Overview of Louisiana’s
Disaster Mental Health
Preparedness and Response to
Hurricane Katrina
The 22nd Annual Rosalynn Carter Symposium on
Mental Health Policy
November 9, 2006
The Carter Center, Atlanta Georgia
Anthony H. Speier, Ph.D.
Louisiana Office of Mental Health
Speier, A. (2006) Louisiana Office
of Mental Health
Speier, A. (2006) Louisiana Office
of Mental Health
Disaster Preparedness
2005
Speier, A. (2006) Louisiana Office
of Mental Health
Pre- Katrina Disaster
Preparedness:
DHH Disaster
Task Force
Staff Call Out Registry
OMH CMHC Staff
Assist at Sp NS
4,000 DHH Employees Trained in 2004
Special Needs Shelter
Disaster Mental Health Training
Hospital Evacuation Readiness
350 OMH and OAD Employees Trained in May 2005
All Hazards Response Planning
Crisis Counseling Intervention With Special
Populations
Disaster Mental Health Intervention in Incidents
Involving Mass Casualties
Speier, A. (2006) Louisiana Office
of Mental Health
Pre-Katrina Disaster Preparedness
July-August 2005
Disaster Response Drills
Including Practice Evacuations
of OMH Hospitals
Disaster Response Plans For :
•Each OMH Hospital and Region
•Hurricane Pam Exercise week of Katrina
•Planning for SpNS, SARBOS, and TMOSA
Speier, A. (2006) Louisiana Office
of Mental Health
Pre-Incident Activities:
Hurricane Katrina August 25-28,
2005
OEP Command Center
DHH Operations
Evacuation of
•Southeast Louisiana State
Hospital
•New Orleans Adolescent
Hospital to Eastern
Louisiana Mental Health
System
Open Special Needs
Shelter (SNS) Operations
New Orleans
Baton Rouge
Terrebonne Parish
Lafayette
Lake Charles
Alexandria
Monroe
Speier, A. (2006) Louisiana Office
of Mental Health
Initial Locations of OMH Incident
Response:
OEP Command
Center
Emergency Response
Sites
OPH Command Center
TMOSA
SARBO
NOPD Sites
OEP – Tent Cities for
Police Units
Baton Rouge Sites
OPH Command
Center
SARBO
New Orleans
Special Needs Shelters
New Orleans
Baton Rouge
Houma/Terrebonne
Lafayette
Lake Charles
Alexandria
Monroe
Speier, A. (2006) Louisiana Office
of Mental Health
TMOSA Sites
•New Orleans
•Baton Rouge
Evacuation of
Charity Hospital in
New Orleans
Acute Unit to
Central Louisiana
State Hospital
OMH Incident Response:
August 29, 2005 to November 2006
Behavioral Health
Command Center
Family Call
Center
SAMHSA
Emergency
Response Grant
7 Mobile Crisis
Teams (Shelter
support)
Hospitals Evacuated
through April 2006
Continuity of Operations
SpNS and General Shelters
operate through early 2006
Initial Crisis
Counseling
Grant
Speier, A. (2006) Louisiana Office
of Mental Health
SAMHSA/Westover
Clinical Teams through
6/30/06
Post Katrina/Rita Realities
2006
Speier, A. (2006) Louisiana Office
of Mental Health
Evacuation Planning
• People will not plan their personal
evacuation before the threat of a storm.
• Making a family/personal evacuation plan
is not easily accomplished
• People are worn out
• People need structure and leadership
Speier, A. (2006) Louisiana Office
of Mental Health
Sheltering Staff
• Staff need reassurance and relief while on the
deployment.
• Job structure is important.
• Maintain a buddy system.
• Value and respect for each other is essential.
• Staff need to be recognized for their efforts.
• Shift change debriefings and on-site stress
managers.
• Need to know who is in charge.
Speier, A. (2006) Louisiana Office
of Mental Health
Sheltering Evacuees
• Psychological first-aid is needed by
everyone.
• Basic needs must be assessed and met.
• Need sufficient staffing to recognize
behavioral problems before they become
overwhelming.
• Pre-planned protocols for managing
behavioral issues.
Speier, A. (2006) Louisiana Office
of Mental Health
OMH Emergency Preparedness
Post Katrina/Rita
1. Each hospital/region/district has a
designated Emergency Preparedness
Coordinator.
2. OMH has established a state level
Emergency preparedness work unit.
3. OMH holds bi-weekly (were weekly during
the major part of hurricane season)
meetings with the regional managers, CEOs
and the emergency preparedness
coordinators.
Speier, A. (2006) Louisiana Office
of Mental Health
OMH Emergency Preparedness
Post Katrina/Rita
4. OMH now has a state wide disaster
preparedness and response plan consisting
of regional plans and hospital plans.
– These plans designate functions to be performed at
Special Needs Shelters by OMH in conjunction with
OPH, OAD and OCDD.
– Protocols for accessing psychiatric crisis services
during a disaster have been identified for each region.
– Staff have been identified who will function as crisis
counselors and as general assistance staff 24 hrs a
day for a period of five days.
– It is our intention to place this information on an
easily accessible section within the OMH web site.
Speier, A. (2006) Louisiana Office
of Mental Health
OMH Emergency Preparedness
Post Katrina/Rita
5. Currently we are developing local clinic level plans for all
hazard preparedness and response. This will include the
provision that all staff have personal emergency response
plans and have an established procedure for contacting
supervisors following a storm if they must evacuate.
– It is also our intention to assist all consumers who are OMH clients with
their own emergency preparedness plans, which will be reviewed and
updated at six month intervals just as treatment plans are currently
reviewed.
6. OMH and the regional housing coordinators have been working
with assisted living programs OMH funds to assure each of
these sites has an emergency response and evacuation plan.
– As emergency preparedness matures into a routine program within
OMH we will initiate a wide array of preparedness drills for provider
agencies and our consumers.
Speier, A. (2006) Louisiana Office
of Mental Health
OMH Emergency Preparedness
Post Katrina/Rita
7. During the current hurricane season we have:
– Conducted a mock evacuation drill for NOAH and SELH
evacuating to ELMHS,
– a "shelter-in-place" drill for NOAH, SELH, ELMHS, and CLSH
in response to a category 2 or less hurricane or a hazardous
materials incident.
– Our biggest challenge is managing the evacuation of
employee families to ELMHS but we are actively working on
that issue.
– We currently have planned an evacuation drill for the
evacuation of acute psych units at WO Moss, UMC, and
Chabert to CLSH with their staff. This will occur within the
next two weeks.
Speier, A. (2006) Louisiana Office
of Mental Health
OMH Emergency Preparedness
Post Katrina/Rita
8. OMH is also working with DHH and the Louisiana Hospital Association
to plan for the evacuation of all psych patients from public and private
facilities.
– There has been some very creative thinking which will probably result in some
utilization of private bed space/staff as part of the response and sheltering
effort. These discussions are underway and will hopefully result bin a strategy
prior to the 2007 hurricane season.
9. OMH is also participating with OPH in preparation for a bird flu
pandemic.
– We are designing the exercise and will test it out in December in Region5.
10. OMH is a full participant with DHH:
– on all emergency response planning and evacuation efforts,
– workforce readiness,
– advise DHH on issues regarding mental health,
– and the specific needs of persons with mental illness.
Speier, A. (2006) Louisiana Office
of Mental Health
OMH Emergency Preparedness
Post Katrina/Rita
11. OMH has worked with DHH in establishing a separate
Behavioral Health desk to handle all behavioral health issues at
the regional and statewide levels. This will allow for the rapid
identification of issues/needs and the mechanisms for securing
the necessary resources for our response.
– 99% of OMH community staff have completed all four of the
required training courses in the National Incident Management
System.
12. OMH has established an emergency response pharmacy plan
for securing OMH medical supplies during a disaster.
– We have also resolved most of the issues regarding access to
psych medications at special needs shelters.
Speier, A. (2006) Louisiana Office
of Mental Health
STATE
EOC
Behavioral Health Incident Management:
Communication Pathway
2006 Hurricane Season
State EOC
DHH DESK
(Independence
Blvd.)
DHH
EOC
(Bluebonnet Blvd.)
OAD
Behavioral
Health Section
Chief
OCDD
OMH
OMH
Disaster
Operations
Executive Staff
OAD
9 DHH Regional
Commanders
(OPH)
Behavioral Health
Regional Liaison
OCDD
Human Services
District./Authority
(AD/DD/MH)
OMH
* note:
•Behavioral Health Branch Manager location is Independence Blvd.
•Staffing is provided by OAD/OCDD/OMH)
Speier, A. (2006) Louisiana Office
of Mental Health
OMH
Regional Managers
Designee
and Inpatient
Facility Manager or
Designee
(Same illustration is applicable to
OAD and OCDD)
The Louisiana Crisis Counseling Program
Speier, A. (2006) Louisiana Office
of Mental Health
What is Louisiana Spirit?
• Louisiana Spirit is an outreach crisis
counseling program designed to
address the emotional and mental
health needs of those impacted by
Hurricanes Katrina and Rita.
• It is funded through the Federal
Emergency Management Agency
(FEMA) and administered through the
Substance Abuse and Mental Health
Services Administration, Center for
Speier,
A. (2006) Louisiana Office
Mental Health
Services
(CMHS).
of Mental Health
ISP and RSP Grant Awards
• The State of Louisiana was awarded a total of
– $19,990,655 for the Immediate Services Program
through August 31, 2006.
– $34,651,835.00 for Regular Services Program
(RSP) for Hurricane Katrina parishes.
– $2,308,237 for Hurricane Rita parishes.
– $ 2,044,724 for the Undeclared Parishes (Northern
Louisiana).
– A total of $39,004,796 for ongoing RSP services.
– Louisiana Spirit CCP funds are targeted to the
residents of all 64 parishes affected by the
devastation of Hurricanes Katrina and Rita.
Speier, A. (2006) Louisiana Office
of Mental Health
Staff and Core Service
Providers
• Louisiana Spirit Hurricane Recovery program
currently employs a diverse workforce of
over 500 staff, primarily Crisis Counselors
and Outreach Workers.
• Six Provider Agencies in designated service
areas:
– Louisiana State University Health Science Center
(LSUHSC) Department of Psychiatry,
– Catholic Charities Archdioceses of New Orleans,
– Harmony Family Support & Outreach Services,
– Options for Independence , Inc.,
– Volunteers of America of Greater Baton Rouge
Speier, A. (2006) Louisiana Office
of Mentalof
Health
– Volunteers of America
Greater New Orleans.
Union
Claiborne
West East
Carroll
Bossier
Lincoln
Webster
Caddo
Ouachita
Jackson
Bienville
DeSoto
Louisiana Spirit
Morehouse
Red
River
Service Area I: CCANO
RichlandSt
Madison
Service Area II: VOA GNO
Caldwell Franklin
Natchitoches
Service Area III: Options
Service Area IV: Harmony
Tensas
Winn
LaSalle
Catahoula
Service Area V: VOA GBR
Undeclared: VOA GBR
Grant
Sabine
Concordia
Rapides
Vernon
Beauregard
Avoyelles
Allen
West East
Feliciana
Evangeline
Pt.
Coupee
St. Landry
Calcasieu
Cameron
Jefferson Acadia
Davis
St.
Martin
Lafayette
Vermilion
St.
Helena
Iberia
Washington
Tangipahoa
East
W.
Baton Rouge Livingston
St. Tammany
Iberville Ascension
St.
St. John
James
St.
Assumption
s
Charles
Lafourche
Orleans
St. Bernard
Jefferson
Terrebonne
Plaquemines
St. Mary
3
Speier, A. (2006) Louisiana Office
of Mental Health
Union
Claiborne
West East
Carroll
Bossier
Lincoln
Webster
Caddo
Ouachita
Jackson
Bienville
DeSoto
Louisiana Spirit
Morehouse
Red
River
Rita ….
Richland
Madison
Caldwell Franklin
Tensas
Winn
Natchitoches
LaSalle
Catahoula
Grant
Sabine
Concordia
Rapides
Vernon
Beauregard
Avoyelles
Allen
West East
Feliciana
Evangeline
Pt.
Coupee
St. Landry
Calcasieu
Cameron
Jefferson Acadia
Davis
St.
Martin
Lafayette
Vermilion
St.
Helena
Iberia
Washington
Tangipahoa
East
W.
Baton Rouge Livingston
St. Tammany
Iberville Ascension
St.
St. John
James
St.
Assumption
s
Charles
Lafourche
St.
Mary
Orleans
St. Bernard
Jefferson
Terrebonne
Plaquemines
3
Speier, A. (2006) Louisiana Office
of Mental Health
Goals and Strategies
• Deliver services to large numbers of residents
affected by Hurricanes Katrina and Rita who are
diverse in age, ethnicity, and needs.
• Louisiana Spirit program design is multifaceted to
reflect the culture, traditions, needs, and values of
Louisiana residents.
• Service delivery, is designed to promote recovery
among individuals, communities, and the entire
affected population in Louisiana.
• The evaluation and quality improvement programs
provide a constant flow of feedback and continually
informs service delivery.
• Significant time and resources are dedicated to
stakeholder support.
• A sustainable recovery requires ongoing community
engagement and the routine monitoring of the health
(2006) Louisiana
Office
and recovery of Speier,
the A.entire
population.
of Mental Health
Community Based Outreach
• Louisiana Spirit is community based, not office based.
• Counseling is brief (1-6 sessions), practical and is
designed to help survivors return to a pre-disaster
level of functioning, renwing the spirit of individuals
and communities.
• Services target direct and indirect victims/survivors,
evacuees displaced by the hurricanes and host
communities throughout Louisiana.
• Programming targets special populations thought to be
at risk including rescue and law enforcement
personnel, children, and those with pre-existing health
and behavioral health vulnerability.
• Services include support to stakeholders involved in
the lives and recovery of hurricane victims/survivors
as well as communities at large.
Speier, A. (2006) Louisiana Office
of Mental Health
Level of Service Needed
Education & Information
Psychological First Aid
Crisis, Trauma,
Grief Loss
Counseling
Referral
for Tx
LA Spirit
LA Spirit
LA Spirit
Mental Health
Agencies
Speier, A. (2006) Louisiana Office
of Mental Health
Children and Adolescent
Services
• LSUHSC has provided over 5000 confidential
screening assessments have been carried out by
teachers and LSUHSC faculty, together with the
assistance of SAMHSA volunteers and Louisiana
Spirit Crisis Counselors at the request of school
districts and administrations.
• Children and adolescents surveyed were those
returning to the St. Bernard Parish Unified School
District, students returning to Orleans and
Plaquemines Parishes, and displaced and receiving
students in St. John the Baptist Parish.
Speier, A. (2006) Louisiana Office
of Mental Health
Facilitating Integration
School Districts
Mental Health
Service Providers
Community Service
Providers
How to facilitate collaboration & coordination of services so that more
needs are
met
effectively
Speier,
A. (2006)
Louisianaand
Officeefficiently?
of Mental Health
State-wide Services Highlights
• Collaborative Partners and Services
– Louisiana Family Recovery Corps
– Schools, public and private
– State agencies, Region and District providers,
OAD, DSS, OPH
– Faith-based organizations
– Crisis hotline through SAMHSA Lifeline1-800-273TALK
– Stress Management Cadre
– First Responder Agencies
– Special Population Groups
Speier, A. (2006) Louisiana Office
of Mental Health
State-wide Services Highlights
• Training
– Disaster Mental Health Services
– Psychological First Aid
– Cultural Competency
– Data Privacy/HIPAA
– Disaster Stress and Trauma
Speier, A. (2006) Louisiana Office
of Mental Health
Louisiana Spirit
Crisis Counseling Program
Data
(9/1/05 – 8/31/06)
Immediate Services Program
Speier, A. (2006) Louisiana Office
of Mental Health
Summary
• 197,750 Individual Contacts (140,151
first visits)
• 756, 054 Brief Contacts
• 176,034 Phone or E-mail Contacts
• 9,848,987 Materials Distributed
– Child/youth self-help
– Grief and bereavement
– Stress management
– Assisting first responders
Speier, A. (2006) Louisiana Office
of Mental Health
Group Counseling and Public
Education
141,266 Contacts Within Group Total
– Group Counseling-49,047
• Crisis counseling with 2 or more persons
– Public Education- 92,219
• Didactic presentations to community and other
stakeholder groups
Speier, A. (2006) Louisiana Office
of Mental Health
Brief, Individual, and Group
Contacts
Over 1,000,000 In-Person Contacts have been made.
800,000
700,000
600,000
500,000
400,000
756,054
300,000
200,000
100,000
197,750
141,266
0
Brief Contacts
Individual Contacts
Group Contacts
Speier, A. (2006) Louisiana Office
of Mental Health
Individual Contacts by Service Area
70000
60000
50000
40000
63147
30000
48760
20000
43393
29880
10000
14253
0
Service Area I
Service Area II
Service Area III
Service Area IV
Speier, A. (2006) Louisiana Office
of Mental Health
Service Area V
Individual Contacts By Age
70000
60000
50000
45012
40000
30000
66659
20000
10000
1848
2225
2821
Age 0-5
Age 6-11
Age 12-17
16852
0
Age 18-39
Speier, A. (2006) Louisiana Office
of Mental Health
Age 40-64
Age 65+
Individual Crisis Counseling
Contacts by Race
80000
68682
68257
70000
60000
50000
40000
30000
20000
10000
1047
1886
American Indian
Asian
396
0
Black
Pacific Islander
Speier, A. (2006) Louisiana Office
of Mental Health
White
Referrals by Type
80948
90000
80000
64895
70000
60000
53198
50000
40000
22318
30000
20000
1163
10000
0
Crisis Counseling
Services
Mental Health
Treatment
Substance Abuse Disaster Services
Other (social
Treatment
Referrals
services/supports)
Speier, A. (2006) Louisiana Office
of Mental Health
Community Networking and
Coalition Building
• Captures the
number of
individuals
Louisiana Spirit
came in contact
with for the
purpose of
networking with
the community
and building
local coalitions.
28593
30000
25000
20000
15000
8298
10000
5852
5000
3381
1753
0
Options
Harmony
Speier, A. (2006) Louisiana Office
of Mental Health
VOA
Catholic
Charities
LSU
Katrina Participant Feedback
Survey
(Fran Norris, Ph.D. and Elizabeth Mercer, MSW, August 2006)
• Survey distributed last week of April
2006
• 2,162 participants (15%) returned
surveys
• 80% resided in one of the disasterdeclared parishes
th grade
• Survey wasSpeier,
designed
on
a
5
A. (2006) Louisiana Office
reading level of Mental Health
Participant Feedback SurveyResults
• 28% of participants felt their lives had
been threatened during the disaster
• 19% had been involved in rescue or
recovery work
• 74% experienced community destruction
• 69% experienced damage to their home
• 61% displacement
• 58% financial loss
Speier, A. (2006) Louisiana Office
of Mental Health
Stress Reactions
•
•
•
•
58% of participants had poor stress tolerance
54% depression
51% arousal symptoms
36% felt they needed help or more help from a counselor
to deal with their reactions to the disaster
• 40% met criteria for severe distress with( 7out of 11
items withintense stress reactions).
• Participants in non-declared parishes averaged almost 6
intense reactions, compared to 5 among participants
living in non-declared parishes.
Speier, A. (2006) Louisiana Office
of Mental Health
Stress Reactions (cont.)
• Younger adults, ethnic minorities, and
participants with less than 12 years of
education had more intense reactions than
did older adults, White participants, and
participants with 12 or more years of
education.
Speier, A. (2006) Louisiana Office
of Mental Health
Program Ratings
• The program performed best in terms of
the respectful manner in which counselors
interacted with participants, regardless of
their race, culture, or religion.
• The results suggest that the crisis
counseling program is doing what it is
supposed to do quite well.
Speier, A. (2006) Louisiana Office
of Mental Health
Response Bias
• Women and older adults were overrepresented in the survey sample.
• There did not appear to be racial/ethnic or
geographic biases.
Speier, A. (2006) Louisiana Office
of Mental Health
Too Many Cooks Spoil the
Broth
Practice and Policy
Considerations
Speier, A. (2006) Louisiana Office
of Mental Health
Pre-Incident Readiness
• Elevate All Hazards Behavioral Health
Emergency Preparedness to a core
function of local and state agencies.
• Behavioral Health Mitigation Funds.
• Preparation of Action Request Forms
(ARFs) for obvious resource needs. (such
as additional staff, medical supplies and
locations for psychiatric inpatient surge).
• NIMS training and exercises
Speier, A. (2006) Louisiana Office
of Mental Health
Pre-Incident Readiness
• Local, Regional and State All-Hazard Behavioral
Health Preparedness Plans.
• Employee call trees and work assignments.
• Job functions and initial assignment protocols
pre-specified.
• Establish and maintain DMH volunteer cadre.
• Practice Drills (Evacuations, Sheltering, etc.)
• Media Shelf Kits (PSAs)
Speier, A. (2006) Louisiana Office
of Mental Health
Pre-filed State Emergency
Response Plans
• Federal Certification of State’s basic
disaster mental health plan…similar to
block grant plan strategy.
• Six month program updates reflect:
– Services to date
– Indicators of individual and community
recovery and remaining challenges
– Recovery strategy
Speier, A. (2006) Louisiana Office
of Mental Health
Incident Classification
• Disaster vs Catastrophic Event
• Program Model and Funding defined by
incident type
Speier, A. (2006) Louisiana Office
of Mental Health
Identify Disaster Incident
Thresholds
•
•
•
•
•
Intensity of the incident
Duration
Displacement
Resource loss—infrastructure damage
Loss of human capital
Speier, A. (2006) Louisiana Office
of Mental Health
Needs Assessment and
Recovery Trajectory
• Capacity of existing infrastructure
• Ability to deliver disaster mental health
services and sustain pre-incident service
levels
• Match Recovery issues with Resource
Needs
• Continuity of operations
• Sustainability of new services
Speier, A. (2006) Louisiana Office
of Mental Health
Basic Services for Individuals
and Communities
•
•
•
•
•
Crisis response
Stress management
Outreach
Accessibility
Treatment interventions consistent with
trauma exposure and phase of
response/recovery.
Speier, A. (2006) Louisiana Office
of Mental Health
Response and Recovery: Keep It
Simple and Mission Focused
• What is the disaster-related
issue/challenge that is consuming you?
• What can you do about it?
• What assistance is needed to resolve it?
• How do you know when the
issue/challenge is resolved?
Speier, A. (2006) Louisiana Office
of Mental Health
Response and Recovery: Keep It
Simple and Mission Focused
• CCP is a supplemental program, not a
new mental health system.
• Fit CCP into existing business model of
state and provider agencies
• More flexibility in administration at the
local and state level…administrative costs.
Speier, A. (2006) Louisiana Office
of Mental Health
Basic Disaster Mental Health
Program Design
• Community Education, Training, and Outreach
• Individual crisis support (including psychological
first aid)
• Individual outreach– canvassing impacted area.
• Treatment of trauma exposure
• Crisis response for psychiatric emergencies
• Media Plan
• Evaluation Plan
• Quality Assurance Plan
• Business Plan—Fiscal Management
Speier, A. (2006) Louisiana Office
of Mental Health
Essential Project Management
for Crisis Counseling Programs
•
•
•
•
•
Policy Recommendations
Identify Recovery Trajectory and adjust at 6
month intervals.
Single Grant Process with six month
amendments linked to Recovery Trajectory
Estimates.
Initial grant funding based on per-capita
allocation formula.
Program Guidelines similar to the SAMHSA
Emergency Response Grants (SERG)
National Behavioral Health Model for
Responding to Mass Casualties.
Speier, A. (2006) Louisiana Office
of Mental Health
What States Need
• Transparency and Support ---Not secret
formulas for evaluating the adequacy of
state CCP project applications --• Rapid and Definitive, Evidence-based
Decision Making, (not personal opinions).
• Macro-level guidance.
• Access to content-knowledge expertise.
Speier, A. (2006) Louisiana Office
of Mental Health
Speier, A. (2006) Louisiana Office
of Mental Health
Hope is the enemy of despair.
If you think you have lost yours, call to just talk
and be heard.
1-800-273-TALK
Speier, A. (2006) Louisiana Office
of Mental Health