Post-Disaster Mental Health Efforts Debated

It is becoming a tradition in Los Angeles: In the wake of a disaster, federal money pours into the city for long-term psychological counseling and other mental health programs to help Angelenos cope.

After the 1992 riots, the Federal Emergency Management Agency allotted more than $11 million to the Los Angeles County Department of Mental Health for a riot-related mental health program called Project Rebound-Civil Unrest, a program that at the beginning was plagued by so many administrative problems that program organizers found it difficult to spend all the money they had been given.

After the wildfires last fall, FEMA allocated almost $500,000 for Project Rebound-Firestorms, an extensive mental health program that relatively few people ever used.

Now, in the wake of the Jan. 17 earthquake and its continuing aftershocks, comes the biggest--and most expensive--disaster-related mental health program ever undertaken in Los Angeles. Project Rebound-Earthquakes, operated like its predecessors under the auspices of the county Department of Mental Health, has been allocated $11.6 million by FEMA--and about $17 million more is being requested.

The question is: Have those multimillion-dollar mental health programs really done any good?

To mental health professionals, the answer is obvious. They believe passionately that counseling is as important to the rebuilding process as steel and bricks and mortar, that every dollar spent on mental health counseling is a dollar well spent.

“You can’t underestimate the costs of long-term, post-traumatic stress” after disasters, said Robert Scott, a psychologist who has advised the Red Cross on disaster-related mental health efforts. “Every dollar you put in immediate mental health programs can save hundreds of dollars in long-term emotional treatment.”

But others--either less sensitive or more practical--complain that what a city needs after a disaster is more shovels, not more social workers. In the immediate aftermath of the earthquake, as counselors from various agencies fanned out across the city to offer free emergency counseling at shelters and parks, even some of the people hardest hit by the quake seemed more concerned about what was happening around their bodies than inside their heads.

“If (counseling) is there, and it’s not too hard to get to, I guess it would be OK for some people,” Verna Stewart, 22, said as she sat on a cot at the Red Cross shelter at Birmingham High School in Van Nuys a day after the earthquake destroyed her Tarzana apartment. “For me, as long as I’m with my family and friends, that’s all the support I need. What I really need right now is a place to live.”

“My mind?” asked Alberto Garcia, 35, as he sprawled on a blanket in Recreation Park in San Fernando, riding out aftershocks with his wife and their three children. “My mind is OK. I just wish (the ground) would stop shaking.”

Nevertheless, thousands of people have received some form of Project Rebound-Earthquakes service, ranging from serious psychological treatment to a few reassuring words as they stood in line at assistance centers.

Statistics provided by Project Rebound-Earthquakes show that in the first five weeks after the earthquake more than 9,000 people called the program’s crisis hot line; during the first week of March, calls were still coming in at a rate of up to 150 a day, program officials said. And aftershocks such as Sunday’s magnitude 5.3 shaker do little to calm frayed nerves.

Project Rebound-Earthquake’s 550 counselors and representatives--who are Department of Mental Health employees, workers loaned from other counties and counselors from private agencies hired by Project Rebound--have made more than 29,000 counseling contacts at shelters, disaster assistance centers and parks where fearful earthquake victims congregated.

(The American Red Cross, which operates its own privately funded post-earthquake mental health program, reports more than 36,000 counseling contacts since Jan. 17. However, according to Red Cross disaster mental health services officer Dusty Bowenkamp, the Red Cross will soon wrap up its program and leave long-term counseling programs to Project Rebound.)

All told, in the first five weeks after the earthquake, the period when it would seem that the demand for counseling would be highest, more than 38,000 people received some form of mental health assistance through Project Rebound--74,000 if the Red Cross program is included.

That may not sound like very many for a disaster that touched millions in one way or another. But Project Rebound officials say it is only the start.

“We’re going to be seeing many, many more people,” Project Rebound-Earthquakes Director Patricia Mendoza said. “It’s going to take a long time for the fear to end.”

It’s also going to take a lot of money; the FEMA-financed mental health services do not come cheap. More than half of the initial $11.6 million FEMA grant, about $6.3 million, is being used to contract with private social service agencies to provide counseling services; mental health workers from those agencies are paid $65 an hour for licensed psychologists to $20 an hour for graduate school interns to $12 an hour for “paraprofessional outreach/community workers.” An additional $1.8 million is being spent on salaries for Project Rebound employees. Other expenses range from $176,000 for the crisis hot line to $173,000 for office supplies to $708 for telephone pagers for Project Rebound workers.

And that’s just for the initial, short-term mental health program. To provide long-term earthquake-related mental health services, Project Rebound-Earthquakes is in the process of applying for an additional $17-million FEMA grant for a nine-month program of counseling, disaster preparedness training and other mental health efforts.

The effectiveness of mental health programs is difficult to quantify. And almost everyone agrees that the earthquake was a much different form of disaster--from a mental health standpoint--than any previous disaster.

Still, if previous Project Rebound programs are any indication, the earthquake mental health program could turn out to be a case of too much, too late.

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The original Project Rebound, Project Rebound-Civil Unrest, got off to a rocky start.

(The name is an acronym for “Rebuilding and Empowerment by Outreach, Understanding, Networking and Dedication”; the words Civil Unrest were added later to distinguish it from subsequent post-disaster mental health efforts.)

That there might be a need for mental health counseling programs was apparent to anyone who saw the shell-shocked looks on people’s faces as they stood amid the smoky ruins of their homes, their businesses or their lives. But six months after the riots, long after the smoke had cleared, after most people had gotten on with their lives, county officials were still struggling to organize the mental health effort.

Armed with millions in FEMA money, Project Rebound organizers were trying to hire “contract agencies” in riot-affected areas to provide psychological counseling programs. Eventually more than 35 organizations, from the Los Angeles Unified School District to the National Conference of Christians and Jews, received Project Rebound grants.

But some private social service agencies declined to participate, citing extensive federal paperwork requirements. There was a shortage of bilingual counselors to provide services in minority neighborhoods. And almost $750,000 was used just to administer the program.

The effort took so long to get off the ground that Project Rebound had to return almost half of its original $5.9-million FEMA grant because it couldn’t spend it before the grant expired. It later received another grant for $8.2 million. (The Project Rebound grants accounted for about 8% of all riot-related FEMA grants in Los Angeles. That figure does not include other federal allocations, such as Small Business Administration loans.)

Mendoza estimated that 400,000 people eventually were served in some way by post-riot Project Rebound mental health programs--some through face-to-face counseling, far more through brief contacts over telephone hot lines and educational programs at schools.

But by the time Project Rebound-Civil Unrest ended last November, the money was being used for programs that had only a marginal connection to the riots of 18 months earlier.

In October, for example, the National Conference of Christians and Jews used part of a $330,000-Project Rebound grant for a weekend retreat for Latino high school students at a private camp in Glendale. The riots were hardly mentioned at the retreat, which followed earlier ones for black students and mixed-race groups. Instead, discussion sessions bore titles such as “Relationships,” “Gay/Lesbian/Bisexuality” and “Life After High School.”

Then, just as the Project Rebound-Civil Unrest was winding down, firestorms ravaged Malibu, Laguna and Altadena.

The mental health efforts for fire victims began last October, before the fires had even been put out, when FEMA awarded a $399,000-grant to the county Department of Mental Health for emergency counseling programs for fire victims. Later, another $65,000 grant was added, with the money being about equally divided between Malibu and Altadena. The program was dubbed Project Rebound-Firestorms.

Immediately after the fires, as happened after the earthquake, Project Rebound-Firestorms personnel went to the disaster areas, and to Red Cross and other relief centers, to answer questions and provide other on-the-spot help. Later the counseling programs, operated by local social service agencies hired by Project Rebound, moved into disaster relief centers.

In the Altadena area, the counselors set up shop in the Community Disaster Recovery and Preparedness Center in Pasadena, a 3,000-square-foot office that served as a fire-related operations center for FEMA, the state Office of Emergency Services, insurance industry representatives and other disaster relief agencies. The center, open Monday through Saturday, opened Dec. 27. Counselors from two Project Rebound-Firestorms contract agencies, Pacific Clinics and Foothill Family Service, were on hand to provide crisis counseling, organize survivors support groups and perform other mental health functions.

But three months after the wildfires raged through Altadena, destroying 151 homes, there was good news and bad news about the mental health of area residents.

The good news was that if the response to the Project Rebound counseling programs was any indication, the mental health of fire area residents was almost shockingly sound. Although thousands of people were affected by the fires, only a few dozen people had showed up for counseling programs in the first two weeks after the opening of the Community Disaster Recovery and Preparedness Center. One support group drew just two participants--and they were married to each other.

The bad news, as far as some fire-area residents were concerned, was that taxpayers had spent about $230,000 for those underused programs for victims of the Altadena fires--money that they said could have been better used elsewhere.

“That’s an awful lot of money,” Frank Griffith of the Eaton Canyon Recovery Alliance, an umbrella group representing eight homeowners’ associations in the fire area, said in a pre-earthquake interview. “That’s 80 more fire hydrants we could upgrade. If you ask me, people up here would be a lot more psychologically relaxed if they just had more hydrants and water tanks and escape routes.”

Similar opinions are offered by other fire-area residents, even while they gave federal and state agencies high marks for other firestorm disaster relief efforts.

“We were watching our kids (in the preschool), but none of the kids had any signs of problems,” said Beverly Slocum, a preschool director, as she and her husband Dick worked in their fire-damaged yard on Kinneloa Canyon Road. “People we know are having a lot more problems with their insurance companies than they are with their mental health.”

“It’s taking a while for the word to get around,” admitted Molly Proctor, a Foothill Family Service counselor who worked at the disaster recovery center.

Pam Clark, an Office of Emergency Services spokeswoman, said an average of three to five people sought psychological services daily at the center in its first two weeks of operation. An estimated 20,000 people live in the Altadena fire area.

Mendoza, the director of Project Rebound-Firestorms as well as Project Rebound-Earthquakes, said several factors may have contributed to the low demand in Altadena, including the relative affluence of the residents, many of whom have the resources to turn to private mental health services if they desire help; the holiday season, which diverted people’s attention, and the fact that disaster-related psychological problems can take a long time to manifest themselves.

“In the immediate aftermath of a disaster people tend to devote their energies to more immediate things such as dealing with insurance companies,” she said. “People will put the emotional stuff on the back burner . . . I think in the future people will find their way to us.”

Still, some Altadena residents weren’t sure they needed, or wanted, government sponsored mental health services.

“We feel lucky, not emotionally damaged,” said Kellin Francis, whose home on Kinneloa Canyon Road suffered only landscaping and outbuilding damage in the fire. As for government-sponsored mental health help, Francis said, “To people around here that has an aura of welfare. If they need that kind of thing, they’ll probably go to a family doctor.”

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It is probably too early to predict whether Project Rebound-Earthquakes will become like Project Rebound-Firestorms or Project Rebound-Civil Unrest, that is, a program that, however well-intentioned, is not used by very many people, or one that seems to last long after the disaster that created it is becoming a dim memory.

The earthquake, of course, was far different from other disasters. For one thing, it affected a wide group of people, rich as well as poor. Also, mental health professionals say, it is a recurring trauma. Every time there is an aftershock, Mendoza and others say, there is a spike in the hot-line calls and visits to earthquake counseling centers.

No one knows how long that will last, or how many people out there need counseling, but for one reason or another have not sought it out.

“We’ve just been touching the tip of the iceberg,” said Cedric McRae, a regional coordinator for Project Rebound, as he stood amid the organized chaos of the Earthquake Service Center on the Westside.