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Delivery of Mental Health Care in a Large Disaster Shelter

  • Carol S. North (a1), Richard V. King (a2), Raymond L. Fowler (a2), Rita Kucmierz (a3), Jess D. Wade (a3), Dave Hogan (a4) and John T. Carlo (a5)...


Large numbers of evacuees arrived in Dallas, Texas, from Hurricanes Katrina and Rita just 3 weeks apart in 2005 and from Hurricanes Gustav and Ike just 3 weeks apart again in 2008. The Dallas community needed to locate, organize, and manage the response to provide shelter and health care with locally available resources. With each successive hurricane, disaster response leaders applied many lessons learned from prior operations to become more efficient and effective in the provision of services. Mental health services proved to be an essential component. From these experiences, a set of operating guidelines for large evacuee shelter mental health services in Dallas was developed, with involvement of key stakeholders. A generic description of the processes and procedures used in Dallas that highlights the important concepts, key considerations, and organizational steps was then created for potential adaptation by other communities. (Disaster Med Public Health Preparedness. 2015;9:423–429)


Corresponding author

Correspondence and reprint requests to Carol S. North, MD, MPE, The Nancy and Ray L. Hunt Chair in Crisis Psychiatry, Department of Psychiatry, UT Southwestern Medical Center, 6363 Forest Park Road, Dallas, TX 75390-8828 (e-mail:


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1. Federal Emergency Management Agency. Disaster Declarations by Year. FEMA website. 2014. Accessed June 10, 2014.
2. North, CS, King, RV, Fowler, RL, et al. Psychiatric disorders among transported hurricane evacuees: acute-phase findings in a large receiving shelter site. Psychiatr Ann. 2008;38:104-113.
3. Greenough, PG, Kirsch, TD. Hurricane Katrina. Public health response--assessing needs. N Engl J Med. 2005;353:1544-1546.
4. Eastman, AL, Rinnert, KJ, Nemeth, IR, et al. Alternate site surge capacity in times of public health disaster maintains trauma center and emergency department integrity: Hurricane Katrina. J Trauma. 2007;63:253-257.
5. North, CS, Pfefferbaum, B. Mental health response to community disasters: a systematic review. JAMA. 2013;310:507-518.
6. BCFS Health and Human Services. Guidance on Planning for Integration of Functional Needs Support Services in General Population Shelters. FEMA, November, 2010. Accessed March 24, 2014.
7. The expert consensus guideline series. Optimizing pharmacologic treatment of psychotic disorders. J Clin Psychiatry. 2003;64(suppl 12):2-97.
8. Hurricane Katrina - States with Official FEMA Shelters. US Department of Homeland Security, Situation Report #28, 2005. Published September 15, 2005. Accessed August 28, 2014.
9. BBC, News. States Taking Hurricane Katrina Refugees. BBC News website. 2005. Accessed August 28, 2014.


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Supplementary materials

North supplementary material
North supplementary material 1

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