title: Coping with disasters: estimation of additional capacity of the mental health sector to meet extended service demands.
abstract: BACKGROUND
  The September 11th disaster in New York City resulted in an increase in mental health service delivery as a vast network of providers responded to the urgent needs of those impacted by the tragedy. Estimates of current capacity, potential additional capacity to deliver services and of potential shortfall within the mental health sector are needed pieces of information for planning the responses to future disasters.
  
  
  OBJECTIVE
  Using New York State data, to determine the distribution of clinical service delivery rates among programs and to examine an explanatory model of observed variation; to estimate potential additional capacity in the mental health sector; and to estimate shortfall based on this capacity and data from studies on the need and use of services post September 11th
  
  
  METHODS
  Empirical distributions of weekly clinical service delivery rates in programs likely to be used by persons with post disaster mental health problems were obtained from available data. Three regression models were fit to explain rate variation in terms of unmodifiable program characteristics likely to impact the rates. We argue that rates could not be easily increased if any of the models had good explanatory power, and could be increased if it did not. All models had poor fit. We then assumed that the median and 75th percentile of the clinical service delivery rates were candidates for the minimum production capability of a clinician. The service rates of those clinicians whose rates fell below these quartiles were increased to the quartile value to yield estimates of potential additional capacity. These were used along with data on clinical need to estimate shortfall.
  
  
  RESULTS
  There is substantial variation in clinical service delivery rates within impact regions and among programs serving different age populations. The estimate of the percent increase in services overall based on the median is 12% and based on the 75th percentile is 27%. Using an estimate of need of.03 suggested by available data, and a range of services (1-10) that might be required in a six month period, shortfall estimates based on the median ranged between 22-92% and for the 75th percentile from no shortfall to 86%. A less conservative estimate of need of.05 produces median shortfall ranging between 59-96% and for the 75th percentile between 10-91%.
  
  
  CONCLUSIONS
  While the program descriptor variables used in the explanatory model of rates were those most likely to impact rates, explanatory power of the model might have increased if other characteristics that are not modifiable had been included. In this case, the assumption that service production can be increased is called into question.
  
  
  CONCLUSIONS
  In the first six months post September 11th, in New York State (NYS) 250,000 persons received crisis counseling through Project Liberty. In 1999, NYS served approximately that same number in mental health clinic programs during the entire year. The estimates of this study suggest that additional funding and personnel are needed to provide mental health services in the event of a major disaster.
  
  
  CONCLUSIONS
  A disaster plan is needed to coordinate the use of current and additional personnel including mental health resources from other sources and sectors.
authors.affiliation: Statistics and Services Research Division, Nathan Kline Institute of Psychiatric Research, New York University Medical Center, Department of Psychiatry, Orangeburg, NY 10962, USA. siegel@nki.rfmh.org
authors.forename: Carole
authors.initials: C
authors.lastname: Siegel
authors.forename: Joseph
authors.initials: J
authors.lastname: Wanderling
authors.forename: Eugene
authors.initials: E
authors.lastname: Laska
mesh_terms: D000328:Adult; D002648:Child; D004189:Disaster Planning; D006295:Health Resources; D006301:Health Services Needs and Demand; D006801:Humans; D008605:Mental Health Services / Q000458:organization & administration*; D020380:Needs Assessment; D009518:New York; D012044:Regression Analysis