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FACING THE FUTURE:
WHO WILL OWN READINESS FOR
OUR EMERGING THREATS?
CARTER CENTER SYMPOSIUM ON MENTAL HEALTH POLICY
November 8-9, 2006
RADM Brian W. Flynn, Ed.D.
Assistant Surgeon General (USPHS, Ret.)
Adjunct Professor Of Psychiatry
Associate Director
Center for the Study of Traumatic Stress
Dept of Psychiatry
Where Have We Been?
• Federal legislation for over 30 years
• Increased understanding of behavioral
health consequences of extreme events
• Individual and collective intervention
models practiced more than researched
• Increased inclusion of behavioral
health/social sciences--increasingly
integrated into disaster health and
emergency management
The Gathering/Perfect Storm…
Changes in public mental
Increased
Decreasing
health
system
“New”
of
events:
Research
challenges:
awareness
of types
confidence in
•Abandonment
of original
of:
•Culture
Pandemic
Increased
research
size and scope• of
government to
community
mental health
fix, denial,
• Terrorism/WMD/IND
•Quick
Little
intervention
behavioral health
manage disasters
models
short
term
planning,
•National/Transnational
research
consequences—
Unaddressed
•Focus
on all
people
one
size
fits
disasters
• Even
less
research
into with
Increased
SMI/SEDresponse
Challenges
interventions,
cheap
preparedness,
expectations
•All
publicmodels
systems under
solutions
and recovery
severe financial pressure
•Lack of parity for behavioral
health
Disaster Scope…
Typical Disaster
Katrina
Pandemic
Bringing The Elephant Into The Living Room:
We Lack Models/Preparedness for
National and Transnational
Disasters With Behavioral & Other
Health Consequences
And
Who Owns the Responsibility for
Preparedness, Response, and Recovery?
Who Owns It? Legislatively/Financially
• Legislatively
– Do we have adequate/appropriate legislation?
– Local, state, federal, international?
– Who does what under what authority?
• Financially (very long term potential-even
global economic collapse)
– Who will pay?
– Pay for what?
– Pay for how long?
Who Owns It? Strategically
• Strategically—
• Where will resources come from?
• Where will the personnel come from?
– Will they come? For how long? What about families?
Where will reinforcements come from?
• How are these decisions
made? Who makes them?
Who Owns It? Socially
• Culturally/Socially (“Terrorism strikes along the
fault lines of society” - Robert Ursano)
– Are we anticipating the potential of class, ethnic,
racial, national disparity?
– What about ostracizing the potentially exposed?
– Who is more valued? Who gets immunized? Who
gets treatment?
– How are these decisions made? Who makes them?
Who Owns It? Existentially
•
•
•
•
•
•
•
•
•
Perhaps our greatest challenge
Who are we individually and collectively?
How will we define “success”?
How will we define “failure”?
What does it mean to have our support system
become our “enemy”?
Who will we be when it is over?
How will we be judged?
Are we even capable as a nation to have this
discussion?
Who leads this discussion?
Suggestions:
• We must begin now to address these issues
• The discussion must include voices from well
beyond the behavioral health community (law,
economics, faith, sociology, anthropology,
risk/crisis communication, political science,
business)
• Prepare with people, not for them
• Leadership must have unquestioned content
credibility, be true “honest brokers”, nonpartisan,
wise, trusted, and at the end of their careers
New Ideas?
“Without a great deal of forethought, prolonged training,
and the development of systematic performances, drills, and
tests of all participants, no community can prepare itself to
provide those additional health services that will be essential
for civilians subject to disasters. When the average
community prepares itself for disasters, the effort of each
citizen and every profession must be fitted into a
coordinated system. Whoever guides each part of the whole
must have a clear concept of the working of all the other
parts.”
Source: William Wilson (Col. MC, USA)
U.S. Armed Forces Medical J., Vol 1, No.4
April 1950
The Cost of Failure
• Increased fear, pain, suffering and loss
• Potentially severe social and economic
decline or collapse
• Continued/accelerated loss of confidence
in government
The Cost of Failure
• Shifting geopolitical
power
• Fear based
behavior/choices
could kill more
people, and do more
socioeconomic
damage, than the
event itself.
Potential Of Success:
•
•
•
•
•
•
Reduced death, loss, suffering
Reduced socioeconomic adverse impact
Economic growth
Stronger individuals and communities
Restoration in confidence in leadership
Promote pro-social/positively adaptive
behavioral choices leading to enhancing
the public’s health
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