 1205

Millersville, MD 21146

410-987-4682

Fax: 410-987-1687

E-mail: brianwflynn@aol.com

Lenore Behar, Ph.D.

Associate Director

National Center for Child Traumatic

Stress

Duke University Medical Center

Box 3454

905 West Main St., Suite 23-E

Durham, NC 27701

919-687-4686, ext. 231

Fax: 919-687-4737

E-mail: lenore.behar@duke.edu

Susan E. Hamilton

Disaster Mental Health Associate

American Red Cross

8111 Gatehouse Road

Falls Church, VA 22042

703-206-8621

E-mail: hamiltons@usa.redcross.org

Jennifer Heffron

Senior Director of Research

Services

National Mental Health Association

1021 Prince Street

Alexandria, VA 22314-2971

703-838-7536

Fax: 703-797-4307

E-mail: jheffron@nmha.org

Joseph W. Hill

State Risk Administrator

Department of Mental Health

30 East Broad Street, 8th floor

Columbus, OH 43215

614-644-6996

Fax: 614-466-6349

E-mail: hillj@mhmail.mh.state.oh.us

Keith J. Lang, M.S.W.

Interim Director

Bureau of Substance Abuse

Services

One West Wilson Street

P. O. Box 7851

Madison, WI 53707-7851

608-266-0040

Fax: 608-266-1533

E-mail: langkj@dhfs.state.wi.us

Diana Nordboe

State Program Manager

Community Residence Project

819 Fulton Avenue

Falls Church, VA 22046

703-538-6334

Fax: 703-538-6334

E-mail:dngd@starpower.net

Alan Q. Radke, M.D., M.P.D.

Medical Director

Department of Human Services

444 Lafayette Road North

St. Paul, MN 55155-3826

651-582-1881

Fax: 651-582-1804

E-mail: alan.q.radke@state.mn.us
B-2

Dori B. Reissman, M.D., M.P.H.

c/o Ragesh Mehta

CDC/NCID/BPRP

1600 Clifton Road

Royball Campus, Bldg. 1

Room 2068

Atlanta, GA 30333

404-639-3623

Fax: 404-639-0382

E-mail: dreissman@cdc.gov

C. Edgar Spencer

Director, Disaster Response

Department of Mental Health

P. O. Box 485

Columbia, SC 29202

803-898-8579

Fax: 803-898-8347

E-mail: ces64@co.dmh.state.sc.us

Shauna Spencer

Department of Mental Health

77 P Street N.E., 4th Floor

Washington, DC 20002

202-673-2200

Fax: 202-673-3433

Bradley Stein, M.D. 

Senior Natural Scientist

RAND

1700 Main Street

P. O. Box 2138

Santa Monica, CA 90407-2138

310-393-0411, ext. 6434

Fax: 310-451-7025

E-mail: stein@rand.org

Daniel Thompson

Director, Disaster Services

Department of Mental Health and

Mental Retardation

P. O. Box 12668

Austin, TX 78711-2668

512-206-4833

Fax: 512-206-4744

E-mail:

daniel.thompson@mhmr.state.tx.us

Marleen Wong, M.S.W.

Director, Crisis Intervention Center,

Los Angeles Unified School District

Director, School Crisis Disaster

Recovery,

National Center for Child Traumatic

Stress

6165 Balboa Boulevard

Van Nuys, CA 91406

818-997-2640

Fax: 818-609-7915

E-mail: mwonglausd@aol.com

Bruce H. Young

Disaster Services Coordinator

National Center for PTSD

795 Willow Road (352 e 117)

Menlo Park, CA 94025

650-493-5000

Fax: 650-617-2694

E-mail: dmhi@bruceyoung.net

Substance Abuse and

Mental Health Services

Administration/Center for

Mental Health Services

Charles Cook, L.S.W.

Senior Program Manager

Emergency Services and Disaster

Relief Branch

Center for Mental Health Services

5600 Fishers Lane, Room 17C-20

Rockville, MD 20857

301-443-4736

Fax: 301-443-8040

E-mail: ccook@samhsa.gov

Robert DeMartino, M.D.

Associate Director for Program in

Trauma and Terrorism

Center for Mental Health Services

U.S. Public Health Service

5600 Fishers Lane, Room 17C-26

Rockville, MD 20857

301-443-2940

Fax: 301-443-5479

E-mail: rdemarti@samhsa.gov

Seth Hassett, M.S.W.

Chief

Emergency Services and Disaster

Relief Branch

Center for Mental Health Services

5600 Fishers Lane, Room 17C-20

Rockville, MD 20857

301-443-4736

Fax: 301-443-8040

E-mail: shassett@samhsa.gov

Gail P. Hutchings, M.P.A.

Acting Director, Center for Mental

Health Services

Substance Abuse and Mental

Health Services Administration

5600 Fishers Lane, Room 12-105

Rockville, Maryland 20857

301-443-4795

Fax: 301-443-0284

E-mail: ghutchin@samhsa.gov

Linda Ligenza, L.C.S.W.

Emergency Services and Disaster

Relief Branch

Center for Mental Health Services

5600 Fishers Lane, Room 17C-20

Rockville, MD 20857

301-443-0168

Fax: 301-443-8040

E-mail: lligenza@samhsa.gov

Allie Wittig-Sakai, M.S.W.

Emergency Services and Disaster

Relief Branch

Center for Mental Health Services

5600 Fishers Lane, Room 17C-20

Rockville, MD 20857

301-443-4735

Fax: 301-443-8040

E-mail: awittig@samhsa.gov
B-3

National Association of

State Mental Health

Program Directors

Robert W. Glover, Ph.D.

Executive Director

NASMHPD

66 Canal Center Plaza, Suite 302

Alexandria, VA 22314

703-739-9333, ext. 129

Fax: 703-548-9517

E-mail: bob.glover@nasmhpd.org

Kevin Ann Huckshorn, R.N., M.S.N.,

I.C.A.D.C.

Director, Office of Technical

Assistance

NASMHPD

66 Canal Center Plaza, Suite 302

Alexandria, VA 22314

703-739-9333, ext. 140

Fax: 703-548-9517

E-mail:

kevin.huckshorn@nasmhpd.org

Catherine Q. Huynh, M.S.W.

Assistant Director, Office of

Technical Assistance

NASMHPD

66 Canal Center Plaza, Suite 302

Alexandria, VA 22314

703-739-9333, ext. 133

Fax: 703-548-9517

E-mail:

catherine.huynh@nasmhpd.org

Andrew D. Hyman, J.D.

Director of Government Relations

and Legislative Counsel

NASMHPD

66 Canal Center Plaza, Suite 302

Alexandria, VA 22314

703-739-9333, ext. 128

Fax: 703-548-9517

E-mail: andy.hyman@nasmhpd.org
C-1

APPENDIX C:

COMMON ACRONYMS AND DEFINITIONS (TDMHMR, 2003)

C OMMON A CRONYMS

T exas Department of Mental Health and Mental Retardation

Disaster Assistance and Crisis Response Services Program

D isaster and Terror ism Menta l Hea lth Response and Recovery P lan

A

ABA—American Bar Association

ACE—Automated Construction

Estimating

AD—Associate Director

ADAMS—Automated Disaster

Assistance Management

System

ALE—Additional Living Expense

ARC—American Red Cross

ASCS—Agricultural Stabilization

and Conservation Service

B

BFC—Bill for Collection

C

CBFP—Cora Brown Fund Program

CBRA—Coastal Barrier 

Resources Act

CBRS—Coastal Barrier Resources

System

CCP—Crisis Counseling Program

CFR—Code of Federal Regulations

CISD—Critical Incident Stress

Debriefing

CMHOvCommunity Mental Health

Organization

CMHS—Center for Mental Health

Services

CPI—Consumer Price Index

D

DAC—Disaster Application Center

DAE—Disaster Assistance

Employee

DARIS—Disaster Automated

Reporting and Information

System

DD—Damaged Dwelling

DFC—Disaster Finance Center

DFO—Disaster Field Office

DH—Disaster Housing

DHAP—Disaster Housing

Assistance Program

DLS—Disaster Legal Services

DLSP—Disaster Legal Services

Program

DOB—Duplication of Benefits

DOL- Department of Labor

DRC—Disaster Recovery Center

DRM—Disaster Recovery

Manager

DUA—Disaster Unemployment

Assistance

DV—Disaster Victim

E

EA—Environmental Assessment

EMI—Emergency Management

Institute

EOC—Emergency Operations

Center

EOP—Emergency Operating

Procedure

ERT—Emergency Response Team

ESDRB—Emergency Services and

Disaster Relief Branch

ESF—Emergency Support

Function

EST—Emergency Support Team

F

FCO—Federal Coordinating Officer

FEMA—Federal Emergency

Management Agency

FHBM—Flood Hazard Boundary

Map

FIRM—Flood Insurance Rate Map

FMHA—Farmers Home

Administration

FRP—Federal Response Plan

FSR—Final Statistical Report

FY—Fiscal Year
C-2

G

GAR—Governor's Authorized

Representative

GCO—Grant Coordinating Officer

H

HHS—Health and Human Services

HR—Home Repairs

HS—Human Services

HSO—Human Services Officer

I

IA—Individual Assistance

IFG—Individual and Family Grant

Program

IFMIS—Integrated Financial

Management Information

System

IMS—Information Management

Systems

IS—Infrastructure Support

ISP—Immediate Services Program

K

KEN—Knowledge Exchange

Network

L

LAN—Local Area Network

M

MRAP—Mortgage and Rental

Assistance Program

N

NASMHPD—National Association

of State Mental Health Program

Directors

NEMIS—National Emergency

Management Information

System

NEPA—National Environmental

Policy Act

NFIP—National Flood Insurance

Program

NGO—Non-Governmental

Organization

NFIRA—National Flood Insurance

Reform Act of 1994

NOGA—Notice of Grant Award

NPSC—National Processing Service

Center

NTC—National Teleregistration

Center

NVOAD—National Voluntary

Organizations Active in

Disasters

O

OFA—Other Federal Agencies

OFM—Office of Financial

Management

OGC—Office of General Counsel

OMB—Office of Management and

Budget

OSD—Operations Support Division

OVC—Office for Victims of Crimes

P

PA—Public Assistance

PDA—Preliminary Damage

Assessment

PFT—Permanent Full Time

Employee

PIO—Public Information Officer

PO—Project Officer

PP—Personal Property

Q

QC—Quality Control

R

RAA—Request for Allocation

Advice

RD—Regional Director

ROC—Regional Operations Center

RP—Real Property

RSP—Regular Services Program

S

SAMHSA—Substance Abuse

Mental Health Services

Administration

SAP—State Administration Plan

SBA—Small Business

Administration

SCO- State Coordinating Officer

SFHA—Special Flood Hazard Area

SMHA—State Mental Health

Authority

SMP—Stress Management

Program

SOP—Standard Operating

Procedure

SSA—Social Security

Administration

SSI—Supplemental Security

Income

U

UNC—Unmet Needs Committee

USDA—United States Department

of Agriculture

V

VA—Veterans Administration

VOAD—Voluntary Organizations

Active in Disasters

VOLAG—Voluntary Agency

W

WYO- "Write-Your-Own" Program

Y

YLD- Young Lawyers Division
C-3

DEFINITIONS

T exas Department of Mental Health and Mental Retardation

Disaster Assistance and Crisis Response Services Program

D isaster and Terror ism Menta l Hea lth Response and Recovery P lan

A

Assistant State Coordinator—DEM

employee.

C

Center for Mental Health Services

(CMHS)—Part of Substance

Abuse and Mental Health

Services Administration within

the U.S. Department of Health

and Human Services.

Crisis Counseling Program (CCP)—

Federally funded counseling

program.

D

Department of Public Safety-State

Police Department.

Disaster Assistance Program—

TDMHMR program designed to

prepare for, plan and respond

to the mental health needs of

victims and responders of local,

State and Federally declared

disasters or emergencies.

Disaster District Chairman—DPS

Trooper (normally Lieutenant or

above) responsible for incident

command in one of six disaster

districts (regional level).

Coordinates response between

State Operations Center and

local emergency management. 

Disaster Field Office—State or

federal disaster operations

headquarters.

Division of Emergency

Management—a.k.a. Governor's

Division of Emergency

Management and/or the Texas

Division of Emergency

Management.

E

Emergency Management

Coordinator—Local (city and/or

county) individual tasked with

ensuring coordination and

integration of local resources

during a disaster.

F

Federal Coordinating Officer

(FCO)—FEMA employee who is in

charge of the disaster field office

and the disaster or event.

I

Immediate Services Program (ISP)—

A 60-day crisis counseling

program funded by FEMA.

P

Post Traumatic Stress Disorder

(PTSD)—A disorder caused by

experiencing traumatic events

that result in prolonged anxiety

and emotional distress.

R

Rapid Assessment Unit (RAU)—A

unit of the DEM that performs

initial damage assessments

following a disaster or

emergency.

Regional Liaison Officer (RLO)—A

DEM employee responsible for

regions in Texas known as

disaster districts.

Regular Services Program (RSP)—A

nine-month crisis counseling

program that is federally funded

through CMHS.

Risk Management—TDMHMR

program to protect employees, the

general public, and the agency’s

physical and financial assets by

reducing and controlling risk in

the most efficient and costeffective manner.

S

State Crisis Consortium—A 

collaborative effort of several State

agencies to plan for and respond

to disasters and emergencies in

the State of Texas.

State Coordinator—DEM employee

who is the federal counterpart at

the disaster field office and in

charge of the State's response.

State Emergency Management

Council—comprised of 33 State

agencies that train for, prepare for,

and respond to disaster or

emergencies for the State.

State Emergency Response Team

(SERT)—Team comprised of State

agency representatives that are

responsible for rapid deployment

and immediate response to

disasters and emergencies for the

State.

Substance Abuse and Mental Health

Services Administration—Agency

of the US Department of Health

and Human Services responsible

for the Emergency Services and

Disaster Relief Branch.

56

U.S. Department of Health and Human Services

Substance Abuse and Mental Health Services Administration

Center for Mental Health Services

5600 Fishers Lane

Rockville, MD 20857

DHHS Publication No. SMA 3829

Printed 2003