By Jon Bowen and Meredith Hogan Pond

Part 1
In towns and cities along the Gulf Coast, survivors and first responders alike continue to show resilience and courage as they face the day-to-day reality of their devastated environment as best they can 3 months after Hurricane Katrina.

November and December may bring relief from the 100-degree heat and humidity of September and October, but for families still living in tents or other temporary shelters, a chill in the air is not a welcome change.

"Tens of thousands of people still require a place to live right now," said Cynthia K. Hansen, Ph.D., a clinical psychologist and American Psychological Association Health Policy Fellow at SAMHSA's Center for Mental Health Services (CMHS).

In late October, Dr. Hansen led a multidisciplinary team of Federal employees and contractors deployed by the SAMHSA Emergency Response Center (SERC) to several towns along the Mississippi coastline. Those towns included Pearlington, Waveland, and Pass Christian.

Survivors get help, photo by Marvin Nauman, FEMA

As a Deputy Incident Commander in the SERC, Dr. Hansen had heard about the serious need for crisis counseling teams along the Gulf Coast. But it was different to witness that need herself.

"We were staffing a free medical clinic next door to a school in Pass Christian where about 85 percent of the teachers were homeless because of the storm. But they were at school teaching the children," said Dr. Hansen in an interview from the field. "And about 20 percent of the staff at the local community mental health centers are living in temporary shelters and still coming in to work every day to see their clients—adults with serious mental illnesses and children with serious emotional disturbances. The compassion and commitment of this local community is absolutely stunning."

Local police officers, firefighters, and other emergency personnel, as well as those working in shelters, clinics, and resource centers, are facing incredible odds to provide adequate services to people in need.

To help, every day SAMHSA staff members join the volunteer teams including psychiatrists, mental health and substance abuse counselors, physicians, nurses, and others wearing the SERC's easily recognizable orange T-shirts and SAMHSA caps.

"Many first responders we talked to had been injured themselves, and they were doing heroic work—working through their personal needs to provide services," said the SERC's Incident Commander Brenda Bruun, Special Assistant to the Director of the Division of Prevention, Traumatic Stress, and Special Programs within CMHS. "They were working under horrible physical conditions to provide continuity of services and care."

SAMHSA Administrator Charles Curie listens to a first responder from the New Orleans Police Department, photo by SAMHSA's Kana Enomoto

In New Orleans, hundreds of first responders and their children have been living onboard anchored cruise ships for months. They are dealing not only with the critical needs of others, but also their own personal trauma. Like most of the other survivors, first responders lost their homes, and many lost loved ones and even members of their immediate family. "We're working with the State of Louisiana on what services those families need and how they can be cared for," Ms. Bruun said.

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SAMHSA's Role in Recovery

As the SERC coordinated deployments to the Gulf Coast, Dan Dodgen, Ph.D., SAMHSA's Emergency Management Coordinator, served as the liaison between the Agency and the Secretary's Operations Command at the U.S. Department of Health and Human Services (HHS). Dr. Dodgen's job was to coordinate SAMHSA's efforts with the efforts of all other HHS operating divisions, specifically with the team from Public Health Emergency Preparedness.

As an ongoing responsibility, HHS has asked SAMHSA to address behavioral health factors—including mental health, substance abuse, and suicide prevention—in preparedness, response, and recovery efforts for all natural and human-made disasters that occur across the Nation. The Agency provides grants, services, and technical assistance to states and tribal organizations in planning for and providing outreach, crisis counseling, and referral services, as well as planning for long-term recovery. SAMHSA also deploys personnel to staff interagency emergency operations centers.

In addition, SAMHSA's Disaster Technical Assistance Center (DTAC) trains state mental health staff to perform outreach and education on reducing stress and to maintain a contact database of state/territory mental health commissioners, substance abuse directors, and disaster coordinators.

"Now we're switching from an emergency response focus to a long-term recovery focus," said Dr. Dodgen. "And we're thinking, how do we restore people's lives and create long-term care?"

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In the SERC

The hum of activity filled the SERC from the beginning, August 31—48 hours after Katrina struck—until October 21, when assignments shifted to individual desks. At that time, the Operations Room was cleared of maps, charts, bulletin boards, and daily briefing notices. "I couldn't get people in the SERC to take a break," said Ms. Bruun, "because they were so committed to seeing people get the services they need."

Incident Commander Brenda Bruun begins a debriefing in the SAMHSA Emergency Response Center

One of the important lessons learned from operations at the SERC is how the entire Agency needs to be educated in emergency response, according to Ms. Bruun. "We all need to know where SAMHSA fits into the national response plan and what our mission is in the response to a disaster. We need to make sure our constituencies understand what we do."

SAMHSA's Emergency Response Center was built on the Incident Command System (ICS), an emergency response management structure designed to streamline response activities by fostering a fluid decision-making process and avoiding duplication of efforts.

"The streamlining happens because each function within ICS has authority to make decisions on behalf of the Agency," said Ms. Bruun.

Responsible for all of the SERC's operational decisions, Ms. Bruun had under her command seven functions staffed by various SAMHSA volunteer personnel on a rotating basis. Each of the functions—planning, logistics, finance, personnel, public information, reporting, and recording—had a distinct task. And each function was responsible for daily decisions affecting people in the Gulf Coast region.

"The planning team looked at the kinds of resources that could be applied to common issues," Ms. Bruun explained. "For example, the evacuated kids from Louisiana were showing up in new school districts, some of which were in other states. Also, administrators in those districts wanted to know how to address trauma issues. So planners worked on a coordinated strategy to provide training and technical assistance for trauma training."

Most phone calls to the SERC came from state authorities looking for resources, and Gulf Coast states were not the only ones looking for assistance. "All 50 states are taking evacuees and serving those evacuees," Ms. Bruun added. "And they're also serving their existing populations. It's a huge job."

See Also-Article Continued: Part 2 »

See Also-Administrator's Message »

See Also-First-Person Accounts »

See Also-Resources »

See Also-Children's Trauma Network »

See Also-Methadone, Buprenorphine »

See Also-Estimates of Substance Use in Affected States »

See Also—Next Article »

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