Anticipating the worst: a little planning can go a long way during an emergency.

Memories of the chaos caused by Hurricane Katrina, coupled with a post-9/11 awareness of the magnitude of emergencies that affect entire communities, have prompted behavioral healthcare organizations to examine their emergency plans, including their role in community-wide disaster-preparedness activities. Recent American disasters have demonstrated that even those organizations with solid plans face daunting challenges when the major parts of a community's infrastructure are damaged or overwhelmed by a population in need of assistance.

During an emergency, 24-hour behavioral healthcare settings must be prepared to care for the needs of their clients in place, while others will focus much of their energy on finding and providing resources for their clients in the community. And of course, some provider organizations will be called on to provide mental health first aid to early responders, witnesses of the event, and a wide variety of other community members who may experience post-trauma distress.

The Joint Commission and various regulators long have mandated that behavioral healthcare organizations plan for emergencies. The goal is to enable organizations and communities to care for themselves in the initial phase following natural or man-made disasters and to build on existing relationships so that comprehensive plans meet the needs of the communities they serve.

The Joint Commission, which has been actively involved in disaster preparedness for more than 30 years, increased its focus on emergency management two years before 9/11, and since has worked even more closely with emergency management experts and healthcare organizations to make this issue a priority. The resulting accreditation standards and overall guidelines developed by multiple expert roundtables better reflect the need for behavioral healthcare organizations to be involved in community-wide planning.

The Joint Commission's Management of the Environment of Care (EC) standards require behavioral healthcare organizations to develop a management plan that ensures an effective response to emergencies, to implement that plan, and to execute the plan by conducting emergency management drills. These standards also require behavioral healthcare organizations to participate with the community in establishing priorities among potential emergencies, defining an organization's role in the community's emergency management program, and linking with the community's command structure. The table lists the 2007-2008 Joint Commission behavioral care accreditation standards for emergency management planning.

Specific Challenges

Behavioral healthcare organizations face special challenges during an emergency. Hurricane Katrina showed that vulnerable populations can be at particular risk. Clients served by behavioral health organizations, especially those living in the community, might not have the information or resources to make a timely response to an emergency and, therefore, are most in need of the good judgment of providers and organizational leaders with whom they are familiar.

When working with community leaders to plan for emergencies, it is important for behavioral healthcare leaders to detail the special needs of their clients. Areas of consideration may include:

Communication. How will communication with clients be handled during the chaos of an emergency? Plans should include instructions to foster parents on emergency contact information. Methadone maintenance clients may need to be made aware of alternative sites for medication.

Basic functions. A 24-hour care setting must consider what resources will be needed to feed and care for the client population and staff in the event they must stay in place without access to community resources.

Mental health first aid. Some community-based providers must consider both the needs of their clients and their role in the community at-large to provide mental health first aid following a disaster.

An All-Hazards Approach

Behavioral healthcare organizations, in collaboration with community leaders, can address the challenges of responding to disasters. By conducting a hazard-vulnerability analysis, organizations can identify the types of emergencies that may occur in their communities and plan for how to respond.

For example, is the behavioral healthcare facility in an area subject to weather emergencies such as blizzards, floods, or tornadoes? Are there railroad tracks or highways nearby that could be the site of a hazardous chemical spill? The idea is to consider the effects that specific types of emergencies would have on the organization and the community, as well as the demand for services.

As part of this process, it is important to remember that an emergency might have a cascading effect. For example, in New Orleans Hurricane Katrina initially did not cause as much damage, but the resulting levee breaches caused devastating flooding that led to the loss of power, communications failures, blocked escape routes, and so forth.

After compiling as complete a list as possible, the organization should prioritize the emergencies based on the likelihood of occurrence. Finally, the areas of vulnerability that most demand organizational attention should be addressed.

Behavioral healthcare organizations will be well served to also work in collaboration with emergency responders such as local fire and police departments and other healthcare organizations in the community, such as acute-care facilities. It is important that other community resources are aware of the nature of the behavioral healthcare organizations' services, the population they serve, and what special needs they might have, as well as what resources they can contribute to the community. For example, community emergency services should have a clear understanding of when behavioral health organizations are not equipped to provide emergency medical services.

By working together with these other experts, behavioral healthcare organizations can help ensure that the full spectrum of likely emergencies and contingencies has been considered. The collaboration also allows each disparate group to understand its role in a larger crisis and plan how the behavioral healthcare organization will respond. For example, road closures or curfews ordered by the municipality may interfere with the transit of essential staff or suppliers following a severe storm. Facilities should communicate with the local police and public works authorities in advance regarding planning and communication to facilitate movement of essential staff and other resources during an emergency.

BY MARY CESARE-MURPHY, PHD

ABOUT THE AUTHOR

Mary Cesare-Murphy, PhD, is the Executive Director for the Behavioral Health Care Accreditation Program at the Joint Commission.

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RELATED ARTICLE: Hogan to represent field on Joint Commission board

The Joint Commission has appointed New York Commissioner of Mental Health Michael F. Hogan, PhD, as the nonvoting behavioral healthcare field representative to its Board of Commissioners.

"This is an honor, and a great opportunity for behavioral health," said Dr. Hogan in a release. "The Joint Commission's action in creating this position reinforces that behavioral health is essential for overall health. I hope to serve our field well in representing our concerns about good care."

"Dr. Hogan's expertise and in-depth experience in the mental health arena will enrich Board discussions on policy issues respecting behavioral health care," said Joint Commission President Dennis S. O'Leary, MD. "This action underscores the commitment of The Joint Commission and its Board to all of those in the behavioral health care field who are in turn committed to serving this vulnerable population."

Before joining the New York Office of Mental Health, Dr. Hogan was director of the Ohio Department of Mental Health from 1991 to 2007, and he was the chair of the President's New Freedom Commission on Mental Health.

TABLE. The 2007-2008 Joint Commission behavioral care accreditation
standards for emergency management planning

EC.4.10
The organization addresses emergency management.

EC.4.20
The organization conducts drills regularly to test emergency management.

EC.7.10
The organization manages its utility risks.

EC.7.20
The organization provides an emergency electrical power source.

EC.7.40
The organization maintains, tests, and inspects its emergency power
systems.

IM.2.30
Continuity of information is maintained.

Source: Joint Commission Resources