Post disaster, the need for mental health, bereavement and grief assessment and support is urgent and widespread. Governmental and nongovernmental organizations (NGOs) have developed extensive response mechanisms to support these mental health needs in areas that have been struck by disasters. These resources are deployed to help victims and survivors, particularly those who have suffered the loss of a close family member or friend. However, these services are often constrained by limited funds. This is where philanthropy has a significant role to play in ensuring that services are available as long as these needs exist. Most government and non-governmental services provide basic crisis counseling and care. In areas of more acute need – repetitive disasters, significant impact – it is important that care be trauma-informed and long-term.
Role of Governmental Organizations
Domestically, there are only a few programs that support mental health, and even fewer after a disaster. Governmental organizations provide limited support for grief and bereavement after crises, with the exception of instances of large-scale violence – i.e., mass shootings. Internationally, this varies greatly depending upon the country. Some countries provide a great deal of crisis and mental health support, in others it is minimal to non-existent.
Through the use of an emergency operations center, governmental organizations coordinate the overall disaster response, including efforts related to mental health. This governmental coordination ensures that the right resources get to the right places at the right time. Only those organizations who have the capacity to deliver appropriate mental health, bereavement and grief services are provided access to the disaster area.
In some cases, governmental organizations are capable of providing or funding these services. In the United States, the Federal Emergency Management Agency (FEMA) Crisis Counseling Assistance and Training Program (CCP) fills this role. The program funds mental health assistance and training in areas that have received a major disaster declaration (meaning smaller disasters do not receive this support). Under the CCP, FEMA can fund an organization providing direct mental health assistance for the first 60 days, and up to an additional nine months after a disaster. It does this through two separate programs:
Immediate Services Program (ISP)
- Application is due 14 days after a Presidential major disaster declaration that includes Individual Assistance (IA).
- FEMA provides funds for up to 60 days of services immediately following the approval of IA for a disaster.
- FEMA awards and monitors the ISP federal award in coordination with SAMHSA.
Regular Services Program (RSP)
- The application is due 60 days after a Presidential major disaster declaration that includes IA.
- FEMA provides funds for up to nine months from the date of the notice of award.
- SAMHSA awards and monitors the RSP federal award in coordination with FEMA.
These are separate programs that require separate applications. ISP is not a prerequisite for RSP, nor is RSP required automatically when ISP has been approved.
Disaster crisis counseling is very different from ongoing mental health treatment. FEMA says, “Crisis counseling seeks to help survivors understand that they are experiencing common reactions to extraordinary occurrences. Crisis counselors treat each individual and group they encounter as if it were the only one, keep no formal individual records or case files. They also find opportunities to engage survivors, encouraging them to talk about their experiences and teaching ways to manage stress. Counselors help enhance social and emotional connections to others in the community and promote effective coping strategies and resilience. Crisis counselors work closely with community organizations to familiarize themselves with available resources so they can refer survivors to behavioral health treatment and other services.”
While this can be very useful for individuals who have suffered some impact or loss from the disaster, it is not as helpful for people whose loss was more extensive or who have been bereaved by the disaster. As the disaster moves further into the past, people still suffering are less likely to be able to access government supported services. This is where the role of NGOs becomes critical.
Role of Nongovernmental Organizations
Much of the work in community mental health is done by nongovernmental organizations; the same is true for grief and bereavement support. NGOs providing these support services can be incredibly varied, ranging from professional associations to faith-based organizations and even local community organizations. These organizations may provide support to a very focused group of people such as emergency responders, children or the elderly; or they may provide services to a wide cross-section of people. In many cases, NGOs will provide direct assistance, including counseling, psychological and psychiatric care at low- or no-cost to those who are experiencing mental health concerns, bereavement or grief after a disaster.
In general, NGOs should make their availability known, but should not actually respond to the area until their presence and services have been requested. Mental health, bereavement and grief support after a disaster must be carefully coordinated to ensure that everyone receives the help that they need. Organizations who respond without being requested run the risk of interfering by not properly connecting and coordinating with other organizations and local providers. Local coordination is essential to providing ongoing support after NGOs leave the disaster area since they will hand over the care of clients to local professionals.
Role of Philanthropy
We know that mental health does not receive a large share of the funding support for disaster recovery. With our partners at Candid, we’ve been able to track philanthropic grants from 2012-2019 for mental health services following a disaster. When you consider that this covers seven years during which we saw Superstorm Sandy, the Ebola Crisis and a series of major hurricanes, the numbers look small, particularly in comparison to other facets of recovery. These numbers would be even smaller when looking at grief and bereavement as separate components.
As can be seen in the “What Donors Are Doing” section, there are many ideas for how philanthropy can support communities in the areas of mental health, grief and bereavement after a disaster. An essential role for funders is ensuring that funds are available for complex care over extended periods of time. It is critical that donors fund these services throughout the entire disaster recovery period. Once government funding runs out – usually within less than a year – philanthropy provides the only formalized funding mechanism for mental health services. This funding should include not only the delivery of counseling services but also awareness and educational campaigns that are shared in mainstream, culturally and racially diverse communications and social media, and that advertise both the availability of services and the importance of accessing mental health support.
Increasingly, in mental health circles there is a focus on trauma-informed care. This kind of therapeutic intervention occurs when a program or organization recognizes the “widespread impact of trauma and understands potential paths for healing; recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; and responds by fully integrating knowledge about trauma into policies, procedures, and practices, and seeks to actively resist re-traumatization.”
“More than anything, survivors need to have their despair normalized and need to have basic coping tips to move forward.” ~ Nancy Beers, Director of the Midwest Early Recovery Fund, Center for Disaster Philanthropy
Trauma-informed services work to meet clients “where they are” rather than engaging in processes that could re-traumatize them. For NGOs and philanthropy, this could include extensive outreach and coordinated intake to avoid having disaster survivors retell their stories repeatedly.
Governmental and nongovernmental policies and planning to address disaster mental health must continue to draw from academic research, programmatic responses, and innovations in diagnostic and therapeutic care. Legislators, care providers and disaster funders should take the long view in supporting mental health issues. Organizations need to be prepared for delays in expressions of distress and financial need since those who experience mental health challenges often do not seek care until long after the precipitating event.