Remarks by
A. Kathryn Power, M.Ed.
Director
Center for Mental Health Services
Substance Abuse and Mental Health Services Administration
U.S. Department of Health and Human Services
The National GAINS Center and The Center on Women, Violence and Trauma Expert Panel Meeting/Opening Remarks
After the Crisis: Healing from Trauma after Disaster
April 24, 2006
Bethesda, MD
Attached is the text prepared for delivery; however, some material may have been added or omitted at the time of delivery.
America has been described as a nation of ideas transformed by events. Some events propel us forward. Others test our mettle. Hurricane Katrina certainly qualifies as an event of the mettle-testing variety.
Clinicians are seeing significant symptoms of traumatic stress among survivors. Calls to local suicide hotlines are up 60% post Katrina. SAMHSA estimates that up to 500,000 people may be in need of assistance...a number that is likely to grow as “Katrina-weariness” sets in, making the survivors even more vulnerable to depression and other problems. Growing anxiety over the upcoming hurricane season…heightened by skepticism over the state of readiness…is taking a heavy toll on the nation’s mental well being.
Yes, the challenges are enormous…and ongoing. But, even in the wake of the hurricane’s unprecedented devastation… even as the crisis continues to unfold…I firmly believe that Katrina can serve as the “tipping point” for a fundamental change in the way we understand and approach mental health disaster preparedness and response, especially for some of the most vulnerable victims of these events.
I believe we can use the lessons learned from the Katrina experience…along with the growing knowledge base about the power of consumer-directed, recovery-focused care…to dramatically improve our ability to meet the particular needs of the population that is the focus of today’s meeting—mental health consumers with previous trauma histories, including those who are involved with the criminal justice system and those who experience violent crimes in the aftermath of this disaster.
I would like to welcome each of you here this morning and thank you for your willingness to come together to explore this very critical issue. The information exchange that will take place over these next two days is crucial to SAMHSA…to the field…and to the Americans who count on us for help at their moments of greatest need. Through this dialogue, we can generate solutions that benefit from the creativity and the diversity of our collective thinking.
I am here this morning to share the SAMHSA perspective…and to describe the Agency’s role in disasters, like Katrina—from crisis response to long-term mitigation and recovery.
I am here because self-help and peer support are increasingly being recognized as vital to promoting recovery in the wake of disasters. I am very excited about the potential inherent in initiatives such as the After the Crisis: Healing from Trauma Following Disasters awareness and assistance campaign. This campaign—designed to promote strategies for addressing the long term mental health needs of victims of disasters and violent crimes—moves us a crucial step closer toward our goal: to improve our ability to effectively respond to every American during times of disasters.
I salute the work that The National GAINS Center and the Center on Women, Violence and Trauma have done to launch this campaign. I am here this morning to join in the chorus of voices who believe and embrace the concept that underlies it—that is, the notion that people with mental illnesses and abuse histories who have been able to rise above the distress of some of our Nation’s worst disasters to provide leadership and support to their peers are central to effective disaster preparedness and response efforts.
(pause)
Effective disaster preparedness and response is an essential part of SAMHSA’s vision of a life in the community for everyone. When Katrina struck, SAMHSA focused all of its resources to help the affected communities along the Gulf Coast deliver an effective behavioral health response.
Of course, dollars were a top priority in making sure that people got the services they needed. SAMHSA provided an immediate initial payment of $600,000 to four impacted states within 14 days of the hurricane’s landfall. These funds provided for much needed clinical services, including pharmaceuticals to ensure continuity of care for those requiring ongoing treatment. More funds were awarded as we determined the types of services that needed to be in place after the shelter phase. Just last month, SAMHSA awarded an additional $300,000 to Mississippi to aid in their ongoing mental health response.
This month, SAMHSA awarded approximately 20 new grants—through a partnership with FEMA—that will enable states to address ongoing counseling needs of persons adversely affected by the hurricanes…regardless of whether they are residing in their home states or resettling in other areas. When combined with the early round of immediate services crisis counseling grants, SAMHSA has supported states’ efforts with more than $97 million in federal crisis counseling grants to date. More grants will be awarded in coming weeks.
Funding was only one piece of the puzzle. We set up the SAMHSA Emergency Response Center, or SERC, through which we served as the coordinating body for the overall federal response for mental health and substance abuse issues around Katrina. The SERC operated 12 hours a day, seven days a week at the height of the disaster. A scaled-back SERC operation is still being maintained to monitor ongoing deployments of mental health and substance abuse professionals.
In the days, weeks, and months immediately following Katrina, the SAMHSA SERC deployed nearly 700 federal and civilian staff to fill gaps in local mental health and substance abuse service capacity. These clinical teams have provided nearly 50,000 counseling sessions since the disaster…helping thousands of vulnerable men and women reconnect with the essential services and medicine they needed to get through this situation and to reconstruct their lives.
The SERC became a one-stop source for the public. We responded to over 5000 e-mails, and phone calls too numerous to count. We developed and disseminated hundreds of thousands of copies of publications, assessment tools, training guidelines, and other publications on disaster behavioral health needs to states, shelters, and others.
We mobilized the SAMHSA-sponsored National Suicide Prevention Lifeline, to assist evacuees around the country who were in crisis. This resource was sorely needed—two months after the storms hit, we recorded a 62% increase over average pre-Katrina call volume.
Together with the Ad Council, SAMHSA has launched an outreach campaign that includes radio and television public service announcements— in English and Spanish— to encourage survivors who may be experiencing psychological distress following the hurricanes to consider seeking mental health services.
Along the way, we learned a number of valuable lessons. Many opportunities for transformative thinking and collaborative action have risen out of the tragedy of Hurricane Katrina.
Katrina challenged us to collaborate more effectively…to make greater use of active community outreach and other proven case management models…and to quickly increase capacity to respond to mounting demands for services. Katrina prompted us to strategize about how to meet the need for immediate assistance while assessing how to rebuild the mental health system in the affected areas in the right way. Katrina challenged us to carefully consider how to invest dollars in evidence-based practices that we know are going to work, and to put the incentives in the right place as these systems are being rebuilt.
How did we do? There were many success stories. In Mississippi, one team thwarted an 11-year-old girl’s suicide plan and arranged for an emergency appointment with the local mental health center. In another instance, our clinicians were asked to evaluate a woman, suffering from paranoia, who was living in a tent on her destroyed property. She held a rifle in her arms to keep anyone from coming near her. The woman refused treatment or her medications. But one of our clinicians was able to encourage her to disarm the weapon. Follow ups found her doing better and back on her medications again.
The bottom line: SAMHSA mounted a response to the Katrina disaster that was as comprehensive as it was complex. Our response encompassed the principles of collaborating with State and local officials as well as disaster relief organizations—both public and private. Our strategies promoted wellness and resilience, prevention of substance abuse and other harmful coping strategies, and help-seeking behavior. SAMHSA’s response efforts brought to the fore the importance of proactive and comprehensive mental health and substance abuse response as a vital and life-saving activity that significantly aids all aspects of disaster recovery.
And, yet, we still could not touch everyone. We still could not meet every need…especially the particular needs of the most vulnerable groups…with our population-based approaches.
That’s why I am here today. I know that more can be done. Especially for people whose severe trauma histories leave them susceptible to re-traumatization, relapse, or the disruption of their ongoing recovery after a disaster. For these very vulnerable men, women, and children, events like Katrina pose a double tragedy. We must redouble our efforts to assist them along their personal journeys of healing and recovery.
Over the course of these next two days we will explore, together, a number of exciting approaches in disaster response that are proving to be quite effective among these most vulnerable populations. Notably, some of the most promising are peer response models.
It should come as no surprise that some of the most innovative and promising approaches to mental health disaster response have grown out of the lived experiences of consumers. The entire concept of recovery began with consumers. The genesis of the recovery movement is in the writings and experiences of consumers who have spoken with such eloquence, such knowledge, such truth and understanding about the ways in which mental illness can transform a life…and the personal struggle for hope that is involved in seeking recovery.
Who better to take the lead in helping others to transform their lives? Who better to inspire others to have hope in recovery even in the face of disaster? Consumers are in a natural position to lead others on the journey of recovery. Consumers are the evidence that counters myth with fact…hopelessness with hope.
And, the consumer-run, peer support model is not new in disaster response. The SAMHSA crisis counseling program—that has been in effect for 30 years—relies on a consumer and peer-driven approach. This program calls on community leaders—individuals who have lived through the crisis and who are relying on disaster relief services, themselves—to help others through their stress. In any given community, individuals who have been identified as mental health consumers may be among these community leaders. This is a very effective form of peer-supported recovery.
The peer run disaster response services programs that we will hear more about during these next two days are shining examples of the power of peer-supported recovery in action. Programs in New York, Pennsylvania, Oklahoma, California, Louisiana, Texas, and Florida clearly demonstrate how peer-run programs are inherently consistent with the established principles of disaster response. These programs emphasize outreach. They occur in natural community settings. They focus on people’s strengths…not their weaknesses. They avoid labels. And they are culturally sensitive because they are delivered by people who are themselves community members.
And, importantly, these programs work. A successful track record has been established. Consumers have shown us…through their proactive initiatives in response to the Oklahoma City bombing, the 9/11 tragedy, and the recent hurricanes…that trauma-informed peer support is effective as a supplement to other disaster efforts.
These programs bring together the best of trauma-informed care, disaster response, and peer support. They provide a particularly supportive environment for addressing prior trauma. It is an exciting development…one that warrants further investigation, further support, and a commitment to incorporate these techniques into mainstream disaster preparedness and disaster response programs.
Why are these kinds of programs so critical for our future work in disaster mental healthcare?
The peer-to-peer model is an exceptional example of the innovative ways in which we can help the system overcome its own barriers. It is an example of the way the system is going to have to transform itself to create an environment conducive for recovery.
These kinds of programs are critical because, as Larry Fricks—Director of the Georgia State Office of Consumer Relations—has said so eloquently, “Our greatest potential for improvement does not lie in mental health systems. It lies within the individual who has faith that she or he can recover, does recover, and then shares that good news with others.” This way of thinking puts consumers at the center of the system of care. It moves the role of consumers and families far beyond simply participating in the system. In this vision, consumers direct their own futures. It is a powerful idea. And a critical one. Because, I believe, the greatest source of transformation—transformation of our disaster response efforts, and of our entire mental health services delivery system—will come from the potential of the individual…of the self.
That’s why we, at SAMHSA, are working hard—within our own Agency, and in States and communities across the country—to promote the importance of consumer-driven approaches… to spread the message of consumer-driven recovery.
In the landmark report, Achieving the Promise: Transforming Mental Healthcare in America, the President’s New Freedom Commission on Mental Health called for a fundamental transformation of our national mental health services delivery system— transformation from a system built to serve bureaucracies into a system that is driven by the needs of consumers and focused on recovery.
SAMHSA and its partners across government have drafted an Action Agenda in response to this call. This first Action Agenda outlines specific steps that we, at the Federal level, can take immediately to advance transformation. A renewed focus on consumer-driven initiatives is central to this agenda. In fact, SAMHSA has declared 2006 as the “Year of the Consumer.” As part of this umbrella initiative, we are committed to helping States expand the use of peer support and other self help and mutual aid models…both in their disaster response activities and across a spectrum of other areas of need.
Later this summer, for instance, we are planning a dialogue session between consumers and representatives of the disaster response community to identify opportunities for improved disaster response to people with mental illnesses. The goal: to bring these two groups together—similar to the way we have come together today—to discuss what is really needed to promote recovery in the wake of disasters…and to develop trust and the mutual understanding necessary to create effective alliances. We believe this face-to-face dialogue will result in further recommendations for increased collaboration and other strategies to promote recovery in the context of behavioral health response to disasters.
The value of peer-to-peer recovery support services are increasingly being recognized across SAMHSA. A few months ago, we announced the availability of $2.5 million for seven Peer-to-Peer Recovery Support Grants to develop, design, deliver, and document peer-driven recovery support services that help prevent relapse and promote long-term recovery from alcohol and drug use disorders.
We are also near completion of a Peer Specialist Certification Resource Kit─a tool designed to assist in training former or current mental health consumers to become Certified Peer Specialists (CPS). The Peer Specialist Certification kit—complete with a manual with detailed information on how to design, plan, implement, and manage a peer specialist program—will be sent out to Commissioners and advocacy groups in each State. When this initiative is complete, every State will be equipped to adopt this Medicaid-billable peer training service and certification process…a process that will help to build an emerging workforce of people in recovery from mental illnesses…people who are strengthening their own recovery by helping others with their recovery. What an incredibly compelling concept! An entire workforce of peers driving change!
Through our work with the Annapolis Coalition—a group committed to promoting, identifying, and implementing strategies for improving our behavioral healthcare workforce —we will continue to examine the role of peers in the workforce.
Another key component of our consumer participation initiative is the development of an evidence -based toolkit on consumer-run services that will help raise the standards and facilitate widespread adoption of consumer-run services.
We also support a statewide consumer network grant program designed to harness the power of consumers to promote systems change. The program enhances State capacity and infrastructure by supporting consumer-run organizations. Grantees throughout the nation—from Alaska to California to Nebraska to Vermont, to South Carolina and elsewhere—use these resources to address stigma, reduce mental health disparities, prevent criminalization, promote self-care and many other activities.
We also support five national technical assistance centers on peer support and we hope to issue new grants for these along with the State network grants, next fiscal year.
What does all of this mean for disaster preparedness and response? It means we are on the right track. By recognizing and harnessing the power of consumers to promote recovery, the After the Crisis: Healing from Trauma Following Disasters campaign is moving us in the right direction. Over these next two days…as we review the knowledge base, identify gaps, and make recommendations for developing strategies to support further development and implementation of trauma-informed, peer-run disaster preparedness and response efforts…we will move even closer to our goal—the day when we can help every American heal from the trauma of disasters.
More research is needed…on trauma-informed peer support…on how disaster response can be successfully integrated with services in criminal justice settings…on strategies for overcoming barriers and forging collaborative partnerships. We have many more questions than we have answers. This will not be easy work. But, the words of a peer counselor from the Project Liberty Peer Support Initiative provide a powerful impetus to keep pushing on.
He said: “For a year and a half, I was involved in Project Liberty…as a way of helping mental health consumers affected by the World Trade Center disaster. In addition to the hope that peer support gives to the recipient consumers, it also provides unique opportunities for the peer counselors. Instead of being the person in need, I was giving services. My self esteem was reborn. I learned a great deal. I learned to believe in myself.”
As these words full of optimism and hope attest, events like September 11 th and Hurricane Katrina may test our mettle, but, they can also propel us forward.
And, isn’t that what “healing after a crisis” is all about?
Thank you.
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