Role of Mental Health In Emergency Response and Recovery


By George W. Doherty (April 28, 2006)

Disasters are complex human, bureaucratic, and political events. Routine resources and procedures are not adequate for managing changes caused by disasters. The number and type of responding groups, agencies, and jurisdictions increase tremendously. Relationships among organizations change. Alterations in traditional divisions of labor and resources increase needs for multi- organizational and multi-disciplinary coordination among all the participants. Without such coordination, it is difficult to share resources and distribute them to fulfill needs. Communication, command and control may be insufficient, essential tasks may be omitted, duplication of effort may occur and activities may become counterproductive.

A disaster differs from routine emergencies in that it cannot be adequately managed by merely mobilizing more personnel, equipment and supplies. A disaster often creates demands that exceed the capacities of single organizations. This requires them to share tasks and resources with other organizations that use unfamiliar procedures. Disasters may also cross jurisdictional boundaries (Auf der Heide, 1989). They change the number and structure of responding organizations and can result in the creation of new ones. They create new tasks, and engage participants who are not ordinarily disaster responders. Disasters also disable routine equipment and facilities needed for emergency responses.

Organizations inexperienced in disasters often respond by continuing their independent roles. They fail to see how their function fits into the big picture and the total response effort (Auf der Heide, 1989). This isolation occurs not just in response, but also in planning. All too often, private sector groups and different levels of government may not have plans that realistically consider the roles and resources of other groups.

Key factors in an organization’s effectiveness are flexibility and the ability to improvise. It is critical for responding agencies to educate themselves about the roles and responsibilities of other local, state, and federal agencies in time of disaster. They must plan for disaster response based on a solid knowledge of the organizational environment.


A mental health disaster plan is essential to coordinating the mental health emergency response efforts with other emergency response organizations in time of disaster. It is strongly recommended that each state department of mental health have a mental health disaster plan which is a component of the state emergency management plan. In many states, the governor mandates a mental health disaster plan by executive order. In a similar manner, each department of mental health, city, county, or regional, should have a mental health disaster plan. This plan should be a well-integrated component of the comprehensive emergency management plan for that jurisdiction. Some states have mandated this by legislation.

The purpose of a mental health plan is to ensure an efficient, coordinated, effective response to the mental health needs of the affected population in times of disaster. It will enable mental health to maximize the use of structural facilities, personnel, and other resources in providing mental health assistance to disaster survivors, emergency response personnel, and the community (California Department of Mental Health, 1989; New Jersey Department of Human Resources, 1991). The mental health disaster plan should specify the roles, responsibilities and relationships of the agency to federal, state, and local entities with responsibility for disaster planning, response and recovery.

The mental health disaster plan should also specify roles, responsibilities and relationships within the mental health agency in responding to disasters (South Carolina Department of Mental Health, 1991). The plan needs to be organized so that it reaches each level and each component of the agency. It should also identify the respective individuals (by position) who are responsible for carrying out the functions. Individuals should all have back-ups, preferably three deep.

Mental health services are provided to disaster survivors in community locations where survivors congregate. These include but should not be limited to shelters and meal sites. These sites are often operated by the Red Cross in cooperation with social services or other organizations. In long-term recovery, mental health efforts should be integrated with other human services offered to survivors. Because close collaboration with these agencies is necessary, the mental health disaster plan is often a component of, or an attachment to the social services/shelter plan. In some areas, mental health agencies have found it beneficial to include in their plan a Memorandum of Understanding (MOU) with the Red Cross, delineating roles and responsibilities of the two agencies. Mental health services to survivors may also be provided at hospitals, first aid sites, and the coroner’s office. Consequently, the mental health plan requires coordination and integration with the emergency medical plan, the public health plan, and the coroner’s plan.


There are often many volunteer organizations that respond to disasters. Their responses are not mandated by law. However, many individual organizations include disaster response in their charters. Moany are members of the National Voluntary Organizations Active in Disaster (NVOAD). Additionally, existing local groups like volunteer centers may provide specific responses to a local disaster. Mental health should be alert to and familiar with voluntary groups’ responses in disasters. These groups often provide human services not otherwise available to survivors.


Section 416 of the Stafford Act authorizes funding for mental health services following a presidentially declared disaster:

Sec. 416. The President is authorized to provide professional counseling services, including financial assistance to state or local agencies or private mental health organizations to provide such services or training of disaster workers, to victims of major disasters in order to relieve mental health problems caused or aggravated by such major disaster or its aftermath. (FEMA/CMHS, 1992).

Purpose and Objectives

The crisis counseling program for survivors of major disasters provides support for direct services to disaster survivors. A training component in disaster crisis counseling for direct services staff of the project and for training of other disaster services workers may be included. This program has been developed in cooperation with FEMA and the Center for Mental Health Services (CMHS) within the Substance Abuse and Mental Health Services Administration (SAMHSA).

The law was enacted and the program developed in response to the recognition that disasters produce a variety of emotional and mental disturbances that, if untreated, may become long term and debilitating. Such problems as phobias, sleep disturbances, depression, irritability, and family discord occur following a disaster. Programs funded under Section 416 are designed to provide timely relief and to prevent long-term problems from developing.

Assistance under this program is limited to presidentially declared major disasters. Moreover, the program is designed to supplement the available resources and services of state and local governments. Therefore, support for crisis counseling services to disaster victims may be granted if these services cannot be provided by existing agency programs. The support is not automatically provided.

Conditions and Terms of Support

For any assistance, an assessment of the need for crisis counseling must be initiated by a state within 10 days of the date of the presidential disaster declaration. There are two types of support: Immediate Services Grants and Regular Services Grants. Monies for both types of support come from FEMA.

Support for Immediate Services must be requested within 14 days of the date of the disaster declaration. Support may be provided for up to 60 days after the date of the major disaster declaration. This decision is made by the regional director of FEMA or his/her on-site designee, the disaster recovery manager (DRM), after consultation with the Emergency Services and Disaster Relief Branch, Center for Mental Health Services (CMHS) within the Substance Abuse and Mental Health Services Administration (SAMHSA).

Regular Services funding must be requested within 60 days of the date of the disaster declaration. Support may be provided by the assistant associate director of FEMA through SAMHSA, based upon the recommendations of the FEMA regional director and the CMHS Emergency Services and Disaster Relief Branch. The Regular Program is limited to nine months except in extenuating circumstances when an extension of up to three months may be requested.

Eligibility Requirements

The law provides that financial assistance may be provided to state, local, or private mental health organizations. A state agency official is appointed by the governor to make all requests for federal disaster assistance (i.e., the state is the official applicant). This official is the governor’s authorized representative (GAR). Requests for funds under both the Immediate and Regular Program must be made by the GAR. The recipient of support may be a state agency or its designee.

Special Concerns

When developing a request for assistance, the applicant should be aware of special concerns, such as:

  • Specific attention should be given to high-risk groups such as children, the frail elderly, and the disadvantages;
  • Prolonged psychotherapy measures are inappropriate for this program;
  • Maximum use should be made of available local resources and personnel; and
  • Programs should be adapted to local needs, including special cultural, geographic, or political constraints.

Disaster survivors are eligible for crisis counseling services if they are residents of the designated major disaster area or were located in the area at the time of the disaster. Additionally, they must (1) have a mental health problem which was caused or aggravated by the disaster or its aftermath, or (2) they may benefit from preventive care techniques (Federal Register, 1989).

Crisis counseling project staff or consultants to the project are eligible for training that may be required to enable them to provide professional disaster mental health services to eligible individuals. In addition, all federal, state, and local disaster workers responsible for assisting disaster victims are eligible for training designed to enable them to deal effectively and humanely with disaster survivors (Federal Register, 1989).


For Immediate Services, an application for funding in the form of a letter of request should be submitted not later than 14 days following the disaster declaration by the GAR to the FEMA disaster recovery manager (DRM). An additional copy will be submitted to the Emergency Services and Disaster Relief Branch, CMHS, by FEMA for consultation in evaluating the need for Immediate Services and the state’s capability for providing services.

The application for Immediate Services must include the state’s assessment of need, initiated within 10 days of the disaster declaration. An estimate of the size and cost of the proposed program is required. Specifically, the state mental health authority should address each of the following issues, for each jurisdiction that is requesting funds:

Extent of Need: To justify initiation of a special mental health program, the state must demonstrate that disaster-precipitated mental health needs exist.

State Resources: A description of current capabilities and additional disaster needs is required.

Program Plan: Plans for outreach, crisis counseling, referral, consultation, and education should be outlined briefly. Staff qualifications and training needs should also be included.

Whereas the Immediate Services application is expected to address the above issues, it is anticipated that requests will be brief – only a few pages. A more comprehensive statement is expected for applications for the Regular Services.


For Regular Services, a grant application must be submitted with Standard Form 424 not later than 60 days following the disaster declaration. The GAR must submit the application to the FEMA assistant associate director, through the FEMA regional director, and simultaneously to the Emergency Services and Disaster Relief Branch, CMHS.

The application for Regular Services must include:

  1. Public Health Service Grant Application Form SF 424.2. The disaster description including the type of disaster, and its time, place, and duration.
  2. Needs Assessment: Estimates of the total number of individuals in need of direct services and the total number of individuals in need of outreach and consultation and education, for each service provider group. Population demographics.
  3. Program Plan: Description of the manner in which the needs of the affected populations will be met, types of services to be offered and a rationale for each. The plan must reflect attention to cultural, ethnic, or geographic needs or other special factors indigenous to the area.
  4. Staffing and Training: Delineation of the number and kinds of staff required as well as specific training programs for staff.
  5. Resource Needs and Budget: Explanation of the extent to which existing resources are unable to meet the needs of the disaster affected population. The budget must be clearly tied to the program and contain both dollars requested and a justification for individual budget items.

A Workbook for Development of a Grant Application for the Regular Program, other technical assistance materials, and information and guidance on either of the two types of application can be obtained by contacting:

Emergency Services and Disaster Relief Branch
Division of Program Development
Special Populations and Projects
Center for Mental Health Services
5600 Fishers Lane, Room 16C-26
Rockville, MD 20857


It is essential that mental health agencies have an understanding of the basic roles, responsibilities and resources of the private and public organizations and agencies involved in disaster response. This is important in order to function effectively in the complex organizational environment of a disaster. It is also important to have an understanding of the funding available through Section 416 of the Stafford Act to assist local mental health agencies in helping disaster survivors with their emotional and psychological recovery.


Auf der Heide, E. (1989). Disaster response: Principles of preparation and coordination. St. Louis, MO: C.V. Mosby Co.California Department of Mental Health (1989). Mental Health Disaster Plan. Sacramento, CA.

Federal Emergency Management Agency and Center for Mental Health Services. (1992). Crisis Counseling for Victims of Presidentially Declared Disasters. Washington, D.C.

Federal Register (March 21,1989). 54(53): 11629.

New Jersey Department of Human Services, Division of Mental Health and Hospitals. (1991). Mental Health/Emergency Disaster Plan. Newark, NJ.

South Carolina Department of Mental Health. (1901). State Mental Health Disaster Plan. Columbia, SC.


The Long Emergency: Surviving the Converging Catastrophes of the Twenty-First Century (Hardcover)

by James Howard Kunstler 

Editorial Reviews

From Publishers Weekly

The indictment of suburbia and the car culture that the author presented in The Geography of Nowhere turns apocalyptic in this vigorous, if overwrought, jeremiad. Kunstler notes signs that global oil production has peaked and will soon dwindle, and argues in an eye-opening, although not entirely convincing, analysis that alternative energy sources cannot fill the gap, especially in transportation. The result will be a Dark Age in which “the center does not hold” and “all bets are off about civilization’s future.” Absent cheap oil, auto-dependent suburbs and big cities will collapse, along with industry and mechanized agriculture; serfdom and horse-drawn carts will stage a comeback; hunger will cause massive “die-back”; otherwise “impotent” governments will engineer “designer viruses” to cull the surplus population; and Asian pirates will plunder California. Kunstler takes a grim satisfaction in this prospect, which promises to settle his many grudges against modernity. A “dazed and crippled America,” he hopes, will regroup around walkable, human-scale towns; organic local economies of small farmers and tradesmen will replace an alienating corporate globalism; strong bonds of social solidarity will be reforged; and our heedless, childish culture of consumerism will be forced to grow up. Kunstler’s critique of contemporary society is caustic and scintillating as usual, but his prognostications strain credibility. (May) Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.

Book Description

With his classics of social commentary The Geography of Nowhere and Home from Nowhere, James Howard Kunstler has established himself as one of the great commentators on American space and place. Now, with The Long Emergency, he offers a shocking vision of a post-oil future. As a result of artificially cheap fossil-fuel energy, we have developed global models of industry, commerce, food production, and finance over the last 200 years. But the oil age, which peaked in 1970, is at an end. The depletion of nonrenewable fossil fuels is about to radically change life as we know it, and much sooner than we think. The Long Emergency tells us just what to expect after the honeymoon of affordable energy is over, preparing us for economic, political, and social changes of an unimaginable scale. Riveting and authoritative, The Long Emergency is a devastating indictment that brings new urgency and accessibility to the critical issues that will shape our future, and that we can no longer afford to ignore. It is bound to become a classic of social science.

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