2005-2009 Statewide Comprehensive Plan for Mental Health Service Services
Chapter 3: Collaborations to Strengthen Planning
OMH believes that a high quality public mental health system can only be sustained with a strong, ongoing collaboration between the State, Local governments and numerous stakeholder groups in the planning and delivery of quality mental health services. To this end, OMH continues to create new opportunities for ongoing dialogues, stakeholder input, and planning collaborations.
Chapter 3 provides a brief overview of planning activities and collaborations carried out since the release of the 2004-2008 Statewide Comprehensive Plan for Mental Health Services. Included are references and links to related documents describing planning activities carried out during 2004. The Chapter also describes progress made in a number of specific, important planning collaborations during the past year.
2004 Planning Activities
OMH has made a major commitment to improve and strengthen the statewide mental health planning process. In 2004, the agency continued this commitment by substantially expanding opportunities for stakeholder input in response to the 2004-2008 Comprehensive Plan. For the first time, interactive, informational briefing sessions were held in all five OMH regions. Briefings were attended by stakeholders including recipients, families, providers, advocates, and county mental health directors and their staff. During these briefings, participants were encouraged to identify and discuss issues of local, regional and statewide importance regarding the adult and children’s mental health systems. Topics included the planning process, and areas of the public mental health system requiring ongoing attention.
Public hearings to obtain formal public response to the 2004-2008 Plan were also held in all five regions. Individual testimony given at the five hearings varied widely in content and focus, but addressed virtually all aspects of the public mental health system. This year, for the first time ever, OMH is providing the full text of this testimony on our Web site at http://www.omh.state.ny.us/omhweb/Statewideplan/testimony/.
OMH has long considered input from its advisory committees (Multicultural Advisory Committee, Recipient Advisory Committee, Commissioner’s Committee on Families, Mental Health Planning Advisory Council, and Mental Health Services Council) to be critical elements that are vital to the planning process. Building upon the positive results from advisory committee input, OMH has put into place a number of formal and informal methods to cultivate ongoing dialogue, obtain public comment and suggestions, promote the cooperative sharing of information, and ultimately, promote recovery.
Highlights of 2004 Efforts to Promote Dialogue and Planning Collaboration
OMH has productive partnerships with stakeholder groups including the Conference of Local Mental Hygiene Directors (CLMHD), general hospitals that operate psychiatric units (known as Article 28 hospitals), current and former recipients of mental health services, families and loved ones of those with a mental illness, culturally diverse communities and constituents, and advocates for special populations including children, older adults and adult home residents. These partnerships provide valuable insight and information for the planning process as OMH continues working toward a system of care that supports an individual’s personal path to recovery. Highlights are provided below.
The Conference of Local Mental Hygiene Directors
An ongoing collaboration between OMH andCLMHD is a critical element of the revitalized planning process, and the two organizations continue to work together to develop and implement principles that will guide the planning process. A collaborative planning agenda was formally renewed in 2004 and an initial meeting was held in January. The two organizations are also working together to refine and strengthen the specific planning roles for the counties and for OMH.
During the 2004-2005 planning cycle, a top planning priority for the Conference was a survey of its membership regarding issues impacting persons with mental illness and services in their localities. Findings from the survey have been shared with OMH and were considered in the formulation of this 2005-2009 Comprehensive Plan. A summary of the survey findings is included as Appendix 2 of this document and can be found on the Web at http://www.clmhd.org/itemfiles/survey_0508_planningpriorities.pdf . (PDF)
In the longer term, OMH and the Conference continue to collaborate to identify and develop ways to strengthen the planning process. Key areas to be addressed in 2005 include the design and production of county planning templates, and the development of county strategic data sets. An agenda and “next steps” have been developed, and OMH has agreed to provide training and technical assistance to counties to facilitate the planning process. A draft County Planning Template is provided in Appendix 3.
OMH is also beginning to work with some counties to identify high users of inpatient care, formulate service plans to help these people live successfully in the community, and develop approaches to link these individuals with intensive community mental health resources. As the utilization of inpatient beds by this group declines, inpatient bed days will be freed up and used to increase access to both Article 28 and State hospital beds.
Recipient Community Input
OMH's partnership with current and former recipients of mental health services is another example of expanded opportunity for collaboration. In addition to the ongoing communication and dialogue that flows through the Office of Consumer Affairs, the agency commissioned Infusing Recovery-Based Principles into Mental Health Service: A White Paper by New York State Consumers, which was presented to Commissioner Carpinello in August 2004. Over 10,000 recipients of mental health services from across New York State participated in the white paper, which presents a picture of what quality, recovery-based services would look like from a recipient's perspective.
This white paper was an outgrowth of OMH's Winds of Change quality initiative, and agency efforts to incorporate the perspectives of recipients into the implementation of evidence-based practices (EBPs). As part of that process, an EBP and recovery consumer/survivor steering committee was convened, and its members have participated in many of OMH's internal workgroups.
The recipient community decided that rather than focusing solely on EBPs, they would take advantage of the opportunity to make recommendations to improve mental health services as a whole. The steering committee discussed the Institute of Medicine's Crossing the Quality Chasm: A New Health System for the 21st Century, and, using that document as a starting point, held a number of inclusive meetings with recipients to draft and explain ten rules for quality mental health services in New York State (Table 3.1).
In its introduction, the white paper is described as “the first step to bring attention and gain support to infuse clear and measurable indicators of quality into all aspects of the mental health system that will guide individuals toward self-help, empowerment and self-determination. The idea [is] that no matter what kind of mental health services are delivered, if the new rules were applied, the recovery outcomes for people who use mental health services would increase…”
After the paper’s formal presentation to Commissioner Carpinello, and the request that OMH partner with people who use mental health services to bring the white paper values into the mental health system, the Commissioner publicly supported the document and charged the Office of Consumer Affairs with implementing the white paper into all areas of service delivery. Additionally, Commissioner Carpinello requested that the group make recommendations for infusing the white paper rules into OMH’s policies, regulations, and licensing.
The first meeting of the white paper implementation committee was held in November 2004 to examine how to accomplish this task. Sixty people who use mental health services met and reached consensus on concepts that will lead to the implementation of quality indicators. The meeting set forth an ambitious time line for a variety of implementation strategies that include multiple presentations, technical assistance offerings, and refinement strategies. Specific, actionable steps are currently being refined for each of the service components within the public mental health system.
Already a valuable resource to OMH, the white paper has been heralded as one of the most important documents of recent years. Its full text is included in Appendix 4.
Planning for Service Needs of Special Populations
Stakeholders' feedback on the 2004-2008 Comprehensive Plan has helped to identify the following set of emerging community mental health needs that New York will begin facing during the next five years.
Populations with Emerging Special Needs
Population groups with emerging special needs were identified during the planning process to include young adults, older adults, and adults in adult homes and in prisons. Information about adult homes is included in Chapter 5.
As an OMH special population, young adults are persons ranging in age from 18 to 24 years. Each year New York's public mental health system serves approximately 52,434 young adults. Of these individuals, the greatest number, 36%, is diagnosed with bipolar disorder or major depression, and a sizeable minority (13%) suffer from schizophrenia and related disorders. The Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition (DSM-IV) also indicates that the age of onset for anorexia nervosa is 17 years old and the onset rarely occurs in females over age 40. Among young adults, four potential areas of need have been identified and initial goals to address them include:
- The smooth transition to adult services for young adults "aging out" of the children's mental health system who will require ongoing services in the adult system.
Goal: Assess issues of access, linkage and coordination, and new service models.
- Effective intervention for young adults of college age who present with serious diagnoses, such as schizophrenia or bipolar disorder, who have not been served in the children's mental health system.
Goal: Identify the at-risk population in preparation for the development of prevention and early intervention strategies.
- Suicide prevention among young persons between 18-24 years, recognizing that suicide is the third leading cause of deaths among this group in our nation.
Goal: As part of OMH's SPEAK public education campaign, identify depression and suicidal ideation among young persons in need of intervention.
- Care for young adults suffering from eating disorders.
Goal: Collaborate with the Department of Health in planning and implementing Comprehensive Care Centers for Eating Disorders, which were signed into legislation by Governor Pataki in June 2004.
During the public input process to the 2004-2008 Comprehensive Plan, stakeholders identified the mental health needs of older adults as a priority area. This subject was the most prominent theme addressed in the New York City public hearing, and the newly formed Geriatric Mental Health Alliance of New York (GMHANY) presented OMH with the report Issues in Geriatric Mental Health Policy: A Report of the Observations of Advocates, Providers, Researchers, Academics, Government Officials and Older Adults. As stated in the report, the Alliance was formed “to advocate for changes in mental health policy that will result in improvements of current mental health services for older adults, and for changes that will lay the groundwork for the development of an adequate response to the mental health needs of the elder boom generation.”
The GMHANY report provides an overview of themes that emerged from a series of discussion groups that included representatives of mental health agencies, psychiatric hospitals, settlement houses and senior centers, nursing homes, home health care agencies, governmental leaders from both aging and mental health, researchers, academics, and advocates. The representation in these groups illustrates that mental health problems of older adults are a shared concern across the public and private sectors. There was widespread agreement among discussion group participants that the fundamental job of a system of services for older adults with mental health problems is to provide support for them to lead satisfying lives in their communities. There was also widespread confidence that effective treatments are now available and they can help people sustain satisfying lives in their communities. At the same time, the report acknowledges that access to effective treatments is limited, and many older adults and their families do not seek treatment even when it is accessible.
Since receiving the report, OMH has been collaborating with stakeholders, including GMHANY, concerning these issues. These collaborations have resulted in the identification of two sub-population for consideration: individuals with a mental illness who are getting older and developing comorbid conditions related to aging, and older New Yorkers who are at risk for developing mental illness. A series of roundtable discussions is planned for Spring 2005, at which experts, stakeholders and providers will further discuss the mental health needs of aging New Yorkers. The GMHANY report and additional information can also be found on the Web at http://www.mhawestchester.org/advocates/issuesd1004.pdf . (PDF)
Adults in Prison
Individuals with mental health disorders in prisons require mental health services to reduce psychiatric symptoms and promote functioning.
As of December 2003, there were approximately 65,000 prisoners incarcerated in Department of Correctional Services' facilities. Of those, approximately 11% or 7,500 inmates were assigned to the OMH corrections-based caseload. The 2005-2006 Executive Budget continues $7 million for a multi-year effort to expand mental health treatment, clinical staffing, and bed capacity. More detailed information about adults in prison is included in Chapter 7.
Planning for Children’s Inpatient Services
Roundtable discussions have also played a prominent role in planning the mental health needs of children and adolescents. When developing the structural design of a children’s unit currently under construction at the Greater Binghamton Health Center, OMH administrators and the project’s architect sat down with children who have been hospitalized and their families, facility staff, and other area mental health providers. Together, they discussed various design elements that would enhance the recovery process, as well as those that may inhibit it. They fine tuned the details, and the end result will be an inpatient unit truly designed to support recovery. It will balance individual privacy and appropriate supervision, provide a safe and therapeutic environment, and will be family friendly, especially in the visiting areas.
In November 2004, OMH hosted a roundtable discussion among leading providers of inpatient care for children and adolescents in the metropolitan New York City area. The discussion also included State and City government representatives, family advocates, and parents whose children have been hospitalized. The purpose of the gathering was to examine the clinical profiles of the youngsters currently receiving inpatient care, explore what treatments are currently being used, and discuss clinical, administrative and structural opportunities that might improve the quality of care provided.
Participant discussion led to consensus around a number of themes including the following examples:
- Develop more extensive crisis services for children. Many children in emergency rooms were described as needing immediate mental health services, but not necessarily inpatient hospitalization. In the absence of a more systematic, completely reliable alternative, many emergency room physicians opt for the safety and immediacy of inpatient care.
- Increase family involvement in the course of inpatient hospitalizations. Family involvement was seen as an important yet often missing component, especially in acute settings.
- Develop core clinical competencies where there is strong research support for particular interventions.
- Explore the use of common assessment and outcome measurement systems.
Discussions and follow-up are continuing. A second follow-up roundtable is planned.
Population-based Planning Efforts
OMH is committed to providing quality mental health services to all New Yorkers in need. Many different communities and constituents are continually engaged to assist the agency in the development and evaluation of services that are culturally appropriate and linguistically suited for New York’s diverse populations. Examples include:
- The Multicultural Advisory Committee (MAC) is composed of diverse consumers, family members and providers. During 2004, the group met directly with the OMH cabinet to address population-based planning efforts as well as disparities that may be present in mental health services. There was an opportunity to exchange information regarding language assistance needs and service adaptations based upon culture, ethnicity, age and gender. Members also made recommendations for development of a standardized cultural competence curriculum for use in training community-based licensed programs. The first draft of the training content has been outlined, and its development continues.
- In addition to the statewide MAC, several counties have local multicultural advisories that are working in collaboration with OMH to improve service quality: The Nassau County MAC has developed a series of culture-specific training opportunities; Suffolk County held an annual cultural competence symposium; Orange County has expanded its training activities to include technical assistance for the development of cultural competence plans for all county human service agencies; Broome County has continued its language interpreter program; and Monroe County continues an extensive cultural competence evaluation, training and plan development process for county agencies.
- Throughout the State, grassroots networks are also partnering with OMH to enhance mental health services. Consumer and family groups such as National Alliance for the Mentally Ill (NAMI) Harlem and Harlem Hospital have hosted events to provide a public education forum about mental illness and mental health. The training, “Cultural Competence: Maintaining an Asking Stance,” has been presented to provider agencies, trade associations, social work education programs, and community groups throughout the State. Agencies have adapted the material to directly address specific community issues and to enhance service planning.
- OMH is also working to increase its outreach efforts by partnering with groups including the Association of Hispanic Mental Health Professionals, Black Psychiatrists of Greater New York, and the Coalition for Asian American Mental Health. Recognizing that many New Yorkers seek assistance outside of formal mental health settings, OMH has also formed alliances with other systems and programs, including the Peri-natal Network and the Caribbean Cultural Center.
The 2004 Interim Report of the Statewide Comprehensive Plan for Mental Health Services contains a more complete description of increased opportunities for public input. It is available on the OMH Web site at http://www.omh.ny.gov/ .
Partnerships in the Development and Implementation of New Service Models
Personalized Recovery-Oriented Services (PROS) is a comprehensive program for individuals with severe and persistent mental illness that is designed to facilitate individual recovery by integrating treatment, support, and rehabilitation services. Goals for individuals in the program are to improve functioning, increase employment, attain higher levels of education, secure preferred housing, reduce contact with the criminal justice system, and decrease utilization of inpatient and emergency services.
Throughout the PROS development process, OMH actively sought input from a broad array of stakeholders, and frequently modified the program’s design in response to their questions and concerns. The agency conducted more than 150 briefings and meetings on PROS with other State agencies, county government officials, mental health service providers, and service recipients who are attending programs that might convert to the new PROS license.
OMH has made concerted efforts to involve county governments as partners in the planning, implementation, and oversight of PROS programs. An extensive county planning process was initiated to ensure that county mental hygiene directors had an opportunity to manage the impact of PROS on their Local service systems. Since PROS programs are funded by Medicaid, OMH has worked with county representatives to fashion regulatory requirements for a county/provider agreement that will replace Local contracting for State Aid funding as the vehicle for supporting the county role in program monitoring and quality improvement.
The OMH Web site contains a PROS section that includes a program description, announcements on the status of implementation efforts, responses to frequently asked questions, and sections of a draft handbook for PROS providers (http://www.omh.state.ny.us/omhweb/pros/). Draft PROS regulations have been posted on the site, and stakeholders have been invited to submit comments in advance of the mandatory comment period that is initiated once the regulations are formally filed as proposed.
The PROS State/county collaborative relationship is continuing as program implementation begins. As announced in October 2004, an initial implementation phase will involve seven counties representing a mix of urban, suburban, and rural settings. The scope of this phase takes into consideration OMH’s ability to provide the intensive technical assistance necessary to support successful program transitions to the new PROS license.
Strengthening the Capacity for Data-Driven Decision Making
OMH remains committed to population based planning, forecasting, and management that uses relevant data from agency performance measures to enable data-driven decision-making. Population-based planning in the public mental health system requires that localities identify the specific services needed in their communities based on the specific groups that need service, taking into account age, ethnicity, sex, and growth projections within the population.
Beginning in April 2004, OMH launched an initiative to strengthen its capacity to use modern geographic information systems (GIS) technology to support data-informed State and Local mental health planning. Local planning is by definition geographically based, and an increasing number of the data sources needed for data-informed planning include geographic information such as county, zip code, and street address. In recent years, the capabilities of GIS technology have expanded rapidly, making it feasible to look with fine-grained geographic precision at important public mental health system issues such as prevalence of serious mental illness and access to evidence-based services. OMH’s GIS initiative has two tracks:
- Improving staff skills so that increasingly sophisticated and useful geomaps of mental health phenomena can be produced.
- Incorporating geographic data into the OMH enterprise data warehouse so that geomaps and spatial analysis can be carried out more efficiently and with greater frequency.
A major target audience for OMH GIS efforts is Local mental health directors and their staff. In a May 2004 regional planning meeting with county mental health directors and State psychiatric center directors, OMH staff presented and discussed an initial set of geomaps that displayed local variation in the prevalence of serious and persistent mental illness and access to Assertive Community Treatment and Intensive Case Management services at the zip code level. At this and subsequent presentations, counties have expressed strong interest in the GIS initiative and have requested additional geomaps, including maps of the prevalence of serious emotional disturbance and access to specialized children’s services. Joint State and Local planning discussions stimulated by the geomaps have begun to produce a common understanding of mental illness prevalence estimates and the relationships between prevalence and service access and use.
Disaster Response and Preparedness
As described in the 2004-2008 Comprehensive Plan, OMH is responsible for coordinating New York State’s emergency mental health response and ensuring that mental health services are available for those in need. OMH is continuing the emphasis on disaster preparedness and response, which includes reviewing emergency mental health response systems through a comprehensive disaster preparedness planning process conducted in collaboration with other State and Local agencies. OMH is also continues to provide leadership in disaster mental health planning with other State agencies, Federal agencies,CLMHD, and the American Red Cross in New York State (ARCNYS). Through these processes, OMH recognizes the complementary roles, shared commitment, and the mutual advantage of an integrated approach to improving emergency mental health services for all New Yorkers.
The 2004-2008 Comprehensive Plan reported on two initiatives to strengthen State and local disaster response and preparedness capabilities.
- OMH,CLMHD, and ARCNYS have been collaborating to establish procedures and protocols to strengthen county and State ability to respond to disasters by providing critical mental health supports to victims. The first step in this effort was signing a Statement of Understanding outlining the roles, responsibilities, and expectations of each organization when responding to a moderate or severe disaster. This document also outlined steps to provide for a more coordinated and cooperative effort in the areas of communication, training, and mobilization of mental health responders, as well as a commitment to pursue an evidence-based approach.
- An additional collaboration with the State Department of Health (DOH) was initiated to develop public mental health education materials that will be included in a Bio-Terrorism Toolkit designed to facilitate Local disaster planning with a focus on preparing families and communities for the potential effects of a biological weapons attack. The kit will include fact sheets about smallpox and anthrax, vaccination information, and how to cope during these uncertain times.
These two initiatives were merged into a single, coordinated project during 2004 and substantial progress was achieved. The next major goal of the partners in this collaboration is to operationalize these agreements at the county level. In Spring 2004, OMH initiated site visits, with itsCLMHD and ARCNYS partners, to several counties with a reputation for having established best practices in the area of disaster mental health response. The purpose was to review current practices, identify potential best practices, and create models that can be shared with other counties. During July visits were completed to five county mental health departments selected to be pilots.
OMH,CLMHD and ARCNYS are also seeking to develop a disaster response curriculum for mental health responders based on evidence-based practice. The goal of this effort is to undertake statewide training of State and county disaster mental health professionals to expand their capabilities for providing effective disaster mental health interventions. The development team has included staff from the University of Rochester Medical Center (URMC) for Disaster Medicine and Emergency Preparedness. URMC was tasked to research national “best practices” and develop the appropriate curriculum upon which the statewide training is to be based.
The county mental health directors invited their Local disaster services partners to the full-day training development meetings. Information gathered at these sessions, together with best practices research, was used to complete an eight-module training curriculum. In August 2004 the full curriculum was successfully pilot tested with two county mental health departments. Phase II of this project, scheduled to begin soon, will advance the training to OMH and county mental health offices through the use of “train-the trainer” (TTT) techniques. This work is to be undertaken during the first half of the 2005 calendar year.
It is OMH’s intent to facilitate the use of this TTT cadre to undertake the training of disaster mental health professional responders across New York State. These resources can than be made available for individual counties to customize the mix of State, Local, and voluntary disaster mental health providers together with the application of the EBP methodologies in which they have been trained.
The September 11 terrorist attacks on the World Trade Center have no precedent in the history of the U.S. The disaster had a dramatic impact on Americans, especially those who were living and working in New York City, in terms of the devastating loss of life, enormity of physical destruction, adverse economic consequences, and serious mental distress and psychological disorder. With support from the Federal government and State and Local mental health authorities, OMH responded rapidly with the development and implementation of a large-scale Federally funded public health program called Project Liberty, which was aimed at addressing a range of psychological reactions and lessening the traumatic consequences experienced by individuals in close proximity to the disaster site and its surrounding areas.1
With incidents of intentional mass violence that result in a significant loss of life and property, as well as extensive unemployment, previous research shows that the resulting trauma may be associated with severe, long lasting, and widespread psychological effects.2 In the immediate aftermath of the World Trade Center disaster, widespread mental distress was found in the general population. One national study found that 44% of adults and 35% of children reported one or more reactions consistent with traumatic stress. For adults living in the City and within 100 miles of the disaster site, 61% reported considerable traumatic stress symptoms. One year after the disaster, New York Academy of Medicine uncovered new-onset post-traumatic stress disorder (PTSD) among World Trade Center disaster victims, where 5% of survey respondents without PTSD in March 2002 met criteria for PTSD in September 2002.3
The terrorist attacks produced an unprecedented and chaotic post-disaster environment that required the most complex emergency management response ever mounted in national history. Project Liberty, which was officially launched in September 2001, was jointly operated by the Federal Emergency Management Agency (FEMA) and the Center for Mental Health Services (CMHS) of the Substance Abuse and Mental Health Services Administration (SAMHSA). It provided funding for short-term public education, outreach, crisis counseling and referral services. The role of OMH was to develop an infrastructure for Project Liberty that enabled the City and county departments of mental health to ensure the effective delivery of a continuum of supportive counseling interventions designed to meet disaster-related mental health needs in their communities. Program services were ended December 31, 2004. In all, Project Liberty was a successful collaboration between the State, local governments, and more than 130 local service providers. It was and continues to be the single largest public mental health program put into operation in the U.S.
While Project Liberty services have ended, Governor Pataki has continued to support the ongoing needs of New York City firefighters and their families. New York State has provided $2 million in State funds, which will be utilized with New York City funds to provide additional mental health and crisis counseling services to the New York City firefighter community.
An important Project Liberty innovation was its evaluation of various components of the crisis counseling model. Prior to Project Liberty, Federal funds were prohibited from being used to evaluate disaster response programs. In partnership with New York City, the disaster-declared counties and its academic partners, Project Liberty, however, began to remedy gaps in knowledge through its evaluation of programs and services. In addition to collecting service encounter data, the Project gathered feedback from stakeholders who provided counseling, shedding light on program implementation and operational issues and the needs of the communities served. Additionally, service recipients were surveyed about their experiences, needs, and opinions and their views on the helpfulness of and satisfaction with counseling services.4
The evaluation provided important information that proved valuable to Project Liberty senior leadership in administering and monitoring program operations, such as reaching populations that are difficult to serve, and enhancing project decision making.5 An essential by-product of the evaluation was the ability of OMH to use data to inform disaster preparedness efforts, by providing a clear picture of the process of implementing a large-scale disaster mental health program; gaining a fuller appreciation of best practices and obstacles encountered; and articulating lessons learned.
During 2005, Project Liberty will complete final reporting to FEMA and CMHS. The final report is expected to yield new insights into the assessment, organization, implementation and evaluation of future disaster mental health response initiatives. OMH will employ reports, presentations, publications, and the dissemination of tools to aid disaster mental health response efforts nationwide. Through its public, private, and academic partnerships, OMH will continue to build on the strengths of Project Liberty’s World Trade Center disaster mental health response efforts and contribute new and vital information to the growing body of disaster mental health knowledge.
National Collaborations for Disaster Preparedness
Since September 11, OMH has been participating in national efforts sponsored by the Federal government to advance our country’s evidence base concerning the mental health impact of terrorism and effective response strategies. Several Federally sponsored scientific meetings have brought together disaster mental health researchers, trauma experts and mental health policymakers over the past three years. These efforts have been an effective forum for synthesizing existing information on the mental health impact of terrorism and appropriate responses and for initial reactions by these experts to new data collected post-9/11, including Project Liberty evaluation findings. Participants at the first of these meetings developed consensus guidelines for appropriate mental health response during the first four weeks following an event. These guidelines were subsequently published by the National Institute of Mental Health (NIMH).
A second forum was held by the National Institute of Medicine (IOM) for the purpose of soliciting expert testimony as a first step in the creation of an IOM report on the mental health impact of terrorism. OMH staff were invited to participate and provided testimony that reviewed the lessons learned from the first year of Project Liberty’s operation. The final IOM report, titled Preparing for the Psychological Impact of Terrorism contains a series of recommendations aimed at strengthening the nation’s disaster mental health preparedness and further increasing scientific knowledge concerning the mental health impact of terrorism and the necessity and effectiveness of interventions to counter that impact. Together, the recommendations represent an overall “call to action” for the creation of a nationwide surveillance and response infrastructure.
A third national meeting in which OMH participated focused on screening procedures and interventions. Discussion at that meeting was informed both by the guidelines produced at the October 2001 meeting and the IOM report but also the intervening two years of real-world experience in responding to September 11. The meeting yielded a high degree of consensus amongst participants concerning the necessary components of an overall mental health response model, and workgroups are now finalizing these recommendations.
As part of our efforts to preserve the mental health response infrastructure created after September 11 and disseminate lessons learned, OMH has developed a toolkit consisting of public educational materials, training curricula, data collection tools and protocols, and screening instruments developed for Project Liberty. This toolkit, which will continue to be revised, is available for free on CD-ROM from OMH.6 We are currently working with our Federal partners at SAMHSA to further refine these toolkit materials into national technical assistance resources available to other jurisdictions in the future.
1Felton, C.J., Donahue, S., Lanzara, C.B., Pease, E.A., & Marshall R. (in press). Project Liberty: Responding to mental health needs after the World Trade Center terrorist attacks.Cambridge: Cambridge University Press.
2Norris, F.H., Friedman, M.J., Watson, P.J., Byrne, C.M., Diaz, E., & Kaniasty, K. (2002). 60,000 disaster victims speak: An empirical review of the empirical literature, 1981-2001. Psychiatry, 65, 207-239.
3Schuster, M.A., Stein, B.D., Jaycox, L., Collins, R.L., Marshall, G.N., Elliott, M.N., Zhou, A.J., Kanouse, D.E., Morrison, J.L., & Berry, S.H. (2001). A national survey of stress reactions after the September 11, 2001, terrorist attacks. New England Journal of Medicine, 345, 1507-1512
4 Felton, C.J. (2004). Lessons learned since September 11th 2001 concerning the mental health impact of terrorism, appropriate response strategies and future preparedness. Psychiatry 67(2), 147-152.
5Appendix 5 contains the latest Project Liberty service delivery data.
6The CD-ROM can be ordered from the Project Liberty Web page at: http://www.projectliberty.state.ny.us/educational.htm
Comments or questions about the information on this page can be directed to the Office of Planning.