In 1974, Congress enacted broad disaster assistance legislation, the Robert T. Stafford Disaster Relief and Emergency Assistance Act (the Stafford Act). This report describes CCP and other programs administered by the Substance Abuse and Mental Health Services Administration (SAMHSA, an agency within the Department of Health and Human Services, HHS) to provide federal assistance for the mental health and substance abuse treatment needs of disaster victims. The report also analyzes the implementation, effectiveness and coordination of other SAMHSA disaster mental health programs, and discusses relevant policy issues in ensuring the provision of mental health and substance abuse treatment services following disasters. This report will be updated as circumstances warrant. For its response to Hurricanes Katrina, Rita and Wilma, SAMHSA received funding to administer CCP programs, and provided SERG grants through its regular appropriations, but did not receive a supplemental appropriation. Issues for Congress

This section discusses several policy issues, including federal leadership and coordination of mental health and substance abuse treatment and other services in the aftermath of a disaster; issues regarding CCP, including the scope and duration of CCP services, as well as matters of program administration and effectiveness; the availability of funds for SERG grants; and, the assessment of resources and needs for mental health and substances abuse services. Hence, federal leadership for disaster mental health in the NRP is delegated to both FEMA and to HHS. Appendix A lists CCP awards to states for ISP and RSP programs in response to Hurricanes Katrina, Rita and Wilma, as reported by SAMHSA. A recent news report has questioned whether the activities carried out in Project H.O.P.E., the CCP program established in Florida in response to Hurricane Wilma (See "Crisis Counseling Assistance and Training Program"), are likely to benefit the mental health of victims. Section 219 of the bill would require that SAMHSA, other relevant federal agencies, and state and local governments, conduct resource assessments and develop strategies to address mental health and substance abuse service needs following disasters. ( S. 3721 would also expand CCP to cover substance abuse services. The federal programs set up to address mental health and substance abuse problems in those affected by the 2005 hurricanes offer opportunities for scrutiny.
Major disasters such as Hurricanes Katrina, Rita, and Wilma, which struck Gulf Coast states in 2005, have the potential not only to cause mental health problems for individuals, but also to weaken or disable the systems designed to address those individuals' needs. Striking an appropriate balance of responsiveness, fiscal responsibility, and accountability in the provision of federal assistance programs during and following a disaster remains a difficult goal.
Federal leadership for mental health and substance abuse programs resides in the Substance Abuse and Mental Health Services Administration (SAMHSA), in the Department of Health and Human Services (HHS). SAMHSA carries out numerous activities to address mental health and substance abuse problems following disasters, including the Crisis Counseling Assistance and Training Program (CCP), which is authorized in the Robert T. Stafford Disaster Relief and Emergency Assistance Act (the Stafford Act) and implemented jointly by SAMHSA and the Federal Emergency Management Agency (FEMA).
The response to the 2005 hurricanes has prompted a re-examination of CCP and other federal assistance programs that address disaster mental health. Concerns include the timeliness and effectiveness of services provided, the appropriate scope and duration of these services, and matters of cost and accountability. In particular, the respective roles and responsibilities of SAMHSA (which provides technical expertise for CCP programs), FEMA (which funds them), and states and their contractors (which implement them), are not always clear.
Following a news investigation, some Members of Congress have expressed concerns about Project H.O.P.E., the CCP program implemented in Florida in response to Hurricane Wilma. Others have sought to expand CCP to provide substance abuse services, and to require that SAMHSA, other federal agencies, and state and local governments conduct resource assessments and develop strategies to address mental health and substance abuse service needs following disasters. (See S. 3721, reported in the Senate.)
This report describes federal assistance programs in HHS that address mental health and substance abuse problems following disasters. In addition, relevant policy issues are presented in the context of the 2005 hurricanes, and several prior disasters. Three appendices provide information on CCP awards made to states in response to Hurricanes Katrina, Rita, and Wilma, and on the scope of services that constitute mental health treatment. This report will be updated as circumstances warrant.