Changes in disaster policy and training during the years between 1970 and 1990 provide a context for mental health assistance for disaster programs. In 1973, while meeting with the team of experts gathered to analyze the mental health issues that arose among survivors of the Virginia Buffalo Creek Dam disaster, professionals made observations that led to new ideas about treatment.
Additional data were added to the growing knowledge base in 1974 at a meeting organized to hear reports on the Xenia, Ohio, tornado. The data showed patterns resembling human reactions of acute loss, mourning, anxiety states, and depression. During another gathering of professionals, the author was asked to present experiences in Managua with a team of post-disaster workers after the earthquake of 1972 and exchange ideas with other workers in the field.
At that time, professionals were still seeking to organize a systematic approach to the development of mental health guidelines for disaster assistance. The exchange of knowledge between professionals in Latin America and the United States prompted the development of intervention modalities for disaster behavior. After several years, the experience gained worldwide from work in disaster situations was used to formulate guidelines for working with survivors.
LEGISLATIVE AUTHORITY FOR DISASTER MENTAL HEALTH ASSISTANCE
In 1974, the enactment in the United States of the Disaster Relief Act (Public Law 93-288, Section 413) laid the foundation for systematic, organized development of this field. The Act reads as follows:
Crisis Counseling Assistance and Training. The President is authorized (through the National Institute of Mental Health) to provide such services or training of disaster workers to victims of major disasters in order to relieve mental health problems caused or aggravated by such major disaster or its aftermath.
The Disaster Relief Act authorizes a program of crisis counseling for survivors of major disasters through grant support for direct services to disaster survivors, as well as training in disaster crisis counseling for crisis workers. This program was developed in cooperation with the U.S. Federal Emergency Management Agency (FEMA), which provides funding for its support.
The law was enacted in response to the recognition that disasters produce a variety of emotional and mental health disturbances which, if untreated, may become long-term and debilitating. Crisis counseling programs funded under Section 413 are designed to provide timely relief and to prevent long-term problems from developing.
Assistance under this program is limited to presidentially declared major disasters. Moreover, the program is designed to supplement the available resources and services of states and local governments. Thus, support for crisis counseling services to disaster victims may be granted if these services cannot be provided by existing agency programs.
The passage of this legislation provided a blueprint for meeting the mental health needs of disaster survivors, a means to channel resources and structures dealing with disasters affecting community populations, and a coalescence of efforts of mental health professionals, the American Red Cross, and government agencies at all levels, including the National Institute of Mental Health (NIMH), the Center for Mental Health Services (CMHS) within the Substance Abuse and Mental Health Services Administration (SAMHSA), and FEMA.
The Disaster Relief Act solidified the position taken by many mental health professionals interested in participating in the response to catastrophic events. Massive training efforts were undertaken by NIMH through staff training programs and in collaboration with FEMA. As funds became available, NIMH organized week-long workshops for multidisciplinary professionals interested in disaster mental health services. The opportunity to network with other government disaster assistance agencies was strengthened by using representatives of these agencies as teachers and panelists. This activity also linked to the American Red Cross and evolved into national and local alliances between mental health workers and local Red Cross chapters.