Objectives
Provide an overview of Missouri’ s 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
www.dps.mo.gov/CampusSafety/GovernorsFinalReport.pdf
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 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.
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.
erip.dps.mo.gov

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 students/faculty
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?

Linkages

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.

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

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
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
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
Use of External Mental Health Planning Resources
Benefits
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
Challenges
Lack of understanding of campus culture can limit effectiveness
Additional costs for the consultant’ s time for:
Planning
Preparedness, including exercises and drills
Development of procedures and protocols
Training
Response

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

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

Disasters
Terrorism
Tragic events

Is a tornado different than a fire incident?
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 don’ t 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 disaster?

Psychological casualty rates are higher than physical fatalities following events.

Support healthy coping skills

Minimize long term adverse consequences

Collective Reactions Typical phases of disaster:

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

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 concentrating
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 weeks
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 System Sympathetic Nervous System

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.

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’ 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

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.
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

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

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 Concerns
5. Practical Assistance
6. Connection with Social Supports
7. Information on Coping
8. Linkage with Collaborative Services

Contact Information
ACI Presenter Name
Address
Phone Number
Email

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