Why can’t the FEMA Crisis Counseling Program treat psychiatric conditions? A parody on government waste

CATEGORY: GOVERNMENT PROJECTS

Source: FEMA press release
Read time: 2.5 minutes
 
This Happened
On February 6, 2025, the Federal Emergency Management Administration (FEMA) issued a press release “offering free and confidential crisis counseling and mental health support” for residents impacted by Tropical Storm Helene.
 
Who Is Doing This?
FEMA routinely offers states the opportunity to apply for federal funding to disseminate their Crisis Counseling Program (CCP) following disasters.
 
The Premise
The federal government spends tens of millions of dollars annually on the CCP. In 2024, for example, those funds went to six states following Hurricane Helene. After Hurricane Katrina in 2005, CCP awards to all states totaled $131.6 million. Following the World Trade Center Disaster in 2001, New York’s CCP allocation was $137 million.
 
The program began in 1974, when the U.S. Congress passed the Robert T. Stafford Disaster Relief and Emergency Assistance Act which formalized a range of assistance programs (e.g., housing assistance, debris removal, and water pumping). 
For mental health, “The President is authorized to provide professional counseling services, including financial assistance to State or local agencies or private mental health organizations to provide such services or training of disaster workers, to victims of major disasters in order to relieve mental health problems caused or aggravated by such major disaster or its aftermath.”
FEMA delegated this to the Substance Abuse and Mental Health Services Administration (SAMHSA). There are at least five major problems with the CCP program.
 
Analysis
1. The program is not intended for those who need clinical-level treatment. Even though the Stafford act allows licensed clinicians to treat psychiatric disorders, SAMHSA opted to invent a unique model of outreach, unsupported by any evidence, that prohibits such treatment [1]. The aim, strangely, was “to serve people responding normally to an abnormal experience” with the logic that this would somehow reduce stigma associated with mental health treatment. Accordingly, the program must hire non-licensed laypersons to comfort individuals in distress as a friend or neighbor might. 

For those who need traditional treatment, CCP MUST refer them to professional community resources, assuming, often wrongly, those still exist in a disaster area.

2. Contact with CCP staff is awkward. A main method of initiating services is a folding table designated for CCP in a FEMA support center. As seen in the images above, there is little privacy. The CCP tables are probably those with a staff sitting alone. 
The other main method is canvassing. FEMA’s idea of quality mental health outreach while reducing stigma is to send non-licensed layperson ‘counselors’ door-to-door.

​Survivors, however, are likely dumbfounded by this, being much more interested in basic needs of repairing homes, dealing with financial losses, and childcare.
3. It’s unclear why “people responding normally” need assistance. The program guidelines are clear that “the thrust of the Crisis Counseling Program since its inception has been to serve people responding normally to an abnormal experience.”  This, by definition, excludes those with PTSD, depression, and anxiety. If individuals are responding normally, why do they need crisis counseling?
4. It is impossible to evaluate the program. All contacts between crisis counselors and individuals are required to be anonymous in the effort to be sensitive to stigma. No screening instrument is used to assess systematically for distress.
The wisdom of this strategy has been challenged by Congress. In 1995 the FEMA Inspector General recommended that a program evaluation be conducted. In 2002, the Government Accountability Office recommended that again. In 2006, a special report from the Congressional Research Service lamented that “the actual effect of the program on health outcomes has not been demonstrated” because it has never been evaluated [2].
5. Evidence shows that disaster victims do not use crisis mental health programs. Even if SAMHSA had designed a robust program to provide real treatment in an accessible fashion, it wouldn’t matter. It has been documented in free treatment programs created following the 2001 World Trade Center disaster, Hurricane Katrina in 2005, and the 2010 Queensland floods, if you build it, they will not come [3]. The Queensland program was the most comprehensive post-disaster outreach program ever devised. They treated fewer than 100 children and adolescents.
 
Millions of taxpayer dollars are spent every year on a program that is insulated from being audited because of anonymous contacts and lack of data collection. The CCP program is so flawed and badly implemented, it seems like a parody that was never intended to help anyone truly in need.
I have sent this information to nearly every new FEMA and SAMHSA director since my personal experience in Hurricane Katrina. None of them have acted. It is time for the Department of Government Efficiency to use the chainsaw.


References
​[1] Robeznieks A (August 26, 2015). Fed dollars to address mental health issues post-Katrina may have been wasted: psychiatrist. Modern Healthcare.
[2] Sundararaman R, Lister S, Williams E. (2006) Gulf Coast hurricanes: Addressing survivors' mental health and substance abuse treatment needs. Congressional Research Service, The Library of Congress; November 29, 2006. RL33738.
[3] Scheeringa MS, Cobham VE, McDermott B (2014).  Policy and administrative issues for large-scale clinical interventions following disasters. Journal of Child and Adolescent Psychopharmacology 24(1), 39-46, DOI: 10.1089/cap.2013.0067.