Overview of Louisiana’s Disaster Mental Health Preparedness and Response to Hurricane Katrina

1. 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

2. Speier, A. (2006) Louisiana Office of Mental Health

3. Disaster Preparedness 2005 Speier, A. (2006) Louisiana Office of Mental Health

4. Pre- Katrina Disaster Preparedness: DHH Disaster Task Force OMH CMHC Staff Assist at Sp NS Staff Call Out Registry • 4,000 DHH EmployeesTrained 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

5. Pre-Katrina Disaster PreparednessJuly-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

6. 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

7. Initial Locations of OMH Incident Response: • TMOSA Sites • New Orleans • Baton Rouge OEP Command Center OPH Command Center SARBO New Orleans Emergency Response Sites OPH Command Center TMOSA SARBO NOPD Sites OEP – Tent Cities for Police Units Baton Rouge Sites Special Needs Shelters New Orleans Baton Rouge Houma/Terrebonne Lafayette Lake Charles Alexandria Monroe Evacuation of Charity Hospital in New Orleans Acute Unit to Central Louisiana State Hospital Speier, A. (2006) Louisiana Office of Mental Health

8. OMH Incident Response:August 29, 2005 to November 2006 Behavioral Health Command Center SAMHSA Emergency Response Grant 7 Mobile Crisis Teams (Shelter support) SpNS and General Shelters operate through early 2006 Hospitals Evacuated through April 2006 Family Call Center Initial Crisis Counseling Grant SAMHSA/Westover Clinical Teams through 6/30/06 Continuity of Operations Speier, A. (2006) Louisiana Office of Mental Health

9. Post Katrina/Rita Realities2006 Speier, A. (2006) Louisiana Office of Mental Health

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. Behavioral Health Incident Management: Communication Pathway 2006 Hurricane Season STATE EOC State EOC DHH DESK (Independence Blvd.) OAD DHH EOC (Bluebonnet Blvd.) Behavioral Health Section Chief OCDD OMH Disaster Operations Executive Staff OMH OAD Human Services District./Authority (AD/DD/MH) 9 DHH Regional Commanders (OPH) Behavioral Health Regional Liaison OCDD OMH * note: OMH Regional Managers Designee and Inpatient Facility Manager or Designee (Same illustration is applicable to OAD and OCDD) • Behavioral Health Branch Manager location is Independence Blvd. • Staffing is provided by OAD/OCDD/OMH) Speier, A. (2006) Louisiana Office of Mental Health

20. The Louisiana Crisis Counseling Program Speier, A. (2006) Louisiana Office of Mental Health

21. Whatis 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 Mental Health Services (CMHS). Speier, A. (2006) Louisiana Office of Mental Health

22. 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

23. 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 • Volunteers of America of Greater New Orleans. Speier, A. (2006) Louisiana Office of Mental Health

24. Louisiana Spirit Union Morehouse Claiborne West East Bossier Carroll Lincoln Webster Service Area I: CCANO Caddo Ouachita RichlandSt Madison Jackson Service Area II: VOA GNO Bienville Red Service Area III: Options River Caldwell Franklin DeSoto Tensas Winn Service Area IV: Harmony Natchitoches Catahoula ServiceArea V: VOA GBR LaSalle Grant Undeclared: VOA GBR Sabine Concordia Rapides Vernon Avoyelles St. Washington West East Helena Feliciana Evangeline Pt. Beauregard Allen Coupee Tangipahoa East St. Landry W. Livingston St. Tammany Baton Rouge Jefferson Acadia St. Calcasieu Davis Martin Orleans Iberville Lafayette Ascension St. St. John James St. Iberia Assumption s Charles Cameron Vermilion Lafourche St. Bernard Jefferson Terrebonne Plaquemines St. Mary 3 Speier, A. (2006) Louisiana Office of Mental Health

25. Louisiana Spirit Union Morehouse Claiborne West East Bossier Carroll Lincoln Webster Rita …. Caddo Ouachita Richland Madison Jackson Bienville Red River Caldwell Franklin DeSoto Tensas Winn Natchitoches Catahoula LaSalle Grant Sabine Concordia Rapides Vernon Avoyelles St. Washington West East Helena Feliciana Evangeline Pt. Beauregard Allen Coupee Tangipahoa East St. Landry W. Livingston St. Tammany Baton Rouge Jefferson Acadia St. Calcasieu Davis Martin Orleans Iberville Lafayette Ascension St. St. John James St. Iberia Assumption s Charles Cameron Vermilion Lafourche St. Bernard St. Mary Jefferson Terrebonne Plaquemines 3 Speier, A. (2006) Louisiana Office of Mental Health

26. 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 and recovery of the entire population. Speier, A. (2006) Louisiana Office of Mental Health

27. 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

28. Level of Service Needed LA Spirit LA Spirit LA Spirit Mental Health Agencies Education & Information Psychological First Aid Crisis, Trauma, Grief Loss Counseling Referral for Tx Speier, A. (2006) Louisiana Office of Mental Health

29. 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

30. Facilitating Integration How to facilitate collaboration & coordination of services so that more needs are met effectively and efficiently? Speier, A. (2006) Louisiana Office of Mental Health

31. 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 Lifeline1-800-273-TALK • Stress Management Cadre • First Responder Agencies • Special Population Groups Speier, A. (2006) Louisiana Office of Mental Health

32. 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

33. Louisiana Spirit Crisis Counseling Program Data (9/1/05 – 8/31/06) Immediate Services Program Speier, A. (2006) Louisiana Office of Mental Health

34. 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

35. 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

36. Brief, Individual, and Group Contacts Over 1,000,000 In-Person Contacts have been made. Speier, A. (2006) Louisiana Office of Mental Health

37. Individual Contacts by Service Area Speier, A. (2006) Louisiana Office of Mental Health

38. Individual Contacts By Age Speier, A. (2006) Louisiana Office of Mental Health

39. Individual Crisis Counseling Contacts by Race Speier, A. (2006) Louisiana Office of Mental Health

40. Referrals by Type Speier, A. (2006) Louisiana Office of Mental Health

41. 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. Speier, A. (2006) Louisiana Office of Mental Health

42. 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 disaster-declared parishes • Survey was designed on a 5th grade reading level Speier, A. (2006) Louisiana Office of Mental Health

43. Participant Feedback Survey- Results • 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

44. 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

45. 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

46. 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

47. Response Bias • Women and older adults were over-represented in the survey sample. • There did not appear to be racial/ethnic or geographic biases. Speier, A. (2006) Louisiana Office of Mental Health

48. Too Many Cooks Spoil the Broth Practice and Policy Considerations Speier, A. (2006) Louisiana Office of Mental Health

49. 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

50. 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