Developing Cultural Competence in Disaster Mental Health Programs:
Guiding Principles and Recommendations

Foreword

Disasters—earthquakes, hurricanes, chemical explosions, wars, school shootings, mass casualty accidents, and acts of terrorism—can strike anyone, regardless of culture, ethnicity, or race. No one who experiences or witnesses a disaster is untouched by it.

Peoples’ reactions to disaster and their coping skills, as well as their receptivity to crisis counseling, differ significantly because of their individual beliefs, cultural traditions, and economic and social status in the community. For this reason, workers in our Nation’s public health and human services systems increasingly recognize the importance of cultural competence in the development, planning, and delivery of effective disaster mental health services.

The increased focus on cultural competence also stems from the desire to better serve a U.S. population that is rapidly becoming more ethnically and culturally diverse. To respond effectively to the mental health needs of all disaster survivors, crisis counseling programs must be sensitive to the unique experiences, beliefs, norms, values, traditions, customs, and language of each individual, regardless of his or her racial, ethnic, or cultural background. Disaster mental health services must be provided in a manner that recognizes, respects, and builds on the strengths and resources of survivors and their communities.

The Crisis Counseling Assistance and Training Program (CCP) is one of the Federal Government’s major efforts to provide mental health services to people affected by disasters. Created in 1974, this program is currently administered by the Center for Mental Health Services (CMHS), Substance Abuse and Mental Health Services Administration (SAMHSA), and the Federal Emergency Management Agency (FEMA). The Program provides supplemental funding to States for short-term crisis counseling services to survivors of federally declared disasters. Crisis counseling services provided through the Program include outreach, education, community networking and consultation, public information and referral, and individual and group counseling. The CCP emphasizes specialized interventions and strategies that meet the needs of special populations such as racial and ethnic minority groups.

The purpose of this guide is to assist States and communities in planning, designing, and implementing culturally competent disaster mental health services for survivors of natural and human-caused disasters of all scales. It complements information previously published by FEMA and CMHS on disaster mental health response and recovery. FEMA provided the funding for this guide as part of the agencies’ ongoing effort to address the needs of special populations in disaster mental health response and recovery. Developing Cultural Competence in Disaster Mental Health Programs: Guiding Principles and Recommendations is part of a series of publications developed by CMHS.

In developing this guide, CMHS recognized that cultural competence is a complex subject—one that has varying terminologies, opinions, expectations, models, and paradigms. The authors sought to identify common concepts and to suggest guiding principles and recommendations for primary and behavioral health care providers working with disaster survivors in multicultural communities. Although it is the hope of CMHS that readers will find the guide useful, the authors also recognize that it is by no means intended to provide comprehensive information on cultural competence.

The guiding principles are based on standards, guidelines, and recommendations established by SAMHSA, the Office of Minority Health, and the Health Resources and Services Administration in the U.S. Department of Health and Human Services (DHHS), although the guiding principles do not necessarily represent these agencies’ specific views. Mental Health: Culture, Race, and Ethnicity—A Supplement to Mental Health: A Report of the Surgeon General (DHHS, 2001) informed our efforts to ensure consistency with fundamental practice and theory.

To produce this guide, the authors invited input from State and local disaster mental health coordinators and consultants as well as from reviewers at the national, State, and community levels. The publication also incorporates information gathered through an extensive literature review. Vignettes from CMHS grant applications and grantee reports illustrate the range of promising practices, experiences, and challenges of State and local disaster mental health programs nationwide. As work on the guide continued, CMHS became increasingly aware that the principles and values underlying cultural competence parallel those historically espoused by disaster mental health service providers.

This publication is a first step toward developing a framework for the design of culturally competent disaster mental health programs. It also is the hope of CMHS that the information it provides will improve understanding and increase the ability of State, local, and community mental health and human service administrators, planners, trainers, and other staff to respond sensitively and effectively to the needs of all disaster survivors.

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