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Disaster Psychiatry and Disaster Behavioral Health Consultation

The provision of consultation regarding extreme events has been a core activity of The Center since its inception. Consultation is offered and sought based The Center’s depth and breadth of expertise as well as its linkage with dozens of partners and stakeholders. This service is especially important as it represents the application of science, diverse professional expertise, and experience in real-life, real-time challenges. Consultation provides informed and objective evaluation of high stress situations, demonstrated ability to rapidly integrate its substantial human and academic resources, and deliver assistance in a variety of formats for end users. Extreme events often occur with little or no notice and the need for consultation can occur in a matter of minutes and hours.

Of special note, is the Center’s provision of consultation to leadership in extreme events. Frequently, governmental, private sector, and community leaders will seek consultation regarding the special challenges they face.  Areas of consultation include natural and human caused events, mass casualty and fatality events (including shootings), and terrorist events. The Center has consulted on events and issues within the United States and internationally.



CSTS was approached by the Executive Director of the NASMHPD to provide advice on the mental health aspects of the emergency in Flint Michigan resulting from long term water contamination. CSTS responded by providing advice, two fact sheets, and the commitment to provide additional assistance as needed. CSTS is in the process of developing additional material specific to this event and will provide them to NASMHPD when completed. In addition, CSTS is in contact with ASPR, DHHS in support of their efforts in the Flint emergency.

Drs. Ursano, Flynn and Morganstein were contacted by, and provided consultation to, the President of the Michigan Psychiatric Society, Dr. Pozios, on leadership principles and unique aspects of responding to the Flint, Michigan water contamination and lead exposure disaster. We also connected Dr. Pozios to the American Psychiatric Association Disaster Committee and provided him with a comprehensive educational document on important issues for healthcare providers to consider when responding to chemical, biological, radiological or nuclear (CBRN) type events.

Dr. Ursano met with the Michigan Psychiatric Society to discuss responses to the Flint Michigan Disaster. Dr. Ursano provided materials and comments about risk communication

CSTS Scientists responded to the tragic shootings at the Pulse nightclub in Orlando, FL with consultation to the American Psychiatric Association and its regional branch in Orlando. In addition, educational fact sheets that assist a wide range of stakeholders in responding and recovering from such events were disseminated to National Association of State Mental Health Program Directors, Department of Health and Human Services, Department of State, and Psychiatry Consultants for the Army, Navy and Air Force.

At the request of the embedded Mental Health leadership for the USAF Distributed Ground Combat Systems, CSTS Scientists developed and disseminated a fact sheet and accompanying Power Point training on "Military Leadership in Stressful Situations" designed to enhance the leadership of first line NCO and junior officer supervisors overseeing the intelligence teams that observe, collect and analyze data in drone aviation.

In response to the catastrophic flooding in Louisiana which resulted in the disinterment of bodies from cemeteries, CSTS developed and disseminated fact sheets that address mental health issues related to exposure and handling of human bodies and mass death. These fact sheets provide an overview of important considerations for relief workers, first responders, and healthcare providers. The fact sheets were provided to the National Association of State Mental Health Program Directors, the Office of the Assistant Secretary for Preparedness and Response, and the American Psychiatric Association for distribution throughout their national and international networks.

Dr. Morganstein, Dr. Benedek, Dr. West, Dr. Meyer, and TSgt Hastings traveled to Langley AFB at the request of the 480th ISR Wing embedded mental health team to conduct interviews assessing the stress and well-being of personnel whose mission is to ensure gathering and processing of auditory and visual intelligence information received from remotely piloted aircraft. The information gathered is part of an ongoing partnership with the mental health team assigned to oversee the mental health and well-being of drone aircraft intelligence personnel.

Dr. West, Dr. Morganstein, Dr. McCarroll, and Dr. Biggs met with workers at the Naval Sea Systems Command to conduct interviews to assess the ongoing impact of the Navy Yard mass shooting of September 16, 2013. This consultation is part of efforts to advise the command on best practices to enhance workplace mental health and well-being.

In response to Hurricane Matthew, CSTS disseminated disaster mental health education fact sheets to leaders directing disaster management efforts in the Department of Defense, Department of Health and Human Services, National Association of State Mental Health Program Directors, American Public Health Association and the American Psychiatric Association. These fact sheets are made accessible to nearly 100,000 stakeholders including public health officials, healthcare workers, first responders, and community leaders.

Dr. Morganstein, Dr. West, Dr. Benedek, Dr. Meyer, and TSgt Hastings provided a consultation report following the site visit to conduct informant interviews with personnel from the USAF 480th Intelligence Surveillance and Reconnaissance Wing at Langley AFB. The report summarized our actions, findings and recommendations to assist in the identification and mitigation of stress in personnel receiving and managing auditory and visual intelligence from UAV/RPA vehicles.


The CSTS Fact Sheet "Recovery in the Aftermath of Workplace Violence: Guidance for Supervisors" was distributed by leadership at Ft. Bliss to behavioral health staff who are providing crisis response support to VA personnel in the aftermath of a shooting at an El Paso Veterans Affairs Clinic.

Dr. Flynn participated in a meeting in Gaithersburg, MD of the Advisory Group for the SAMHSA funded Disaster Distress Hotline (DDH). Dr. Flynn has served on that group representing CSTS for approximately one year. The DDH is a nation-wide 24/7 phone resource providing counseling, information and referral to those experiencing disaster related stress. The Advisory Group reviews program status and advises the grantee as well as SAMHSA on issues related to current and future operations of the DDH. The meeting provided an opportunity to facilitate the utilization of CSTS web based and other resources in service to disaster victims and survivors. Dr. Flynn will continue to work with not only SAMHSA and DDH staff but other Advisory Group members to further integrate with complimentary CSTS efforts.

In response to the shootings at Emanuel African Methodist Episcopal Church in Charleston, SC, we disseminated educational fact sheets to assist community leaders, first responders, healthcare providers, and family members in addressing the mental health needs of those effected. The fact sheets provided brief, timely, relevant information that is easy to read and use to support individuals impacted by this event. The fact sheets were disseminated to over a thousand personnel providing mental health services through the American Psychiatric Association, as well as the Charleston, SC Veteran's Administration and Department of Mental Health.

Dr. Ursano consulted with the Texas Senate Committee on Veteran Affairs and Military Installations on suicide prevention for service members and veterans.

In response to the tragic shootings of WDBJ7 employees in Roanoke, Virginia, the Center for the Study of Traumatic Stress developed and disseminated educational fact sheets providing actionable guidance to leaders, managers, and families regarding caring for self and others in the aftermath of a shooting. These fact sheets were disseminated to leadership at the Virginia branch of the American Psychiatric Association to support their mental health response as well as through the CSTS website and social media outlets.

Dr. Flynn and Morganstein produced a detailed response to a request from the U.S. Department of Agriculture (USDA), Region V, Emergency Management and Homeland Security Branch, concerning advice on behavioral health factors related to AHPIA (Highly Pathogenic Avian Influenza A-H5N1). In the spring/summer of 2015 an outbreak of this virus produced significant adverse consequences to both producers and responders dealing with the outbreak. The request for guidance was generated in anticipation of the potential for another outbreak as early as fall 2015. CSTS provided guidance based upon a review of the literature and CSTS senior staff experience in related events.

In response to the shootings at Umpqua Community College in Oregon, CSTS developed and disseminated educational fact sheets for victims, families, community leaders, and healthcare providers that provided information on reducing distress and enhancing well-being of those affected by this tragic event. Fact sheets were disseminated broadly through the National Association of State Mental Health Program Directors and the American Psychiatric Association as well as the CSTS website and social media outlets.

In response to the shootings in San Bernadino, Dr. Morganstein and other CSTS staff developed and disseminated educational fact sheets to State mental health program directors and local mental health leaders through partnerships with the National Association of State Mental Health Program Directors and the American Psychiatric Association, respectively. These fact sheets provided just-in-time, easy-to-read, actionable guidance to assist those managing the disaster response to reduce distress and increase well-being in the population impacted by this mass shooting event.


Center provided consultation and knowledge support to the Washington State Department of Mental Health for distribution to National Guard medical personnel and mental health counselors who were on-site responding to the landslides in Washington State.

The Center also provided informal consultation to the Centers for Disease Control and Prevention (CDC) in directing their public response to the Ebola virus incidents that occurred within the United States. The Center adapted and customized fact sheets in response to the mudslides in Washington State.

Center Associate Director, Dr. Brian Flynn, was appointed to the SAMHSA Disaster Distress Helpline (DDH) advisory committee. This new advisory committee works to establish, monitor and maintain evidence-informed standards and best practices in the areas of outreach, communications and training for the Disaster Distress Helpline, ensuring that the project provides the most effective services possible.

The Center provided consultation and educational materials in support of the response to the South Korea ferry disaster.


Washington Navy Yard Shooting. Center Scientist, Navy Commander Patcho Santiago, led a team from Walter Reed National Military Medical Center (WRNMMC) to support the Special Psychiatric Rapid Intervention Team (SPRINT) that provided Psychological First Aid to the Sailors and Navy civilians working aboard the Navy Yard. U.S. Public Health Service CDR Josh Morganstein, M.D., RADM (Ret.) Brian Flynn, Ed.D., and LCDR Jennifer Bornemann provided ongoing consultation expert consultation to local officials and DoD personnel involved in the disaster response. The CSTS response was featured in the APA’s Psychiatric News Alert titled, “Mental Health Response Quickly Follows Navy Yard Shooting.” CSTS also distributed customized, just-in-time fact sheets to over 2,000 government and private sector stakeholders on diverse topics including “leadership in the face of workplace tragedy”, “stress management” and “managing a workplace after a disaster”.

2013 also saw two natural disasters, domestic and international, and a terrorist event that engaged our Center’s expertise. We provided educational outreach, just-in-time education and consultation to community leaders in the wake of the Moore, Oklahoma tornado, the Boston Marathon bombings and Typhoon Haiyan.


Drawing upon his expertise in helping communities respond to and recover from traumatic events, CSTS Associate Director for Health Systems, Dr. Brian Flynn, reached out to the National Association of State Mental Health Program Directors in the aftermath of the Aurora, Colorado movie-theater shooting that occurred on July 20, 2012.

Unfortunately, 2012 saw two tragic mass shooting episodes: in a movie theatre in Aurora, Colorado and Sandy Hook Elementary School in Newton, Connecticut. In both instances, the Center and its Associate Director, Brian Flynn provided expertise in the form of consultation and public health resources to mitigate the behavioral health consequences of such traumas on those affected and on their communities.

Dr. Flynn actively consulted with the State of Connecticut following the Sandy Hook Elementary School shootings that occurred on December 14, 2012 in Newtown, Connecticut. He provided phone consultation around preparation and process for official death notification, advised the State on management of the influx of volunteers, and leadership interaction with grieving families and the media.

In response to Superstorm Sandy that occurred in the fall of 2012, LCDR Jennifer Bornemann deployed as a member of one of the United States Public Health Service Access Teams to help hurricane victims. LCDR Bornemann assisted the case management and social services staff at Bayshore Community Hospital in Holmdel, NJ with patient assessments, discharge planning and staff resiliency.


The Center provided consultative assistance on another domestic event with disaster implications providing written and phone consultation to the Missouri Department of Mental Health (MO DMH) regarding the destruction by the Army Corps of Engineers of the levee at Birds Point, Missouri. This outreach was useful to the entire group of State agencies and department, and also to its pubic information officers and coroners.

In March, the Center provided extensive, disaster education resources to support the response efforts to the Great Eastern Japan Earthquake. A former USUHS Disaster and Preventive Psychiatry Fellow living in Sendai, Japan and working with the Japanese Defense Forces at the National Defense School of Medicine, facilitated the translation from English into Japanese of relevant Center fact sheets. These disaster response fact sheets were widely disseminated, and captured the attention of the Japanese Cabinet, which has engaged the Center’s expert consultation up to the present. The Center also consulted with the International Initiative for Mental Health Leadership on short-term and long-term mental health needs in the aftermath of the earthquake in Christchurch, New Zealand.