The work of the national dialogue is commendable and this is idea is meant to further build upon the structure. It is agreed that there needs to be a focus on resilience although a change in focus from response to resilience may have the effect of losing ground regarding the progress made in the area of response over the last 5 years at least. The “All Hazards” trainings conducted in 2004 were highly successful in bringing together Statewide Emergency Management, Public Health, Mental Health, American Red Cross and other voluntary sector responders with the goal of establishing a multi-discipline preparedness plans. Some of these individuals came together for the first time as a group, never having met each other despite their roles in each state as first responders. These trainings also accomplished the development of regional and national networks which, as we know from 9/11/01 and to some extent, Hurricane Katrina, strengthened the response across states.

The shift in focus from community wide, multi-discipline response planning for emergencies and large scale catastrophes would be a loss to the nation. While a focus on resiliency is important-to design programs that provide the message that local and state responses are powerful and necessary to strengthen survivors from within, a shift to resilience instead of response seems to be going backwards. There needs to first be a response in order to help communities move towards resilience. We need only to look at the last two large scale events in this country to see the effects. In 9/11/01, where I had the privilege of managing the mental health response in NYC, Project Liberty, the overwhelming messages from across the country let those affected in New York, Virginia and Pennsylvania know that they were supported. This catapulted these communities towards actions that lead to a show of extraordinary resilience on both local and national levels. In Hurricane Katrina, in New Orleans especially, a delayed response prompted a negative start in the recovery process and even today, the efforts of many affected communities towards resilience activities exist in a limited number and even these seem to be struggling.

This speaks to the overall idea of more strongly integrating the psychosocial responses to emergencies and disasters in the U.S. These include:

1) Continuing the multidiscipline preparedness and response efforts begun on a nationwide basis post 9/11/01

2) Bringing attention to the increased need to address psychosocial interventions as part of overall planning and response.

3) Increasing and expanding Public Messaging around ‘Preparedness, Response and Resiliency’ as a method of accomplishing all three of these goals-similar to the public messaging campaigns launched to destigmatize mental illness (e.g. television commercials describing how ‘depression hurts’and the campaign to decrease breast cancer by increasing screenings and self examination).

While we know that natural disasters, terrorism and armed conflicts have increased in the past decade. John Holmes, the Undersecretary General of the United Nations, speaking to the issue of tomorrow’s disasters in Nov. 2008 as reported in the Economist, reports that recorded disasters have doubled in the past two decades and that nine out of ten are climate-related. Additionally, these weather changes effect natural resources and have the potential to further exacerbate the political conflicts that continue to exist across the globe. Human conflicts for such resources may be more likely to exist on an internal basis-local community members, state to state, etc.

The Substance Abuse and Mental Health Services Administration’s Emergency Mental Health and Traumatic Stress Branch has conducted national, state and local training to ready community members to participate in the Crisis Counseling Assistance and Training Program (CCP). The CCP, authorized by the Robert T. Stafford Disaster Relief and Emergency Assistance Act (Public Law 93-288), allows for the education, training and support to communities that request assistance when an area has been declared a federal disaster. Research tells us that the psychological effects of a traumatic event are second only to death or injury, yet less attention is paid to addressing the psychological preparedness and response to such events than to the impact on buildings and other physical structures.

The National Dialogue on this issue brings the opportunity to fully integrate psychosocial preparedness, response and resiliency building education, training and practice into the full sphere of Homeland Security activities related to disasters.  Working with SAMSHA, the U.S. Public Health Service, FEMA and the State Emergency Management Offices, Disaster Coordinators, Universities and the volunteer sector of disaster response agencies, the U.S. can continue to build upon the preparedness work conducted over the past decade and further expand these efforts to include resiliency building activities, which fall under the domain of psychosocial intervention. This would accomplish keeping a hold of the preparedness and response planning that states have conducted to date as well as adopting activities that would further the efforts of resiliency building. This would seem a logical and practical idea rather than making a shift to resilience and losing ground in the area of psychosocial capacity building.

Integrating the education, training and support services to states around preparedness, response and resiliency activities serves to strengthen communities who face the adversity of natural and human caused disasters. With the increasing occurance of such incidents, communities can lose confidence in their ability to bounce back from such events. Social support, education and training can migiate the affects of traumatic events. Migation is the core of what FEMA attempts to do in the aftermath of disasters and addressing the psychosoical needs of individuals, families and communities can help accomplish this goal.