A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center 

The Dialogue 

2021 | VOLUME 16 | ISSUE 2 

First Responder Training 
 

 

 

 

 

 

 

IN THIS ISSUE 

3 In This Issue 

4 Contributors 

6 Technical Assistance Snapshot 

7 SAMHSA’s Online Training Courses for First Responders 

10 P-FLASH©: An Empirically Based Disaster Mental Health Training Program 

13 Training with First Responders—Lessons Learned from the U.S. Virgin Islands 

15 Improving First Responder Organizational and Personal Resilience and a Guide 

to Self-care 

20 Recent Technical Assistance Requests 

The Dialogue is a quarterly technical assistance journal on disaster behavioral health which 

is produced by the Substance Abuse and Mental Health Services Administration (SAMHSA) 

Disaster Technical Assistance Center (DTAC). Through the pages of The Dialogue, disaster 

behavioral health professionals share information and resources while examining the 

disaster behavioral health preparedness and response issues that are important to the field. 

The Dialogue also provides a comprehensive look at the disaster training and technical 

assistance services SAMHSA DTAC provides to prepare states, territories, tribes, and local 

entities so they can deliver an effective disaster behavioral health response. 

SAMHSA DTAC provides disaster technical assistance, training, consultation, resources, 

information exchange, and knowledge brokering to help disaster behavioral health 

professionals plan for and respond effectively to mental health and substance misuse needs 

following a disaster. 

To learn more or receive The Dialogue, please call 1–800–308–3515, email dtac@samhsa. 

hhs.gov, or visit the SAMHSA DTAC website at https://www.samhsa.gov/dtac. 

The Dialogue is not responsible for the information provided by any web pages, materials, or organizations referenced in this publication. Although 

The Dialogue includes valuable articles and collections of information, SAMHSA does not necessarily endorse any specific products or services 

provided by public or private organizations unless expressly stated. In addition, SAMHSA does not necessarily endorse the views expressed by such 

sites or organizations, nor does SAMHSA warrant the validity of any information or its fitness for any particular purpose.
A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

 

 

In This Issue 

Disaster response work can be very 

rewarding for those involved; however, it 

can also take a toll on your mental and 

physical health. First responders come face 

to face with terrible and highly stressful 

situations on a regular basis and need to 

develop healthy coping strategies to handle 

the stress. It is crucial for first responders

to take steps to protect themselves from 

potential mental health effects, such as

posttraumatic stress disorder, resulting 

from disaster response work. 

One way to mitigate the effects of stress is support from

supervisors and coworkers. Support from organizational 

leadership and coworkers is essential to establish a 

work environment that encourages responders to feel 

safe to seek help if needed. Additionally, organizations 

should clearly define roles during response efforts to cut

down on potential sources of stress. Responders should 

also keep in mind that situations may change once the 

response begins. Flexibility is key! 

Prior to deployment, proper training to educate first

responders about the mental health needs of survivors 

may encourage responders to feel more confident in

their ability to help survivors. First responders also need 

to be trained to assess their own mental health as well 

as their coworkers’. Stress management techniques are 

an important tool for first responders. These pre-disaster

actions may lead to decreased on-the-job stress.

This issue of The Dialogue focuses on trainings 

available for first responders to help mitigate the stress

and trauma they encounter every day on the job. We

start off the issue with an article about the first responder

trainings developed by the Substance Abuse and 

Mental Health Services Administration (SAMHSA) 

Disaster Technical Assistance Center (DTAC). These 

trainings are available online, free of charge. The next 

article discusses a training curriculum developed after 

2021 | VOLUME 16 | ISSUE 2 | PAGE 3 

September 11 to better prepare first responders to

effectively handle the mental health needs of disaster

survivors. We then move to an article written by a first

responder who provided disaster behavioral health 

training in the U.S. Virgin Islands after Hurricanes 

Irma and Maria. We conclude the issue with an

article from a law enforcement trainer on improving 

organizational and personal flexibility after a disaster

among first responders. This article also addresses the

importance of self-care.

Do you know of a training that would benefit first

responders? We encourage you to contact us to share

your recommendations. ■

Captain Erik Hierholzer, B.S.N. Program 

Management Officer, Emergency Mental Health and

Traumatic Stress Services Branch 

erik.hierholzer@samhsa.hhs.gov 

Nikki Bellamy, Ph.D. Public Health Advisor, 

Emergency Mental Health and Traumatic Stress

Services Branch 

nikki.bellamy@samhsa.hhs.gov 

Shannon Loomis, M.A. Director, SAMHSA DTAC 

dtac@samhsa.hhs.gov 
A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

 

Contributors 

Barry A. Hong, Ph.D., ABPP 

is a Professor of Psychiatry at 

Washington University School

of Medicine. He holds joint

appointments in the Department 

of Medicine and in the 

Department of Psychology. He is the Vice-Chairman for

Clinical Affairs in Psychiatry and the Chief Psychologist

for Barnes-Jewish Hospital. He is an active researcher

funded by the National Institutes of Health (NIH) 

concerning living organ donors, hepatitis C treatments, 

and the study of interstitial cystitis (functional pain). He 

has been one of a team of NIH investigators who have 

conducted medical and psychological follow-up studies

of over 2,500 living kidney donors and several hundred 

living lung donors from multiple transplant centers. 

Presently, he is working with the National Living Donor 

Assistance Program, a project which has facilitated over

5,000 living kidney transplants. Together with Dr. Carol 

North, he has published on disaster mental health and 

posttraumatic stress disorder. 

Brenda Mannix, LMSW is an 

Emergency Medical Services

Lieutenant at the Rockville 

Volunteer Fire Department 

where she has served for over 

7 years. She is also the Vice

President of the organization. Ms. Mannix is a licensed 

master of social work working as a consultant. In 

addition, she also works as an instructor at Montgomery 

College. Ms. Mannix has 22 years of experience 

working with the SAMHSA and other federal agencies, 

including her role as Special Assistant to the Deputy 

Administrator of SAMHSA. In that capacity, Ms. 

Mannix led a wide range of efforts to improve policy

and operations within the agency, such as changing the 

2021 | VOLUME 16 | ISSUE 2 | PAGE 4 

grants and contracts policy review and approval process, 

the Office of Management and Budget clearance

process, and the indefinite delivery/indefinite quantity

competition process. Ms. Mannix worked in several 

other capacities within SAMHSA developing and 

enhancing program analysis, leading business process 

improvement efforts, and providing expertise in several

key program areas such as disaster preparedness and 

response and suicide prevention. In 2005, Ms. Mannix 

served as the Incident Commander for the Hurricane 

Katrina, Rita, and Wilma responses—a 24/7 job—for

the SAMHSA Emergency Response Center. Under her

leadership, SAMHSA deployed or arranged for the 

deployment of nearly 3,000 mental health and substance 

use professionals to assist the states and communities 

disrupted by Hurricanes Katrina and Rita. Ms. Mannix 

trained agency personnel in the incident command 

structure, functions, and roles as the agency was 

implementing it and delivering services. Ms. Mannix 

also visited the affected states to provide oversight to the

disaster behavioral health teams, liaise with local and 

state officials to better understand ongoing needs, and

provide technical assistance. 

Carol S. North, M.D., M.P.E., 

DLFAPA serves as Medical 

Director of the Altshuler Center 

for Education & Research at

Metrocare Services in Dallas, 

Texas. Holding the Nancy and 

Ray L. Hunt Chair in Crisis Psychiatry, she is a boardcertified Professor with tenure in the Department of

Psychiatry at The University of Texas Southwestern 

Medical Center in Dallas, Texas, where she is Director 

of the Division of Trauma and Disaster. Dr. North 

completed medical school and residency training 

in psychiatry at Washington University School of
2021 | VOLUME 16 | ISSUE 2 | PAGE 5 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

 

Medicine in St. Louis, Missouri, followed by a National 

Institute of Mental Health postdoctoral fellowship and 

a master’s degree, both in psychiatric epidemiology, at 

the same institution. Dr. North has been an international 

leader in shaping the science of disaster mental health, 

continuously conducting federally funded research for 

more than a quarter of a century, and has studied 3,500 

survivors of 15 major disasters of all types.

Leslie Weisman, LCSW has 

over 30 years of experience in 

the mental health and criminal 

justice sectors. She retired from

Arlington County, Virginia, as a 

Bureau Chief in the Behavioral 

Healthcare Division of the Department of Human 

Services (DHS). Ms. Weisman provided oversight to

the Crisis Intervention Center, intake and discharge 

planning services, Forensic Case Management/Jail

Diversion, to include Crisis Intervention Team training, 

and homeless outreach. She also co-led a DHS-wide

Trauma-informed Care Initiative. She functioned as the

Mental Health Liaison to the Arlington County Police 

Department’s Crisis Negotiation Unit. Ms. Weisman is

an adjunct instructor at the Northern Virginia Criminal

Justice Academy where she trains law enforcement and

dispatchers on trauma, self-care, flexibility in times of

trauma, mindfulness, and meditation. She has presented 

at local, state, regional, and national conferences 

related to emergency mental health and the provision 

of mental health expertise to law enforcement. Ms. 

Weisman is certified in Psychological First Aid Training

and Critical Incident Stress Debriefing. Ms. Weisman

was a participant on the Diane Rehm Show (nationally 

syndicated NPR production) in December 2012, 

representing the community mental health perspective 

after the Sandy Hook tragedy. She is a licensed clinical 

social worker in Virginia as well as a registered yoga 

teacher with a certification in yoga for first responders.
2021 | VOLUME 16 | ISSUE 2 | PAGE 6 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

 

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2021 | VOLUME 16 | ISSUE 2 | PAGE 7 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

 

SAMHSA’s Online Training Courses for 

First Responders 

By SAMHSA DTAC Staff

First responders are 

disproportionately affected by

disaster behavioral health issues. In 

fact, 30 percent of first responders

experience substance use and/or

mental health issues, including, 

but not limited to, depression 

and posttraumatic stress disorder 

(PTSD), as compared with 20 

percent in the general population 

(Abbot et al., 2015). First responder 

jobs—within law enforcement,

emergency medicine, and 

firefighting—are physically and

emotionally demanding and stressinducing. Studies have shown that 

levels of PTSD in first responders

are comparable to levels among 

war veterans, specifically those in

the Iraq and Vietnam Wars (Berger,

2012). 

Over the past several years, 

SAMHSA DTAC has been 

reviewing and publishing content 

surrounding mental health and 

substance use concerns for first

responders. While the scope of this

problem seems to be expanding, 

there remains a dearth of resources 

available to address it. While highquality trainings exist, they are 

typically hours—or days—long and

require approvals for attendance and 

often a fee to complete. The fastpaced, on-the-go nature of a first

responder’s job makes it difficult

to prioritize a classroom-style

Shield of Resilience 

is now a mandatory 

training for the 36,000 

officers in the New York 

City Police Department, 

the largest police 

department in the country.

 Source: Rayman, 2019 

training—especially if it focuses on

seeking mental health and substance 

use or emotional support. Too often 

the “hero” culture or the “suck it 

up” mentality prevails, resulting 

in stigma—or the fear of being

labeled—and preventing someone

needing help from seeking it. 

SAMHSA DTAC has developed 

four free, online trainings for first

responders. These trainings were 

designed to help anyone from a 

rookie police officer to a seasoned

emergency medical technician 

(EMT) to a career firefighter

improve their awareness and 

understanding of the mental health 

and substance use effects emergency

response may have on themselves 

and their peers. These courses 

are meant to help first responders

understand not only their increased 

risk for mental health and substance 

use issues, but also how to act—by

learning the signs and risk factors to 

note in themselves and their peers, 

and to learn where and how to reach 

out to for help. 

The intention is for training 

coordinators within departments 

and agencies to share these trainings 

with groups of first responders

or require that they complete the 

courses individually. SAMHSA 

DTAC is also working with several 

police departments across the 

country, including the New York 

City Police Department, who have 

adapted a course into their own 

learning management systems 

for training use for hundreds, or 

thousands, of first responders.

Each course was developed based

on research and an environmental 

scan of existing trainings on these 

topics. Beyond videos, the courses 

contain interactive features and 

assessment tools such as quizzes, 

scenarios, and a final exam. Real

first responder faces and voices from

various professions and departments 
2021 | VOLUME 16 | ISSUE 2 | PAGE 8 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

 

 

come alive in these trainings to offer

their peers an authentic experience. 

Further, SAMHSA DTAC worked 

with active duty and retired first

responders to develop and review 

the course content to ensure 

accuracy and relevancy. 

Following are brief descriptions of 

each course and its objectives.

First Response: Working on 

the Front Lines of the Opioid 

Crisis 

According to the Centers for Disease 

Control and Prevention (CDC), drug 

overdoses claimed more than 630,000 

lives from 1999 to 2016—and roughly 

66 percent of those deaths involved an 

opioid, either prescription or illicit (CDC, 

2018, September 10). 

This free, 1-hour, online training

course was developed in response 

to the impact of the opioid crisis 

on first responders across the

country. It addresses the mental 

and physical stressors faced by 

firefighters, emergency medical

services personnel, and police when 

responding to opioid overdose calls. 

This course is accredited by the 

Commission on Accreditation for 

Pre-Hospital Continuing Education

(CAPCE).

After completing this course, you 

will be able to do the following: 

• Describe the opioid crisis,

including its extent and how it

affects the critical work that first

responders do.

• Describe mental health and

substance use issues and mental

and substance use disorders that

are more common among first

responders than the general public.

• Recognize the warning signs of

mental and substance use disorders

in yourself and your peers.

• Help reduce stigma, or negative

and incorrect ideas about mental and

substance use disorders—including

the nature of opioid use and misuse,

opioid use disorder, and addiction,

and the needs of first responders.

• Identify and use stress management

and healthy coping strategies.

• Share evidence-based practices and

resources for self-care and positive

responses to work stress.

Shield of Resilience: A Course 

for Law Enforcement Officers

Law enforcement officers are more likely

to die by suicide than in the line of duty 

(Heyman et al., 2018). 

This free, 1-hour, online course

provides law enforcement officers

with a foundational skill set to better 

understand and address the stressors 

that are unique to law enforcement. 

Mental health and substance use 

issues are the most significant risk

to the safety of law enforcement 

officers.

Shield of Resilience is a training 

course that helps law enforcement 

officers learn to recognize signs and

symptoms of stress, depression, 

posttraumatic stress disorder 

(PTSD), and suicidal thoughts and 

actions. 

This course will suggest ways to 

develop and build the ability to 

recovery quickly after a trauma, and 

offer tips on where and how to seek

help, if it is needed. 

Shield of Resilience helps law 

enforcement officers understand the

following: 

• The unique stressors that law

enforcement officers are exposed to

in the course of their duties

• How to recognize the signs and

symptoms of acute and chronic

stress, depression, and PTSD

• The signs and symptoms of

suicidal ideation and how to talk

with a fellow officer who may be

experiencing suicidal thoughts

• How to facilitate peer-to-peer

mental health and substance use

issues support
2021 | VOLUME 16 | ISSUE 2 | PAGE 9 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

 

 

 

Studies of the psychological impact of disasters on responders show that provision of pre-disaster 

training and information enables individuals to be emotionally and cognitively ready 

for what they may face, leading to better well-being outcomes. 

• The resources and support tools

that help build flexibility during

recovery

• Where to find help and support for

themselves or fellow officers

Service to Self: Behavioral 

Health for Fire and EMS 

Personnel 

Individuals serving dual emergency 

medical services (EMS)/firefighting roles

had six times the likelihood of suicide

attempts as compared to those serving 

in firefighting roles only (Stanley et al.,

2016). 

Service to Self: Behavioral Health 

for Fire and EMS Personnel

is accredited CAPCE. Course

participants complete a final exam to

obtain continuing education credit. 

This 60-minute course includes

relatable firsthand video accounts

from volunteer and career 

firefighters and EMTs, as well as

helpful resources and interactive 

components to support learning. 

This course is designed to help 

firefighters and EMS personnel to:

• Be aware of risk factors for

and prevalence of mental health

and substance use issues in their

professional communities.

• Recognize the warning signs of

mental health and substance use 

issues in yourself and your peers. 

• Discuss mental health and

substance use-related issues with

colleagues to help reduce stigma.

• Identify and use stress management

and healthy coping strategies.

• Be aware of and share evidencebased practices and resources for

increasing capacity to cope with

occupational stressors.

Creating Safe Scenes: 

A Training Course for 

First Responders Helping 

Individuals in Crisis 

People with mental illness may be 

more vulnerable to injury because 

officers misinterpret their behavior and

demeanor (Kerr et. al, 2014). 

Creating Safe Scenes helps first

responders use safe, positive 

approaches to assist individuals 

in mental illness or substance use 

crisis. The course, which is CAPCE

accredited, is designed to help first

responders understand more about 

mental health, mental illness, and 

substance use disorders so they can 

better assess risks and apply the 

safest strategies for taking care of 

themselves and the individuals in 

crisis. Course participants complete 

a final exam to obtain continuing

education credit. 

Source: Brooks et al., 2016 

Creating Safe Scenes helps first

responders: 

• Understand how individuals come

to experience a mental health or

substance use crisis

• Understand how best to make a

safe connection with an individual

experiencing a crisis

• Learn about de-escalation

strategies for working with people

in crisis

• Learn strategies for developing

community networks and referral

resources

• Understand how to improve the

safety of both the responder and the

individual in crisis

That these training courses have 

been viewed and shared by first

responders thousands of times since 

their posting on the SAMHSA 

website is a positive indication that 

we are addressing the very real 

mental health and substance use 

issues first responders face. The

common goal of these courses is 

to help make it easier to talk about 

these realities, and to acknowledge 

that asking for help is an important 

way to care for ourselves and one 

another. ■
2021 | VOLUME 16 | ISSUE 2 | PAGE 10 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

 

P-FLASH©: An Empirically Based Disaster

Mental Health Training Program

By Barry A. Hong, Ph.D., ABPP and Carol S. North, M.D., M.P.E., DLFAPA 

Mental health and healthcare 

professionals, first responders,

and others who work with disaster 

survivors must be prepared to 

respond effectively to mental health

needs. Well-designed training

programs can support this mission. 

New York City’s mental health 

community was largely unprepared 

to meet the psychological needs 

of survivors after the September 

11, 2001, terrorist attacks on the 

World Trade Center. Few mental

health professionals in the area had 

experience caring for distressed 

survivors of large-scale disasters or

training to prepare them for their 

new roles in disaster mental health. 

The September 11th Fund 

was created by the New York 

Community Trust and the United 

Way of New York City to address

the psychosocial needs of 9/11

victims and their families through 

both direct services and training 

programs. The Fund contracted 

with us to develop and deliver a 

9/11 disaster response curriculum

similar to the mental health training 

we had created for St. Louis area 

community leaders after the great 

Midwestern floods of 1993. We were

joined by Dr. Betty Pfefferbaum,

who provided child and family 

disaster mental health expertise 

from her Oklahoma City bombing 

response and research efforts. With

input from local expert consultants, 

we produced the “Practical Front 

Line Assistance and Support for 

Healing” (P-FLASH©) training 

program (North et al., 2008). 

The P-FLASH curriculum was 

delivered in a day-long presentation

to groups of 12–25 mental health 

professionals. P-FLASH was 

distributed by local professionals 

to encourage communities to 

continue using it after we developed 

the original program. A 2-day

“train-the-trainer” model for local

presenters was organized around 

an easy-to-follow slide deck and a
2021 | VOLUME 16 | ISSUE 2 | PAGE 11 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

 

manual with detailed background 

for each slide, imparting consistency 

of presentation and fidelity to the

curriculum. 

Sections of the P-FLASH curriculum 

cover 1) empirical disaster mental 

health research, providing the 

foundation for disaster response; 

2) assessment of mental health

needs, which is fundamental to

choosing effective interventions;

and 3) formal treatment and other

interventions. An important

feature of P-FLASH is that it builds

from empirical disaster mental

health research in establishing

decision paths for assessment and

intervention efforts (summarized in

other publications, such as North et

al., 2018, and North et al., 2013).

The P-FLASH curriculum provides

detailed instruction on treatment of

PTSD and other post-disaster mental

illness, and Psychological First Aid

(PFA) for psychological distress,

directed by assessment findings.

Four enduring principles of disaster

mental health response summarize

relevant scientific findings

to organize disaster response

recommendations.

The first principle is that postdisaster mental illness must be 

separated from the distress people 

commonly experience after a 

disaster. This difference is critical for

choosing interventions appropriate 

to needs: mental illness requires 

professional treatment, but distress 

can be addressed through crisis 

counseling and PFA. Many do not 

realize that disaster survivors often 

recover quickly from psychological 

difficulties. Research findings

show that only 30–45 percent of

people exposed to disasters develop 

PTSD or other psychopathology. 

Most people, however, experience 

psychological distress. Thus, 

individuals providing mental health 

assistance after disasters are more 

likely to encounter survivors with 

emotional distress than mental 

illness. Clinicians may see survivors 

with emotional and behavioral 

responses to disasters that they 

have not previously encountered. 

They also may need to adopt new 

approaches to provide care in 

nontraditional settings; conduct 

focused, rapid assessment; and have 

effective encounters with individuals

they see only one time. 

The second principle is that PTSD, 

the signature diagnosis among 

mental illnesses linked to disaster, 

is a reasonable initial focus of 

assessment. People must be exposed 

to trauma to be diagnosed with 

PTSD, which is usually the most 

prevalent post-disaster disorder,

occurring in 20–35 percent of 

people; major depressive disorder is

typically second in frequency. These 

disorders may lead to substantial 

suffering and functional impairment,

thus requiring attention. Because 

PTSD is usually comorbid with 

other disorders, assessment and 

treatment must be more broadly 

focused than for PTSD alone. Selfreport symptom questionnaires may 

be useful for screening and referring 

to treatment, but diagnosis requires 

assessment of full psychiatric 

criteria and is needed for choosing 

appropriate treatment. Psychiatric 

symptoms usually begin quickly, 

but they must last at least 1 month 
2021 | VOLUME 16 | ISSUE 2 | PAGE 12 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

 

 

for a diagnosis of PTSD and at least 

2 weeks for a diagnosis of a major

depressive episode. Recovery may 

not occur for months or years if at 

all, highlighting the need for mental 

health services over the long term. 

The third principle is that alcohol 

and drug use after disasters may 

increase somewhat over limited 

timeframes, but disasters do not 

regularly lead to new alcohol or 

drug use disorders. Individuals 

with preexisting substance use 

disorders may need extra support 

after disasters, and the post-disaster

setting may be an opportunity for 

identification and care of these

disorders. 

The fourth principle is that 

understanding the risk for postdisaster mental illness can help 

focus efforts toward the most

Check out the SAMHSA DTAC Supplemental Research Bulletin 

edition, Disaster Behavioral Health Interventions Inventory, 

to learn more about the full range of disaster behavioral health 

interventions. This publication lists interventions that can be used 

in the early, intermediate, and long-term disaster response phases

to help survivors cope with the most common reactions. For 

each intervention, a table lists delivery modality and settings and 

populations for whom the interventions can be used. 

vulnerable groups. Women have

twice the risk for PTSD and postdisaster depressive and anxiety 

disorders, but men have higher 

risk for substance use disorders. 

Preexisting mental illness doubles 

the risk for development of PTSD. 

These factors are even stronger 

predictors of PTSD than severity 

of trauma exposure. Major

avoidance and numbing symptoms 

are strong predictors of PTSD, 

whereas intrusion and hyperarousal 

symptoms without prominent 

avoidance and numbing largely 

reflect more common varieties of

post-disaster distress.

The P-FLASH curriculum features 

separate modules tailored for first

responders, clergy, child and day 

care center providers, medical 

practitioners, and medical centers. 

With assistance from the New

York Mental Health Association, 

more than 5,000 people completed 

P-FLASH training during funding

years 2002 through 2004. The

full P-FLASH training was later

expanded to other centers across

the United States, and modified

versions were developed for briefer

presentations and disseminated

through web-based training.

For more information about 

P-FLASH, please contact Dr.

Carol North at carol.north@

utsouthwestern.edu. ■
2021 | VOLUME 16 | ISSUE 2 | PAGE 13 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

 

Training with First Responders—Lessons 

Learned from the U.S. Virgin Islands 

By Brenda Mannix, LMSW 

The U.S. Virgin Islands requested 

assistance from SAMHSA DTAC 

in developing an in-person training

for their first responders to help

first responders better assist

individuals in a disaster behavioral 

health crisis. Over several months 

I worked with SAMHSA DTAC 

and the U.S. Virgin Islands to 

scope out an in-person training

designed for law enforcement, fire,

and emergency medical services. 

Some community members may 

attend but the target audience was 

traditional first responders. Several

factors complicated the design of 

this training, including: Hurricane 

Maria destroyed much of the 

infrastructure so many services two sessions were held per day. Our How they interacted independently 

necessary to support individuals desired training outcome was very and together to support individuals 

with mental health and substance use simple—have responders walk out in a mental health or substance 

issues were no longer available; staff of the room feeling they had learned use crisis varied by island and the 

shortages among first responders something they could immediately community resources available on 

created increased workload on top use. According to post-training that island. For example, for all the 

of their personal recovery needs; evaluations, we were successful with training sessions on St. Croix, only 

and managing training time so as not most participants saying they wished the police attended along with a 

to create more stress for the public they had more training time or more few clergy. The police played the 

safety system. frequent opportunities to have this primary role in assisting individuals 

training. In addition, we learned in crisis. It is also important to

Ultimately, the training format three key lessons: understand that even first responders would be a 4-hour in-person training may be unclear about each other’s 

modeled after SAMHSA DTAC’s 1. First responders have separate role. In one session a spirited

online training Creating Safe cultures and different roles to play exchange occurred between law

Scenes. The training included stress in public service. It is essential to enforcement and EMS over a

management for first responders and understand those roles. For example, perceived lack of support for each role-playing exercises. To meet the in the U.S. Virgin Islands, police, other’s roles. Law enforcement 

U.S. Virgin Islands’ goal of training fire, and emergency medical services believed that EMTs were not helpful

as many responders as possible, (EMS) are three separate systems.

Hurricane Maria, Saturday, September 23, 2017. Satellite image by National Oceanic and Atmospheric 

Administration (NOAA). 
2021 | VOLUME 16 | ISSUE 2 | PAGE 14 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

 

when called to a scene to assist 

police after taser deployment. EMTs

tried to explain they could not 

remove the prongs on scene. Law 

enforcement was also frustrated 

when EMTs called for assistance

with a patient because they were not 

sure what the EMTs wanted them

to do. As a nationally registered 

EMT myself, I was able confirm the

EMT’s assertion that they are not

allowed to remove the prongs from 

a taser deployment in the field. This

can only be done at the emergency 

room by a physician. I was also 

able to help the police understand 

that EMS receives no training on

restraints or holds so sometimes the 

police are needed to help protect 

EMTs while they are assisting

someone in crisis. 

2. Attend to first responder stress

levels first. This training occurred

nearly 2 years after Hurricane

Maria and the police were just

relieved of mandatory overtime

Dolores Harvey/stock.adobe.com 

requirements. Nearly all of the 

first responders I spoke with were

personally affected by the hurricane

and many were still not back in 

their homes. All of the participants 

reported severe staff shortages at

their organizations, increasing the 

workload on those that remained. 

Recognizing and attending to their 

mental and emotional health needs, 

allowed them to be more open 

and empathetic to individuals with 

mental health and substance use 

challenges. 

3. First responders want better

information and training on

helping individuals with mental

health and substance use needs.

They feel the pressure of aiding

when citizens call 911 about an

individual in crisis when there

are few if any mental health and

substance use services to access in

the community. There are really

three key subcomponents to this

lesson: (1) Gentle reminders that

mental illness is not a crime. It’s 

okay to assess the situation and do 

nothing in terms of transporting to 

the hospital or arresting. Referring to 

other agencies or organizations (for 

example, food banks, housing, etc.) 

would be helpful if such services 

exist. (2) Skip the PowerPoint and 

the statistics and focus on roleplaying de-escalation strategies

using examples the participants 

have. Allow them to act out past 

situations with an instructor’s 

support and feedback. Background 

information on the prevalence of 

mental illness and substance use 

disorder can be woven in. The best 

session I ran was on St. John where

there was no projector or screen, so

no PowerPoint. We had a lot more

time for role-playing. (3) Roleplaying is incredibly effective at

both modeling skills (instructor) 

and allowing participants to practice 

safely. Two instructors would be 

ideal. 

As a first responder and a social

worker it was a privilege to bring 

these skills together for the U.S. 

Virgin Islands’ first responders.

I was incredibly heartened at the 

level of participation in the training 

and the desire to better understand 

the needs of individuals in a crisis. 

Communities interested in learning 

more about first responder trainings

should visit the SAMHSA DTAC 

website for resources including 

online training courses available 

to first responders free of charge at

https://www.samhsa.gov/DTAC/ 

education-training. ■
2021 | VOLUME 16 | ISSUE 2 | PAGE 15 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

 

 

Improving First Responder Organizational and

Personal Resilience and a Guide to Self-care 

By Leslie Weisman, LCSW 

Given the well-documented and

sobering statistics related to first

responder suicide and the prevalence 

of PTSD, it is imperative that first

responder organizations become 

trauma-informed and knowledgeable

related to resilience. Statistics show 

that no less than a third of first

responders will suffer from some

form of acute posttraumatic stress 

during their career (“Changing 

Police Culture: 5 things cops need 

to know about PTSD” – PoliceOne. 

com – June 2016). For organizations

and individuals to fully grasp the 

importance of resilience, they need 

to fully understand the deep and 

lasting effect of trauma and the scars

it can leave within the body and the 

psyche. 

How to Improve Organizational 

Resilience 

There are many definitions of

organizational resilience but 

one that is most fitting for first

responder culture is the “ability 

to survive a crisis and thrive in a 

world of uncertainty...it is not just

about getting through the crisis 

but the foresight and situational 

awareness to prevent future 

crises from emerging” (Resilient 

Organizations Ltd). In addition, 

first responder agencies must

remain focused on maintaining 

a trauma-informed organization.

This type of organization is based 

on a solid understanding of the 

physical, psychological, and 

social effects of trauma. Per the

Law Enforcement Mental Health

Wellness Act of 2017, it is highly

recommended that agencies “support 

the identification, development, and

delivery of successful resiliency 

training programs...” The focus 

must be on developing resilience to 

the constant onslaught of stress and 

learning the skills of self-regulation.

Organizations that undertake these 

efforts are more likely to have

personnel who experience less 

stress overall and higher quality 

performance. 

To improve organizational resilience 

an agency must integrate knowledge 

about trauma, resilience, and 

self-care into their policies and

procedures. They recognize the 

need to develop programs that 

promote whole body health as well 

as resilience. These organizations 

recognize the potential negative 

consequences of the work and 

they assume responsibility for 

proactively addressing the effect

of vicarious trauma through their 

policies and procedures (Office of

Justice Program’s Vicarious Trauma

Toolkit). This includes traumainformed supervision where the 

effect of the calls and the events that

occur in the field are reviewed by a

commander with the first responder,

not just for tactical soundness

but to ensure the mental wellness 

 
2021 | VOLUME 16 | ISSUE 2 | PAGE 16 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

 

of the responder. Departments 

need to provide their staff a range

of mental health and substance 

misuse services and these should 

be introduced and normalized from 

hiring through—and past—retiring.

By normalizing these conversations 

and incorporating them into each 

department’s culture, there is less 

stigma associated with seeking help 

and acknowledging when there are 

challenges in the ranks. 

For organizations to be resilient 

there needs to be a focus on the 

general wellness of staff. Agencies

should encourage and incentivize 

wellness activities like yoga, 

meditation, and other forms of 

exercise. Trainings should be 

provided that specifically reference

the chronic emotional stress 

inherent in first responder work

and the importance of self-care.

Organizations will do well to 

emphasize social cohesion among 

staff and create opportunities for

workplace connectedness. High rates 

of suicide may be partially due to a 

sense of isolation and the stigma of 

mental health issues that still prevail 

in many departments. 

How to Improve Personal 

Resilience 

Resilience has been defined as

the ability to bounce back or rise 

above adversity. To be resilient in 

this work, is to use one’s internal 

resources to negotiate hardship and 

look closely at the results of adverse 

events on the mind and body. It is 

critical to recognize that the ability 

Stress Management Tips for First Responders

and Disaster Responders 

• Know your role during a disaster.

• Develop a self-care plan prior to

deployment, and use it during deployment.

• Practice stress management during all

phases of the disaster response effort.

• Involve loved ones in your preparation

and planning activities.

• Make sure you have an individual and family

preparedness plan to cover loved ones if

the disaster is in your community.

For more information on how to manage the stress of deployment to a 

disaster, please see SAMHSA DTAC’s Tips for Disaster Responders: 

Preventing and Managing Stress at https://store.samhsa.gov/product/ 

sma14-4873. 

to be resilient is not static and can 

both grow and dissipate depending 

on circumstances in a person’s life. 

A person’s ability to be resilient can 

be eradicated following an acute 

trauma or it can be strengthened 

through a process of self-reflection,

surrounding oneself with supportive 

friends, family, and colleagues. 

A truly resilient first responder

can successfully move from one 

challenging event to the next without 

undue emotional struggle. Through 

a proactive approach to resilience, 

the first responder will more easily

grow from adversity and find the

posttraumatic growth necessary to 

continue the work. 

There are many aspects to resilience 

to include cultural, racial, and ethnic 

characteristics. Resilience can be 

seen in workers with strong family 

bonds, in those who have strong 

practices of a spiritual or religious 

nature, and those who use humor in 

their life and in their work as well 

as creativity. Resilience can also be 

seen in those workers who practice 

healthy coping skills and have an 

ability to stay present and mindful. 

These workers value strong, safe 

relationships where one can give and 

receive support. 

Self-care for First Responders 

Per Blue H.E.L.P., a non-profit

organization that collects data on 
2021 | VOLUME 16 | ISSUE 2 | PAGE 17 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

 

 

 

police suicide and supports families 

in the aftermath, first responders

have high rates of suicide, PTSD 

to include cumulative PTSD, and 

other serious medical issues. Life 

expectancy is notably shorter than 

civilians. If first responders are to

live a longer, fuller life, the need for 

self-care is paramount. This begins

with a healthy work and life balance 

where each individual leaves space 

and time to care for their mind, 

body, and spirit. 

First responders have a significant

task in their need to regulate stress. 

As is now well known, the body 

“keeps the score” and shows the 

effects of stress and trauma in a wide

variety of ways both mental and 

physical. An attitude of gratitude, 

despite the horrors that have been 

experienced, will help to keep the 

mind in a more positive place. Not 

surprisingly, more physical exercise 

will result in fewer physical ailments 

and bring increased serotonin and 

therefore a more optimistic outlook. 

In addition, it is critical to maintain 

a healthy diet, reduce caffeine,

sugar, and nicotine, monitor alcohol 

consumption, and get enough sleep. 

To conclude, it is essential for first

responders to connect the dots and 

see that practicing daily self-care

The body “keeps the score” 

and shows the effects of 

stress and trauma in a wide 

variety of ways both mental 

and physical. 

will increase one’s resilience and 

lead to a more successful career and 

a longer life expectancy. 

For more information about 

the signs of stress and stress 

management, visit the SAMHSA 

DTAC First Responders and 

Disaster Responders Resource 

Portal. ■

The following page is an 

informational pullout poster 

that you can print and post. It 

provides information on ways 

first responders can reduce

survivor stress. 
2020 | VOLUME 16 | ISSUE 2 | PAGE 18 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

 

 

– – – – – – – – –

First on the scene and need to 

reduce disaster survivors’ distress? 

Provide Psychological First Aid (PFA): 

 Respond to requests and

initiate contacts in a nonintrusive, compassionate,

and helpful way.

 Help people meet basic

needs and help them COMMON 

STRESS 

SYMPTOMS feel safe.

 Calm emotionally

overwhelmed or

disoriented individuals.

 Identify immediate needs

and concerns.

ADDITIONAL RESOURCES: 

 Empower people to take

steps to meet their needs.

 Keep families together or

help people contact friends

and family.

 Provide information about

common stress reactions

and coping.

 Link people with available

services.

Disaster Distress Helpline: 1–800–985–5990 

National Suicide Prevention Lifeline: 

1–800–273–TALK (1–800–273–8255) 

The Substance Abuse and Mental Health Services 

Administration (SAMHSA) National Helpline: 

1–800–662–HELP (1–800–662–4357) 

PFA Online Course from the National Child Traumatic 

Stress Network and National Center for Posttraumatic 

Stress Disorder: https://www.nctsn.org/resources/ 

psychological-first-aid-pfa-online. 

SAMHSA Disaster Technical Assistance Center website 

at https://www.samhsa.gov/dtac or call us at 1–800– 

308–3515. 

Source: National Child Traumatic Stress Network (n.d.). About PFA. Retrieved from 

https://www.nctsn.org/treatments-and-practices/psychological-first-aid-and-skills-forpsychological-recovery/about-pfa 

SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities. 

1 877 SAMHSA 7 (1 877 726 4727) • 1 800 487 4889 (TTY) • https://www.samhsa.gov 
A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

 

RECOMMENDED RESOURCES 

Disaster Behavioral Health Planners Resource Portal 

The SAMHSA DTAC has developed a Disaster 

Behavioral Health Planners Resource Portal to help 

you find resources to assist and strengthen your disaster

behavioral health plans. The portal includes relevant 

issues of SAMHSA’s Supplemental Research Bulletin, 

podcasts, webcasts, the Crisis Counseling Assistance 

and Training Program Toolkit, and more. 

Find the resources at https://bit.ly/2Nmz7WO. 

Approaching Alzheimer’s: First Responder Training 

This training was developed by the Alzheimer’s 

Association for first responders with input from first

responders. Understanding Alzheimer’s is important to 

ensuring your response is appropriate when providing 

support to a person with dementia. This training delivers 

an interactive format on learning how to respond to 

these types of calls and related topics you can explore in 

detail. 

Find the course at https://bit.ly/2pLEm9y. 

Dealing with Stress in Disasters: Building 

Psychological Resilience 

This online training from the Institute of Massachusetts 

is intended for emergency responders and public health 

workers to better understand stress. This 2-hour training

summarizes the three major types of stress and the

effects it has on health. The course teaches participants

how to identify compassion fatigue, risk factors, and 

provides coping strategies to help ease stress. 

Find the course at https://bit.ly/2pfbXZj. 

2021 | VOLUME 16 | ISSUE 2 | PAGE 19 

Disaster Behavioral Health Online Training 

This free, 1-hour online training from the University

of Washington Northwest Center for Public Health

Practice was developed for public health workers 

looking to learn more about the psychological phases of 

a community-wide disaster. It covers disaster behavioral

health outcomes that usually occur, abnormal reactions 

that may require further help, and more. 

Find the training at https://bit.ly/2pDydMV. 

Crisis Management for School-Based Incidents— 

Partnering Rural Law Enforcement, First 

Responders, and Local School Systems 

This 8-hour first responder training from the Rural

Domestic Preparedness Consortium was developed for 

rural law enforcement personnel, school administrators, 

teachers, and staff. It provides information on how to

respond to an emergency in a K–12 environment and 

establishing a school-based emergency response plan.

Find the course at https://bit.ly/2JhIc4l. 
2021 | VOLUME 16 | ISSUE 2 | PAGE 20 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

 

Recent Technical Assistance Requests 

In this section, read about responses SAMHSA DTAC staff have provided to recent technical assistance (TA) requests.

Send your questions and comments to dtac@samhsa.hhs.gov. 

Request: SAMHSA DTAC received a TA request 

from a first responder looking to train local first

responders in his state to prepare them for an upcoming 

large-scale event.

Response: SAMHSA DTAC provided the following 

resources: 

 Online Disaster Behavioral Health Trainings—This

installment of the SAMHSA Disaster Behavioral

Health Information Series is a comprehensive

collection of online trainings for disaster behavioral

health professionals and first responders. Find the

installment at https://www.samhsa.gov/dbhiscollections/online-trainings?term=Online%20

Training%202018-DBHIS.

 The Rural Domestic Preparedness Consortium—

Their website offers several online trainings for first

responders. Several of them cover topics such as

terrorism and event security planning. The website can

be found at https://www.ruraltraining.org/training/

online.

Request: SAMHSA DTAC received a TA request 

from a disaster behavioral health professional requesting 

resources on working with and managing disaster 

response volunteers. 

Response: SAMHSA DTAC provided the following 

resources: 

 Successful Strategies for Recruiting, Training, and

Utilizing Volunteers—This guide from SAMHSA

provides information for helping to manage

volunteers, including training and evaluating them.

Find the guide at https://www.samhsa.gov/sites/

default/files/volunteer_handbook.pdf.

 Managing Spontaneous Volunteers in Times of

Disaster—This training from the Corporation for

National and Community Service provides information

and activities for professionals who may be in the role

of managing disaster response volunteers. The training

is available at https://www.nationalservice.gov/sites/

default/files/resource/hon-cncs-msvtd_participant_

materials.pdf.

 U.S. Department of Homeland Security’s Training

Resources—This web page has some information

for training first responders on a wide range of topics

including bioterrorism, emergency preparedness, and

suicide prevention. Find the web page at https://www.

dhs.gov/science-and-technology/frg-training.

 The National Consortium for the Study of

Terrorism and Responses to Terrorism—Their

website offers resources, information, and training

for better understanding terrorism and a community’s

ability to bounce back after a disaster. Find the website

at https://www.start.umd.edu/training.

Help Improve SAMHSA’s Disaster

Services and Products 

As a subscriber to this 

newsletter, you are 

invited to participate 

in a short, web-based

survey to provide the 

SAMHSA Disaster 

Technical Assistance Center (DTAC) with 

feedback about your experiences with our 

products and services. The survey should take no 

more than 15 minutes. Complete the survey by 

clicking on this link, or copy and paste the URL 

https://iqsolutions.qualtrics.com/jfe/form/SV_

bjYCSJDUQAGi1h3 into your web browser. 
2021 | VOLUME 16 | ISSUE 2 | PAGE 21 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

 

 Capability 15: Volunteer Management—This

Centers for Disaster Control and Prevention planning

document on volunteer management clearly outlines

public health volunteer capabilities. The document is

available at https://www.cdc.gov/cpr/readiness/00_

docs/capability15.pdf.

Request: SAMHSA DTAC received a TA request for 

traumatization resources for communities that have been 

re-affected by disasters.

Response: SAMHSA DTAC provided the following 

resources: 

 Tips for Survivors of a Disaster or Other Traumatic

Event: Coping with Retraumatization—This tip

sheet from SAMHSA DTAC provides information for

survivors who have been retraumatized by a disaster.

It lists the signs and symptoms of retraumatization

and provides suggestions for building flexibility

after a disaster. The tip sheet can be found at https://

store.samhsa.gov/product/Tips-for-Survivors-of-aDisaster-or-Other-Traumatic-Event-/sma17-5047.

 Trauma and Your Family—This tip sheet from The

National Child Traumatic Stress Network provides

information for families on the causes and symptoms

of traumatic stress. It also provides some coping

strategies. The tip sheet is available at https://www.

nctsn.org/resources/trauma-and-your-family.

 Risk and Resilience Factors After Disaster and

Mass Violence—This web page from the U.S.

Department of Veterans Affairs includes information

on the risk and protective factors for individuals

experiencing traumatic events such as disasters.

Find the web page at https://www.ptsd.va.gov/

professional/treat/type/disaster_risk_resilience.asp.

 Post-disaster Retraumatization: Risk and Protective

Factors—This SAMHSA DTAC webcast informs

disaster behavioral health professionals about

the concepts and signs of retraumatization and

associated risk and protective factors, and highlights

promising treatment strategies and tips for avoiding

retraumatization. The webcast is available at https://

www.youtube.com/watch?v=1O7w6pu4BdI&list=P

LBXgZMI_zqfRcTt9ndxkbieQ-pQslk-R6. ■

Are you looking for disaster behavioral health resources? 

Check out the new and updated 

SAMHSA DTAC Disaster Behavioral Health Information Series (DBHIS) installments. 

https://www.samhsa.gov/dtac/dbhis-collections 
2021 | VOLUME 16 | ISSUE 2 | PAGE 22 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

 

REFERENCES 

Abbot, C., Barber, E., Burke, B.,

Harvey, J., Newland, C., Rose,

M., & Young, A. (2015). What’s 

killing our medics? Ambulance 

Service Manager Program. Conifer, 

CO: Reviving Responders. 

Retrieved from http://www.

revivingresponders.com/originalpaper/

pt5lehsknczsaofld89leijbmehz3c

About NYPD. (n.d.). Retrieved from 

https://www1.nyc.gov/site/nypd/

about/about-nypd/about-nypdlanding.page 

Berger, W., Coutinho, E. S. F., Figueira,

I., Marques-Portella, C., Luz, M.

P., Neylan, T. C., Marmar, C. R., &

Mendlowicz, M. V. (2012). Rescuers 

at risk: A systematic review and 

meta-regression analysis of the

worldwide current prevalence and 

correlates of PTSD in rescue workers. 

Social Psychiatry and Psychiatric 

Epidemiology, 47, 1001. doi:10.1007/

s00127-011-0408-2

Brooks, S. K., Dunn, R., Amlôt, R., 

Greenberg, N., & Rubin, G. J. (2016).

Social and occupational 

from https://rudermanfoundation.org/

white_papers/police-officers-andfirefighters-are-more-likely-to-die-bysuicide-than-in-line-of-duty

Kerr, A. N., Morabito, M., & Watson,

A. C. (2010). Police encounters,

mental illness and injury: An

exploratory investigation. Journal

of Police Crisis Negotiations: An

International Journal, 10, 116–132.

doi:10.1080/15332581003757198

North, C. S., Downs, D. L., & Hong,

B. A. (2018). PTSD: A systematic 

approach to diagnosis and treatment. 

Current Psychiatry, 17, 35–43.

North, C. S., Hong, B. A., &

Pfefferbaum, B. (2008). P-FLASH:

Development of an empirically-based

post-9/11 disaster mental health

training program. Missouri Medicine, 

105, 62–66. 

North, C. S., & Pfefferbaum, B. (2013).

Mental health response to community 

disasters: A systematic review. JAMA, 

310, 507–518.

Rayman, G. (2019, August). NYPD 

orders cops to take mandatory 

suicide prevention training. 

Daily News. Retrieved from 

https://www.nydailynews.com/

new-york/nyc-crime/ny-suicideprevention-training-20190816-

mlyvmvh53vgndeg7pxsu2d523ustory.html 

Stanley, H., Hom, M. A., & Joiner,

T. E. (2016). A systematic review

of suicidal thoughts and behaviors 

among police officers, firefighters,

EMTs, and paramedics. Clinical 

Psychology Review, 44, 25–44. doi:

10.1016/j.cpr.2015.12.002

The Dialogue is not responsible for the 

information provided by any web pages, 

materials, or organizations referenced 

in this publication. Although The 

Dialogue includes valuable articles and 

collections of information, SAMHSA 

does not necessarily endorse any 

specific products or services provided 

by public or private organizations 

unless expressly stated. In addition, 

SAMHSA does not necessarily 

factors associated with endorse the views expressed 

psychological distress and by such sites or organizations, 

disorder among disaster nor does SAMHSA warrant 

responders: a systematic the validity of any information 

review. BMC Psychology, or its fitness for any particular 

4(18). doi:10.1186/s40359- purpose.

016-0120-9

The views, opinions, and 

CDC. (2018, September 10). content expressed in this 

Opioids portal. https://www. publication do not necessarily 

cdc.gov/opioids reflect the views, opinions, 

or policies of the Center 

Heyman, M., Dill, J., & for Mental Health Services 

Douglas, R. (2018, April). (CMHS), the Substance Abuse 

The Ruderman white paper and Mental Health Services 

on mental health and Administration (SAMHSA), or 

suicide of first responders. the U.S. Department of Health 

Ruderman Family and Human Services (HHS).

Foundation. Retrieved 
Prepare • Respond • Recover

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CONTACT US 

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Assistance Center 

Toll-free: 1–800–308–3515 

dtac@samhsa.hhs.gov 

https://www.samhsa.gov/dtac 

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ACCESS ADDITIONAL SAMHSA DTAC RESOURCES 

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to the SAMHSA DTAC Bulletin subscription list. 

The SAMHSA Disaster Behavioral Health Information Series contains resource collections 

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preparedness and response. Visit the SAMHSA DTAC website at 

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