The 2017 Atlantic hurricane season was one of the most destructive in recent history. During the recovery phase of a disaster, all impacted areas strive to stabilize, rebuild, recover, and be ready for the next emergency. Returning to readiness is a slow pivot and a relentless fight to re-establish broad public health and medical care services. The challenges and issues following a large-scale disaster are often too complex for any one agency or organization to address. Assembling a coalition of community stakeholders can be an effective strategy to determine what health care support services and treatment options are available, who the providers are, and whether gaps or duplication of services exist.

During the response to Hurricanes Irma and Maria, responders identified that many communities in Puerto Rico and the U.S. Virgin Islands (USVI) were not emotionally or psychologically prepared for an extended disruption in basic behavioral health services. A behavioral healthcare coalition can help communities swiftly assess their needs and begin to address the mental health needs of survivors. Further, a behavioral health coalition can serve as a vital network to address the needs of individuals and the community as time progresses.

For years, the Department of Health and Human Services (HHS) has used behavioral health coalitions to facilitate communication across provider groups; coordinate health care efforts; help identify existing and emergent needs; eliminate duplication of services; and launch community-wide initiatives in targeted areas. Building a community-based coalition for behavioral health also allows the long-term opportunity to have organizations coordinate their resources and services to bring about the most effective and efficient delivery of programs. In short, these types of coalitions empower their communities by forging partnerships to help meet behavioral health needs.

HHS Implements the Behavioral Health Coalition Concept in Puerto Rico and USVI

During the response and recovery to Hurricanes Irma and Maria, public health advisors from the Substance Abuse and Mental Health Services Administration and behavioral health subject matter experts (SMEs) from the United States Public Health Service facilitated the development and implementation of behavioral health coalitions in Puerto Rico and USVI. Each coalition involved service providers and funders, Voluntary Organizations Active in Disaster, non-governmental organizations, and governmental agencies.

In Puerto Rico, behavioral health coalition members utilized the Disaster Behavioral Health Coalition Guidance to structure its activities. This coalition’s diverse membership collectively identified concerns and solutions, and formed action plans to address the behavioral health needs for response and recovery.

As a result, the behavioral health coalition in Puerto Rico accomplished the following:

• established regional behavioral health points of contact to facilitate coordination of services during recovery activities;
• disseminated Centers for Medicare and Medicaid Services issued waivers to pharmacists and medical providers allowing patients to receive behavioral health services, including prescription coverage, without preauthorization;
• collaborated with FEMA and the government of Puerto Rico to develop behavioral health media campaigns to disseminate around the 2017 winter holidays;
• evaluated the existing clinical capacities (i.e. number of providers) present on the island following the impact of the hurricanes; and
• ensured long-term support by institutionalizing the behavioral health coalition within the Administración de Servicios de Salud Mental y Contra la Adicción (ASSMCA), which is the government of Puerto Rico’s Administration for Mental Health and Addiction Services. ASSMCA aims to expand the behavioral health coalition’s activities by creating a Disaster Preparedness Group to increase communications at-large among social services agencies to develop a comprehensive behavioral health plan for Puerto Rico.

In USVI, federal SMEs helped the island develop a broad-based behavioral health coalition soon after the hurricanes hit the island. This coalition is now working with the U.S. Virgin Islands’ Territorial Mental Health Director and other private behavioral health service providers, behavioral health patient advocates, and governmental agencies to develop a jurisdictional health plan that identifies the top three behavioral health priorities and action plans to strengthen the long-term recovery of the behavioral health system across the island.

Every community is different, and there is no standard for how long a community takes to recover. Developing a behavioral health coalition that is prepared to function during all phases of the disaster management cycle is one way to strengthen community resilience.

The Office of the Assistant Secretary for Preparedness and Response’s Division of At-Risk, Behavioral Health, and Community Resilience created the Disaster Behavioral Health Coalition Guidance. The guide offers recommendations on behavioral health coalition membership and the activities this type of coalition should implement before, during, and after a disaster strikes.