Recommendations for Mental Health Disaster Preparedness/Response for Racial/Ethnic Minority
Communities and Populations/Helping Hands and Healing Minds Project/ Vickie Mays/UCLA
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Mental Health Disaster Preparedness and Response in Racial/Ethnic
Minorities Populations and Communities
Vickie M. Mays, Ph.D., MSPH, “Helping Hands, Healing Minds”
Director, UCLA Center on Research, Education, Training and Strategic Communication on
Minority Health Disparities
mays@ucla.edu
Proposed National Recommendations
DRAFT RECOMMENDATIONS NOT FOR FURTHER DISTRIBUTION OR CITATION
There are a number of recommendations that will be contained in the final report that will be
forwarded to Kellogg as well as various other relevant groups. The local recommendations are
shared with the local on the ground community individuals and the national recommendations
are being shared with you.
Some recommendations have a clear direction as to whom it should be directed and others do
not. One goal of this meeting is not just to tinker with the recommendation but also to determine
what agencies these recommendations should be targeted to in order to implement them. Our
job as representatives of minority mental health organizations is to determine if
recommendations adequately represent your specific racial/ethnic populations as it may require
additional risk factors or strategies for those you represent. The most useful way to approach
this would be if before and during the meeting that you insert track changes into your document
with any changes that you wish to discuss at the meeting. During the meeting as the discussion
take place modify the document in anyway that you wish so that you leave with a modified
document and that I receive a modified document. This will help to move the document along
and make sure that I capture all of your comments.
Our partners will be experts on discussing who they perceive should be at the table for each
recommendation, the feasibility of the recommendation and if such things are already underway.
Since there may be changes to the document by the time our federal partners arrive they may
wish to offer us comments about those which are already being done if they are and then as we
share the changes offer us guidance about how to craft them so that they can be implemented.
While we all know that budget is a concern for both federal agencies and foundations we should
not let that deter our recommendations but we should be mindful that budget considerations can
be a reason for the recommendations not being to go forth. So we may want to be thoughtful
about how many large scale retooling efforts we ask an agency to do but at the same time if it is
necessary to allow it to go forth.
A. Infrastructure
A1. Rationale
One of the hardest hit groups post disaster in relationship to mental health are adolescents,
particularly those who are school going. An emerging body of research indicates that
racial/ethnic minority adolescents are not likely to seek mental health services through
Recommendations for Mental Health Disaster Preparedness/Response for Racial/Ethnic Minority
Communities and Populations/Helping Hands and Healing Minds Project/ Vickie Mays/UCLA
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traditional counseling avenues but rather are more likely to receive services through school
mental counseling services.
A1. Recommendation
In areas where disasters are repetitive and have a high likelihood of occurring it is
recommended that in predominantly racial/ethnic minority communities, particularly where the
utilization of clinical mental health services are low and often a scarce resource that school
based clinics with mental health counseling services be instituted. In the recovery process even
if the school is not functional the mental health counseling service should be connected to the
federal/state/local disaster response with a particular responsibility for racial/ethnic minority
adolescents and their families. (Office Disaster Preparedness and Department of Education)
A2. Rationale
For a variety of reasons the educational resources in some racial/ethnic minority communities
are below standard. Disruption to these available resources tends to decrease school
readiness and school preparedness in communities already struggling to perform on
standardized tests. In New Orleans there were kids who were out of school for an entire year
with no educational activities during that year.
A2. Recommendation
In areas of great devastation and disruption when individuals are sheltered for long periods of
time or put into large areas of temporary housing that those who set up those facilities should
through the use of volunteers using structured and approved curriculum for children and
adolescents maintain a predetermined number of hours per day an educational activities such
as reading, math, social studies etc. Behavioral observations could be integrated into this
activity in order to intervene early with children and adolescents who are noted to suffer
uncharacteristic responses to the disaster. As an example if an area is developed to house
families in trailers or temporary shelter one trailer or common area should be devoted to
educational and supervised play activities. (Red Cross, Department of Education, FEMA, HUD,
Office of Disaster Preparedness).
A3. Rationale
As the numbers of racial/ethnic minority mental health providers increase there is a growing
ability for the disciplines of psychology, psychiatry and social work to develop and maintain
thriving national organizations. The ability to grow these organizations varies with African
American and Latinos being the strongest and Native American and ANHOPI being among the
weakest in their growth and development.
A3. Recommendation
OMH, relevant federal agencies and private foundations should support for a 3-5 year period the
development of the federation/council of Minority Mental Health Organizations whose sole goal
is to build a council of racial/ethnic minority mental health groups in order to participate in and
direct national policy on the mental health of racial/ethnic minority in the United States. It would
be tasked as one of its first goals is to develop policies and procedures to ensure the
participation of their members in disaster response and recovery and to advocate that its’
chapter members throughout the United States participate in local disaster education and
response. For the Native American and the ANHOPI groups their physician association should
be the initial participants with additional funding to develop and to coalesce specific
subpopulations, tribal and other specific clustering which can later join the federation. As an
Recommendations for Mental Health Disaster Preparedness/Response for Racial/Ethnic Minority
Communities and Populations/Helping Hands and Healing Minds Project/ Vickie Mays/UCLA
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example the National Council of Asian American Physicians would work to develop the Filipino
Association of Psychiatrists, the Korean American Association of Psychiatrists. This federation
should be funded to maintain an office in the District of Columbia area and represent the
federation in working with the National Red Cross, FEMA, etc.,
B. Operations
B1. Rationale
Our work in NOLA began because the community requested racial/ethnic minority mental health
providers.
B1. Recommendation
The Red Cross, FEMA, SAMSHA and other agencies that call out volunteers or send in
evaluators or develop service contracts should correspond directly with racial/ethnic minority
mental health organizations. These agencies may find it worthwhile to aggressively pursue
training opportunities with the members of these organization to assure a trained culturally and
linguistically similar volunteer and workforce. Training opportunities aligned with the national
meetings and national conventions of racial/ethnic minority mental health associations should
be considered.
B2. Rationale
Most Red Cross call outs for volunteers requires a two week commitment. In our work with
racial/ethnic minority mental health providers we learned that many could not commit two weeks
without devastating their own practices, or current employment. They wanted to help and tried
to find volunteer activities through sources other than the Red Cross.
B2. Recommendation
In the case of domestic disasters reduce volunteer call out to 7 days. Racial/ethnic minority
providers often have networks and contacts of their members to bring them up to speed. They
can access communities via these networks and faith-based communities and can often be of
great service in 7 days. The two week requirement is a particular hardship financially for many
of the racial/ethnic minority providers but they are really needed.
B3. Rationale
Getting racial/ethnic minorities to leave their home can be difficult as well as fearful. Emerging
research indicates that Latinos in particular are concerned about how they and their families will
be treated (mistreated) and some who are not citizens fear deportation.
B3. Recommendation
In some racial/ethnic minority communities’ churches/mosques/temples, particularly large ones
should be considered as possible sites for shelters, for recovery service areas or for dispersal of
food, clothing and other donated items.
C. Education and Training
C1. Rationale
Recommendations for Mental Health Disaster Preparedness/Response for Racial/Ethnic Minority
Communities and Populations/Helping Hands and Healing Minds Project/ Vickie Mays/UCLA
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Disasters are disruptive particularly to those who live fragile and marginal lives such the
seriously mentally ill, substance abusers and the homeless. The loss of routine, physical space
and disruption to treatment regimens can cause regression to active states of mental disorders
and substance use/abuse. As a method to prevent harm to these individuals as well as others
and decrease crime interventions by trained personnel are critically important.
C1. Recommendation
In order to qualify for ongoing federal disaster relief law enforcement and emergency response
personnel agencies must have at least 20% of its personnel trained in a basic 40 hour Critical
Incident Training (CIT) with refreshers every five years.
C1b. Recommendation
The Office of Disaster Preparedness should work with the CDC Funded Disaster Preparedness
Centers to evaluate and develop mental health response training modules for the Community
Emergency Response Trainings (CERTS) who in disasters will be called out to volunteer.
C1c. Recommendation
The Office of Disaster Preparedness should work with SAMSHA to develop guidelines for the
use of mental health debriefings for volunteer CERTS and other volunteers who either work at a
particularly devastating disaster (i.e. trained derailments, earthquake searches and rescue) or
who work more than 7 days to decrease the likelihood of their development of PTSD or PTSD
symptomatology.
C2. Rationale
Mental Health disaster education and response currently is taught outside of educational
systems of universities and colleges or professional continuing education. It is learned through
attendance at free courses taught through local Red Cross, fire departments and law
enforcement agencies.
C2. Recommendation
HRSA, CDC, FEMA and others should consider the development of online as well as face to
face mental health disaster education curriculums fused with cultural competency training in
order to increase the number of trained racial/ethnic minority individuals or individuals in general
with greater knowledge of the cultural demands of populations often at high risk. Increasing the
workforce capacity of mental health professionals trained in disaster response could be
facilitated through training grants through NIH’s NIMH, training grants through the Association of
Schools of Public Health, the CDC Disaster Centers could be required to engage their local
groups in mental health trainings and HRSA offering training grants to mental health
professionals who are training for mental health service delivery.
C3. Rationale
The definition of first responders is often used in a formal manner to include medical,
emergency and law enforcement personnel. Yet there are within ethnic minority communities
an additional set of individuals with authority and access to the community who should be
viewed as first responders. Faith based leaders often function as first responders in disasters.
They are called upon in leadership roles, their places of workshop become sites for gathering
and they are called upon to minister to their congregants even when they are dislocated and are
often a very good source of where individual are located.
C3. Recommendation
Recommendations for Mental Health Disaster Preparedness/Response for Racial/Ethnic Minority
Communities and Populations/Helping Hands and Healing Minds Project/ Vickie Mays/UCLA
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Develop curriculum and training for racial/ethnic minority faith based leaders in mental health
disaster preparedness as well as disaster response. Faith based leaders must know their levels
of expertise in order to respond as many are trained in pastoral care and counseling but not in
mental health disorders. Curricular trainings in which faith based leaders could prepare their
membership as well as the church itself for disaster response which would save lives.
C3b. Recommendation
Many faith based leaders will find themselves in leadership roles post a disaster.
While trained in pastoral care and counseling many are not trained in crisis intervention.
The federal government or private foundations should develop model curriculum for divinity
schools and other school of religious training that can be integrated into their pre degree or
training for their religious degree or used for continuing education credit. This course would be
drawn from Critical Incident Training with a particular focus on how handle individuals and signs
and symptoms of needed interventions for individuals who have been exposed to or involved in
a disaster.
C4. Rationale
Language and culture are important components of health literacy and health education efforts.
In recent years hospitals and medical care providers have collected data on race, ethnicity and
primary language. Individuals are asked what language they prefer for the delivery of their
health care services and health education.
C4a. Recommendation
The OMH has issued CLAS (National Standards on Culturally and Linguistically Appropriate
Services. All federal agencies should be guided by these standards in the production of their
written and online materials as well as in the conduct of trainings and other interactions
particularly in regard to preferred language. Warnings, evacuation procedures and other critical
information must be delivered in preferred mode and by credible messengers. This may involve
the use of ethnic media, ethnic radio, ethnic cable stations and other ethnic preferred outlets
that are both language proficient and credible in their commentary about the warnings.
C4b. Recommendation
All warnings and status reports about disasters should take into account research findings about
the needs, worries and concerns of racial/ethnic minorities as well as be available in language
preferred.
C4c. Recommendation
Using findings from risk communication analyses studies of racial/ethnic minorities, warnings
and requests for evacuation should be grounded in that research.
D. Services
D1. Rationale
Currently in our work in NOLA there are needed mental health counseling services for very
specific groups, faith based leaders, adolescents who have returned and the homeless mentally
ill. Mental health providers left in waves leaving the area without mental health providers yet for
Recommendations for Mental Health Disaster Preparedness/Response for Racial/Ethnic Minority
Communities and Populations/Helping Hands and Healing Minds Project/ Vickie Mays/UCLA
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some there were critical mental health needs that the longer they are unaddressed the worst the
mental health.
D1a. Recommendation
The federal government should in the event of disasters that devastate the mental health
workforce, particularly those with the expertise to serve racial/ethnic minority communities
engage a loan repayment and housing allowance program to entice individuals to practice in the
area for a 2-5 year period. This procedure should be engaged immediately in the event of a
large devastation particularly after it has removed its commissioned core personnel.
D1b. Recommendation
The federal government should in the event of disasters that devastate the mental health
workforce, particularly those with the expertise to serve racial/ethnic minority communities
should engage a IPA sabbatical arrangement with academic institutions that would allow
practicing academics to provide clinical services or collect data for surveillance, evaluation or
research for a period of 1 quarter, 1 semester up to a two year period depending on the severity
of the disaster. If the federal government is unable to pay the full salary they could consider
some supplement and provide universities with some incentive (federal aid for students,
educational grants and resources) to share/loan their faculty for a short term period.
E. Data Collection and Research Needs
E1. Rationale
The evidence based practices around disaster response are still in infancy. Research on
disasters is often difficult to conduct because of their immediacy. The IOM offered a number of
directions that future activities should proceed but there is an overwhelming lack of guidance
around the services, treatment and assessment tools specific to the needs and experiences of
racial/ethnic minorities. Recent studies indicate differential worry and concerns by racial/ethnic
groups particularly Latinos. There are also differential levels of vulnerability based on resource
availability, disability and language
E1. Recommendation
Concerns and worries about disasters and how they intertwine with individuals vulnerability such
as disability, lack of economic resources, family responsibilities, language and citizenship
status. It is recommended that CDC and NIH engage a research program that elucidates how
diverse vulnerabilities intersect with behaviors of disaster response.
NIH and NSF should engage a research agenda that examines disaster related perceptions of
risk, risk analysis and risk communications in order to develop better guidance for the disaster
related decision-making in racial/ethnic minorities under particular sets of vulnerabilities that are
factored into their disaster related response
E2. Rationale
Currently we do not have a standardized approach to PTSD assessments or to data collection
on ASD.
Recommendations for Mental Health Disaster Preparedness/Response for Racial/Ethnic Minority
Communities and Populations/Helping Hands and Healing Minds Project/ Vickie Mays/UCLA
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E2. Recommendation
It is recommended that NIMH or IOM bring together a panel of experts in the area of PTSD,
ASD, trauma, and mental health consequences of disasters to recommend assessment
development work that is needed to capture the short and long term mental health experiences
of racial/ethnic minorities. It is unclear whether our current instruments are sufficient in tapping
the most important domains of fear, worry, concern and consequences. The field would
enormously benefit from an examination of the current PTSD assessment tools and suggested
changes that should be made in order to determine symptoms and mental health diagnosis
particularly as it relates to racial/ethnic minorities and the ability to translate these concepts into
appropriate languages.
E3. Rationale
Many of the racial/ethnic minorities impacted by disasters are sometimes in fragile living
situations making the collection of data difficult.
E3. Recommendation
The National Committee on Vital and Health Statistics working with HIS should be tasked to
explore how and what data should be collected for the purposes of surveillance of the mental
health consequences of exposure to disasters. In particular a set of hearings should be held
with geographically diverse populations such as Native Hawaiians, tribal communities
continually at risk from wild fires, Pacific Islander groups, Gulf regions and other areas where
there is continual disaster peril to determine how to collect data about their ongoing mental
health states in order to ensure that adequate levels of services and education on how to
reduce the distress, worries and concerns can be addressed.
E4. Rationale
We know little about the disaster experience of racial/ethnic minorities. We do not know the
term prevalence of mental health consequences from disasters in this population as they are
often hard to separate from consequences of other life experiences and exposures to other
stressors.
E4. Recommendation
NIH/AHRQ/CDC should fund ethnic specific population based surveys that could examine
exposure, response and belief, attitudes and worries about disasters for racial/ethnic
populations particularly in those regions of the US and outlying territories that are in constant
peril of disasters. This one time set of studies would help direct the research, mental health
services and educational needs of private and federal agencies in mental health recovery efforts
that are both long and short term.
E5. Rationale
One of the subgroups within the racial/ethnic minority community that has suffered severe
consequences from some of the recent disasters have been children and in particular
adolescents. Yet we have no evidence based practices that have been culturally tested with
these populations and we have no true sense of the prevalence of their mental health disorders
relative to long term consequences
Recommendations for Mental Health Disaster Preparedness/Response for Racial/Ethnic Minority
Communities and Populations/Helping Hands and Healing Minds Project/ Vickie Mays/UCLA
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E5 Recommendation
NIH should be engaged to develop a RFA or cooperative agreements through its Population
Centers, particularly those focused on health disparities to examine the mental health
experiences and needs of racial/ethnic minority children and adolescents, particularly those who
experienced death, loss, family separation and displacement.
E5b. Recommendation
NIH should be engaged to develop a RFA to examine and test post disaster response
approaches that include culturally preferred places of delivery, culturally consistent with rituals
and world views and design RCT to determine if current psychological interventions work
equally as well in racial/ethnic minority children and adolescents.
