Behavioral Health Planning for Higher Education

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Mental Health Planning for Higher Education

• ACI Train the Trainer Course

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Objectives

• Provide an overview of Missouris leadership
  efforts in campus safety
• Understand key concepts of disaster psychology
  and the contribution of mental health experts to
  emergency planning events
• Identify community resources available to support
  campuses in planning emergency responses that
  will address the mental health needs of students,
  faculty, administration and families.

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Development of Recommendations for Mental
Health Response

• Virginia Tech Shooting
• Governor Blunt appoints Campus Security Task
  Force, 4-20-2007, led by Dr. Robert Stein,
  Commissioner of Higher Education and Mr. Mark
  James, Director of Public Safety
• Development of Recommendations 8-21-2007
  Securing Our Future Making Colleges and
  Universities Safe Places to Learn and Grow
• http//www.dps.mo.gov/CampusSafety/GovernorsFinalR
  eport.pdf
• Missouri Homeland Security Advisory Council
  appoints Higher Education to Council and forms a
  Higher Education sub-committee

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Mental Health Recommendations

• Students and other members of the campus
  community should have access to on-campus,
  licensed mental health services 24 hours per day,
  7 days per week
• On-campus mental health providers should
  establish consultation and referral relationships
  with public and private facilities that accept
  civil commitments
• Every campus should establish a multidisciplinary
  (academic, law enforcement, mental health) team
  who share and review information about members of
  the campus community who are perceived as
  exhibiting behavior that has caused concern.

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Mental Health Recommendations

• The multidisciplinary team should work
  collaboratively to develop intervention
  strategies for individuals who potentially pose a
  risk to themselves or others.
• Early intervention efforts should also include
  prevention programs to address alcohol and drug
  abuse and related violence
• Prevention programs should ensure that consistent
  messages and interventions are delivered
  throughout the campus

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Related recommendations

• All colleges and universities should use the
  Emergency Response Information Program (ERIP)
  web-based tool to construct their all-hazard
  plan.
• 2009 pilot yr. with feedback to Higher Education
  subgroup of Homeland Security Advisory Council
• ERIP includes Mental Health planning section
• Emergency plans should include appropriate
  crisis-specific mental health responses,
  protocols and recovery functions including
• Evidence-based mental health practices for
  responding to mental health needs of individuals
  directly or indirectly exposed to violence or
  trauma
• Agreements involving mental health as a function
  of the emergency operations plan are available to
  incident command staff for decision making,
  planning, and support of responders.
• The State Emergency Management Agency (SEMA)
  should ensure that adequate involvement from
  mental health professionals is included in
  response and recovery efforts for all crises,
  including those affecting postsecondary
  institutions.

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Planning tool Missouri ERIP

• Emergency Response Information Plan
• FREE -On line multi-hazard emergency planning and
  training tool for K12 schools, higher education
  and child care agencies
• Available on secure site to Response agencies
  to include school building layouts, etc.
• Availability through the State Emergency
  Operation Center MERIS Program.
• http//erip.dps.mo.gov

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Mental Health Aspects of an All-Hazard Plan

• All Hazards plans include preparedness and
  response for all types of hazards
• Natural
• Technological or man made
• Health
• Social

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Types of Events

• Natural disasters
• Terrorism
• Campus shootings
• Community violence
• Bus, plane or other motor vehicle accident
• Suicide or other traumatic death

• Bomb threats
• Public health emergency or illness outbreak
• Extended shelter in place (hazmat, nuclear)
• Decontamination
• Fire

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Mental Health Aspects of an All-Hazard Plan

• Mental health response should be seamless and
  built into the planning
• Location of response
• Survivors
• Residential non-residential students
• Staff faculty
• Visitors
• First Responders
• Need for outside assistance
• Outreach mechanisms (i.e. may be different if on
  campus and school has just started vs. toward the
  end of the school year)

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Mental Health as a Part of All-Hazards Annexes

• Would mental health planning be different for the
  different kinds of hazards?
• CBRNE Chemical, Biological, Radiological,
  Nuclear or Explosive
• Pandemic
• Earthquake
• Tornado
• Flood
• Bus or Airplane wreck of students/team
• What if it was an evacuation situation vs. a
  shelter-in-place situation?

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How does Higher Education mental health planning
relate to the emergency management field?

• Emergency management is a structured system
  National Incident Management System (NIMS)
  
• Incident Command System (ICS) Mental
  health has a role
• Guidance enhances planning for needs of
  students/faculty
• Response incorporates mental health planning

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Understand because

• Perimeter control access
• Crime scene issues
• Resource requests
• Needs assessment
• Mental health others
• Media coverage communications
• Other examples?

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Linkages

• Internal departments
• Other campus counseling networks
• community

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Internal Departments

• Administration
• Mental Health Clinic
• Medical Clinic
• Wellness Centers
• Emergency and Safety Managers
• Campus security/law enforcement
• Departments that teach counseling, psychology,
  nursing, emergency management courses
• Consider linkages and how staff and students in
  these departments can be trained to assist.

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Network of Higher Education Mental Health and
Counseling Services

• Organized network to consider
• Shared training in risk assessment and
  evidence-based practices pre and post emergency
• Research
• Resource inventories
• Setting standards
• Consultation and peer review
• Building relationships with campus and local law
  enforcement
• Involvement in after action analysis

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Community Partnerships

• Community coordination
• DMH Administrative Agents (Community Mental
  Health Centers)
• Access Crisis Intervention (Crisis hotlines)
• Local Colleges and Universities
• Administration
• Emergency Management
• Clinics and Mental Health
• Law Enforcement/Security
• Volunteer Organizations Active in Disaster
• National Organization of Victim Assistance
• American Red Cross
• Salvation Army
• Spiritual Care faith based organizations on
  campus/off campus

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Mental Health Service Portals in Emergency

• Campus clinic
• Campus classrooms, gatherings, memorials
• Local hospitals
• Family Assistance Centers
• Scattered geographic areas
• Alternate housing/dining locations
• Risk communication
• With Students
• With Families
• Web, Text, phone, media

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Using Internal Mental Health Planning Resources

• Benefits

• Challenges

• Plan may be isolated from community plans
  resources
• Risks if planning is an additional duty or if
  there is not continuity over time
• Emergency planner may be affected by the campus
  event unavailable for response
• Need to consider redundancy
• Cost of time and money for assigned party in
  terms of training time away from other
  assignments

• Know campus environment involved parties
• Credibility and relationships that make planning
  more effective
• Logical for disaster mental health planner to be
  involved as part of EOC response efforts
• Easier to involve in drills/exercises
• Greater involvement in preparedness prevention

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Use of External Mental Health Planning Resources

• Benefits

• Challenges

• For events that exceed campus resources, use of
  external expertise may improve local and state
  collaboration outside the college/university
• May provide redundancy for campus events that
  overwhelm the resources of the college/university

• Lack of understanding of campus culture can
  limit effectiveness
• Additional costs for the consultants time for
• Planning
• Preparedness, including exercises and drills
• Development of procedures and protocols
• Training
• Response

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Emergency Planning and Disaster Mental Health



YES
Involve in campus emergency planning efforts
Identify internal mental health expertise and
determine expertise with disaster mental health

• Support training from
• SEMA/DHSS
• Local Red Cross
• DMH Psychological First Aid

Involve in campus emergency planning efforts
Determine strategy for including mental health
issues in campus emergency planning efforts
NO

• Identify local disaster mental health expertise
• Red Cross
• Community Mental Health Center ACI
• Regional Hospital Bioterrorism Planning Efforts

• Request assistance and establish working
  agreement regarding
• Extent of involvement in planning
• Responsibilities in emergency
• Resource commitments in exchange for planning
  assistance

Involve in campus emergency planning efforts
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PLANNING CONSIDERATIONS

• Linkages and agreements
• Community Mental Health Centers
• Other mental health providers
• Reciprocal agreements with other college campuses
• Employee Assistance Programs (EAP)
• Mental Health coverage for students

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Other Mental Health Resources

• FEMA Crisis Counseling Program grant
• Application through DMH when there is a Federal
  declaration for individual assistance
• Depends on CMHC needs assessment including
  campuses
• SAMHSA Emergency Response Grant (SERG)
• Funding for emergency mental health services
  disaster related substance abuse treatment and
  prevention programs
• Available in non-presidentially declared
  disasters
• Particularly helpful in cases of mass criminal
  victimization

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Discussion or Questions
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BREAK
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Mental Health Aspects of All-Hazards Planning

• Disasters
• Terrorism
• Tragic events

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Thinking about your campuses

• Is a tornado different than a fire incident?

A disease outbreak?
A campus shooting or terrorist attack
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Disasters Trauma

• Natural vs. human-caused
• Degree of personal impact
• Size and scope
• Visible impact
• Probability of recurrence
• Media coverage

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Defining Terrorism

• The FBI defines terrorism as
• The unlawful use of force or violence against
  persons or property to intimidate or coerce a
  Government, the civilian population, or any
  segment thereof, in furtherance of political or
  social objectives.

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Motives of Terrorists

• A primary goal is to create fear!
• Higher symbolic value more publicity
• More publicity greater fear
• Greater fear greater success

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What scares us?

• Things frighten us more if they are
• Imposed by other's)
• Controlled by others)
• Not beneficial in any way to anyone
• Hard to treat or rationing required
• Manmade
• Catastrophic or deadly
• Caused by someone or something we dont trust
• Exotic or unusual

• Than things that are
• Voluntary or by choice
• In our control
• Helpful or beneficial to us or society
• Easily quickly diagnosable treatable
• Natural
• Survivable
• Managed by a trusted person or organization
• Familiar and routine

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Keep in mind

• Different perceptions of risk
• Different assumptions about luck
• Different comfort levels
• Degree of control a variable
• World views differ
• Negative vs. positive benefit

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Why be concerned about emotional care after a
disaster?

• Psychological casualty rates are higher than
  physical fatalities following events.
• Support healthy coping skills
• Minimize long term adverse consequences

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PSYCHOLOGICAL CONSEQUENCES OF DISASTER AND
TERORISM
From IOM publication Preparing for the
Psychological Consequences of Terrorism
www.nap.edu NOTE Indicative only not to scale
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Collective ReactionsTypical phases of disaster
Adapted from CMHS, 2000.
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Model of Responses to Trauma Bereavement, CMHS,
1994
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Table Activity

• Pick a campus based incident
• May 2, 2003 F2 tornado hits William Jewel College
  in Liberty MO causing damaging nearly every
  building and causing 15 to 20 million in damage.
• August 27,2005 Hurricane Katrina Tulane
  University closed for 4 months New Orleans,
• April 16, 2007 Virginia Tech Shootings 32
  killed, wounded, Gunman Cho kills self
• Feb. 6, 2008 Tennessee tornado destroys
  dormitories on Union University campus, Jackson
  TN. 13 trapped under debris, 51 injured with 9
  seriously injured.
• June, 2008 Hurricane Ike floods inundate 20
  campus buildings and numerous athletic fields
  University of Iowa
• February 14, 2008 Northern Illinois University
• Campus shooting in Dekalb kills 5, wounds
  18
• Relate behavior and reactions
• observed to the model

University of Iowa Campus, 08
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Common Reactions are Holistic
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Common Reactions

• Emotional crying, anger, excessive worry,
  feeling overwhelmed, irritability, guilt, sadness
  and depression
• Behavioral Increase risky behaviors excessive
  use of alcohol or drugs
• Cognitive Inability to focus, Cannot problem
  solve difficulty making decisions or
  concentrating
• Physical Headaches, stomachaches, numbing,
  fatigue changes in eating or sleeping patterns
• Spiritual Religious confusion, anger at God,
  renewed commitment

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Other Student Reactions

• Heightened vulnerability
• Major life decisions changes
• Increased risk taking
• A student may wish to consider professional
  mental health assistance if he/she
• Has strong feelings that will not go away
• Intense reactions that occur longer than 4 6
  weeks
• Has an inability to resume normal activities,
  studies, etc

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Other Student Reactions

• Feels depressed, or has feelings of hopelessness
  or anger
• Is extremely anxious
• Continues to have events dominate thoughts
• Avoids people or places because they remind
  him/her of the event
• Suffers from continued physical problems for
  which no organic cause can be found
• Sees his/her life falling apart with a loss of
  friendships, or problems with family or at school
  or work
• Is overly reliant on alcohol or other drugs to
  block emotional pain
• Has thoughts of suicide or hurting others.

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Autonomic Nervous SystemSympathetic Nervous
System
Threats to survival Fear Reactions to fear
Fight
Flight or submission
Adrenaline pumps Body reacts
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Key Concepts (cont.) Risk factorsPopulation
Exposure Model

• Injured survivors, bereaved family members
• Survivors with high exposure to disaster trauma,
  or evacuated from disaster zones
• Bereaved extended family and friends, first
  responders
• People who lost homes, jobs, and possessions
  people with pre-existing trauma and dysfunction
  at-risk groups other disaster responders
• Affected people from the larger community

Adapted from DeWolfe, 2002.
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Trauma

• Traumatic Crisis an event in which people
  experience or witness
• Actual or potential death or injury to self or
  others.
• Destruction of homes, neighborhood, or valued
  possessions.
• Loss of contact with family/close relationships.
• Traumatic Stress may affect
• Cognitive functioning.
• Physical health.
• Interpersonal relationships.

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Group Activity

• Each of you should take 6 index cards
• List on two a person you care about
• List on two a favorite possession
• List on two something you enjoy doing

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Group Activity

• Shuffle your cards upside down
• Now draw two and turn them over in front of you.
• Imagine that you lost these things in a disaster
• Discuss feelings with group

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Disaster Mental Health Response

• People reacting normally to an abnormal situation
• Identification of people at-risk of severe
  psychological reactions
• Work in non-clinical settings
• Deliver stress management, problem solving,
  advocacy referral
• Changes with evolving emergency phases
• Response may be to students, faculty, staff, and
  campus responders including non traditional
  responders such as health care workers

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Mediating Factors

• Prior experience with a similar event
• The intensity of the disruption in the survivors
  lives
• Individual feelings that there is no escape,
  which sets the stage for panic
• Emotional strength of the individual
• The length of time that has elapsed between the
  event occurrence and the present

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Important Principles

• A range of response is normal
• Other recent losses/stressors may increase risk
• Stress and grief are
• normal reactions to an abnormal situation
• Immediate reactions are not pathologized.
• Individual coping styles are respected.
• Do no harm.

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Debriefing

• The National Disaster Mental Health Work Group
  recommended against debriefing as part of the
  response to crisis and disaster situations
  because of the possibility of psychological
  harm.
• Mandatory or required psychological interventions
  should not be universally applied to survivors or
  responders
• There is currently no empirical evidence to
  support any intervention that utilizes components
  of trauma remembrance and emotional processing in
  the early phases following mass violence
• There is some evidence that suggests that early
  intervention in the form of a single one-on-one
  recital of events and expression of emotions
  evoked by a traumatic event does not consistently
  reduce risks of later developing PTSD or related
  adjustment difficulties.

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Groups

• If the University/college sponsors groups for
  students after campus trauma, consider the
  following
• Do not over expose students to graphic
  information separate into groups based on
  exposure level if possible
• Do not compel attendance or force students to
  talk
• Be prepared to meet current needs of students
  (i.e. connection to social supports, families,
  etc.)
• Dispel rumors
• Provide psycho-educational resources for students
  as well as
• Hotline numbers
• Clinic access numbers
• Other resource numbers

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Tips for Assisting College Students

• Be willing to listen if students want to talk
• Advise students to
• Limit media viewing
• Cope in healthy ways by getting plenty of rest,
  exercise, and healthful eating
• Journal
• Take relaxation time go to movies, coffee shop,
  etc.
• Avoid excess drinking, drugs, risk taking
  behaviors
• Stay connected
• Take action candlelight vigil, benefits, group
  discussions, safety committee, etc.
• Resume routines

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Psychological Tasks for Recovery

• Acceptance of the disaster and losses
• Identification, labeling, and
• expression of emotions
• Regaining sense of mastery and
• control.

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Intervention Principles

• Psychological and emotional reactions vary
• Talking with a person in crisis does not always
  mean talking about the crisis
• People pace their dosage when dealing with
  pain, sorrow, periods of normalcy, and respite

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Psychological First Aid

• All Populations
• Adults
• College students
• High school Students
• Children
• Persons with disabilities
• First responders

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Goal of Psychological First Aid

• Reduce stress
• Assist with current needs
• Promote adaptive functioning
• NOT to elicit details of traumatic experiences
  and losses

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Psychological First Aid

• Non-traditional services
• Walk around mental health
• Stealth mental health
• Grandma, not grad school
• Practical assistance
• Goals
• Normalize reaction
• Reassure, reduce arousal reconnect

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PFA Eight Core Actions

• 1. Contact and Engagement
• 2. Safety and Comfort
• 3. Stabilization
• 4. Information Gathering Current Needs and
  Concerns
• 5. Practical Assistance
• 6. Connection with Social Supports
• 7. Information on Coping
• 8. Linkage with Collaborative Services

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Contact Information

• ACI Presenter Name
• Address
• Phone Number
• Email