August, 2006
TO: DMH Administration Division Directors, Community Mental Health Center Directors, Hospital Directors
FROM: Ed Spencer, M.Ed., MSW
Manager, Emergency Preparedness Planning and Response
SUBJECT: State Mental Health Disaster Recovery Plan: An All Hazards Approach
DATE: June 1, 2006
Enclosed are important additions to the DMH Disaster Response Plan including the national Operating Conditions (OPCON) structure, specifics regarding the preparation of DMH response teams (Away Teams) and community recovery strategies. This material has been developed in conjunction with changes within the Emergency Response Plan of the SC Emergency Management Division. Orientation and Training on will be provided to center and hospital Disaster Coordinators in January 18, 2006
Please call me at (803) 898-8579 with questions and comments.
ES: sjn
Enclosure
DISASTER ACTION GUIDE TO BE
COMPLETED FOR EACH COUNTY AND
INCLUDED IN EACH MHC/HOSPITAL PLAN
IN THE EVENT A DISASTER IS PREDICTED OR HAS OCCURRED IN YOUR AREA, TAKE THE FOLLOWING IMMEDIATE ACTION:
1. NOTIFY YOUR CENTER/HOSPITAL DIRECTOR OR THE PERSON ACTING IN THAT CAPACITY:
NAME:____________________________________
OFFICE PHONE: ___________________________
HOME PHONE: ____________________________
2. NOTIFY THE OFFICE OF PUBLIC SAFETY AT THE DEPARTMENT OF
MENTAL HEALTH:
EMERGENCY NOTICE: (803) 935-5499
24 HOUR DISPATCHER NUMBER: (803) 935-5478 or 935-5470
GIVE THE NAME, LOCATION, DIRECTIONS AND PHONE NUMBER OF THE MENTAL HEALTH CONTACT PERSON IN THE AREA.
3. SEND A MHC STAFF MEMBER TO THE COUNTY EMERGENCY
OPERATIONS CENTER LOCATED AT:
ADDRESS: ______________________________________________________
DIRECTIONS: ___________________________________________________
_________________________________________________________________
NAME OF COUNTY EMERGENCY PREPAREDNESS DIRECTOR:
_________________________________________________________________
PHONE NUMBER DURING REGULAR WORKING HOURS: ( )
PHONE NUMBER 24 HOURS A DAY: ( )
4. IMPLEMENT YOUR CENTER or HOSPITAL DISASTER PLAN.
5. MAINTAIN CONTACT WITH THE DEPARTMENT OF MENTAL HEALTH
OFFICE OF PUBLIC SAFETY AT LEAST EVERY TWO HOURS UNTIL
ADVISED OTHERWISE.
STATE ACTION GUIDE
TO BE COMPLETED FOR EACH COUNTY AND
INCLUDED IN EACH MHC/HOSPITAL PLAN
1. COUNTY: ______________________________________________________
2. LOCAL MENTAL HEALTH CENTER/CLINIC CONTACT PERSON:
NAME: __________________________________________________________
HOME ADDRESS:________________________________________________
HOME PHONE: __________________________________________________
DIRECTIONS TO THE HOME FROM COLUMBIA: _________________________________________________________________
_________________________________________________________________
OFFICE ADDRESS: _______________________________________________
OFFICE PHONE: _________________________________________________
DIRECTIONS TO THE OFFICE FROM COLUMBIA: _________________________________________________________________
_________________________________________________________________
3. COUNTY EMERGENCY PREPAREDNESS OFFICE CONTACT PERSON:
NAME: __________________________________________________________
EMERGENCY OPERATIONS CENTER ADDRESS: _________________________________________________________________
_________________________________________________________________
EMERGENCY OPERATIONS CENTER PHONE NUMBER: ____________
DIRECTIONS TO THE COUNTY EMERGENCY OPERATIONS CENTER FROM
COLUMBIA: _____________________________________________________
_________________________________________________________________
The South Carolina Department of Mental Health is indebted to Peggie Shealy, Ph.D., (Ret.) and Fred L. Sons, Director of Public Safety (Ret.) who pioneered disaster preparedness planning and response from the mental health perspective in South Carolina and nationally. Their leadership in educating staff about the role of public mental health agencies in disasters and their coordination of the Department's response to the Tornadoes of 1984 resulted in a cadre of staff knowledgeable about mental health disaster services. Their legacy proved invaluable in organizing the Department's response to Hurricane Hugo in September, 1989.
The Department of Mental Health also acknowledges the outstanding contributions of its employees who responded to Hurricane Hugo, either by going into the affected areas or by working double shifts or covering additional services back home. These employees were magnificent.
Their analysis of the Department's response during the Hugo Retrospective Conference in October and November, 1990, which was funded by the Federal Emergency Management Agency and the National Institute of Mental Health, provided the information that was needed to make the original plan possible. The work of the Statewide Disaster Preparedness Committee in providing critiques of drafts of the original plan was invaluable.
A very special Thank You goes to Nancy Carter, retired. Her commitment to faithfully reflect the information and recommendations made by staff is commendable.
Through the work of Emergency Services Branch of the Center for Mental Health Services in Rockville, Maryland and the Federal Emergency Management Agency, the Department of Mental Health has had the privilege of learning from other States' experiences with disaster mental health services since our experience with Hurricane Hugo. The ever growing knowledge base from these experiences has contributed significantly to this revision of the plan. We thank them for their consistent help and support.
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 |
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| Alison Y. Evans, Chairperson Mental Health Commission |
John J. Connery, M.A., Interim State Director |
June 1, 2006
Local Action Guide
State Action Guide
Acknowledgments
Statement of Execution
Basic Plan
Introduction to Plan
Purpose
Threat of a Natural Disaster Event
Hurricane Evacuation Terminology
Section I - Overview
Introduction
Statutory Authority
Organizational Structure and Overview of Responsibilities
Responsibilities of State Offices and Divisions
Planning and Preparedness Section Overview
Alert and Mobilization Section Overview
Response Section Overview
Recovery Section Overview
Section II - Planning and Preparedness
Planning Guidelines for State Offices and Divisions
Planning Guidelines for Mental Health Centers
Planning Guidelines for DMH Inpatient Hospitals
Section III - Alert and Mobilization
Guidelines for Activating the Plan
Influenza Pandemic Plan
Procedures for Activating the Plan
Establishment of a Mental Health Emergency Operations Center
Actions of the State Coordinating Team
Establishment of Needs Assessment Teams
Needs Assessment Check List
Conducting the Needs Assessment
Establishment of Crisis Counseling Teams
Alternate Plan for Department of Mental Health Disaster Coordination
Section IV - The Response Phase
Actions of the State Coordinating Team
Needs Assessment
Response Coordination
Structural Relationships
Team Development and Operations
Support Services
Debriefing Procedures
Section V - Recovery Phase
Disaster Response Team
Needs Assessment
Crisis Counseling Services
Reference I - Office of Public and Legislative Affairs
Reference II - Office of Public Safety
Reference III - Office of General Counsel
Reference IV - Division of Community Care Systems
Reference V - Division of Children, Adolescents, and Their Families
Reference VI - Services to Persons with Mental Illness and Deafness
Reference VII - Division of Quality Management
Reference VIII - Division of Financial Services
Reference IX - Division of Human Resource Services
Reference X - Division of Education Training and Research Services
Inpatient Program
Planning Grants Data Outcome and Evaluation
Reference XI - Division of Information Technology Services
Reference XII- Office of Multicultural Services
Introduction
Initial Needs Assessment
Daily Needs Assessment Form
Shelter and DAC Information
Disaster Services Contact Form
Appendix B - Essential Documents
Annex J: County-CMHC Planning Document
Appendices To Annex J
1. Organization Chart
2. SCDMH Disaster Response Team
3. Mental Health Alert List
4. Adjacent Counties/Mental Health Centers
5. Mental Health Requirements Statement
Statutory Authority
The Role of the SC Department of Mental Health
Domestic Preparedness Readiness and Response Levels
Conglomerate Operations
System of Operating Condition (OPCON'S)
Roles and Responsibilities of "Go" teams
Utilization of Volunteers
Notice of Distribution
Unified Community Crisis Counseling Teams ("Away Teams")
School Related Disaster Response
Interface with Disaster Plans of Other Agencies
Memoranda of Agreement with Related Agencies
Fact Sheet for "Go" teams
MH Disaster Shelter Operations
State level Emergency Management
Orientation to Community Assignments
Disaster Response: Impact on staff
Worker Stress Reactions
Support and Stress Management Checklist
Disaster Response: Scope of Disasters
Disaster Matrix: Local and State Declared
Disaster Matrix Graphic
All Hazards Disaster Planning
Federally Declared Disasters:
American Red Cross MOA (See Disaster Manager)
SC Social Services MOA (See Disaster Manager)
Appendix D - Miscellaneous
National Incident Management System Testing Link (NIMS)
Heat Wave: A Major Summer Killer (.pdf format)
Criteria for the Selection of Disaster Crisis Counselors (.pdf format)
The purpose of the South Carolina DMH Disaster Recovery Plan is to provide a framework for the delivery of coordinated assistance to local mental health centers and hospitals. This plan provides processes and procedures to utilize crisis counseling and other disaster related services in time natural disaster or act of terrorism.
_________________________
Interim Director
_________________________
C. Edgar Spencer
DMH Disaster Response Manager
Office of the Medical Director
1. INTRODUCTION:
A. General. The policy of the State of South Carolina is to be prepared for any emergency or disaster. South Carolina State Regulations 58-1 and 58-101 require contingency plans and implementing procedures for all major hazards, other natural or manmade disasters, led by the state and coordinated with counties that have a potential of being impacted. The South Carolina Emergency Management Division Plan augmented by this plan, and the Emergency Support Functions (ESFs) Standard Operating Procedures (SOPs), meet the requirements of the stated regulations. It is the goal of the South Carolina Department of Mental Health to establish and maintain close collaboration with Sister agencies including Department of Alcohol and Drug Abuse (DADOAS), Department of Health and Environmental Control, South Carolina Vocational Rehabilitation ns the Department of Disabilities and Special Needs.
B. Specific: This plan establishes specific policies and procedures to be followed by the mental health centers and hospitals when responding to the threat of a natural or terrorism related disaster. The SC Emergency Management Division (SC EMD) Plan addresses all forms of disaster operations if South Carolina is impacted by an event.
The SC Emergency Management Division Plan covers the threat, operations and recovery terminology, the utilization of the various disaster plans as the basis for disaster preparedness and planning, evacuation decision timeline, phased evacuation decision factors, and lane reversal/counter flow indicators when indicated.
Each state designated geographic conglomerate section serves as the general operational plan for the conglomerate.
To prevent or minimize injury to individuals and damage to property or to the environment resulting from a disaster by planning and coordinating the application of DMH, state and local crisis counseling resources to warning, evacuating, sheltering and recovery activities for South Carolina citizens and visitors.
3. THREAT OF A NATURAL DISASTER EVENT:
South Carolina is susceptible to all levels of tropical cyclones, from tropical depressions to severe category 5 hurricanes. These tropical cyclones produce three major hazards: the storm surge, high winds, and rainfall-induced flooding.
A. Storm Surge. The storm surge is a large dome of water often 50 - 1- miles wide that sweeps across the coastline near where a hurricane makes landfall. The surge of high water topped by waves is devastating. The stronger the hurricane, the higher the surge will be. Along the immediate coast, storm surge is the greatest threat to life and property.
B. Winds. Hurricane winds can destroy building, mobile homes, and other property. Debris, such as signs, roofing material, siding, and other items become missiles in a hurricane. The winds are the greatest cause of property damage inland off the coast. In addition, hurricanes often produce numerous tornadoes, which add to the storm's destructive power. These tornadoes most often occur in rain bands well away from the center of the storm.
C. Rainfall-induced Flooding. Widespread torrential rains, often in excess of 6 inches, can produce deadly and destructive floods. Long after the winds have subsided, hurricanes can generate immense amounts of rain. In 1999, Hurricane Floyd produced high rainfall totals that resulted in devastating floods in South and North Carolina.
4. HURRICANE EVACUATION STUDY TERMINOLOGY:
A. General. The South Carolina Hurricane Evacuation Study (HES) prepared by the U.S. Army Corp of Engineers (COE) includes analyses of technical data concerning hurricane hazards, vulnerability of the populations, public response to evacuation advisories, timing of evacuations, and sheltering needs for various hurricane threat situations. These analyses, all or in part, had significant impact on the South Carolina Hurricane Plan. The major analyses are: hazards, vulnerability, behavioral, shelter, and transportation analysis.
The COE managed the project with input and coordination from federal, state, and local agencies. The HES provides tools for use by emergency managers in preparing for and initiating hurricane evacuation operations. The key components are the hurricane evacuation zones and estimated evacuation clearance times. Both components are further addressed in the Basic Plan and the respective Conglomerate Annexes Introduction Section.
B. Hazards Analysis. The hazards analysis determines the timing and magnitude of wind and storm surge hazards that can be expected from hurricanes of various categories, tracks, and forward speeds. The Sea, Lake, and Overland Surges from Hurricanes (SLOSH) numerical models were used by the National Hurricane Center to compute surge heights. The South Carolina coast is included in three SLOSH basins: Wilmington, Charleston, and Savannah. The COE based hazards from freshwater flooding on the Federal Emergency Management Agency's (FEMA's) Flood Insurance Rate Maps.
C. Vulnerability Analysis. Using the results of the hazards analysis, the vulnerability analysis identifies those areas, populations, and facilities that are vulnerable to specific hazards under a variety of hurricane threats. Inundation maps were produced and evacuation scenarios were developed. The evacuation scenarios are based on the category of storm. For each scenario evacuation zones were delineated. Population data were used to determine the vulnerable population within each evacuation zone. In areas of potential inundation, critical facilities were identified, such as nursing home and hospitals.
D. Evacuation Zones. These are areas in coastal counties vulnerable to storm surge inundation and rainfall-induced flooding. A product of the Hurricane Evacuation Study, the zones meet the following objectives: be describable over radio/TV media to public; be based upon easily identifiable roadway or natural features for boundary identification; relate to storm surge limits based on the most recent SLOSH models; allow coastal county residents to determine if their home is in a storm surge vulnerable evacuation area; be useable for the HES transportation modeling; and be related to census/traffic analysis zone boundaries for population and dwelling unit tabulations and calculation of vulnerable populations. The zones are depicted and described in the respective Conglomerate Annexes' Introduction Section.
E. Behavioral Analysis. This analysis determined the expected response of the population threatened by various hurricane events in terms of the percentage expected to evacuate, probable destinations of evacuees, public shelter use, and use of available vehicles. The methodology employed to develop the behavioral data relied on: discussions concerning expected behavioral response with emergency management staff in each county, review of past behavioral studies as a part of various hurricane planning efforts conducted by COE and FEMA, behavioral research by Hazards Management Group for the region, and behavioral data collected for the 1996 Hurricanes Bertha and Fran responses in Horry County. Even with these resources, the COE used a great deal of assumptions and judgment in developing the needed parameters.
F. Shelter Analysis. The shelter analysis presents an inventory of pre-designated public shelter facilities, capacities of the shelters, vulnerability of shelters to storm surge, flooding, and shelter demand for each county. Shelter inventories were furnished by emergency management offices in each county and by the local American Red Cross Chapter. The COE estimated the shelter demands from behavioral analysis data.
G. Transportation Analysis. The principal purpose of the transportation analysis was to determine the time required to evacuate the threatened population (clearance times) under a variety of hurricane situations and to evaluate traffic control measures that could improve the flow of evacuating traffic. Transportation computer modeling techniques developed to simulate hurricane evacuation traffic patterns were used to conduct this analysis. To provide a better estimate of where these people will go, the behavioral studies included work to estimate what portion of the evacuees will go to other inland counties or seek safe haven in other states.
1. Estimated Evacuation Clearance Times. A HES tool describing the time required to clear the roadway of all vehicles evacuating in response to a hurricane situation. Clearance time is one of two major considerations involved in issuing an evacuation order or advisory. The other time is the arrival of sustained tropical storm winds. The clearance times were developed by storm scenario and by behavioral characteristic for each conglomerate.
Clearance time begins when the first evacuating vehicle enters the road network and ends when the last evacuating vehicle reaches an assumed point of safety. Clearance time includes the time required by evacuees to enter the road network (referred to as mobilization time) and the time spent by evacuees traveling along the road network due to traffic congestion (referred to as queuing delay time). Clearance time does not relate to the time any one vehicle spends traveling on the road network and does not include time needed for local officials to assemble and make a decision.
Several hundred clearance time runs were done based on differing intensity of hurricanes, evacuation area assumptions, rapidity of evacuees' response, and differing tourist seasons. Clearance times generally fall below 24 hours for most of the scenarios. However, due to the limited road network and large numbers of tourists and permanent residents who would have to evacuate in the northern conglomerate, times could potentially exceed 30 hours for a Category 4-5 hurricane, high tourist occupancy scenario.
Pursuant to the plan South Carolina Department of Public Transportation on file with the South Carolina Office of Emergency Preparedness, (803-737-8500), one or more conglomerates' evacuation traffic does nothing to an adjacent conglomerates' clearance time situation. The clearance evacuation time used when one or more conglomerates evacuate is the longest time for each conglomerate based upon their own individual clearance time and track/forward speed of the storm relative to their area location. In addition, traffic produced by inland county mobile home evacuees does little to impact congestion levels on inland evacuation routes. Inland traffic assignments reflect the tendency for inland mobile home residents to evacuate with the county.
The clearance time calculated for each scenario (category of storm) was based on three criteria: evacuation zone participation rates, population response rate, and level of tourist occupancy.
2. Evacuation Zone Participation Rates. Participation rates assumed by zones within a county, and for each scenario, are part of the clearance time model. Key factors behind the participation assumptions are as follows:
a. Zones to be evacuated for storm surge were assumed to have 100% participation rate. Even though in actuality these rates will be lower, as a matter of public safety the clearance times calculated in this study should allow those who are vulnerable to storm surge the opportunity to evacuate whether they choose to or not.
b. All mobile home residents in conglomerate counties are assumed to evacuate.
c. A portion of the theoretically non-vulnerable population was also assumed to evacuate in the modeling. This percentage could be higher than what was used particularly for more intense hurricanes (1% - 15%), but will be balanced out with the less than 100% of surge residents who will participate in an actual event.
3. Response Rate. A critical behavioral aspect considered for the transportation analysis was the rapidity of evacuation response of the evacuating population. Behavioral data from past hurricane evacuations shows that mobilization and actual departures of the evacuating population can occur over a period of many hours or over a very brief time. In the Hurricane Bertha and Fran evacuation, evacuees loaded the road network over a long period due to the meteorology and path of the storm. In Hurricane Floyd, traffic loaded the road network very quickly.
4. Tourist Profile. The tourist population varies throughout the hurricane season. The clearance times were estimated for a low and high tourist population. The high tourist population is based on 90% occupancy of tourist units and the low tourist population is based on 30%.
Federal legislation requires that states provide crisis counseling to survivors of natural and terrorism disasters. In most cases, this responsibility rests with DMH and local community mental health centers.
Disasters are unplanned and involve a host of unexpected elements. Disasters often result in feelings of fear, anger, stress, anxiety, depression and many other emotional reactions. These are normal responses to overwhelming stress from coping with an abnormal situation created by a disaster. In recent years, mental health professionals have been called upon to address such emotional reactions in these situations, hence the mental health role in disaster response and recovery.
Knowledge about the emotional effects of disasters and the emotional effects of trauma and post traumatic stress reactions have joined as a multi-agency and multi-disciplinary field of endeavor. Consequently, the role of the public mental health system now encompasses traumatic community events such as terrorism, violence, loss of life from fire, auto, bus or industrial accidents, etc. Community based crisis response teams are developed to respond to these local events. These teams often include trained staff from emergency medical services, fire and law enforcement agencies, the community clergy and public and private mental health practitioner as well as collaboration with DHEC, DDSN, SCVR and DADOAS. The South Carolina Department of Mental Health and several of its community mental health centers and facilities are members of the South Carolina Crisis Response Team Consortium. The goal of the statewide Consortium is to encourage the development of local crisis response teams; providing training in debriefing skills to individual members and to assist communities experiencing a traumatic event to heal from that experience. The South Carolina Department of Mental Health Disaster Plan now includes planning for a mental health response to community incidents as well as responding to regional and national major disasters.
The purpose of disaster planning is two-fold: First to specify the role, responsibility and relationship of the agency to federal, state and local entities who have overall responsibility for disaster planning, response and recovery; second, to specify roles, responsibilities and relationships internally in the agency in responding to disasters.
The plan that follows consists of an explanation of statutory authority for Emergency Preparedness Planning and Response. It then details the organizational structure of the Department of Mental Health in responding internally and in collaboration with the SC Emergency Management Division. In appropriate sections, it also outlines the role and responsibility of community mental health centers and hospitals in responding to local disasters and traumatic events.
The Robert T. Stafford Disaster Relief and Emergency Assistance Act and Miscellaneous Directives of P. L. 100-707 establishes the requirements that SC Emergency Management Division plan for providing mental health crisis counseling services in manmade or natural disaster response and recovery. Section 416 of this act specifically addresses the mental health function. The law states:
The President is authorized to provide professional counseling services, including financial assistance to state and 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.
South Carolina state statutes have also been established in order to address state, county and municipal responsibility during a disaster situation through all phases of response and recovery. (Refer to acts 25-1-420, 25-1-430 and 25-1-450, S.C. Code of Laws, at Appendix B).
The State Director of the Department of Mental Health also established in April, 1990, a policy directive which defines the responsibility of the Department of Mental Health regarding disaster preparedness planning and response. (Refer to Directive 783-90 in Appendix B).
1. The Commission of the South Carolina Department of Mental Health is responsible for establishing policy which governs the administrative actions of the State Director. In turn, the State Director has delegated operational responsibility for disaster preparedness planning, training and implementation to the Office of the Medical Director. The clinical management role is further delegated to Director, Division of Special Projects, and Office of the Medical Director.
2. Operational principles and responsibilities of this clinical manager are as follows:
D. RESPONSIBILITIES OF DMH OFFICES AND DIVISIONS
1. Office of the State Director:
The State Director and/or Deputy Director supervises all disaster coordination activities including the following:
A. Office of Public and Legislative Affairs I (Reference I):
1. Coordinate all media relations including involvement with print and visual media materials.
2. Develop and maintain a library of brochures and educational materials for public dissemination.
3. Provide liaison to volunteer services external to DMH including the Mental Health Association, American Red Cross, faith community, Volunteer Organizations Assisting in Disasters, etc. and coordinate DMH volunteer responses.
B. Office of Public Safety (Reference II):
1. Serve as a Departmental team member to the S.C. Emergency Management Division disaster activities.
2. Supervise and help staff with needs assessment and resource acquisition.
3. Provide on-site security for DMH staff in the disaster area.
4. Provide logistical planning and support in transporting personnel, deploying supplies, medication and assorted equipment.
5. Serve as the primary liaison with state and county Emergency Operations Centers where needed.
C. Office of General Counsel (Reference III):
Provide legal consultation, advice and assistance when unusual circumstances arise.
D. Office of the Medical Director and Division of Community Care Services (Reference IV) "General":
1. Coordinate the Department's overall clinical response to the disaster, including activation of the DMH Disaster Response Team and local EOC process.
2. Identify and orient clinical staff as needed to respond to the disaster.
3. Supervise all grants earmarked for crisis counseling and trauma services.
4. Supervise the implementation and maintenance of disaster related crisis counseling programs.
Office of the Medical Director/Division of Community Care Services/Joint Emergency Operations Center (Reference IV) "Specific":
1. Provide clinical staff for the needs assessment and response phases.
2. Coordinate the formation and deployment of crisis counseling "Away Teams".
3. Coordinate coverage for Disaster Application Centers, local Emergency Operations Centers, Shelters and other sites as may be needed in the affected area.
4. Coordinate 24 hour phone coverage of the DMH Emergency Operations Center.
5. Provide support and staff for clinical coordination activities.
6. Provide medical equipment and medications through the pharmacies.
7. Plan for the evacuation of patients from DMH hospitals in a disaster area to hospitals in non-affected areas.
8. Plan for receiving inpatients from hospitals in affected areas.
9. Plan for receipt of nursing home or non-critical medical patients from community facilities.
10. Supervise a mandatory debriefing process and procedure for DMH employees and volunteers who are responders in the field.
Division of Community Care Services (Reference IV):
1. Assist the Community Office of the Medical Director and Division of Community Care Services in the selection and deployment of crisis counseling teams.
2. Ensure that people with psychiatric disabilities are educated about how to personally prepare for a disaster, how to access disaster related services and the plan for restoring community mental health services in the event of a disaster.
3. Develop a peer counseling program in which consumers can provide crisis counseling services to consumers impacted by the event.
E. Division of Children, Adolescents and Their Families (Reference V):
1. Coordinate the presence of children's mental health workers on crisis counseling teams.
2. Provide consultation and training to children's mental health workers about disaster trauma, trauma resolution and assisting families, teachers and other caregivers to help their children work through the disaster experience.
F. Services for Persons with Mental Illness and Deafness (Reference VI):
1. Coordinate the availability of American Sign Language interpreters and counselors for deaf persons to serve on crisis counseling teams.
2. Ensure the availability of stress de-briefing services for deaf responders and stress reduction services for the general public who are deaf.
G. Office of Financial Services (Reference VIII):
1. Provide a system to document all costs including equipment, supplies and regular and overtime hours of personnel involved.
2. Facilitate emergency purchases and contracts.
3. In coordination with the Office of Information Technology Services, procure communications and other equipment as many are needed.
4. Provide food, supplies and equipment to support crisis counseling teams and local MHC and hospital recovery operations.
5. Provide engineering services to assess the damage to office buildings and effect sufficient repairs to make sites operable.
6. Provide priority printing services to insure the availability of public information.
H. Division of Human Resource Services (Reference IX)
1. Issue identification tags for volunteers working under DMH supervision.
2. Expedite approval process for hiring new crisis counselors.
3. Establish policies and procedures governing unusual personnel actions which may require staff to respond to emergencies.
4. Secure trauma counseling and debriefing services for the DMH Disaster Response Team members and DMH employee responders through a contract.
I. Division of Education, Training, Research and Evaluation (Reference X):
1. Under the Office of Continuing Education and Staff Development:
2. Provide clinical staff for the needs assessment phase.
3. Provide staff to assist the Division of Community Care Services in carrying out their responsibilities.
4. Provide maintenance personnel to assist with debris removal, delivery, setup, operation and maintenance of equipment (e.g., generators, chain saws, etc.).
5. Supply and maintain vehicles.
6. Complete property damage assessments and coordinate appropriate insurance claims and determine needs beyond insurance coverage.
7. Collect data regarding disaster impact on personal and property losses.
8. Supervise the development of the Immediate Services Grant for crisis counseling services.
9. Supervise the development of the Regular Services Grant for crisis counseling services.
J. Division of Information Technology Services (Reference XI):
1. Organize and report data collected from crisis counselors in the course of their providing services to disaster survivors to support data information requirements for grant applications and the documentation of grant supported services.
2. Coordinate the procurement and issuing of communications equipment and services.
The Planning and Preparedness Phase includes the time period before a disaster. Activities include the development of plans and participation in local, regional or statewide training exercises. Disaster plans need to include the role of the hospital or center as a survivor and as a responder. Plans need to address internal lines of authority and action. Joint plans and collaboration with the local County Emergency Preparedness authority are also needed at the community mental health center level. This phase also includes provision of appropriate training for staff and at least an annual update or revision of plans and a comprehensive review of the plan with all staff.
The Alert and Mobilization Phase includes the time period immediately preceding a forecasted disaster and/or the impact phase of the disaster. Activities include activating the plan, notifying the system to go on Alert, forming the state level coordinating team, setting up the Mental Health Emergency Operations Center and reassigning staff in preparation for the event. Early training and deployment of staff to shelters, EOCs, etc., the development of stand-by staff and crisis counseling teams and taking inventory of supplies and equipment, all take place during this phase. This section outlines areas of responsibility for the pre-disaster warning period and the initial response activities and broadly describes procedures which will be followed.
This section focuses on the manner in which disaster mental health services are provided from impact until the recovery phase begins. During this period, which generally lasts no more than six to eight weeks, resources from within the mental health system are dedicated to the affected areas until the crisis is resolved or federally supported crisis counselors are hired to take over the longer term services needed by survivors. Assistance in restoring community mental health center operations and stationing staff at congregate sites in the community where survivors are likely to be are the two primary goals. Working in concert with local mental health staff, FEMA and other response personnel, outreach to the public and center clients is conducted; individuals and families are counseled; responders are debriefed; and people in need of longer term crisis counseling services are identified.
This section addresses the provision of crisis counseling services to survivors for a nine month period. These services are provided by full-time temporary staff, usually indigenous workers with trained and experienced clinical supervisors. These services are provided through outreach and in community settings where survivors live and work.
The following guidelines should be viewed in the context of the overall Department of Mental Health All Hazards Disaster Plan. The major sections that follow this can serve as a guide to community mental health centers and inpatient hospitals as to what should be addressed. Community mental health centers and hospitals are strongly encouraged to plan from the level of "small" community incidents such as random violence or chemical spills to major catastrophic events like earthquakes and hurricanes. Centers and hospitals are also encouraged to participate through their individual staff activities and other related response organizations.
Each office and division shall develop a written plan that specifies how the assigned responsibilities will be carried out. These plans will be reviewed and updated annually.
1. The Internal Disaster Plan:
2. County Disaster Plans
1. Inpatient programs will have disaster plans which meet the requirements of their accrediting bodies.
2. Plans will list specific primary staff contacts and telephone/fax numbers by which those staff members may be reached. Back up staff members, who may be contacted if primary staff are absent when activation of the plan occurs, will also be listed. These staff listings should be separated into
Clinical Staff and Administrative/Support Staff lists for ease of use.
3. Plans will address how the Inpatient Program relates to and works with the local and/or state Disaster Response Teams. The SCDMH Teams will also identify necessary linkages to other affected agencies and service providers/groups and ensure that these linkages are initiated and maintained as necessary.
4. Inpatient programs will have plans for housing evacuees from other inpatient and community programs on an emergency basis.
5. Plans will provide a framework for ensuring that adequate staffing exists to continue the day to day operations of each affected inpatient program or hospital. This will be especially important when designated staff members from those hospitals are called to the field to provide crisis counseling, damage assessments, or other needed services during or after a disaster.
6. Inpatient hospitals will review and update their internal Disaster Plans at least once a year, involving all staff in this process. Any necessary forms, assessment tools, or other items that need to be added to the Plan will be addressed at these annual reviews.
7. The Division of Community Care Services shall be responsible for coordinating the development of disaster plans with the Emergency Preparedness Offices in Richland and Anderson counties on behalf of the hospitals located in those two counties.
The following are general guidelines. In all instances, the magnitude of the disaster shall take precedence over the size of the area affected in governing the Department's response. Local mental health agencies are expected to be proactive in assessing whether they need to respond to a local incident and in advising the Department of Mental Health that outside assistance is needed to ensure the availability of recovery activities and services.
1. Community Incidents/Emergency Situations:
In situations where small groups of individuals are affected by a traumatic event or where one county or service area is affected, it is the responsibility of the community mental health center/inpatient facility to activate its plan. When the plan is activated, the DMH Disaster Response office is to be notified immediately. In these situations, casualties and property losses are minimal and response is generally within the capability of the local mental health. Should outside assistance or special expertise be needed, the Department of Mental Health through SCEMD GSF-8 will secure that on behalf of the local center. CMHCs and inpatient hospitals need to develop a capacity to work with local community based Crisis Response Teams at this level of event.
In the event of a Center Specific loss or tragic event which impacts the entire Center, The Office of the Medical Director, Division of Emergency Prepared Response at the request of the affected organization, shall ensure the operations of the Center are covered by clinical and administrative staff and shall provide post traumatic stress debriefings as requested.
2. Small Scale Disasters:
When one or two service areas, four or fewer counties, one hospital or a portion of a hospital is affected by a disaster, this would qualify as a small scale disaster. A Presidential Declaration may or may not exist. The responsibility for alert, response and recovery remains with the local area though DMH assistance may be needed. State level assistance would be available for needs assessment, deployment of outside assistance and other necessary supports. CMHCs and Inpatient hospitals are responsible for activating their plans and for notifying the DMH Disaster Response Office of their status and needs. Local CMHC staff should immediately be deployed to county EOCs to monitor the impact and keep local and state staff advised of developing issues.
3. Large Scale Disasters:
Three or more service areas or more than four counties affected by a disaster or a Presidential Declaration constitutes a large scale disaster. DMH, CMHCs and Inpatient hospitals, DHEC, DDSN, SCVR,DADOAS, will automatically activate their respective plans. Immediate contact should be made with the DMH Disaster Response Manager, if at all possible. The DMH will also exercise its judgment to immediately deploy a needs assessment team(s), if preliminary reports indicate the scope and magnitude is significant. The needs assessment will form the basis for determining the resource and support needs of the affected mental health system and geographical area.
B. DMH Influenza Pandemic Plan
In the event that the President, Office of Homeland Security and/or the Center for Disease Control implement emergency plans to address an influenza pandemic, the South Carolina Department of Mental Health in conjunction with the Department of Health and Environmental Control (DHEC) will implement plans to address the threat to our clients, staff and their families.
In concert with the South Carolina Pandemic Plan (SCPP) at DHEC, SCDMH will prioritize the distribution of vaccines and anti-viral in the following manner.
1. All personnel providing direct care services to those hospitalized in DMH Facilities, including Nursing Homes, will be offered the inoculations in the first phase of implementation including the Office of Public Safety. The staff of those residential Care Facilities housing clients, Towards Local Care of SCDMH will be offered the vaccine.
2. In the event of an avian influenza event, the areas impacted will, with the permission of the Governor, Close the Community Mental Health Centers in the impacted areas. Center Staff selected by the Center Director, will assist in local facilities designated by DHEC to ensure clients have access to needed mental health services.
3. Key SCDMH staff including the State Director of Mental Health, the Medical Director, the Director of the Division of Community Care Services, the Director of Emergency Preparedness, and selected members of the Disaster Coordinators Director of the Division of Financial Services, Director of Information Technology and key staff; Director of Communications, Director of Human Resource Management and skeleton staff, and volunteer administrative assistants will receive the vaccine.
4. SCDMH will follow the State plan and take every precaution to provide prevention programs, containment strategies and crisis support to those affected by the pandemic.
1. Notification: The State Director, Deputy Director, Division head, and staff that are in an acting role in these positions including the DMH Disaster Response Manager are authorized to activate the State Mental Health Disaster Plan.
If anyone other than the Director activates the plan, the Director must be notified immediately after the event and the Chairperson of the Mental Health Commission is to be notified thereafter.
Members of the management team are to be notified through phone, e-mail and/or fax that the plan is being activated and are to notify their staff, centers, hospitals, offices and units.
2. Preliminary Actions:
The DMH Disaster Response Manager is responsible for establishing and supervising the MHEOC. In turn, each CMHC/hospital should address the need for the establishment of a local MHEOC. If desired, local service areas can develop mutual aid agreements with regard to supporting the implementation of local disaster plans. The DMH EOC will be staffed 24 hours a day for as long as necessary and serve as the point of contact between state level coordination and local needs, including assembling information about resource needs.
The DMH Disaster Response Team shall convene with the activation of the State Mental Health Disaster Plan or at the discretion of the State Director or his designee(s) depending upon the magnitude of the disaster. It shall remain operational until the recovery phase begins. The Disaster Response Team will meet daily to review the status of the response, emerging needs and requirements, assign tasks and areas of responsibility and debrief groups returning from the field assignments.
Needs assessment teams shall evaluate the magnitude of the disaster with regard to casualties and damage incurred by the disaster, the status and needs of the CMHC/hospital director, the capacity of staff from the affected area to respond and the needs of community leaders and the general public in the affected area.
1. Community Incidents/Emergency Situations:
CMHC's and hospitals shall plan for and conduct a needs assessment. The assessment should address the needs of survivors, their families, by-standers or witnesses, first responders and the community at large. It should also address service delivery in concert with existing community based Crisis Response Teams. Debriefing and crisis counseling services should be available for people directly impacted and public education provided to the community. CMHCs should move pro-actively in these events and not wait to be called.
2. Small Scale Disasters:
CMHC's and hospitals should activate their plans. An assessment of the scope and magnitude of the event and the number of people affected directly and indirectly should be carried out as quickly as possible. Local mental health staff should begin crisis counseling and debriefing services immediately. The CMHC should call the DMH Disaster Response Manager as soon as the plan is activated and keep the Disaster Response Manager advised of the needs. If additional assistance is needed, DMH will activate its plan to provide it.
3. Large Scale Disasters:
DMH will automatically activate its plan and send need assessment teams when large scale disasters are predicted or occur without warning. These teams will link with the CMHC at the County EOC unless other arrangements are made beforehand. State needs assessment staff will work with local mental health staff to determine the full impact of the event and needs resulting from it. The DMH Disaster Response Team will coordinate the deployment of state needs assessment teams and request Public Safety Officers to accompany teams. If necessary, state team members may remain in the affected area until a response may be organized.
A check list will be sent with state level needs assessment teams and is recommended for use by local teams when smaller scale disasters occur. Completed needs assessment checklists will be reviewed by the DMH Disaster Response Team to formulate its response.
1. Needs assessment will include damage assessment of MHC/hospital physical plants and office sites, the status and needs of DMH staff affected by the disaster and their capacity to respond, estimate of casualties and the amount and kind of assistance needed.
2. In large scale or Presidential Declared disasters, DMH needs assessment teams will consist of at least one public safety officer and one or two clinicians in conjunction with a CMHC/facility employee from the affected area. One member of the State team may be required to stay at the County EOC as a primary contact person until a full response is organized, but no more than 24 hours.
3. Need Assessment Teams Shall:
4. Orientation, Training and Instructions:
Orientation and instructions will be provided by the DMH Disaster Response Team. The scope and nature of the event, potential problems that may be encountered and requirements for establishing contact in the affected counties and maintaining contact with the MHEOC will be outlined.
1. The DMH Disaster Response Team, with the assistance of the Division of Behavioral Healthcare Services, shall develop a mechanism for unaffected CMHC's and hospitals to provide a list of staff who are on standby or available to report for immediate deployment to affected areas.
2. Rosters and schedules shall be maintained by the DMH EOC regarding crisis counseling teams on standby and in the field documenting:
1. In the event that the DMH Administrative Building in Columbia is incapacitated due to a disaster, the alternate DMH Coordination site will be Patrick B. Harris Psychiatric Hospital in Belton, South Carolina.
2. In this situation, the Director of Harris Hospital shall have the same authority as the State Director of Mental Health and his staff until the State Director of Mental Health or a member of his line of succession can resume his or her responsibilities.
3. Unaffected CMHCs and hospitals shall coordinate their deployment of personnel and assistance under the supervision of Harris Hospital.
The DMH Disaster Response Team (DRTeam) will meet daily in this phase of the disaster to ensure a steady flow of information, staff, supplies and equipment to affected areas. The focus of coordination will be problem identification and resolution with responsibilities assigned to members or their staff as needed and required.
1. Responsibility for needs assessment will shift to the DMH EOC with support from the Office of Information Technology Services, Office of Medical Director and the Division of Community Care Services
2. The DMH Disaster Response Team will:
1. Crisis counseling team leaders will generally be employees with previous disaster response experience and hold program management or middle management roles in community mental health centers or hospitals.
2. Centers and hospitals will provide a list of staff recommended as crisis counseling team leaders.
3. Team leaders will be trained by the DMH Disaster Response Team with support from the Division of Education, Training, Research and Evaluation when such training becomes available or prior to going into the field in a disaster situation.
1. Team leaders are responsible to the DMH Disaster Response Team in carrying out their overall mission.
2. Team leaders, while responsible to the DMH Disaster Response Team for their overall mission, report to the supervision of the local CMHC/hospital director or his/her designee on site.
3. The Disaster Response Team, in consultation with the Director of the Division of Community Care Services and the affected Executive Director of the CMHC/hospital or his/her designee, will advise the team leaders about where and to whom to report at the disaster site.
4. Team members, regardless of the office, division, CMHC or hospital, will report to the Team Leader for day to day direct supervision while in the field.
5. Team Leaders have the authority and responsibility to return team members to their home base if, in the judgment of the Team Leaders, the team members is unable to carry out the necessary tasks for any reason.
6. Team Leaders have the authority and responsibility to advise the Disaster Response Team if they believe a Center Director is impaired. The Disaster Response Team will consult with the Director of Community Care Services about the matter. The Director of the Division of Community Care Services or his/her designee will supervise or manage any action that may be required.
Teams are made up of clinical and support staff from CMHCs and hospitals in unaffected areas of the state. Their purpose is to provide debriefing and crisis counseling services to responders, community leaders and the general public who are experiencing emotional stress and trauma that follow a disaster experience.
1. Team Functions:
2. Team Structure:
3. Team Configuration:
4. Team Call Up Procedure:
5. Team Assignment:
6. Team Rotation:
The following are guidelines which may vary depending upon the scope and nature of the disaster and varying needs and stresses as the response effort matures.
1. Provision for Teams:
The Division of Administrative Services, will the support of Office of Public Safety, is responsible for procuring, coordinating and disseminating supplies, equipment and other resources needed by teams responding to the disaster and MHCs/hospitals affected by disaster. (See Reference III)
2. Assignment of Vehicles
The Division of Administrative Services shall coordinate the assignment, deployment, servicing and maintenance of vehicles for staff requiring transportation to a disaster site and on-site transportation. (See Reference XII)
3. Facility and Office Building Repair and Debris Removal:
The Division of Administrative Services is responsible for deploying appropriate staff to effect repairs on and remove debris from damaged buildings used by DMH to the extent of making them operable and/or protecting property. (See Reference XII)
4. Medical and Medication Supplies and Equipment
5. Communications:
Telephone lines and equipment, including cellular or mobile phones, specifically designated for disaster response, will be procured by the Office of Information Technology Services. In the event telephone lines are inadequate or inoperable, that Division will coordinate obtaining alternative means of communication. (See Reference XI)
Debriefing encompasses the exchange of information for purposes of planning and coordinating services, as well as, the need for all staff involved in the disaster to deal with the emotional effects of the experience. Debriefing is a specific clinical skill and only people trained in a debriefing model will be permitted to carry out this function. Participation in debriefing is mandatory for all staff involved in disaster work.
1.Process Debriefing:
2. Post Rotation Debriefing:
3. Debriefing for Affected CMHCs/facilities:
4. Debriefing for the DMH Disaster Response Team.
Human Resources Services, through the Employee Assistance Program, will maintain a contact with a non-Departmental trauma counseling firm to debrief state level staff.
Plans for debriefing will be established and coordinated prior to disbandment of the DMH Disaster Response Team.
The Recovery Phase begins when either the local Community Mental Health Center returns to normal operations and provides long term crisis counseling services to survivors or response teams are replaced by temporary full-time crisis counselors. In a Presidential Declared disaster these counselors will be hired with funds from FEMA and the Center for Mental Health Services. In the event the disaster is not declared, DMH may have to support the hiring of full-time temporary crisis counselors if providing this service to survivors is beyond the existing financial capacity of the affected CMHC or hospital.
The DMH DRTeam will be disbanded when the Recovery Phase begins six (6) to eight (8) weeks, post event. The Disaster Response Team will transfer responsibility for service coordination to the Division responsible for managing on-going crisis counseling services. This will most likely be the Office of the Medical Director. The Disaster Response Team will continue to assist that Office with Immediate and Regular Services Grant preparation and implementation as well as The American Red Cross..
The needs assessment function will become one of case finding and establishing referral mechanisms between the crisis counseling program and FEMA, Red Cross Salvation Army, DSS, and other entities who will encounter persons at risk.
These services will be provided by existing local staff when it is within their capacity to do so. If supplemental staff are needed, the following provisions apply.
1. The Medical Director will hire, appoint or reassign a qualified staff member as Project Manager to implement and supervise a State supported program of crisis counseling services or a Federally funded Immediate and Regular Services Grant Program.
2. With the support of the Division of Human Resource Services and with the active involvement of CMHC Directors, a process for recruiting, screening, hiring, training and deploying crisis counseling staff will be negotiated.
3. As a general guideline, crisis counselors will be people indigenous to the affected area who are supervised by trained clinical staff.
4. The Recovery Phase will last from six (6) to twelve (12) months depending on the needs.
5. The final 60 days of the project will focus on termination of counselors with their clients and with their jobs. All reasonable efforts will be made to assist crisis counselors in finding permanent positions with the agency or related health and human service agencies.
6. The Focus of Services and Training of Crisis Counselors:
7. Within three (3) months after the conclusion of the Recovery Phase, an evaluation will be done of the plans and preparation, alert and mobilization and response and recovery phases to revise, refine and improve the Department's capacity to respond.
To provide accurate and timely information and guidelines to the public about how to cope with their emotional reactions to a disaster experience; develop and disseminate educational materials for the public, especially children, their families and teachers; respond to requests from the media about the emotional issues associated with a natural or manmade disaster experience.
A. Develop and disseminate public service announcements and news releases pertinent to the type of disaster and appropriate to the phase of the disaster.
B. Coordinate media relations and support and assist the SC Emergency Management Division Information Officer as resources allow.
C. Develop a library of brochures and educational materials which address a range of possible disasters. Resources are also available on the FEMA site www.usfa.fema.gov.
D. The Department of Mental Health (DMH) makes available to the general public information to help parents and children cope with natural disasters. For example, on the DMH external website, those interested can find coloring books for children who have experienced a tornado or a hurricane. This material is prepared in an easy to read format. Other information is also available on the external site.
On the anniversary of a disaster, DMH Public Affairs can make information available pertaining to the disaster, as well as support the community, schools, and local media in the vicinity of the disaster.
E. The DMH Office of Public Affairs networks with all relevant Public Information Officers (PIO) throughout the state when a disaster occurs, coordinating information as needed. The DMH Public Affairs office maintains a working relationship with the state emergency PIO.
Further, the DMH PIO has taken both the basic PIO class offered by the Stat e Emergency Preparedness Division (EMD) as well as the advanced PIO class offered by FEMA in Emmitsburg, Maryland. In addition, the administrative assistant in DMH Public Affairs has also taken the basic PIO class offered by EMD.
F. DMH Public Affairs makes the public aware of disaster information through various media networks. This includes both print and broadcast. Public Affairs can e-mail in an instant news releases or media advisories to all of the daily papers as well as 35 of the non-daily papers (including some Spanish language) ASL for deaf persons, in the state. Radio and TV stations get faxed material as well as e-mails where requested. At mental health centers throughout the state, the centers’ public information person or disaster coordinator may handle media relations. In addition, Public Affairs will make information available on the DMH external website.
G. In the event of a disaster, DMH Public Affairs can disseminate information to the public regarding experts in a particular field who may be of service. For Example, after 9/11, Public Affairs provide internet links to experts in counseling how to cope with loss.
H. DMH Public Affairs maintains an on-going relationship with the principal media representatives in South Carolina, who will call the PIO for information as needed. DMH will work with media to ensure all information regarding disasters will be broadcast in closed captioning.
To provide for the coordination and delivery of personnel, supplies and equipment to a disaster site; to aid in safety, service delivery, needs assessment, logistical support and communication.
A. Participate in a Department of Mental Health Emergency Operations Center (EOC).
B. Maintain 24 hour liaison with the State Emergency Operations Center for as long as needed.
C. Coordinate obtaining and delivering supplies and equipment needed in the field.
D. Participate in the organizing, briefing and deployment needs of assessment teams, ensuring that a Public Safety Officer travels with each team.
E. Maintain list of key center staff and their locations to facilitate needs assessment team contact and coordination; maintain director list of CMHCs and County EOCs to facilitate local contact and coordination.
F. Maintain master keys to DMH hospital buildings and Central Administration Building.
G. Assign Public Safety Officers to each response team sent to affected areas.
H. Provide for safe transport and storage of medications and other supplies and equipment.
I. Provide security for DMH personnel in affected areas.
J. Organize a courier service in support of response teams, supplies and equipment being deployed to the field as needed.
K. Assist in the evacuation of inpatient facilities when necessary.
L. Maintain a written plan for implementing these activities.
To provide legal guidance to the DMH DRT regarding the legal procedures that may need to be altered to accommodate unusual conditions created by the disaster; assist in negotiating issues of licensure and insurance coverage for out-of-state volunteers; to assist in forms control in ensuring that commitment forms are available to be sent into the field if damage results in the loss of these at a local service site.
A. Assist the DMH DRT to ensure that its decisions and actions are within the scope of law and the statutory mandates of the agency.
B. Provide phone consultation 24 hours a day during the Response Phase to staff in the field if they encounter legal questions.
C. Maintain a current copy of commitment forms which can be used for copying purposes by DMH facilities or other appropriate entities.
D. Process questions related to responsibility, liability, licensure and malpractice for out-of-state volunteers who may offer assistance.
E. Maintain a written plan for implementing these activities.
To ensure a coordinated response to survivors, family members and others in the general population who may have special crisis counseling needs following a disaster.
A. To ensure that the Division of Community Care Services and the community mental health centers and hospitals have current disaster plans that meets the requirements of the State Mental Health Disaster Plan.
B. To educate consumers and their families about disaster preparedness, including shelter options, basic survival information for the first 72 hours, and where to obtain assistance after the disaster.
C. To ensure that specialty staff serving the deaf mentally ill, children, adolescents and their families, the psychiatrically disabled and the elderly have plans to coordinate specialized services for these vulnerable populations.
D. To ensure that staff is available to carry out the organizing, coordinating and supporting functions necessary to respond to a disaster.
E Maintain a written plan for implementing these activities.
To coordinate the involvement of the Division in disaster response and ensure that CMHCs have local disaster plans which meet the requirement of the State-wide DMH Disaster Plan.
A. To participate in needs assessment and coordinate the development, deployment and rotation of response teams in the field.
B. In coordination with the Office of Public Safety, coordinate scheduling of 24 hour phone coverage at the DHEOC.
C. To implement and supervise Immediate and Regular Services Grant programs.
D. To insure that CMHC's participate in local disaster drills.
E. To insure that CMHC's have current disaster plans that meet the requirements of the State Mental Health Disaster Plan.
F. To maintain a written plan for implementing these activities.
To provide for the safety of hospital and nursing home residents in the event of a disaster and to assist in the provision of crisis counseling services in the event of a disaster.
A. To insure that each facility has a current disaster plan that meets accreditation requirements and the requirements of the State Mental Health Disaster Plans.
B. To insure that facility disaster plans are integrated with County Emergency preparedness Offices of the County in which they are located.
C. In the event of a disaster, to ensure that a mechanism is in place access the available staff and bed capacity to determine the number of victims/evacuees who could be housed and/or treated in the hospital or nursing homes. In coordination with the Division of Community Care Systems services provide staff to assist with needs assessment and crisis counseling services in the field during a disaster.
D. To have mutual aid agreements between facilities to accommodate evacuees.
E. To maintain a current written plan for implementing these activities.
_________________
¹It is envisioned that there would be one plan for the Richland County facilities and one with Anderson County for Harris Hospital.
Crisis counseling services will be provided to children, adolescents and their families who are survivors of the natural or manmade disaster, including training and consultation to schools and agencies serving this population.
A. Assist in coordinating the assignment of child mental health workers to response teams.
B. Develop a training curriculum for teachers, guidance counselors and school administrators that is age appropriate, about the nature of trauma, how it is expressed by children and how to work with children to help them resolve the impact of the trauma.
C. Assist in setting up day care areas at congregate sites like shelters, Disaster Application Center, feeding and relief sites.
D. In coordination with the Office of Communications, develop guidelines for families about how to relate to their children about the event and ways families can relieve stress that will be experienced during and after a disaster.
E. Provide direct service commensurate with the need.
F. Work with other disaster agency representatives to coordinate efforts and resources.
G. Maintain a written plan for implementing these activities.
H. Operate within departmental guidelines for implementation.
To educate deaf mentally ill clients and family members about disaster preparedness and crisis counseling services available to deaf survivors.
Deaf and hard of hearing disaster victims are particularly vulnerable in an emergency situation. Clear communication and access to information needs to be assured. For people who rely on sign language or other visual communication modalities, the involvement of professionals with sign adequate language capabilities is crucial.
In a disaster situation, one or two "Deaf Disaster Response Teams" will be assembled, composed of DMH clinical personnel with fluency in American Sign Language. They will be accessible via pager and/or cellular telephone. When other Teams encounter deaf disaster victims, the Deaf Disaster Response Teams should be contacted and involved in relief efforts. In addition, the Deaf Disaster Response Team(s) will work closely with local deaf community resources to coordinate the location and identification of victims and culturally appropriate relief efforts.
All television broadcasts in an emergency area or situation need to be CAPTIONED, and if possible, a sign language interpreter should also be employed to convey emergency information in ASL.
A. Assist in coordinating the assignment of Deaf Services staff and interpreters to response teams.
B. For deaf staff assigned to response teams, assure interpreter services both during training and actual work in the field.
C. Provide crisis counseling services to deaf disaster survivors and their families.
D. Incorporate disaster preparedness planning into educational services for deaf mentally ill clients to include, but not be limited to, where their nearest shelter is and how to get there, how to survive the first 72 hours after a disaster and where to gather for assistance after the disaster.
E. Maintain a written plan for implementing these activities.
To assist the Division of Behavioral Healthcare Services in coordinating and implementing the State Mental Health Disaster Plan.
A. Provide staff to assist with the community needs assessment phase.
B. Provide assistance in coordinating response teams and providing 24 hour phone coverage of the MH EOC.
C. Provide staff to perform Office of Planning development of the FEMA grant process.
D. Maintain a written plan for the implementation of these activities.
To provide for the procurement, reassignment, coordination and utilization of supplies, equipment and vehicles in a disaster situation. To document the cost of DMH's response to a disaster and losses resulting from a disaster; procure goods and services that may be needed on an emergency basis including facilitating emergency contracts for training and grant writing; assist in the preparation and monitoring of grant budgets.
A. Maintain a current inventory of state owned vehicles and their state of repair and have a mechanism for assigning the best vehicles for the use of disaster response staff on a priority basis.
B. Develop a mechanism to provide for the temporary repair of community mental health center service sites and inpatient facilities sufficient to protect property and, if reasonable, render sites useable.
C. Provide maintenance personnel to assist with debris removal and the delivery, set up, operation and servicing of equipment.
D. Ensure the availability of printing services on a priority basis to print educational information for dissemination to the public.
E. Coordinate and conduct property damage assessments of DMH owned property in the community and on hospital grounds which encompasses structural damage, as well as, supply, furnishings, equipment and vehicle losses.
F. Coordinate insurance claims and, where appropriate, Federal Public Assistance claims for damage and loss reimbursement.
G. Support the State Emergency Preparedness Division and the Budget and Control Board by assisting them with damage assessments to the extent that resources are available to do so.
H. In coordination with the Division of Administrative Services, ensure that the cost of supplies, equipment, transportation, etc., of the response/recovery effort is well documented.
I. In coordination with Human Resource Services, document all staff time with particular attention to overtime expenditures for those classes of employees for whom overtime pay is required under the Fair Labor Standards Act and assist in the recoupment of those costs in coordination with the Office of Planning and any grants that may be written.
J. Provide for emergency contracting for supplies, equipment, personnel, service sites, training, or other services as may be needed.
K. Develop and/or review projected FEMA grant budgets and assist in monitoring grant expenditures consistent with Federal requirements.
L. Procure and/or provide supplies and equipment as may be needed including food, generators, chain saws, water and gasoline and containers for same, medication and medical equipment, etc., as may be needed to support response teams, affected staff and restore basic operations.
M. Maintain a written plan for implementing these activities.
To manage the human resource issues associated with a short term and long term response to a disaster.
A. Establish policy ensuring flexibility in work hours requirements to permit the DMH to respond on the basis of the magnitude of the disaster.
B. Establish policy to ensure that employees are not penalized on their performance appraisal for having volunteered or not volunteered for or been assigned to disaster work, including a recourse if the person's continued employment is not in jeopardy.
C. Establish a mechanism to ensure that all DMH employees understand that while volunteers will be sought first for disaster response work, employees are subject to reassignment in order for DMH to meet its mandated responsibility.
D. Develop mechanisms to permit rapid hiring of crisis counselors such that mechanisms are in place within five (5) working days after a Presidential Declaration of the Disaster.
E. Establish a mechanism to provide liability coverage for in-state and out-of-state volunteers working under the auspices of the Department of Mental Health during a disaster.
F. Maintain a written plan for implementing these activities.
To provide for the safety of hospital residents in the event of a disaster and to assist in the provision of crisis counseling services in the event of a disaster. The Office of Continuing Education and Staff Development of ETR, and provide a trained workforce capable of responding to a disaster.
A. To assist in meeting the requirements outline in the Disaster Plan for other DMH inpatient facilities in disaster planning and response.
B. Provide basic information to new DMH Employees about the role of the Department of Mental Health in disaster response and that they may be called upon as part of their work to assist in a disaster.
C. Assist in the location of and delivery of a curriculum to brief, train and orient response teams about their role and responsibility in disaster response; how debriefing differs from crisis counseling; how crisis counseling differs from traditional mental health treatment as a prelude to sending teams into the field.
D. Training curricula for training DMH staff in techniques of effective debriefing, crisis counseling and response team leadership for periodic and regular delivery to insure a trained workforce.
E. Maintain a process for the implementation of these activities.
To develop and maintain procedures for collecting data related to needs assessment and documenting the Department's actions in order to support applications for Federal and State disaster assistance grants; write the Immediate and Regular Services Grant Applications as provided by FEMA and support by the national Center for Mental Health Services.
A. Serve as liaison to the SC, EMD, FEMA and Center for Mental Health Services in the preparation and submission of Federal grant applications.
B. In consultation with the Division of Community Care Services, the affected Community Mental Health Centers and inpatient hospitals, prepare grant applications that reflect the program focus, staffing and resource requirement needs to carry out an effective program of crisis counseling.
C. Collect data from needs assessment teams, DMH DRT, SCEMD, FEMA, Red Cross and others to support grant applications and to document the Department's actions.
D. In coordination with the Office of Public Safety, DMH DRT will represent DMH at appropriate briefings held at the Disaster Field Office and report on the services provided by DMH and document service needs.
E. Maintain appropriate demographic, economic, social and geographic data as may be needed to facilitate the grant application process.
F. Maintain a written plan for implementing these responsibilities.
To provide for the information and broad communications needs in responding to disasters.
A. Establish and maintain telephone or other appropriate communication lines to communicate between the MH EOC and various field operations.
B. Procure cellular or mobile phones as needed to facilitate communications.
C. Assist in the computerization of data collected as a result of all DMH disaster related activities.
D. Assist the Office of Planning in providing data and information needed to prepare FEMA grant applications and/or document grant activities.
E. Maintain a written plan for implementing these responsibilities.
To identify and train persons for SCDMH clinicians as well as non clinicians to be sensitive to people from diverse cultures in addition to those with limited English proficiency including English, American Sign Language Spanish so as to implement the disaster plan effectively.
A. In close collaboration with the office of Disaster Services, secure and develop appropriate materials for distribution to Community Mental Health Centers. These materials disaster, will address access a safe environment prior to the crisis and access to appropriate care after the disaster.
B. Ensure that each Mental Health has the necessary information to secure interpreter services they may require including but not limited to interpreter services they may require, including American Asign Language, English and Spanish critical.
C. Assure that identified staff provide clinical incident debriefing interventions are culturally and linguistically appropriate.
D. Assist members of the "Response Teams" in acquiring relevant knowledge to adequately address consumers of diverse ethnic backgrounds and Limited English Proficiency at a time of disaster.
Two sets of forms are used in the needs assessment process. The "Initial Needs Assessment" focuses on an in depth assessment of the status and capacity of the CMHC to provide on-going and disaster related mental health services. A preliminary evaluation of the magnitude of the disaster is also done to determine if outside assistance is needed and, if so, how much and what kind of help is needed during the first few days following impact.
The "Long Term Needs Assessment" form is for the routine collection of needs assessment data during the response phase. It focuses on documenting the magnitude of the disaster more fully, as well as, determining the types and locations of overall recovery services. It is used to guide the deployment of response workers during the recovery period and to document any grant applications for crisis counseling services.
1. CMHC/FACILITY IMPACTED: ___________________________________________________________________
2. SERVICE AREA COUNTIES AFFECTED: ___________________________________________________________________
3. TYPE OF DISASTER: DATE OF DISASTER: DATE OF INSPECTION:
___________________________________________________________________
4. DAMAGE ASSESSMENT TO FACILITIES/SERVICE SITES (INDICATE LOCATIONS):
| 1. | 5. |
| 2. | 6. |
| 3. | 7. |
| 4. | 8. |
B. BUILDING DAMAGE: USE THE NUMBER OF THE LOCATION TO INDICATE THE TYPE OF EXTENT OF DAMAGE:
| COMPONENTS | DESTROYED | HEAVY DAMAGE | LIGHT DAMAGE | NO DAMAGE |
| ROOF | ||||
| EXTERIOR | ||||
| INTERIOR | ||||
| FLOORS | ||||
| PLUMBING | ||||
| HEAT/AIR | ||||
| POWER | ||||
| RECORDS | ||||
| OFFICE FURNITURE | ||||
| COMPUTERS | ||||
| OFFICE EQUIPMENT | ||||
| SUPPLIES | ||||
| GROUNDS | ||||
| WINDOWS | ||||
| OTHER |
5. WHICH FACILITIES ARE OR CAN BE MADE SERVICEABLE?
LOCATION: 1. _____ ; 2. _____ ; 3. _____ ; 4 _____; 5. _____; 6. _____; 7. _____; 8. _____.
6. WHAT TEMPORARY REPAIRS WILL NEED TO BE MADE?
| 1. | 5. |
| 2. | 6. |
| 3. | 7. |
| 4. | 8. |
6. PRELIMINARY AREA ASSESSMENT: (DATE SOURCE SHOULD BE AT THE COUNTY EMERGENCY OPERATIONS CENTER)
| IMPACT DATA | NUMBER | TYPE LOSSES | ESTIMATED AMOUNT OF LOSSES |
| NUMBER OF SHELTERS OPENED | PERSONAL | $ | |
| NUMBER OF SHELTERS | BUSINESS | $ | |
NUMBER OF FATALITIES |
PUBLIC FACILITIES | $ | |
| NUMBER OF INJURED | FARMING | $ | |
NUMBER HOSPITALIZED |
AGRICULTURAL | $ |
| TYPE FACILITY | # DESTROYED | # DAMAGED | SERVICE DISRUPTION | YES | NO |
| HOUSES | WATER | ||||
| MANUFACTURING | POWER | ||||
| BUSINESSES | SEWERAGE | ||||
| SCHOOLS | PHONES | ||||
| HOSPITALS | |||||
| CHURCHES |
OTHER COMMENTS AND OBSERVATIONS: ___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
TUS OF CENTER/HOSPITAL LEADERSHIP:
A. IS THE DIRECTOR ABLE TO REPORT FOR DUTY?_____________________
___________________________________________________________________
B. IF NOT, WHAT ASSISTANCE IS NEEDED?____________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
C. IS THE ASSISTANT DIRECTOR ABLE TO REPORT FOR DUTY?
___________________________________________________________________
D. IF NOT, WHAT ASSISTANCE IS NEEDED? ___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
E. WHO HAS THE DIRECTOR OR ASSISTANT DIRECTOR AUTHORIZED TO ACT IN THEIR BEHALF?
NAME: ____________________________________________________________
PHONE NUMBER: __________________________________________________
LOCATION: _______________________________________________________
F. WHAT NEEDS/PROBLEMS/CONCERNS WOULD THE DIRECTOR/ASSISTANT DIRECTOR LIKE TO HAVE ADDRESSED AS QUICKLY AS POSSIBLE? ___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
2. STAFFING CAPACITY
| STAFF LOSSES AND CASUALTIES | EMPLOYEES | FAMILIES | STAFF ABLE TO REPORT | NUMBER |
| NUMBER OF HOMES DESTROYED | FULL TIME | |||
| NUMBER OF HOMES DAMAGED | PART TIME | |||
| NUMBER OF OFFICE SITES DESTROYED | CONTRACT | |||
| NUMBER OF OFFICE SITES DAMAGED | DELAYED RETURN | |||
| NUMBER WITHOUT TRANSPORTATION | UNABLE TO LOCATE | |||
| NUMBER KILLED | ||||
| NUMBER INJURED | ||||
| NUMBER HOSPITALIZED |
3. RESPONSE TEAM REQUIREMENTS:
| RESPONSE TEAM STAFFING NEEDS | NUMBER | SPECIAL EXPERTISE | NUMBER |
| PHYSICIANS | INTERPRETERS FOR THE DEAF | ||
| NURSES | COUNSELORS FOR THE DEAF | ||
| PHARMACISTS | GERIATRIC SPECIALISTS | ||
| COUNSELORS/SOCIAL WORKERS | CHILD/ADOLESCENT WORKERS | ||
| PUBLIC SAFETY OFFICERS | FOREIGN LANGUAGE (SPECIFY) | ||
| ADMINISTRATIVE SUPPORT STAFF | OTHER (SPECIFY) | ||
| OTHER (SPECIFY) | OTHER (SPECIFY) |
COMMENTS AND RECOMMENDATIONS: ___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
4. SUPPLY REQUIREMENTS: CHECK ALL THAT APPLY
| ITEM | AMOUNT | ITEM | AMOUNT | ITEM | AMOUNT | ITEM | AMOUNT |
| FOOD | CANDLES | SLEEPING BAGS | |||||
| WATER | MATCHES | WET WIPES | |||||
| GASOLINE | CAMP STOVES | MEDICATIONS |
5. EQUIPMENT REQUIREMENTS: CHECK ALL THAT APPLY
| ITEM | # & LOCATION | ITEM | # & LOCATION | ITEM | # & LOCATION |
| GENERATORS | TOOLS | TRUCKS | |||
| CHAIN SAWS | VEHICLES | WALKIE TALKIES | |||
| MOBILE PHONES | PLYWOOD | HAND RADIOS |
ADDITIONAL NEEDS: _______________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
6. DESCRIBE THE GENERAL EMOTIONAL STATE AND FUNCTIONAL CAPACITY OF LOCAL STAFF:
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
7. STATE NEEDS ASSESSMENT TEAM MEMBERS NAMES:
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
8. LOCAL NEEDS ASSESSMENT TEAM MEMBERS NAMES:
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
9. NAME AND PHONE NUMBER OF STATE NEEDS ASSESSMENT TEAM MEMBER AT THE COUNTY EOC:______________________________________________________
___________________________________________________________________
COUNTY: _____________________________________DATE:_______________
1. DAMAGE ASSESSMENT:
| ITEM | # DAMAGED | # DESTROYED | ESTIMATED LOSSES |
| SCHOOLS | |||
| CHURCHES | |||
| BUSINESSES | |||
| INDUSTRIES | |||
| SINGLE FAMILY UNITS | |||
| MOBILE HOMES | |||
| MULTI-FAMILY UNITS | |||
| PUBLIC BUILDINGS | |||
| HOSPITALS | |||
| UTILITIES | |||
| ROADS | |||
| BRIDGES | |||
| AIRPORTS | |||
| RAILROADS | |||
| OTHER (SPECIFY) |
DESCRIBE AGRICULTURAL LOSSES: ___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
II. CASUALTIES:
| TYPE | NUMBER |
| FATALITIES | |
| INJURED | |
| HOSPITALIZED | |
| UNEMPLOYED | |
| HOMELESS | |
| SHELTERED |
III. DESCRIBE ANY OTHER LOSSES RELATED TO THE DISASTER OR PROBLEMS UNIQUE TO THE DISASTER:
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
COMPLETED BY: __________________________ DATE: ___________________
DAILY NEEDS ASSESSMENT DATA
SHELTER AND DAC INFORMATION
(TO BE REPORTED DAILY FOR EACH SHELTER)
| SHELTER NAME | DAC NUMBER | ||||||||
| SHELTER NAME | LOCATION | ||||||||
| SHELTER LOCATION | # SEEN AT DAC | ||||||||
| # OF SHELTER STAFF | # APPS. TAKEN | ||||||||
| SHELTERS HAVE Y/N | # SEEN BY DMH | ||||||||
| WATER | EST. CLOSING DATE | ||||||||
| FOOD | |||||||||
| POWER | |||||||||
| MEDICINE | |||||||||
| CLOTHING | |||||||||
| BEDDING | |||||||||
| PHONES | |||||||||
| SHELTER NEEDS | |||||||||
| # OF MEALS SERVED | |||||||||
SERVICES DATA:
| SERVICES PROVIDED | # INDIV | # GRPS | # FAM | # ELD | # MINORITY | # CHILD/ADOL |
| CRISIS COUNSELING | ||||||
| INFORMATION REFERAL | ||||||
| ACTIVE LISTENING | ||||||
| SUPPORTIVE COUNSELING | ||||||
| EDUCATION | ||||||
| DEBRIEFING | ||||||
| DEFUSING | ||||||
| SUPPORT SYSTEM DEVV./REDEV. | ||||||
| DAY CARE/PLAY THERAPY | ||||||
| OBTAIN RELIEF/RESOURCES | ||||||
| OUTREACH | ||||||
| ADVOCACY | ||||||
| CONSULTATION | ||||||
| TRAINING | ||||||
| CRISIS INTERV/STABIL. | ||||||
| OTHER (SPECIFY) |
PRESENTING PROBLEMS: GIVE THE NUMBERS OF PEOPLE BY AGE, SEX AND RACE FOR EACH PROBLEM LISTED.
| TYPE PROGRAM |
< 5 YRS |
6-12 |
13-18 YRS |
9-60 YRS |
MALE | FEMALE | AA | C | NA | AS | H | O |
| AGITATION/ANXIETY |
||||||||||||
| CONFUSION/DISORIENTATION | ||||||||||||
| LOSS/GRIEF | ||||||||||||
| SADNESS/SITUATIONAL DEPRESSION | ||||||||||||
| NON-VIOLENT ANGER/ADULTS | ||||||||||||
| RELIEF/RESOURCES | ||||||||||||
| ACTING OUT CHILD/YOUTH | ||||||||||||
| SCHOOL ADJUSTMENT | ||||||||||||
| INFORMATION/REFERRAL | ||||||||||||
| NON-VIOLENT ANGER/CHILD-YOUTH | ||||||||||||
| SUBSTANCE ABUSE | ||||||||||||
| MAJOR MENTAL ILLNESS | ||||||||||||
| COMMUNITY/NATURAL SUPPORTS | ||||||||||||
| VIOLENT ACTING OUT/ADULT | ||||||||||||
| VIOLENT ACTING OUT CHILD-YOUTH |
SPECIAL SERVICE RECIPIENTS:
| RECIPIENT | # OF INDIVIDUALS | # GROUPS | DE-BRIEF | DE-FUSE | EDUC. | CONSULT | TRAIN |
| LAW ENFORCEMENT |
|||||||
| SOCIAL SERVICES | |||||||
| TEACHERS | |||||||
| GUIDANCE COUNSELORS | |||||||
| PUBLIC OFFICIALS | |||||||
| HEALTH CARE PROVIDERS | |||||||
| GENERAL PUBLIC | |||||||
| OTHER (SPECIFY) |
DISASTER SERVICES CONTACT/DATA SHEET
TO BE COMPLETED BY EACH PERSON PROVIDING A DISASTER RELATED SERVICE
LOCATION OF SERVICE: _______________________DATE: ______________ TIME ON DUTY: __________
STAFF NAME: _________________________________SS#: ______________ TIME ON DUTY: __________
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
| INDIVIDUAL/GROUP NAME | AGE | SEX | RACE | PROBLEM TYPE | SERVICE PROVIDED | STAFF TIME | #SERVED |
PLEASE ENTER THE FOLLOWING CODES IN THE APPROPRIATE BOX
1 |
2 |
3 |
4 |
| ENTER CLIENT INITIALS OR THE GROUP'S NAME | 1 2 3 4 1= 0 - 5 YRS 2 = 6 -12 YRS 3= 13 - 18 YRS 4 = 19 - 60 YRS 5 = OVER 60 YRS |
M=MALE F=FEMALE | AA= AFRICAN/AMERICAN C = CAUCASIAN NA = NATIVE AMERICAN AS = ASIAN H = HISPANIC O = OTHER |
5 |
6 |
7 |
8 |
| 1. AGITATION/ANXIETY 2.CONFUSION/DISORIENTATION 3. DISASTER FEARS 4. LOSS/GRIEF/GUILT 5. SADNESS/SITUATIONAL DEPRESSION 6. NON-VIOLENT ANGER - ADULTS 7. NON-VIOLENT ANGER - CHILDREN AND YOUTH 8. ACTING OUT - CHILDREN AND YOUTH 9. SCHOOL ADJUSTMENT 10. NEED FOR INFORMATION/REFERRAL 11. NEED FOR RESOURCES/ASSISTANCE 12. SUBSTANCE ABUSE 13. MAJOR MENTAL ILLNESS 14. COMMUNITY/NATURAL SUPPORTS 15. VIOLENT ACTING OUT - ADULT 16. VIOLENT ACTING OUT - CHILD/YOUTH 17. OTHER (SPECIFY) |
1. CRISIS COUNSELING 2. INFORMATION AND REFERRAL 3. ACTIVE LISTENING 4. SUPPORTIVE COUNSELING 5. EDUCATION 6. DEBRIEFING 7. DEFUSING 8. SUPPORT SYSTEM DEVELOPMENT/REDEVELOPMENT 9. DAY CARE/PLAY THERAPY (CHILD) 10 OBTAIN RELIEF/RESOURCES 11. OUTREACH 12. ADVOCACY 13. CONSULTATION 14. TRAINING 15. CRISIS INTERVENTION/STABILIZATION 16. OTHER: SPECIFY |
IN 15 MIN. INCREMENTS | # SERVED |
SC EMERGENCY MANAGEMENT DIVISION AND SC DEPARTMENT OF MENTAL HEALTH
COUNTY - MHC MODEL PLANNING DOCUMENT FOR CRISIS COUNSELING
Date: _______________________________________________________________
ANNEX TO _______________________________________________ COUNTY
EMERGENCY OPERATIONS PLAN
MENTAL HEALTH
I. GENERAL:
A. Purpose:
1. To organize within ____________________________ County government the capability to meet the basic human needs of persons experiencing extreme emotional and psychological stress in a disaster situation.
2. To outline responsibilities and policy established for mental health service operations before, during and after a disaster, whether natural or man-made, including war.
B. Authority:
1. ___________________________County Ordinance Number________________
2. South Carolina Legislative Act Number 199, 1979.
3. South Carolina Legislative Act Number 223, 1967, as amended.
C. Definitions:
DISASTER CRISIS COUNSELING: Services provided by mental health professionals to disaster casualties such as bystanders, victims, relatives of victims and rescue workers who experience shock, anxiety, hysteria, and other extreme stress or loss such as damage to home or workplace, displacement, missing family members, mass casualties, etc.
D. Organization:
1. Organization chart for mental health is at Appendix 1.
2. The Director, ________________________________ Mental Health Center is responsible for securing and coordinating all governmental and non-governmental agencies that comprise the mental health organization, which effectively supports the needs of the populace of the county during emergencies and disasters.
3. In ________________________ County, this has/has not been delegated to the Director of _____________________ County Satellite Office.
II. SITUATION:
During and following a disaster, whether natural, terrorism or war, some individuals or families having experienced extreme emotional or psychological stress will require mental health services. These services can be administered at the disaster site, shelter site, a medical facility, school, Disaster Assistance Center, mental health office or other designated area.
III. MISSION:
To coordinate the mental health resources available to _________________________County through the _________________________ Mental Health Center and the MHC Clinic Office for treatment of persons experiencing emotional and psychological post disaster stress.
IV. EXECUTION:
A. Concept of Operations:
1. On notification by the Director of _____________________________ County Emergency Preparedness Agency that a disaster is imminent or has occurred, the Director, _________________________________ Mental Health Center will activate its disaster plan and staff appropriate disaster service sites.
2. If notification is received by the mental health center from any other source, the County Emergency Preparedness Agency will be contacted to verify that an emergency exists.
3. Control of operations will be conducted from the Emergency Operations Center or the ____________________________County mental health office or as designated by the Director of the ____________________________Mental Health Center in consultation with the Emergency Preparedness Director.
4. If the mental health center emergency operations center is not co-located with the County Emergency Preparedness Agency, the mental health center shall sign a liaison to be present in the local County Emergency Operations Center.
B. Tasks:
1. Pre-Disaster Phase: The area Mental Health Center Director shall supervise and coordinate:
2. Disaster Phase: The Area Mental Health Center Director shall:
3. Recovery Phase: The Area Mental Health Center Director shall ensure that all mental health offices continue to maintain essential services as well as provide short and long term treatment to disaster survivors and related individuals as needed. The Area Mental Health Center Director shall perform the following:
V. ADMINISTRATION AND LOGISTICS:
A. Administration:
Initial situation reports will be submitted to the Director, __________________ Mental Health Center at the Emergency Operations Center as soon as practical. Reports will be consolidated and submitted to the Director, ______________________ County Emergency Preparedness Agency and the State Department of Mental Health for analysis and further distribution and include, but not be limited to:
1. Number of individuals who were provided crisis counseling during the emergency;
2. Types of problems encountered;
3. Resources used and recovery opportunities;
4. Needs assessment of potential users of crisis counseling services based on damage estimates and numbers of persons affected.
B. Logistics:
1. Supplies, transportation, and equipment necessary for emergency operations will be drawn from within the ____________________ Mental Health Center organization.
2. Additional requirements, if needed, will be requested through the County EOC, SC EMD and the SC Department of Mental Health as appropriate.
VI. DIRECTION AND CONTROL:
A. Direction and control of crisis counseling services will be coordinated by the Director, _______________________ Mental Health Center.
B. Line of Succession:
1. Director, ____________________________ County Mental Health Clinic Office (if applicable).
2. Director, ____________________________ Mental Health Center.
3. Medical Director, _____________________ County Mental Health Clinic Office or Mental Health Center (as applicable).
4. If the mental health staff/mental health center are incapacitated and cannot respond, refer to Appendix 3.
C. Communications:
1. Communications will be maintained through normal channels.
2. Additional communication may be requested through the County EOC or SC Department of Mental Health as appropriate.
VII. This plan will be reviewed and revised as needed annually by both parties and submitted jointly to the Emergency Management Division in the Adjutant General's Office and the Medical Director of the Department of Mental Health by September first of each year.
_________________________________ _______________________________
Director, ____________________County Date
SC Emergency Management Agency
_________________________________ ________________________________
Director, ____________________County Date
Health Care
_________________________________ ________________________________
Director, ____________________County Date
Mental Health Clinic Office
1. Organization Chart
2. Alert List
3. Adjacent County(ies)/Mental Health Center Backup List
4. Mental Health Requirements Statement
APPENDIX 1 TO ANNEX J - ORGANIZATION CHARTS
1. SCDMH Organization Chart (pdf format)
2. SCDMH Disaster Response Team:
APPENDIX 2 TO ANNEX J - MENTAL HEALTH ALERT LIST
_________________________________COUNTY
(Key People Only)
| TITLE/AGENCY | TELEPHONE |
| Director, ______________________________________________ County Mental Health Clinic Office |
|
| Director, ______________________________________________ Mental Health Center Director |
|
| Medical Director, _______________________________________ Mental Health Center |
|
| DMH Disaster Manager | (803) 898-8579 |
| Chief of Public Safety, Department of Mental Health | (803) 935-5470 |
(The alert list should be developed in the order
of succession of first call responsibility)
ADJACENT COUNTIES/MENTAL HEALTH CENTERS
FOR _________________________ COUNTY EMERGENCY OPERATIONS PLAN
______________________________ AREA MENTAL HEALTH CENTER
______________________________ COUNTY
MENTAL HEALTH CENTER TELEPHONE
1. ________________________ ___________________
2. ________________________ ___________________
3. ________________________ ___________________
(Centers/Clinics should be listed in order of succession if the mental health operation of the affected county is incapacitated in the emergency.
APPENDIX 4 TO ANNEX J - MENTAL HEALTH REQUIREMENTS STATEMENT
(Equipment, supplies, personnel, etc.)
I. DISASTER SITE REQUIREMENTS:
II. HOST AREA REQUIREMENTS:
§ 25-1-420. South Carolina Emergency Management Division of Office of Adjutant General; administration; duties.
There is established within the office of the Adjutant General, the South Carolina Emergency Management Division (SC EMD).
The Division shall be administered by a director appointed by the Adjutant General, to serve to his pleasure, and such additional staff as may be employed or appointed by the Adjutant General.
The Division shall be responsible for the implementation of the following:
(a) Coordinating the efforts of all state, county and municipal agencies and departments in developing a State Emergency Plan.
(b) Conducting a statewide preparedness program to assure the capability of state, county and municipal governments to execute the State Emergency Plan.
(c) Establishing and maintaining a State Emergency Operations Center and providing support of the state emergency staff and work force.
(d) Establishing an effective system for reporting, analyzing, displaying and disseminating emergency information.
§ 25-1-430. Definitions.
As used in this article:
(a) "Emergency Preparedness" shall mean the extraordinary actions of government in preparing for and carrying out all functions and operations, other than those for which the military is primarily responsible, when concerted, coordinated action by several agencies or departments of government and private sector organizations is required to prevent, minimize and repair injury and damage resulting from a disaster of any origin.
(b) "Emergency" shall mean actual or threatened terrorist attack, sabotage, conflagration, flood, storm, epidemic, earthquake, riot or other public calamity.
(c) "South Carolina Emergency Management (Civil Defense) Organization" shall mean all officers and employees of state government, county government and municipal government, together with those volunteer forces enrolled to aid them in an emergency and persons who may by agreement or operation of law be charged with duties incident to protection of life and property of this State during emergencies.
§ 25-1-440. Additional powers and duties of governor during declared emergency.
(a) The Governor, when an emergency has been declared, as the elected Chief Executive of the State, shall be responsible for the safety, security and welfare of the State and shall be empowered with the following additional authority to adequately discharge this responsibility:
(1) Issue emergency proclamations and regulations and amend or rescind them. Such proclamations and regulations shall have the force and effect of law as long as the emergency exists.
(2) Declare a state of emergency for all or part of the State if he finds a disaster has occurred, or that the threat thereof, is imminent, and extraordinary measures are deemed necessary to cope with the existing or anticipated situation. A declared state of emergency shall not continue for a period of more than fifteen days without the consent of the General Assembly.
(3) Suspend provisions of existing regulations prescribing procedures for conduct of state business if strict compliance with the provisions thereof would in any way prevent, hinder or delay necessary action in coping with the emergency.
(4) Utilize all available resources of state government as reasonably necessary to cope with the emergency.
(5) Transfer the direction, personnel or functions of state departments, agencies and commissions, or units thereof, for purposes of facilitating or performing emergency services as necessary or desirable.
(6) Compel performance by elected and appointed state, county and municipal officials and employees of the emergency duties and functions assigned them in the State Emergency Plan or by Executive Order.
(7) Direct and compel evacuation of all or part of the populace from any stricken or threatened area if this action is deemed necessary for the preservation of life or other emergency mitigation, response or recovery; to prescribe routes, modes of transportation and destination in connection with evacuation; and to control ingress and egress at an emergency area, the movement of persons within the area and the occupancy of premises therein.
(8) Within the limits of any applicable constitutional requirements and when a major disaster or emergency has been declared by the President to exist in this State:
(i) Request and accept a grant by the federal government to fund financial assistance to individuals and families adversely affected by a major disaster, subject to terms and conditions as may be imposed upon the grant but only upon his determination that the financial assistance is essential to meet disaster related expenses or serious needs that may not be otherwise met from other means of assistance.
(ii) Enter into an agreement with the federal government, through an officer or agency thereof, pledging the State to participate in the funding of the financial assistance authorized in sub item (i) of this item, under a ratio not to exceed twenty-five percent of the assistance.
(iii) Make financial grants to meet disaster related necessary expenses or serious needs of individuals or families adversely affected by a major disaster which may not otherwise be adequately met form other means of assistance. No individual or family may receive grants aggregating more than ten thousand dollars with respect to any single major disaster subject to the limitations contained in sub item (ii) of this item. The ten thousand dollar limit must annually be adjusted to reflect changes in the Consumer Price Index for All Urban Consumers published by the Bureau of Labor Statistics of the United States Department of Labor.
(iv) Promulgate necessary regulations for carrying out the purposes of this item.
(b) The Governor shall be responsible for the development and coordination of a system of Comprehensive Emergency Management which shall include provisions for mitigation, preparedness, response and recovery in anticipated and actual emergency situations.
(1) Any person who fraudulently or willfully makes a misstatement of fact in connection with an application for financial assistance made available pursuant to item (8) of subsection (a) of this subsection, upon conviction of each offense, must be fined not more than five thousand dollars or imprisoned for not more than one year, or both.
(2) Any person who knowingly violates any regulation promulgated pursuant to item (8) of subsection
(a) of this subsection is subject to a civil penalty of not more than two thousand dollars for each violation.
(3) A grant recipient who misapplies financial assistance made available by item (8) of subsection (a) of this subsection is subject to a civil penalty in an amount equal to one hundred fifty percent of the original grant amount.
§ 25-1-450. Duties of state, county and municipal governments for mutual assistance in emergencies.
State, county and municipal governments shall cooperate in developing and maintaining a plan for mutual assistance in emergencies.
(1) State government shall be responsible for:
(a) Establishing policies and developing a plan and procedures to insure maximum utilization of all state resources to minimize loss of life and injury to the populace and destruction or damage to resources and facilities of the State during emergencies resulting from enemy attack or natural or man-made emergencies.
(b) Providing state forces and resources to support local governmental emergency operations and coordinating support with local governments from other sources, including the federal government and those unaffected counties of the State, and implement mutual assistance agreements with adjoining states.
(c) Assuming direction and control of area or local government emergency operations when requested by the county legislative delegation or their designees or when local government authority has broken down or is non-existent or when the nature or magnitude of an emergency is such that effective response and recovery action is beyond local government's capability or when, in the event of a war emergency or declared natural or man-made emergency, state direction is required for implementation of a national plan.
(2) County and municipal governments shall be responsible for:
(a) Organizing, planning and otherwise preparing for prompt, effective employment of available resources of the county or municipality to support emergency operations of the municipalities of the county or to conduct emergency operations in areas where no municipal capability exists.
(b) Coordinating support to municipal emergency operations from other sources including state and federal assistance as well as support made available from other municipalities of the county.
(c) Developing and implementing a shelter/relocation plan to protect the populace from the hazards of a nuclear emergency and to provide for the congregate housing and care of persons displaced or rendered homeless as a result of a natural or man-made emergency.
The South Carolina Department of Mental Health, under the leadership of the State Director of Mental Health appointed by the Mental Health Commission, is one of the statewide agencies that becomes part of the South Carolina Emergency Management Organization in the event of a disaster or emergency. The role of the Department of Mental Health is to prevent, minimize and repair the trauma, injury and damage of psychological stress which occurs in people as a result of natural and man made disasters, thus preventing future emotional problems in survivors. The goal is to work closely with those impacted by the emergency through the provision of Disaster Crisis Counseling and Trauma Services.
Crisis Counseling is a service provided by mental health professionals and ancillary mental health staff to disaster survivors such as witnessing by-standers, relatives of the dead, injured and missing, people suffering loss of housing, employment, workplace or school, and response personnel who experience stress as they carry out response and recovery activities.
The Department of Mental Health responds to emergencies at four levels.
(1) A local level response is required by mental health centers and hospitals in relation to local emergencies and county emergency preparedness offices.
(2) A state level response is required as a result of notification by the SC Emergency Management Division and through Gubernatorial Declaration or at the request of local mental health centers and hospitals.
3) A state level response is also required in collaboration with the SC Emergency Management Division and other agencies when there has been a Presidential Declaration of a disaster and a need for disaster assistance.
(4) An internal response within the Department of Mental Health is required when there has been a major disruption in the operation of a mental health center or hospital.
The State Director of Mental Health is responsible for the safety, security and welfare of the Department and the people entrusted to its care and the employees during a declared emergency. He is able to exercise these responsibilities by taking one or more of the following actions:
(1) Issue emergency policies and procedures. Such policies and procedures have the effect of policy sanctioned by the Mental Health Commission for as long as the emergency exists.
(2) Take necessary measures to protect people and property and to mitigate the effects of a disaster or the imminent threat thereof for a period not to exceed that of the declared emergency.
(3) Suspend provisions of existing policy and procedure to conduct Department business if strict compliance with the provisions of these would in any way prevent, hinder or delay necessary action in coping with the disaster.
(4) Utilize all available resources of the Department as reasonably necessary to respond to the event.
(5) Transfer or delegate the supervision and direction of personnel and resources of the Department's administrative, clinical and operational components as necessary for purposes of covering essential services and performing emergency services.
(6) Coordinate the performance of emergency duties and functions of employees with those of elected and appointed state, county and municipal officials and employees as assigned them in the State Emergency Preparedness Plan or by Executive Order.
(7) Coordinate Department activities with an order directing or compelling evacuation of all or part of the citizens from a stricken or threatened area if this action is deemed necessary for the preservation of life or other emergency mitigation, response or recovery; using routes, modes of transportation and destinations in connection with evacuation plans; and to control ingress and egress at the emergency area, the movement of persons within the area and the occupancy of premises therein, as may be appropriate within the operational requirements of the Department of Mental Health, its centers and hospitals.
(8) Within the limits of any applicable constitutional requirements and when a major disaster or emergency has been declared by the President of the United State to exist in this State:
(a) To request, accept and administer, through the Governor' Office and appropriate Federal officials, Federal grant funds to support an immediate capability to provide crisis counseling services to individuals and families adversely affected by disaster as authorized in Federal legislation.
(b) To request, accept and administer through the Governor and appropriate Federal officials a Federal grant to fund a crisis counseling regular program for individuals and families adversely affected by a major disaster.
| SYSTEM | LOW | MINIMAL | POTENTIAL | CREDIBLE | INCIDENT |
| Emergency Operations Center – OPCONS | 5-Day-to-Day operations to include normal tracing and exercises. | 4-Possibility of an emergency or disaster situation that may require a partial or full activation of the SEOC. | 3-Disaster or emergency situation likely or imminent. Full or partial activation of SEOC; active South Carolina Emergency Operations Plan and the appropriate specific impact hazard emergency plan. | 2-Disaster or emergency situation in effect; maximum preparedness level; full activation of the SEOC. | 1-Disaster or emergency situation in effect full-fledge emergency response operations on going; highest state of emergency operations. |
| FBI Threat Levels | 5-Day-to-Day operations to include normal tracing and exercises. | 4-Received threats do not warrant actions beyond normal liaison notifications or placing assets or resources on a heightened alert (agencies are operating under normal day-to-day conditions). | 3-Intelligence or an articulated threat indicates a potential for a terrorist incident. However, this assessed as credible. | 2-The threat is credible, and confirms a developing terrorist incident. Crisis management focuses on LEA actions for public safety and welfare, and to anticipate, prevent, and/or resolve the crisis. Consequence management focuses on contingency planning and prepositioning of resources. The threat increases the significance when the presence of an AME capable of causing a significant destructive event is confirmed or a high probability that a devise exists. The threat is now a WMD terrorist situation requiring an immediate process to identify, acquire, and plan the use of Federal resources in lessening or averting the potential consequences. | 1-Situation Progression, the potential for significant consequences may become imminent. Consequence management agencies re-deploy from the JOC to its EOC but maintain a liaison for the FBI OSC. Emergency management may pre-deploy state and federal consequence management assets. If a WMD terrorism incident has occurred which requires Federal resources? This incident has resulted in mass casualties. The response is primarily directed toward public safety and welfare and the preservation of human life and assistance to governments for consequence management takes priority. |
HSAS: Homeland Security Advisory Systems |
Green-Low Risk Day to day operations to ensure preparedness and readiness. |
Blue-General Risk Curtail routine operations where necessary. Verify that current policies and procedures insure internal and external communications’ means are operational. Meeting of the Homeland and Security Council |
Yellow-Significant Risk Increase security at all critical locations and activities. Activation of EOC where appropriate. Increase liaison activities with other state, federal and local agencies. Coordinate emergency plans and communications with border states. Implement necessary contingency and emergency response plans. Meeting of the Homeland Security Council. |
Orange-High Risk Respond appropriately to intelligence EOCs fully operational. Coordinate with Armed Forces, active guard, and reserve. Restrict entry to critical allocations and events. Additional security at public events. Restrict leave or off-site training for all personnel. |
Meeting of the Homeland Security Council. Red-Sever Risk React appropriately to intelligence that moved us to this level. Pre-position all especially trained teams and units. Where appropriate, close government and public facilities. Monitor, redirect and/or constrain transportation systems. Meeting of the Homeland Security System Council. |
EMERGENCY OPERATIONS
A. Conglomerate Operations. For the purpose of hurricane-related activities, South Carolina state government response will operate on a regional basis. These regions are called hurricane conglomerates and consist of the Southern Coastal Conglomerate, the Central Coastal Conglomerate, the Northern Coastal Conglomerate, and the Western Hurricane Conglomerate. The * designates the lead county in the three coastal conglomerates. There is no designated lead county for the Western Conglomerate.
Southern Coastal Conglomerate |
Central Coastal Conglomerate |
Northern Coastal Conglomerate |
Western Conglomerate |
| Beaufort Jasper Colleton Hampton Allendale Bamberg Barnwell Aiken |
Charleston Berkeley Dorchester Calhoun Orangeburg Lexington Richland |
Horry* |
Abbeville |
B. Operations Terminology. To prevent confusion and misunderstanding, it is necessary to standardize terminology regarding evacuation issues.
1. Estimated Evacuation Clearance Times. Clearance time begins when the first evacuating vehicle enters the road network and ends when the last evacuating vehicle reaches an assumed point of safety.
2. Evacuation Zones. Areas in coastal counties vulnerable to storm surge inundation and rainfall-induced flooding.
3. Hurricane Tracking Tools. Several computer programs are used to track hurricanes during the life of a tropical storm. The primary program used in South Carolina is HURREVAC.
4. Voluntary Evacuation. In the event a hurricane begins to pose a threat to the coast, local officials or the Governor can recommend that those citizens who feel uncomfortable about the storm leave the area. This action is considered a voluntary evacuation. During a voluntary evacuation, mandatory evacuation shelters will be opened.
5. Mandatory Evacuation. The Governor is the only person legally authorized to order and compel evacuation in South Carolina. The SCEMD Director will recommend to the Governor that a mandatory evacuation be ordered, and will propose a timetable. During a mandatory evacuation, mandatory evacuation shelters will be opened in accordance with this plan.
6. Lane Reversal. Altering the flow of traffic in a manner that traffic on all available lanes is moving in the same direction. Based on the situation, information and recommendations provided by the ESF Evacuation Traffic Management (ESF-16), the SCEMD Director will assess the situation and in coordination with SCDPS and SCDOT, as well as the impacted counties, will make a recommendation to the Governor regarding implementation of the reversal plan.
7. Counter Flow. Altering the flow of traffic in such a manner to allow for at least one lane of traffic to remain in the normal flow direction. On a four-lane highway, three lanes of traffic would move in one direction with one lane moving in the opposite direction.
8. Protective Relocation. Inland counties are not vulnerable to the storm surge; however, they are at risk to the high winds and rain-induced flooding associated with hurricanes. In order to protect this population, it may be necessary to relocate those living in vulnerable structures or low-lying areas. The decision to issue a protective relocation order is the responsibility of each inland county's public officials based on local authority. The SEOC will assist the provide guidance and recommendations.
9. Reentry. Reentry is the transition from evacuation and landfall to the recovery phase. Once the threat of the hurricane has passed or the hurricane has made landfall and initial damage assessment reports are evaluated, the SCEMD Director will recommend that the Governor rescind the mandatory evacuation order and advise citizens to refer to local officials for direction on reentry. A recommendation to the Governor regarding reversing roadway lanes eastbound is based on initial damage assessments and guidance from the Evacuation Traffic Management ESF (ESF-16). Although the SEOC will immediately begin coordination of reentry operations, reentry is managed at the local level.
C. Sheltering Terminology. To prevent confusion and misunderstanding, it is necessary to standardize terminology regarding evacuation issues.
1. Voluntary Evacuation Shelter. In the event that the Governor recommends a voluntary evacuation, all voluntary evacuation shelters within the impacted conglomerate will be prepared to open within four hours.
2. Mandatory Evacuation Shelter. In the event a mandatory evacuation is ordered by the Governor, all mandatory evacuation shelters within the impacted conglomerate will be open within four hours of the mandatory evacuation decision. All voluntary shelters remain open.
3. Reverse Shelter. In the event that the demand for shelters exceeds the capacity of the voluntary and mandatory evacuation shelters, reserve shelters will be opened. This might occur because of a higher than anticipated shelter demand or because of a major hurricane (category 3-5).
4. Shelter Emergency Capacity. The number of evacuees that a shelter can accommodate. During a hurricane landfall event, capacity is base on 20 square feet per person.
5. Sheltering Requirement. An estimate of the vulnerable population needing shelter within each conglomerate. This value is a planning tool for the population that can be accommodated by the shelter emergency capacity.
Types of Activities
In order to make maximum use of advance warning, the State has adopted a system of Operating Condition (OPCON) levels. These OPCONs increase the State's level of readiness of a scale from 5 to 1. Each OPCON level is declared when a predetermined set of criteria has been met. OPCONs will not necessarily progress sequentially from 5 to 1. The OPCON placed in effect at any given time will be the appropriate one for existing conditions at the time. The SC CMD director will assign OPCON levels. OPCONs are designated by numbers as shown below:
| OPCON LEVEL | Level of Readiness: |
| 5 | DAY TO DAY: Throughout the Year (Storms more likely than terrorism) Day to day operations include normal readiness. Training and regularly scheduled drills are conducted throughout the year. Each Center and hospital will maintain a Response Plan which is reviewed and updated annually. DMH staff are pre-selected and oriented as "Away Team" members. Teams may consist of medical and clinical counselor staff in groups of three to four persons. Equipment to be used in the field will be identified and kept in good working order. Center and hospital Disaster Response coordinators attend DMH Quarterly training/orientation meetings in Columbia. During hurricane season (June 1-November 30), all storms are tracked and monitored at this level. Terrorism acts may reduce the timeframe between OPCON 5 and 1 dramatically. |
| 4 | ALERT: 48 - 96 Hours Prior to Event There is the possibility of an emergency or disaster situation that may require a partial or full activation of the SC Emergency Operations Center (SC EOC) and county EOC's. Normal weather monitoring by SC EOC staff or DMH Disaster Coordinators reveals that a hurricane condition may exist in the Atlantic Ocean. SC EOC then notifies the agencies on the various ESF's to facilitate the preliminary coordination and preparation of staff and equipment. The Agencies would then pass the information down to local operational levels to ensure an early readiness state. This activity heightens communications and provides a focal point of interest. Plans are reviewed and procedures are noted. The DMH Disaster Manager may be required to report to the SC EOC for "partial activation" and the DMH Disaster Manager would alert the DMH DRTeam members and agency director of full or partial activation of the SC EOC. |
| 3 | 3 STAND BY: 36 Hours Prior to Event A natural disaster or terrorist act is likely or imminent and, as a result, the SC EOC and county EOC's are partially or fully activated. The decision will be based on the characteristics of the storm or other emergency. The EOC will fully activate the State Disaster Plan which triggers appropriate key support agencies to activate their respective plans. The Agencies will then enter a higher state of readiness by selecting and placing staff/equipment in designated storage areas. Upon notification and with the approval of the DMH Director or his designee, the DMH Disaster Manager will activate the DMH Disaster Response Team (DRT) to assemble in the response site of Room 404 with the appropriate communications equipment. At the same time, full notice is given to the centers and hospitals in the disaster zone so that they may complete necessary preparations and notify vulnerable consumer special populations like children, persons with deafness and the elderly. The primary events which will occur in this stage include evacuation discussions (including voluntary and mandatory evacuation), holding pre-evacuation conferences and many other preparatory activities. The DMH Disaster Manager will report to the SC EOC to facilitate the state and private agency response linkage while leadership at the DRT is assumed by Jac Upfield or Bruce Cannon. As the DRT receives condition reports and specific requests for services, the members will develop and implement plans to detail the requests within DMH resources. An assessment of local readiness is made, particularly in those coastal areas which may be directly affected by the storm. DDS and Red Cross plan when and where to open shelters. DOT strongly considers lane reversals to facilitate voluntary and mandatory evacuations. In inland centers and hospitals, disaster coordinators are implementing their disaster plans by identifying response processes, staff and materials. Communications with local Disaster Operations is formalized and mutual support is arranged. Lists of Away Team members are completed in each non affected center and hospital. Each member is given a general orientation as to the disaster area and expected conditions after the storm passes. The Office of Communications will prepare for news releases regarding activities to support local communities and special materials such as children's hurricane and tornado color books are made available. In short, DMH is prepared to provide requested services and staff following the post assessment period of the emergency. Attention to all communication systems will be increased. |
| 2 | FINAL PREPARATION: 20 - 24 Hours Prior to the Event The full emergency situation is in effect with all systems and agencies at maximum preparedness levels. Once a state-level decision is made that a voluntary or mandatory evacuation order or emergency is imminent, the level automatically moves to OPCON 2. All EOC's will be under "Full Activation" at this level. Both DMH and SC EOC operations are fully staffed and assessing the events around the disaster. DMH is making final assessments regarding resources like available beds to receive evacuees, food, medication, transportation and ability to respond quickly to local system requests. |
| 1 | LANDFALL AND RECOVERY: 24 Hours Prior to 72 Hours After Terrorism response or the emergency is currently occurring and continuous assessment is made during the event. Once the emergency or evacuation order is announced to the public, the level automatically moves to OPCON I. As soon as the initial disaster occurs, the SC EOC dispatches an assessment team to survey the damage and render a report on types of needs, extent of damage and specific resource needs. These findings are relayed to the SC EOC for processing by the state and private agencies there. This information is communicated to the DMH DRT to further detail in terms of needs vs. resources within DMH. The DRT communicates with local MHC's and hospitals to relay specific needs and to determine the location and time table to provide the resources. The DRT matches the requested need with larger system resources and dispatches the resources as expeditiously as possible. Away Teams receive final orientation and are sent into the affected area with necessary supplies. Communication occurs with team members throughout their five day rotation. The DRT also arranges for adequate debriefing as teams return from the disaster area. During the entire recovery phase, documentation is kept to use should a federal assistance grant be necessary. Such grants, if necessary, will be completed by the DMH Grants Coordinator with input from the local Disaster Coordinator, DMH Disaster Response Manager, DRT Coordinator and an appropriate FEMA representative. Grants which require a Principal Investigation will generally designate the local Disaster Coordinator for on site coordination. The DMH DRT will stay open and advise as long as the SC EOC indicates such need exists. Finally, brief overviews will be made available to the DMH Director and Senior Management throughout the operation. |
Disaster mental health roles and responsibilities are often complex and diverse. Thoughtful matching of responder skills and personalities to the specific assignment can help ensure success of mental health.
1. Crisis counseling: For most disaster survivors, traditional office type psychotherapy is not necessary or appropriate. Crisis intervention, brief treatment, support groups and practical assistance are most effective. Mental health staff must have a working knowledge and skill in these several modalities.
Qualifications of professional disaster mental health team members.
Ideally, the disaster mental health team should be multidisciplinary and multi-skilled. Staff should be experienced in psychiatric triage, first aid, crisis intervention, and brief treatment. They should have knowledge of crisis, post-traumatic stress and grief reactions, and disaster psychology. Survivors are often reluctant to come to mental health centers for services. As a result, staff must be able to provide their services in non-traditional community-based settings. Prior disaster mental health training and experience are highly recommended. In situations of mutual aid where licensed professionals cross state lines to provide assistance in disaster, licensing in the impacted state may be waived under the Good Samaritan law. This issue should be investigated in instances of cross-state mutual aid.
Mental health responders should be well-acquainted with the functions and dynamics of the community's human service organizations and agencies. They should have experience in consultation, collaboration, and community education. Excellent communication, problem-solving, conflict resolution, and group process skills are needed, in addition to an ability to establish rapport quickly with people from diverse cultures and backgrounds.
Managers should pay careful attention to the state's scope of practice laws for various mental health professional disciplines. Individuals who provide formal assessment and counseling which fall into the definition of psychotherapy should be appropriately licensed and insured for professional liability.
2. Outreach: Working in disaster affected neighborhoods, mass care shelters, Disaster Application Centers or other community settings requires workers who are adept at such nontraditional mental health approaches as "spot consultations" and "over a cup of coffee" assessments and interventions.
3. Public education and information: Public education efforts require staff that are interested and effective in public speaking and working with the media. The development of fliers and brochures requires good writing skills.
4. Community liaison: Establishing and maintaining effective liaison with community leaders requires individuals who understand and are effective in dealing with organizational dynamics and the political process. Working successfully in the "grass roots" community requires someone who understands the local culture, social networks, formal and informal leadership, and is effective in establishing relationships at the neighborhood level. Liaison activities might include everything from attending school or church gatherings, participating in neighborhood meetings, or providing disaster mental health consultation to government officials.
Spontaneous volunteers who contact the DMH Emergency Operations Center will be referred to the Department of Labor, Licensing and Regulations-LLR-(telephone: 803 896-4300) for primary credential and legal screening. Upon receiving LLR approval for assignment to the disaster recovery process, DMH will consult with the American Red Cross, Department of Social Services and other VOAD partners to determine the best assignment venue for the volunteer. In most cases, the volunteer will be paired with local professionals to provide a mentor relationship in the assigned activity. Due to the variety of conditions and needs in the field, a homogeneous cadre of volunteers would better serve to meet a broad range of disaster situations. Peer counselors will be encouraged to participate fully in the recovery process. The field performance of volunteers will be evaluated by the Team Leader for relevance and appropriateness. All volunteer activity information will be included in the Team reporting assessments. Normal staff rotation schedules will apply to all volunteers. Any volunteer may be returned from the recovery area when, in the judgment of the Team Leader, performance falls below that which is acceptable.
All DMH mental health center and hospital Disaster Coordinators will be notified that this Manual is posted on the DMH World Wide Web site. They will be encouraged to copy the text and have readily available as an adjunct to their local Disaster Plan. Periodic opportunities for review and input are provided and notices of available updates are circulated. The Disaster Response Manager in the Office of the Medical Director is responsible for the updating and distribution activities.
Notice of the availability of this Disaster Response Manual on the DMH Web site will be provided to all members of the public and private response network comprised of state and private agencies operating within and outside the SC Emergency Management Division, MMRS partners, SC VOAD members, SAMHSA Advisory Council members, SAMHSA and CMHS consultants and local fire/life safety representatives.
Unified Community Crisis Counseling Teams (“Away Teams”)
DMH has partnered with the other agencies represented in the SC Emergency Management Division’s Emergency Support Function-8 to select, orient, assign and coordinate unified Community Crisis Counseling Teams composed of professionals who have behavioral health training and experience. The Teams will consist of representatives from mental health (DMH), substance abuse (DAODAS), public health (DHEC) and Vocational Rehabilitation (SC VR) developmentally disabled (DDSN). Thus, Team members so comprised, are prepared to bring combined agency resources to bear in the recovery process. These Teams will work collaboratively with the local Incident Command System leadership to provide a broad spectrum of counseling services. Teams will be rotated on a regular schedule which begins with an orientation to site conditions and needs and ends with an exit meeting at the end of the assignment.
School Related Disaster Response
The DMH Division of Children, Adolescents and their Families offer unique services to children and their families during and following All Hazards disaster events. Counseling staff with special training are grouped in teams and dispatched to the area with the disaster. Members have access to specially designed materials to inform, educate and aid youth and their families in the recovery process. DMH representatives will work closely with the SC Department of Education staff and Law Enforcement officials to coordinate all provided services. In the event of an emergency where the local community has exceeded local resources, assistance from DMH school-based mental health professionals is accessed through the following procedure:
1-Call your local mental health center and speak with the Director of Children’s Services to specify your needs. (See the DMH Web site for center locations, names and phone numbers)
2-The Director will contact the appropriate professional(s) to send to your school as soon as possible.
3-If you are unable to reach the local mental health center for any reason, please contact the SC Department of Mental Health Public Safety Dispatch phone at 803 935-5470 and asked to be connected to the Children’s Division in the agency Administration Building for assistance to meet your immediate needs.
Interface with Disaster Plans of Other Agencies
This Plan has been reviewed by the Administration of Department of Alcohol and Other Substance Abuse Services, American Red Cross, the SC Emergency Management Division and the Department of Health and Environmental Control to be used to cross reference the four Plans in terms of ensuring joint planning and implementation of disaster response services. Such common elements prepare the way for the pooling and distribution of human and material resources. A joint Emergency Operations Center at DMH will be operated by staff from DMH (Disaster Response Team) and the Alcohol and Other Substance abuse agency. Finally, the DMH Community Crisis Counseling Response Teams sent into the disaster area will be composed of staff from these agencies.
Memoranda of Agreement with Related Agencies
The DMH Disaster Response Manager regularly participates in the review and update of the SC Emergency Management Division several specific Disaster Plans. As a result, the DMH is specifically referenced as the designated provider of Disaster Crisis Counseling in a number of citations in the Plans. These reference points are agreed upon by DMH and the other agencies participating in the review process. As the lead agency in Disaster Crisis Counseling, DMH works diligently with other service agencies like American Red Cross, the Department of Social Services (ESF-6) and the Department of Alcohol and Other Drug Abuse Services (ESF-8) to coordinate the respective crisis counseling training and assignment of response teams in times of all hazard disasters. To clarify these roles and responsibilities, DMH has detailed Memoranda of Agreements with the American Red Cross and the SC Department of Social Services (see Appendix). Generally, DMH has agreed that, to the extent possible at the time, the agency will provide both professional and line staff to assist with a multitude of disaster related activities ranging from disaster crisis counseling on the one hand to evacuation shelter services on the other. Each request for staff and/or materials will be evaluated on the basis of the nature and extent of the disaster combined with agency resources availability at the time. It is agreed that each agency will collaborate closely and pledge mutual support to ensure adequate and timely recovery.
for Volunteer Staff Members on "Away-Teams"
PRIOR TO DISASTER:
| Pre-designate the Go Team members/location | |
| Include multicultural, multi-language capability to reflect makeup of community | |
| Include special population workers (children, older adults) | |
| Orient the Go Team members in disaster mental health outreach techniques and disaster resources | |
| Train the team on personal and family disaster preparedness; all team members have personal disaster kit (food, water, clothes, sleeping bag, cash, medications, hygiene supplies, flashlight etc.) in trunk of car | |
| Provide the team with identification cards recognized by S.C. emergency management and local law enforcement officials | |
| Assemble supplies and equipment for immediate use by team (distribute to team in advance or keep in accessible location) | |
| Provide cellular phones or arrange with local amateur radio group to provide communication linkage | |
| Give them a resource directory | |
| Have brochures and fliers on common disaster reactions, ways to cope, and where to call for help (may leave blank space for disaster hotline numbers); in multiple languages, in needed | |
| Provide pens, paper, necessary forms, clipboards | |
| Complete simple data collection forms to track services delivered, funds expended, and to collect needs assessment date for FEMA and other available grants | |
| Have the office of Communications prepare sample public service announcements (PSAs), news articles, and sample interviews for radio and television; distribute as appropriate. | |
| Identify and establish relationships with community agencies that will be key to successful outreach efforts: American Red Cross, schools, agencies serving special populations | |
| Identify special populations or groups in community likely to be vulnerable in disaster; outline outreach strategies and key resources for each group. |
DISASTER RESPONSE:
Identify sites or shelters where groups of survivors are likely to gather (shelters, food kitchens, community centers, hospitals, schools, the morgue, standing in lines, at roadblocks, in neighborhoods, etc.)
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| Contact survivors via letters, phone calls, or door-to-door visits; provide informal assessment, education, support and resources | |
| Establish and maintain contact with agencies, caregivers, key community members, and businesses used by survivors | |
| Provide public education to community-at-large regarding common reactions, coping strategies, and where to call for help | |
| Use print and electronic media for articles, interviews, public service announcements, paid advertisements, call-in, TV shows | |
| Provide public speakers to civic groups, service clubs, PTAs, churches, etc. | |
| Attend community gatherings and meetings, fairs, and other events; circulate and talk with survivors for informal assessment, education, support, and providing resources | |
| Hang posters on bulletin boards, buses, bus stops, in clinics, waiting rooms, and other public places | |
| Distribute brochures and fliers door-to-door, in shopping bags, on literature racks, in department, etc.) | |
| Acquire or develop boy and girl game activities or coloring books for children | |
| Train and educate community professionals, caregivers, and informal support systems of survivors regarding mental health aspects of recovery and how to help survivors | |
| Consult with community professionals and caregivers to facilitate their work with survivors | |
| Help community organization efforts among survivors or among informal resource groups | |
| Help community organization efforts among survivors or among informal resource groups |
PRE-DISASTER
Develop a memorandum of understanding between mental health and the American Red Cross.
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| Train mental health staff on the disaster mental health plan, roles, and responsibilities. | |
| Cross-train mental health staff in American Red Cross operations. | |
| Provide mental health staff with identification cards recognized and approved by emergency management and law enforcement officials. | |
| Have mental health supplies and materials preassembled for transport to shelter, including mental health brochures in languages appropriate to the community population. | |
| Clarify procedures with Red Cross for administering medications and record keeping in the shelter. |
DISASTER RESPONSE
| Wear proper identification. | |
| Meet with shelter manager and Red Cross nurse, review and clarify mental health roles and responsibilities. | |
| Obtain briefing on conditions, tour the shelter, become familiar with operation. | |
| Assess population of survivors for special needs, e.g., children, older adults, mentally ill, specific ethnic groups, drug/alcohol dependents, individuals experiencing severe loss or trauma, language interpreter services. | |
| Develop mental health staffing schedule according to needs. | |
| Set up quiet area for mental health consultations, and drug/alcohol detoxification room if needed. Consult with shelter manager and nurse as needed regarding shelter environment, needs of individual survivors, and stress management for shelter staff. |
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| Assist in establishing sources of information for shelter: Disaster Welfare Inquiry, newspapers, bulletin boards, briefings by emergency officials, brochures about resources, etc. | |
| Assist in establishing activities to promote stress reduction for shelter residents and staff, e.g., childcare, recreation, exercise, support and debriefing groups. | |
| Circulate through the shelter and provide brief assessment, intervention, comfort, assistance, and follow-up for individual shelter survivors and staff as needed. | |
| Distribute brochures on mental health reactions of adults and children to disaster, self-help stress management suggestions, and where to call for additional help. | |
| Provide staff support groups, stress reduction activities, brief supportive counseling services, and debriefings for shelter staff and volunteers. | |
| Provide in-service training or consultation to shelter staff about mental health issues pertinent to the shelter population. | |
| Provide a summary report of mental health conditions and significant activities to each new shift of mental health and American Red Cross personnel. | |
| Set up a charting system for persons receiving psychiatric evaluations, medications, or intervention of more than a brief nature. | |
| Keep accurate records of numbers of people seen, problems they were experiencing, and types of interventions given. | |
| Maintain records of staff hours, supplies, and costs associated with their shelter assignment. | |
| With agreement of Red Cross Management, provide debriefing for Red Cross personnel at the end of shelter operations (if other mental health resources are not providing the service). | |
| Arrange debriefing by outside resource for mental health personnel at the end of shelter operations. |
POST-DISASTER
| Provide recognition to mental health staff for contribution to the disaster effort, including those who stayed at the clinic or office to "mind the store." | |
| Arrange a critique for mental health staff to evaluate effectiveness of their shelter operations. | |
| Revise disaster plan, policies, procedures, and memoranda of understanding, based on recommendations from the critique. |
General:
The authority and responsibility for emergency management at the state level belong to the Governor or his/her designee. While state laws vary, the Governor is typically given the powers or options to do the following:
1. Suspend state statutes, rules and regulations.
2. Procure materials and facilities without regard to limitations of existing law.
3. Direct that evacuation be initiated.
4. Control the entrance to and exit from the disaster area.
5. Authorize the release of emergency funds.
6. Activate emergency contingency funds and reallocate state agency budgets for emergency work.
7. Issue state or area emergency declarations and invoke appropriate state response actions.
8. Apply for and monitor federal disaster and emergency assistance.
Specific
Day to day emergency management responsibilities are delegated by the Governor to the lead agency in the state, called the SC Emergency Management Division. Various other state agencies are mandated to carry out assigned activities related to mitigating the effects of an emergency and to cooperate with each other and other political subdivisions in providing assistance.
The responsibilities of the SC Emergency Management Division are as follows:
1. Prepare and maintain a comprehensive state emergency plan and emergency management program.
2. Assign emergency functions to various state agencies, and coordinate the activities of the agencies in developing the state emergency plan.
3. Ensure that all personnel assigned specific responsibilities in support of the state plan are adequately trained and prepared to assume those responsibilities.
4. Support and facilitate local government preparedness efforts, to ensure that disasters are handled at the lowest government level; write standards and requirements for county and municipal plans; and review and maintain a file of current plans that are developed or updated under those standards.
5. Oversee the damage assessment process following emergencies.
6. Administer and coordinate state resources providing assistance requested by the county or affected area, and request federal disaster assistance, if warranted.
7. Administer the state mutual aid system, with regional or state staff assisting local emergency operations at the request of local disaster coordinators.
8. Maintain mutual aid agreements with adjoining states.
When a disaster exceeds the local government's ability to respond effectively, the state Emergency Management Division activates functions that are essential to a coordinated response in support of the local jurisdiction.
ORIENTATION OF DISASTER STAFF TO COMMUNITY ASSIGNMENTS
In addition to training, managers should be sure that an orientation to the disaster is provided to mental health staff before deployment. The following topics should be covered:
1. Status of the disaster: nature of damage and losses, statistics, predicted weather or condition reports, boundaries of impacted area, hazards, and response agencies involved.
2. Orientation to the impacted community: demographics, ethnicity, socioeconomic makeup, pertinent politics, cultural mores, language requirements, etc.
3. Local Community and disaster-related resources: handouts with brief descriptions and phone numbers of human service and disaster-related resources. FEMA or the state Office of Emergency Services (OES) usually provides written fliers describing state and federal disaster resources once Disaster Application Centers (DACs) are opened. If available, provide them to all staff. Provide workers with a supply of mental health brochures or fliers to give to survivors, outlining normal reactions of adults and children, ways to cope, and where to call for help. For volunteers or mutual aid personnel, provide a brief description of the sponsoring mental health agency.
4. Logistics: arrangements for workers' food, housing, obtaining messages, medical care, etc.
5. Communications: how, when, and what to report through mental health chain of command; orientation to use of cellular phones, two-way radios, or amateur radio volunteers, if being used.
6. Transportation: clarify mode of transportation to field assignment. If workers are using personal vehicles, provide maps, delineate open and closed routes, indicate hazard areas; provide appropriate agency approved identification materials.
7. Health and Safety in a disaster area: outline potential hazards and safety strategies (e.g., protective action in earthquake aftershocks, flooded areas, etc.). Discuss possible sources of injury and injury prevention. Discuss pertinent health issues such as safety of food and drinking water, personal hygiene, communicable disease control, disposal of waste, and exposure to the elements. Inform of first aid/medical resources in the field.
8. Field assignments: outline sites where workers will be deployed (shelters, meal sites, etc.). Provide brief description of the setup and organization of the site and name of the person to report to. Provide brief review of appropriate interventions at the site.
9. Policies and procedures: briefly outline policies regarding length of shifts, breaks, staff meetings, required reporting of statistics, logs of contacts, etc. Give staff necessary forms and inform where to return forms.
10. Self-care and stress management: require the use of "buddy system" to monitor each other's stress and needs. Remind responders of the importance of regular breaks, good nutrition, adequate sleep, exercise, deep breathing, and positive self-talk, appropriate use of humor, "defusing" or talking about the experience after the shift is over. Inform workers regarding required debriefing to be provided at the end of each tour of duty in the field.
DISASTER RESPONSE: IMPACT ON STAFF
Disaster workers go through a series of emotional phases related to the nature of their jobs. At times, workers may feel "out of sync" with the reactions of survivors. This is especially common in the early hours and days of the disaster while workers are still making heroic efforts to organize and deliver services. At other times, mental health workers may closely identify with survivors and experience their emotions vicariously. While it is impossible to specify exactly what a given mental health worker will experience at any one point in time, the following are the usual disaster worker phases:
Alarm phase. This phase involves comprehending and adjusting to the news of the disaster, collecting and making sense of whatever facts and information are available, and gearing up to respond. In a warning period in which workers are waiting to see whether an event will materialize (a tornado watch, for example), they may experience vague filings of anxiety, restlessness, and irritability. Post-impact, workers, like survivors, may initially feel shocked and stunned. An orientation or briefing for workers before they first enter the disaster area can help to prepare them for the conditions they may find, and can help to reduce some emotional shock.
Mobilization phase. Workers quickly recover from their initial shock and start developing and coordinating plans. Supplies, equipment, and personnel are inventoried and local community needs are assessed. Mental health center/hospital aid may be requested. Staff are selected and activated.
Action phase. Workers actively and constructively work at necessary tasks. There are two aspects to the mental health action phase (New Jersey Office of Emergency Management, Dec. 1991):
A. Response. This phase occurs immediately before, during and after the impact. Mental health response activities may include staffing at shelters, first aid stations, meal sites, morgues, Emergency Operations Centers, or command centers. There is usually a high level of activity and often a high level of stress. Many frustrations may occur due to adverse conditions, lack of equipment, communication breakdowns, and the like. Nevertheless, workers proceed diligently and often heroically, frequently ignoring their own fatigue and injuries. During disaster operations that continue for more than a day or two, worker burnout can occur if needs for breaks, food, sleep, and stress management are ignored.
B. Recovery. Short-term recovery includes activities intended to return vital life-support systems to more normal levels of operation. Psychological first-aid, crisis intervention, and defusing are short-term mental health recovery activities. Long-term recovery activities are designed to return life to normal or improved levels. Long-term mental health recovery activities include outreach, consultation and education, individual and group counseling, community organization, advocacy, and referral to community resources. Mental health recovery services in the long-term may extend to or beyond the first anniversary of the disaster.
Recovery-phase disaster work has a slower pace and can be less immediately rewarding than early-phase response. Because disaster survivors do not usually seek out counseling services in large numbers, outreach and community education activities comprise a large part of recovery activities. Because of the lack of large numbers of clients, combined with the difficulty of evaluating effectiveness of outreach and education efforts, workers can lose heart and question the value of their work.
The emotional impact of disaster is especially strong for workers if contact with survivors is prolonged. Staff identify with and sometimes take on the frustrations in their rebuilding efforts. Continuous exposure to survivors' stories of loss and grief can be painful for workers, and, if unrecognized, can play into an unconscious desire to avoid listening to painful material.
Letdown phase. This phase involves the transition from the disaster operation back into the normal routine of work and family life. It can be a difficult period for workers if feelings have been suppressed or denied during the action phase, and the feelings now begin to surface. In addition, workers may experience feelings of loss and "letdown" as they move out of the challenging disaster assignment and return to their usual activities.
WORKER STRESS REACTIONS DURING THE DISASTER
The following are some list of common disaster worker stress reactions. They are provided to alert workers and supervisors to what stress reactions commonly occur, and to help them in determining if they are experiencing a problematic level of stress. Usually, the symptoms are normal in every way, and simply suggest a need for corrective action to limit the impact of a stressful situation. In some situations, stress symptoms may be delayed for weeks, months, or years following the event.
No clear-cut guide exists for how and when to know if workers are experiencing excessively high stress levels. One fact is clear: workers are usually not the best judges of their own stress, as they tend to become intensely involved in the disaster work. Therefore, a buddy system, where coworkers agree to keep an eye on each other's stress reactions, can be important.
Table 1 shows the common stress reactions that may occur for disaster workers.
TABLE 1
COMMON DISASTER WORKER STRESS REACTIONS
PSYCHOLOGICAL/EMOTIONAL
Feeling heroic, invulnerable, euphoric
Denial
Anxiety and fear
Worry about safety of self or others
Generalized anger
Irritability
Restlessness
Sadness, grief, depression, moodiness
Distressing dreams/unsatisfying sleep
Guilt or "survivor guilt"
Feeling overwhelmed and hopeless
Feeling isolated, lost or abandoned
Apathy, emotionally neutral
Over identification with survivors
COGNITIVE
Memory problems
Disorientation
Confusion
Slowness of thinking and comprehension
Difficulty calculating, setting priorities, making decisions
Poor concentration
Limited attention span
Loss of objectivity
Unable to stop thinking about disaster
Blaming
BEHAVIORAL
Change in activity levels
Decreased efficiency and effectiveness
Difficulty communicating
Increased use of humor
Outbursts of anger and/or frequent arguments
Inability to get proper rest and feelings of being "let down"
Change in eating habits: too much or too little
Change in sleeping patterns
Change in patterns of intimacy, poor sexual performance
Change in job performance
Periods of crying and depression
Increased use of alcohol, tobacco, and other drugs to excess
Social withdrawal, increased silence
Vigilance about the safety of the environment
Avoidance of activities or places that trigger negative memories
Proneness to accidents and falls
PHYSICAL
Increased heartbeat and breathing pattern
Increased blood pressure
Upset stomach, nausea, diarrhea
Change in appetite, weight loss or gain
Sweating or chills
Tremors (hands, lips, facial area)
Muscle twitching
"Muffled" hearing
Tunnel vision
Feeling uncoordinated
Headaches
Soreness in muscles
Lower back pain
Feeling a "lump in the throat"
Exaggerated startle reaction
Fatigue
Menstrual cycle changes
Change in sexual desire
Decreased resistance to infection through immune system suppression
Flare-up of allergies and arthritis
Hair loss
Table 2 provides a list of physical stress reactions that require prompt medical evaluation.
TABLE 2
PHYSICAL STRESS REACTIONS REQUIRING PROMPT MEDICAL EVALUATION
Chest pains
Irregular heartbeat
Difficulty in breathing
Fainting or dizzy spells
Collapse
Unusually high blood pressure
Numbness or paralysis of part of body
Excessive dehydration
Frequent vomiting
Blood in stool
HOW TO KNOW WHEN STRESS REACTIONS BECOME A PROBLEM
Usually, worker stress reactions will diminish with practice of stress management approaches, the passage of time, the ability to talk about the event and its meaning, and the support of family, friends, and the worker's organization. Sometimes, the disaster or disaster work may be so stressful for the worker that symptoms do not seem to diminish on their own. The following are some guidelines for separating normal stress reactions from those that may be problematic:
Duration: the duration of a stress reaction will depend on the severity of the event, the meaning of the event to the worker, and the individual's coping mechanisms and support system. Stress symptoms related to the actual disaster usually subside in about six weeks to three months. Intense symptoms lasting longer may require professional assistance. Stress reactions related to the stressors of the disaster assignment can continue as long as the worker is in his/her disaster role. Careful attention should be paid to eliminating occupational stressors, providing organizational supports for workers, and building stress management strategies into the workplace. In addition, it is important to provide workers with anticipatory guidance about transition back into regular work roles and activities.
Intensity: This is a highly subjective criterion. However, any symptoms that seem acutely intense, disturbing, or out of control to the worker may require professional assistance. In particular, unusual physical reactions, visual or auditory hallucinations, extremely inappropriate emotions, phobic or panic reactions, antisocial acts, serious disorientation, or suicidal or homicidal thoughts should receive mental health assistance.
Level of functioning: Any symptoms that seriously interfere with an individual's functioning at work, at home, or in social relationships should be considered for mental health assistance.
ORGANIZATIONAL SUPPORT FOR MENTAL HEALTH STAFF IN THE IMMEDIATE RESPONSE PHASE
In the response phase during and immediately after impact of the disaster, the provision of certain supports for workers can help mitigate stressors and help workers to remain effective in their jobs. There are a variety of services such as communications, food, shelter, and supplies that are essential to "keep the organization going." In a large-scale disaster mental health operation, the organization must consider assigning a logistics coordinator to this function. The following should be considered.
Assistance with locating and checking on families
When disaster strikes during work hours, employees' prime concern will be learning information about the well-being of their families. Worker anxiety will increase and efficiency will markedly decrease until such information is obtained. Some anxiety may be mitigated if workers have disaster plans at home, and know that their family members have the skills and supplies to take care of themselves. Nevertheless, staff will need information about the status of their families.
If workers do not have information about the well-being of their families, the organization should make every effort to help them in obtaining information. All agencies with disaster responsibilities should have a pre-established plan for how employees will check on their families if disaster strikes during the work hours. It has been suggested that each employee should have on file a regularly updated list of family members, addresses, phone numbers, and usual whereabouts during given hours of the day. Employees are strongly encouraged to establish a plan with their family members by which the family will make every effort to contact the workplace to report on family well-being. This is especially important in those situations where employee roles are essential and they may not immediately be able to leave the workplace.
If conditions allow, staff may be released to go home and take care of their families before reporting to duty for disaster response. In the situation where staff cannot be released (on an inpatient unit, for example), there are several options. When additional staff report for duty, staff can be released to check on families. Staff in less critical roles (clerical staff, for example) may be assigned to family locator functions, and may go into the community to check on families, conditions permitting. If phones are working, one line can be dedicated to family search activities.
Debriefing of mental health staff
It is essential that disaster mental health workers begin to process their own emotions about the disaster before attempting to help survivors. It is strongly recommended that a pre-deployment briefing or other group discussion of workers own reactions be conducted for workers before deployment.
Utilization of a team approach
Whenever possible, mental health personnel should be assigned to work in teams of two. If there are not enough mental health workers to allow this arrangement, staff can often work in a team assignment with public health nurses, Red Cross workers, or other human service-type disaster responders. This ensures a system by which staff can serve as a check-and-balance for each other in assessing needs, making decisions, setting priorities, etc. in the chaotic disaster environment. It also provides staff with a "buddy system" for monitoring each other's stress level and providing support and encouragement.
Briefing
Provide workers with as much information as possible about what they will find at the disaster site. This may involve a quick briefing before sending workers into the field, or a briefing for new staff as they arrive at the scene. This forewarning can help personnel gear up emotionally for what they may find.
Work related supplies
Pens, paper, data collection forms, name tags, educational brochures on disaster stress reactions and stress management, and any other necessary supplies should be sent with workers to the worksite.
Official identification
Official identification cards that are recognized by law enforcement will be necessary to enter the disaster site. In addition, name tags will be important once staff get to their assigned worksite. Most disaster survivors do not see themselves as needing mental health services, and may shy away from talking to staff that have name tags saying "psychologist" or "psychiatrist." Experience has shown that titles like "crisis worker," "crisis services," or "health services" are less intimidating to survivors.
PRE-DISASTER ACTIVITIES
| Develop a mental health disaster plan that specifies responsibilities and functions of mental health personnel in time of disaster. | |
| Train mental health staff in disaster roles, responsibilities, principles of disaster mental health practices, and stress management for disaster workers. | |
| Participate in regular area and statewide disaster exercises. | |
| Strongly encourage all mental health staff to have family, school, and workplace disaster preparedness plans. | |
| Prepare or obtain brochures on disaster work stress. | |
| Provide mental health staff with identification cards recognized and approved by emergency management and law enforcement officials. | |
| Purchase or designate supplies and equipment to be used in time of disaster. |
DISASTER RESPONSE ACTIVITIES
| Support and assist mental health staff in locating their families and assessing personal losses. | |
| Brief staff regarding conditions in the field before deploying them to their assigned sites. | |
Provide staff with necessary supplies, including brochures on disaster worker stress management and self-care. |
|
| Establish chain of command and supervision from Emergency Operations Center to field staff; brief staff. | |
| Establish a mechanism for communicating with staff in the field; provide staff with necessary communications equipment. | |
| Arrange for food and shelter for staff in field, if necessary. | |
| Determine safe routes to sites where workers will be assigned; provide escort of transportation for staff if necessary. | |
| Be sure all staff have official identification. | |
| Deploy staff in teams of two or more. | |
| Ensure team coordination with other community resources, e.g., American Red Cross Disaster Services. | |
| In the field, observe staff for signs of stress; encourage good stress management practices. |
DISASTER RECOVERY ACTIVITIES
| Assign staff to work in teams on long-term recovery projects. | |
| Provide regular in-service training and consultation to staff. | |
| Provide regular, periodic debriefing or support groups. | |
| Observe staff for signs of stress and burnout; encourage good stress management practices. |
POST-DISASTER ACTIVITIES
| Provide debriefing by a trained facilitator for staff at the end of the disaster assignment. | |
| Engage staff in a critique of the disaster operation or project. | |
| Provide recognition to staff who participated in disaster operations as well as those staff who "held down the fort" by covering regular work assignments. |
Level I: (Limited Scope)
In the event of a Center Specific loss or tragic event which impacts the entire Center, The Office of the Medical Director, Division of EPPR upon the request of the affected organization shall ensure the operations of the Center are covered by clinical and administrative staff and shall provide post traumatic stress debriefings as requested.
Level II: (Moderate):
Level III: (Severe/Major): May be large scale natural event or massive act of terrorism
SCDMH DISASTER MATRIX: Local and State Declared
Local Community Disasters:
LOCAL DISASTER is any event, real and/or perceived, which threatens the well being (life or property) of citizens in one local community
A LOCAL DISASTER is manageable by local representatives without a need for outside resources.
RESPONSE is by local government, such as mental health center staff, police, fire chief, mayor or county judge and/or other legal authority of local government.
A RESPONSE by a Community Mental Health Center (CMHC) is NOT required by State Authority. The CMHC MAY choose to respond if a request is made by local officials and/or a need is evident.
There is no set time of duration for response to a local disaster and this type of disaster is not usually reimbursable.
STATE DECLARED DISASTERS:
A STATE DISASTER is any event, real and/or perceived, which threatens the well being of citizens in multiple cities, counties, regions, and/or overwhelms a local jurisdiction's ability to respond, or affects a state owned property or interest.
A STATE DECLARED EMERGENCY can only be designated by the Governor or his/her designee. Response and Recovery is the responsibility of the SC Emergency Management Division and its public and private sector partners.
A RESPONSE MAY BE required depending upon the magnitude, nature and duration of the emergency or disastrous event. The SC Department of Mental Health (SCDMH) may also supplement local resources with hospital and center staff and/or other staffing opportunities.
The DURATION OF RESPONSE for this category of disaster is generally for the duration of the event or until it is jointly determined by the SCDMH and the SC Emergency Management Division, that a response is no longer necessary and/or appropriate.
This type of disaster may not be REIMBURSABLE. Only under highly unusual circumstances would the SCDMH be allowed to apply for funds.
Disaster Definition |
Ownership |
Response Required |
Duration of Response |
Reimbursable |
|
| Local | A local disaster is any event, real and/or perceived, which threatens the well being (life, property) of citizens in one municipality. A local disaster is manageable by local officials without a need for outside resources. | Local government, such as a mental health center, police or fire chief, mayor or county judge and/or other legal authority. | A response by a Community Mental Health Center is NOT required by the State Authority. The mental health MAY center choose to respond if a request is made by local officials and/or a need is evident. | Not applicable.
|
YES/NO YES, if the SCDMH seeks Federal Crisis Counseling Program |
| State | A state disaster is any event, real and/or perceived, which threatens the well being of citizens in multiple cities, counties, regions, and/or overwhelms a local jurisdiction’s ability to respond, or affects a state owned property or interest. | A state declared emergency can only be designated by the Governor or his/her designee. Response and recover is the responsibility of the SC Emergency Management Division. | A response MAY BE required depending upon the magnitude, nature and duration of the emergency or disastrous event. The SCDMH may also supplement local resources with hospital staff and/or other staffing opportunities. | For the duration of the event or until it is jointly determined buy the SCDMH and the SC Emergency Management Division, that a response if no longer necessary and/or appropriate. | NO Only under highly unusual circumstances would the SCDMH be allowed to apply for contingency funds from the Governor’s office. |
| Federal | A federally declared disaster is any event, real and/or perceived, which threatens the well being of citizens, overwhelms the local and state ability to respond and/or recover, or the event affects federally owned property or interests. | A federally declared disaster can only be designated by the President of the United States. The Governor of a state must request a Presidential Declaration. | YES A response will be required according to actual or perceived need. |
For the duration of the event or until it is jointly determined by the SCDMH and the SC Emergency Management Division, that a response is no longer necessary and/or appropriate. For the duration of the grant period, if a Federal Crisis Counseling Program Grant is obtained. | YES/NO YES, upon requested and approval by the State and Federal authorities. If a disaster is approved for “Public Assistance,” a municipality may apply for reimbursement. |
Hazard-Specific Planning
In the context of plan content that applies to nearly all types of events, there is a need to plan for the specific and sometimes unique aspects of these different events. Events may have unique characteristics that lead to special psychosocial consequences that have significant implication for the DMH (i.e. slow-rising, long-standing flooding may result in delayed reconstruction or repair to homes and may result in victims spending longer periods of time in shelters or with friends and families, which can generate additional individual and family stress).
In addition, some types of events are accompanied by significant government regulations that have serious impact on the response and recovery, and may impact psychosocial sequellae. For example, the locations where suspected terrorist events occur are considered crime scenes. This may result in delayed body recovery and release of surviving victims. It may result in recovery workers also becoming witnesses for criminal proceedings. These special factors can have a significant impact on the course and timing of psychological recovery.
Hazard-specific planning by the DMH should also occur in the context of such planning by the SC Emergency Management Division (EMD). The DMH workers will have performed significant and detailed risk assessments that can be utilized by the DMH. This planning will also include identification of events when an agency other than emergency management (e.g., the FBI or military) is in control of the response. Plans should include identification of types of risks as well as geographic areas that are believed to be at risk. Not all states are susceptible to the same risks, and different portions of states may be at greater or lesser risk for different types of events. In addition, the DMH may have facilities in high-risk areas or facilities that are to be used as back-up facilities.
A detailed listing of types of risks a state may experience can be found in the matrix in Appendix A.
Terrorism
Planning for the consequences of terrorist acts presents numerous challenges. The national experience and the experience of most individual states is limited. There are many types of potential terrorist acts to consider during planning. The scientific knowledge about the psychological and medical aspects of some types of terrorist acts, especially bioterrorism, is not as precise and complete as had been thought. Because there is so much emphasis currently on preparing for a wide variety of terrorist incidents, the planning environment is changing very rapidly, with new laws, guidelines, and key players emerging constantly.
In some cases the DMH plan could reference the EMD plan. There may also be reluctance to put some material in a plan that is posted on the Web or is otherwise easily accessible to a very wide audience. Again, taking the lead of the DMH may be the best strategy. With these factors in mind, the DMH plan for terrorism should be developed by being informed of the following issues.
Continuity of Operations for the State Mental Health Agency(SCDMH)
No organization can mount a response to a disaster if the fundamental operations of that organization are not functioning. DMH is no exception. In addition, there are preexisting and ongoing responsibilities of the DMH that do not stop, even when disaster strikes. As a result, part of a meaningful plan is the provision for the DMH to continue its essential functions when disaster strikes through a Continuity of Operations Plan (COOP). In many states, these issues will be contained in documents separate from the DMH Disaster Plan. In some states, it will be integrated as part of the disaster plan. In any case, there is certainly a role for disaster planners in preparing for worker stress issues inherent in any situation that would activate a COOP. To ensure continuity of essential operations, the following items should be addressed.
A FEDERALLY DECLARED disaster is any event, real and/or perceived, which threatens the well being of citizens and overwhelms the local and state ability to respond and/or recover, or the event affects federally owned property or interests.
A FEDERALLY DECLARED disaster can only be designated by the President of the United States. The Governor of a state must request a Presidential Declaration of disaster.
A RESPONSE will be required and the level of response will be according to actual or perceived needs.
The DURATION OF RESPONSE for this type of disaster will be for the duration of the event or until it is jointly determined by the SCDMH and the SC Emergency Management Division, that a response is no longer necessary and/or appropriate. For the duration of the grant period, if a Federal Crisis Counseling Program Grant is obtained.
This type of disaster will be reimbursable only upon request and approval by the State and Federal authorities. If a disaster is approved for "Public Assistance", a municipality may apply for reimbursement. Also, if the State Authority seeks a Federal Crisis Counseling Program Grant or through the Governor's Office funds for these services will be made reimbursable.
Link to National Incident Management System Testing (NIMS)
Heat Wave: A Major Summer Killer (.pdf format)
Criteria for the Selection of Disaster Crisis Counselors (.pdf format)
