Cheryll Bowers-Stephens, M.D., M.B.A. Assistant Secretary for the Office of Mental Health

1. Leading a Mental Health Care System Impacted by A Severe Natural Disaster __________ National Association of State Mental Health Program Directors Winter 2005 Commissioners’ Meeting Cheryll Bowers-Stephens, M.D., M.B.A. Assistant Secretary for the Office of Mental Health Louisiana Department of Health & Hospitals Presented December 12, 2005

2. News Report Clip

3. State of Mental Health Service Prior to Hurricane Katrina • According to 2004 census Louisiana’s population is 4,515,770 • 903,154 individuals estimated to have a mental disorder within one year • 179,848 adults (18+) have a serious mental illness • Anywhere from 65,554 to 77,473 children have a serious mental illness • 45,979 individuals were served by the Louisiana Office of Mental Health in 2004

4. Disaster Preparedness DHH Disaster Task Force • 4,000 DHH Employees Trained in 2004 • SNS Disaster Mental Health Training Disaster Response Plans For each OMH Hospital and Region Including Planning for SNS, SARBOS, and TMOSA • 350 OMH and OAD Employees Trained in May 2005 • All Hazards Response Planning • Crisis Counseling Intervention With Special Populations • Disaster Mental Health Intervention in Incidents Involving Mass Casualties Staff Call Out Registry Prepared Disaster Response Drills Including Practice Evacuations of OMH Hospitals

5. Pre-Incident Activities Evacuated Southeast Louisiana State Hospital and New Orleans Adolescent Hospital to Eastern Louisiana Mental Health System • Activated OEP Command Center • DHH Operations • Activated Special Needs Shelter (SNS) Operations • New Orleans • Baton Rouge • Terrebonne Parish • Lafayette • Lake Charles • Alexandria • Monroe

6. Katrina Approaches • Hurricane Katrina is the most devastating natural disaster to occur in the United States. • As a Category IV hurricane, winds of nearly 150 miles per hour tore through the Eastern Parishes of Louisiana and the Coastal cities in Mississippi. • The hurricane winds tore boats from their moorings, ripped homes apart, destroyed infrastructure and toppled hundred year old trees like saplings. • Cities and towns in Eastern Louisiana were devastated by the force of the winds.

7. Katrina Hits • A storm surge of nearly thirty feet inundated the streets and bayous of coastal Louisiana, destroying anything left behind by the hurricane force winds. • Not everyone evacuated, and when the levees holding the waters of Lake Ponchartrain gave way 24 hours after the storm had passed, thousands in the New Orleans Metropolitan area raced for high ground. • The inundation was so fast that many were forced to scramble up into their attics or rooftops in a fight for their lives.

8. Incident Response • SARBO • New Orleans OCD Command Center OPH Command Center • TMOSA • New Orleans • Baton Rouge 7 Mobile Crisis Teams Behavioral Health Command Center Family Call Center SAMHSA Emergency Response Grant • Emergency Response Sites • OPH Command Center • TMOSA • SARBO • NOPD Sites • OEP – Tent Cities for Police Units (Baton Rouge) • Baton Rouge Sites • Special Needs Shelters • New Orleans • Baton Rouge • Houma/Terrebonne • Lafayette • Lake Charles • Alexandria • Monroe Evacuation of Charity Hospital in New Orleans Acute Unit to Central Louisiana State Hospital Initial Crisis Counseling Grant

9. Katrina’s Impact on the Mental Health System in Louisiana • Estimated 3.2 million individuals in need of crisis counseling services • 1,034,428 registrations have been submitted for FEMA assistance throughout the declared parishes • Preliminary Population-level needs assessment: loss of homes; overcrowded living situations; economic loss; chronic health concerns; significant need for mental health counseling

10. The Severity of Katrina’s Impact Analysis of research from the National Center for Post-traumatic Stress Disorder has shown that in communities moderately exposed to the destruction caused by a natural disaster, 5-10% of the affected population will experience clinically significant issues as a result of the event. An additional 5-10% will experience issues that are sub-clinical but still require support. In severely exposed communities, 25-30% of the population will experience clinically significant issues and an additional 10-20% will fall into the sub-clinical category.

11. Displaced Children from Hurricanes Katrina and Rita • Over 189,000 children in Louisiana displaced following Hurricanes Katrina and Rita • Approximately 1500 displaced children ages 0-6 with concentrations in 21 parishes

12. Priorities in Recovery and Rebuilding • First Responders Services and Support • Statewide Acute Care Crisis Intervention System: • Mental Health, Substance Abuse, and Development Disability • Integrating Behavioral Health and Primary Care

13. Hurricane Katrina Emergency Response Documentation Plan • Evacuations of OMH Facilities and Provision of Inpatient Mental Health Services • Maintaining Adequate Mental Health Workforce • Disaster Relief Mental Health Services (DeWolfe Population Exposure Model)

14. DeWolfe Disaster Population Model • Seriously injured victims and bereaved family members • Victims with high exposure to trauma and victims evacuated from disaster zone • Bereaved extended family members and friends, rescue/recovery workers with prolonged exposure, medical examiner’s office staff, and other service providers involved with death notification and bereaved families • Persons who have lost homes, jobs, pets, valued possessions, • Mental health providers, clergy, chaplains, spiritual leaders, emergency health providers, school personnel, and media personnel • Government officials and other groups that identify with the target population • Businesses with financial impacts, and • Community at large

15. LESSONS LEARNED • Evacuate Inpatient Facilities + Safeguard/Stockpile Medications • Shore Up Infrastructure: Organizational Structure/ Incident Command • Redundant Communication Systems • Key Public Information Mental Health Disaster Response

16. ISP/RSP Crisis Counseling Program:Louisiana Spirit • Individual Outcomes • Community Outcomes • Population Outcomes

17. Comments Office of Mental Health Louisiana Department of Health & Hospitals