Mental Health Planning for Higher Education

1. Mental Health Planning for Higher Education • ACI Train the Trainer Course

2. Objectives • Provide an overview of Missouri’s leadership efforts in campus safety • Understand key concepts of “disaster psychology” and the contribution of mental health experts to emergency planning events • Identify community resources available to support campuses in planning emergency responses that will address the mental health needs of students, faculty, administration and families.

3. Development of Recommendations for Mental Health Response • Virginia Tech Shooting • Governor Blunt appoints Campus Security Task Force, 4-20-2007, led by Dr. Robert Stein, Commissioner of Higher Education and Mr. Mark James, Director of Public Safety • Development of Recommendations: 8-21-2007: Securing Our Future: Making Colleges and Universities Safe Places to Learn and Grow • http://www.dps.mo.gov/CampusSafety/GovernorsFinalReport.pdf • Missouri Homeland Security Advisory Council appoints Higher Education to Council and forms a Higher Education sub-committee

4. Mental Health Recommendations • Students and other members of the campus community should have access to on-campus, licensed mental health services 24 hours per day, 7 days per week • On-campus mental health providers should establish consultation and referral relationships with public and private facilities that accept civil commitments • Every campus should establish a multidisciplinary (academic, law enforcement, mental health) team who share and review information about members of the campus community who are perceived as exhibiting behavior that has caused concern.

5. Mental Health Recommendations • The multidisciplinary team should work collaboratively to develop intervention strategies for individuals who potentially pose a risk to themselves or others. • Early intervention efforts should also include prevention programs to address alcohol and drug abuse and related violence • Prevention programs should ensure that consistent messages and interventions are delivered throughout the campus

6. Related recommendations • All colleges and universities should use the Emergency Response Information Program (ERIP) web-based tool to construct their all-hazard plan. • 2009 pilot yr. with feedback to Higher Education subgroup of Homeland Security Advisory Council • ERIP includes Mental Health planning section • Emergency plans should include appropriate crisis-specific mental health responses, protocols and recovery functions including: • Evidence-based mental health practices for responding to mental health needs of individuals directly or indirectly exposed to violence or trauma • Agreements involving mental health as a function of the emergency operations plan are available to incident command staff for decision making, planning, and support of responders. • The State Emergency Management Agency (SEMA) should ensure that adequate involvement from mental health professionals is included in response and recovery efforts for all crises, including those affecting postsecondary institutions.

7. Planning tool: Missouri ERIP • Emergency Response Information Plan • FREE -On line multi-hazard emergency planning and training tool for K12 schools, higher education and child care agencies • Available on secure site to Response agencies – to include school building layouts, etc. • Availability through the State Emergency Operation Center – MERIS Program. • http://erip.dps.mo.gov

8. Mental Health Aspects of an All-Hazard Plan • All Hazards plans include preparedness and response for all types of hazards: • Natural • Technological or man made • Health • Social

9. Types of Events • Natural disasters • Terrorism • Campus shootings • Community violence • Bus, plane or other motor vehicle accident • Suicide or other traumatic death • Bomb threats • Public health emergency or illness outbreak • Extended shelter in place (hazmat, nuclear) • Decontamination • Fire

10. Mental Health Aspects of an All-Hazard Plan • Mental health response should be seamless and built into the planning • Location of response • Survivors: • Residential & non-residential students • Staff & faculty • Visitors • First Responders • Need for outside assistance • Outreach mechanisms (i.e. may be different if on campus and school has just started vs. toward the end of the school year)

11. Mental Health as a Part of All-Hazards Annexes Would mental health planning be different for the different kinds of hazards? • CBRNE: Chemical, Biological, Radiological, Nuclear or Explosive • Pandemic • Earthquake • Tornado • Flood • Bus or Airplane wreck of students/team What if it was an evacuation situation vs. a shelter-in-place situation?

12. How does Higher Education mental health planning relate to the emergency management field? Emergency management is a structured system: National Incident Management System (NIMS) Incident Command System(ICS) Mental health has a role: Guidance enhances planning for needs of students/faculty Response incorporates mental health planning

13. Understand because… • Perimeter control & access • Crime scene issues • Resource requests • Needs assessment • Mental health & others • Media coverage & communications • Other examples?

14. Linkages Internal departments Other campus counseling networks community

15. Internal Departments • Administration • Mental Health Clinic • Medical Clinic • Wellness Centers • Emergency and Safety Managers • Campus security/law enforcement • Departments that teach counseling, psychology, nursing, emergency management courses • Consider linkages and how staff and students in these departments can be trained to assist.

17. Network of Higher Education Mental Health and Counseling Services • Organized network to consider: • Shared training in risk assessment and evidence-based practices pre and post emergency • Research • Resource inventories • Setting standards • Consultation and peer review • Building relationships with campus and local law enforcement • Involvement in after action analysis

18. Community Partnerships • Community coordination: • DMH Administrative Agents (Community Mental Health Centers) • Access Crisis Intervention (Crisis hotlines) • Local Colleges and Universities • Administration • Emergency Management • Clinics and Mental Health • Law Enforcement/Security • Volunteer Organizations Active in Disaster • National Organization of Victim Assistance • American Red Cross • Salvation Army • Spiritual Care – faith based organizations on campus/off campus

19. Mental Health Service Portals in Emergency • Campus clinic • Campus classrooms, gatherings, memorials • Local hospitals • Family Assistance Centers • Scattered geographic areas • Alternate housing/dining locations • Risk communication: • With Students • With Families • Web, Text, phone, media

20. Using Internal Mental Health Planning Resources Benefits Challenges Plan may be isolated from community plans & resources Risks if planning is an “additional duty” or if there is not continuity over time Emergency planner may be affected by the campus event & unavailable for response Need to consider redundancy Cost of time and money for assigned party in terms of training & time away from other assignments • Know campus environment & involved parties • Credibility and relationships that make planning more effective • Logical for disaster mental health planner to be involved as part of EOC & response efforts • Easier to involve in drills/exercises • Greater involvement in preparedness & prevention

21. Use of External Mental Health Planning Resources Benefits Challenges Lack of understanding of campus “culture” can limit effectiveness Additional costs for the consultant’s time for: Planning Preparedness, including exercises and drills Development of procedures and protocols Training Response • For events that exceed campus resources, use of external expertise may improve local and state collaboration outside the college/university • May provide redundancy for campus events that overwhelm the resources of the college/university

22. Emergency Planning and Disaster Mental Health YES Involve in campus emergency planning efforts Identify internal mental health expertise and determine expertise with disaster mental health • Support training from: • SEMA/DHSS • Local Red Cross • DMH Psychological First Aid Involve in campus emergency planning efforts Determine strategy for including mental health issues in campus emergency planning efforts NO • Identify local disaster mental health expertise • Red Cross • Community Mental Health Center ACI • Regional Hospital Bioterrorism Planning Efforts • Request assistance and establish working agreement regarding: • Extent of involvement in planning • Responsibilities in emergency • Resource commitments in exchange for planning assistance Involve in campus emergency planning efforts

23. PLANNING CONSIDERATIONS • Linkages and agreements: • Community Mental Health Centers • Other mental health providers • Reciprocal agreements with other college campuses • Employee Assistance Programs (EAP) • Mental Health coverage for students

24. Other Mental Health Resources • FEMA Crisis Counseling Program grant • Application through DMH when there is a Federal declaration for individual assistance • Depends on CMHC needs assessment including campuses • SAMHSA Emergency Response Grant (SERG) • Funding for emergency mental health services & disaster related substance abuse treatment and prevention programs • Available in non-presidentially declared disasters • Particularly helpful in cases of mass criminal victimization

25. Discussion or Questions

26. BREAK

27. Mental Health Aspects of All-Hazards Planning Disasters Terrorism Tragic events

28. Thinking about your campuses… Is a tornado different than a fire incident? A disease outbreak? A campus shooting or terrorist attack

29. Disasters & Trauma • Natural vs. human-caused • Degree of personal impact • Size and scope • Visible impact • Probability of recurrence • Media coverage

30. Defining Terrorism • The FBI defines terrorism as: “The unlawful use of force or violence against persons or property to intimidate or coerce a Government, the civilian population, or any segment thereof, in furtherance of political or social objectives.”

31. Motives of Terrorists A primary goal is to create fear! Higher symbolic value = more publicity More publicity = greater fear Greater fear = greater success

32. What scares us? Things frighten us more if they are… • Imposed by other's) • Controlled by others) • Not beneficial in any way to anyone • Hard to treat or rationing required • Manmade • Catastrophic or deadly • Caused by someone or something we don’t trust • Exotic or unusual Than things that are… • Voluntary or by choice • In our control • Helpful or beneficial to us or society • Easily & quickly diagnosable & treatable • Natural • Survivable • Managed by a trusted person or organization • Familiar and routine

33. Keep in mind… • Different perceptions of risk • Different assumptions about luck • Different comfort levels • Degree of control a variable • World views differ • Negative vs. positive benefit

34. Why be concerned about emotional care after a disaster? • Psychological casualty rates are higher than physical fatalities following events. • Support healthy coping skills • Minimize long term adverse consequences

35. PSYCHOLOGICAL CONSEQUENCES OF DISASTER AND TERORISM From IOM publication “Preparing for the Psychological Consequences of Terrorism” www.nap.edu NOTE: Indicative only; not to scale

36. Collective ReactionsTypical phases of disaster: Adapted from CMHS, 2000.

37. Model of Responses to Trauma & Bereavement, CMHS, 1994

38. Table Activity • Pick a campus based incident • May 2, 2003 F2 tornado hits William Jewel College in Liberty MO causing damaging nearly every building and causing 15 to 20 million in damage. • August 27,2005 Hurricane Katrina: Tulane University closed for 4 months; New Orleans, • April 16, 2007: Virginia Tech Shootings: 32 killed, wounded, Gunman Cho kills self; • Feb. 6, 2008 Tennessee tornado destroys dormitories on Union University campus, Jackson TN. 13 trapped under debris, 51 injured with 9 seriously injured. • June, 2008 Hurricane Ike floods inundate 20 campus buildings and numerous athletic fields – University of Iowa • February 14, 2008 Northern Illinois University Campus shooting in Dekalb kills 5, wounds 18 • Relate behavior and reactions observed to the model University of Iowa Campus, 08

40. Common Reactions are Holistic

41. Common Reactions • Emotional: crying, anger, excessive worry, feeling overwhelmed, irritability, guilt, sadness and depression • Behavioral: Increase risky behaviors: excessive use of alcohol or drugs • Cognitive: Inability to focus, Cannot problem solve; difficulty making decisions or concentrating • Physical: Headaches, stomachaches, numbing, fatigue; changes in eating or sleeping patterns; • Spiritual: Religious confusion, anger at God, renewed commitment;

42. Other Student Reactions • Heightened vulnerability • Major life decisions changes • Increased risk taking • A student may wish to consider professional mental health assistance if he/she: • Has strong feelings that will not go away • Intense reactions that occur longer than 4 – 6 weeks • Has an inability to resume normal activities, studies, etc

43. Other Student Reactions • Feels depressed, or has feelings of hopelessness or anger • Is extremely anxious • Continues to have events dominate thoughts • Avoids people or places because they remind him/her of the event • Suffers from continued physical problems for which no organic cause can be found • Sees his/her life falling apart with a loss of friendships, or problems with family or at school or work • Is overly reliant on alcohol or other drugs to block emotional pain • Has thoughts of suicide or hurting others.

44. Autonomic Nervous SystemSympathetic Nervous System Threats to survival = Fear Reactions to fear: Fight Flight or submission Adrenaline pumps Body reacts

45. Key Concepts (cont.) Risk factors—Population Exposure Model: • Injured survivors, bereaved family members • Survivors with high exposure to disaster trauma, or evacuated from disaster zones • Bereaved extended family and friends, first responders • People who lost homes, jobs, and possessions; people with pre-existing trauma and dysfunction; at-risk groups; other disaster responders • Affected people from the larger community Adapted from DeWolfe, 2002.

46. Trauma • Traumatic Crisis: an event in which people experience or witness: • Actual or potential death or injury to self or others. • Destruction of homes, neighborhood, or valued possessions. • Loss of contact with family/close relationships. • Traumatic Stress may affect • Cognitive functioning. • Physical health. • Interpersonal relationships.

47. Group Activity • Each of you should take 6 index cards • List on two a person you care about • List on two a favorite possession • List on two something you enjoy doing

48. Group Activity • Shuffle your cards upside down • Now draw two and turn them over in front of you. • Imagine that you lost these things in a disaster • Discuss feelings with group

49. Disaster Mental Health Response • People reacting normally to an abnormal situation • Identification of people at-risk of severe psychological reactions • Work in non-clinical settings • Deliver stress management, problem solving, advocacy & referral • Changes with evolving emergency phases • Response may be to students, faculty, staff, and campus responders including non traditional responders such as health care workers

50. Mediating Factors • Prior experience with a similar event • The intensity of the disruption in the survivors’ lives • Individual feelings that there is no escape, which sets the stage for panic • Emotional strength of the individual • The length of time that has elapsed between the event occurrence and the present