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Behavioral Health Planning for Higher Education


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Title: Behavioral Health Planning for Higher Education

Mental Health Planning for Higher Education
  • ACI Train the Trainer Course

  • 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.

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//
  • Missouri Homeland Security Advisory Council
    appoints Higher Education to Council and forms a
    Higher Education sub-committee

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.

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

Related recommendations
  • All colleges and universities should use the
    Emergency Response Information Program (ERIP)
    web-based tool to construct their all-hazard
  • 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
  • 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

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//

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

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

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)

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?

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
  • Response incorporates mental health planning

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

  • Internal departments
  • Other campus counseling networks
  • community

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
  • Involvement in after action analysis

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

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

Using Internal Mental Health Planning Resources
  • Benefits
  • Challenges
  • Plan may be isolated from community plans
  • 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
  • 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

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

Emergency Planning and Disaster Mental Health

Involve in campus emergency planning efforts
Identify internal mental health expertise and
determine expertise with disaster mental health
  • Support training from
  • 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
  • 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

Involve in campus emergency planning efforts
  • 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

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
  • SAMHSA Emergency Response Grant (SERG)
  • Funding for emergency mental health services
    disaster related substance abuse treatment and
    prevention programs
  • Available in non-presidentially declared
  • Particularly helpful in cases of mass criminal

Discussion or Questions
Mental Health Aspects of All-Hazards Planning
  • Disasters
  • Terrorism
  • Tragic events

Thinking about your campuses
  • Is a tornado different than a fire incident?

A disease outbreak?
A campus shooting or terrorist attack
Disasters Trauma
  • Natural vs. human-caused
  • Degree of personal impact
  • Size and scope
  • Visible impact
  • Probability of recurrence
  • Media coverage

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.

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

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

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

Why be concerned about emotional care after a
  • Psychological casualty rates are higher than
    physical fatalities following events.
  • Support healthy coping skills
  • Minimize long term adverse consequences

From IOM publication Preparing for the
Psychological Consequences of Terrorism NOTE Indicative only not to scale
Collective ReactionsTypical phases of disaster
Adapted from CMHS, 2000.
Model of Responses to Trauma Bereavement, CMHS,
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
  • Relate behavior and reactions
  • observed to the model

University of Iowa Campus, 08
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Common Reactions are Holistic
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
  • Physical Headaches, stomachaches, numbing,
    fatigue changes in eating or sleeping patterns
  • Spiritual Religious confusion, anger at God,
    renewed commitment

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
  • Has an inability to resume normal activities,
    studies, etc

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.

Autonomic Nervous SystemSympathetic Nervous
Threats to survival Fear Reactions to fear
Flight or submission
Adrenaline pumps Body reacts
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
  • 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.
  • Traumatic Crisis an event in which people
    experience or witness
  • Actual or potential death or injury to self or
  • Destruction of homes, neighborhood, or valued
  • Loss of contact with family/close relationships.
  • Traumatic Stress may affect
  • Cognitive functioning.
  • Physical health.
  • Interpersonal relationships.

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

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

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

Mediating Factors
  • Prior experience with a similar event
  • The intensity of the disruption in the survivors
  • 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

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.

  • 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
  • Mandatory or required psychological interventions
    should not be universally applied to survivors or
  • 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.

  • If the University/college sponsors groups for
    students after campus trauma, consider the
  • 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
  • Be prepared to meet current needs of students
    (i.e. connection to social supports, families,
  • Dispel rumors
  • Provide psycho-educational resources for students
    as well as
  • Hotline numbers
  • Clinic access numbers
  • Other resource numbers

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,
  • Avoid excess drinking, drugs, risk taking
  • Stay connected
  • Take action candlelight vigil, benefits, group
    discussions, safety committee, etc.
  • Resume routines

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

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

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

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

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

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

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