Transcript 9/11 Mounting a Mental Health Response in the Wake of Terrorist

9/11:
Mounting a Mental Health
Response in the Wake of
Terrorist Attacks
Presenter: Nancy E. Wallace, LMSW
International Conference on Social Work and Disaster Recovery
Conference Theme:
Resilience and Strength in Disaster Recovery and Management
National Taiwan University
Taipei, Taiwan
13-14 June, 2011
9/11 Post Disaster Mental Health Impact
 Expectations of consequences
 Profound and far-reaching, affecting people
throughout NYC) area and the US who were the
terrorists’ psychological target
 Effective disaster mental health planning and response
depend on accurate information about the numbers of
people who will need various types of services
 National survey conducted weeks after attacks found
44% of adults and 35% children reported one or more
substantial symptoms of traumatic stress (not PTSD)
 Risk factors for severity included being near or injured
around the site of the attacks, losing a family member of
someone close as a result of the attacks, being
unmarried, having low social support, and reporting
previous trauma
9/11 Post Disaster Mental Health Impact
 Intentionally caused incidents of mass violence
characterized by large-scale loss of life, property
loss and widespread unemployment
 Associated with severe, lasting and pervasive
psychological effects
 Mental health impact of terrorist attacks was
initially severe for many individuals within
commuting distance of the World Trade Center
 Prevalence of PTSD symptoms declined
dramatically 5 months after the attacks, from
7.5 to .6%
 17.4 to 4.7% subsyndromal PTSD
 Minority of individuals continued to report relatively
severe chronic psychological distress
Preparing for Post Trauma Interventions
Normal Responses / Resilience and
Strength Based Interventions – Short term
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Physical
 Muscle tremors, fatigue, chills, sweating, shock
symptoms, gastrointestinal distress, dizziness,
difficulty breathing, chest pain, headaches, elevated
blood pressure, feeling of hollowness, weakness,
sensitivity to noise
Emotional
 Impatience, fear, anxiety, anger, irritability,
numbness,
loneliness, guilt, shame, lack of
enjoyment in
everyday activities, dissociation
Cognitive
 Difficulty concentrating or remembering things,
confusion, limited attention span, decreased ability
to make decisions or solve problems, calculation
difficulties, recurring dreams or nightmares,
reconstructing events in order to make it come out
differently, repeated thoughts or memories, intrusive
thoughts
Behavioral
 Overprotecting self & family, isolating, startled
response, sleeping problems, avoiding activities that
bring back memories, conflicts, keeping excessively
busy, tearfulness, crying for no reason, changes in
appetite, alcohol/ drug use, discarding treasured objects
Spiritual
 Crisis of faith, questioning basic religious beliefs,
anger at God, displaced anger towards authority
figures, increased faith
Psychological Disorders
– Long tem
 Major depression
 Substance abuse
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disorder
Generalized anxiety
disorder (GAD)
Panic disorder
Acute stress disorder
(ASD)
PTSD
Brief psychotic
disorder
Initiating a Corporate EAP Response
Assessment Directs the Outreach
 Major Financial Institution
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Ties to WTC
24 Hour Operation
Potential Terrorist Target
Male Oriented Environment
 Direct Views
 Planes Hitting
 Towers Falling
 Dust Clouds / People Fleeing
 Aftermath
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Respite Center
Exposure to First Responders
Frozen Zone
Trucks hauling debris
 Impact
 Deaths of Workers, Family Members
 Direct Exposure / Indirect Exposure
 Past Traumas
Post Disaster Intervention
 Employee Assistance Program (EAP)
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 Initial Intervention models
 What went wrong
Modified CISD
 Crisis Incident Stress Debriefing
Psycho-Education
Resource Development
Triage
 Support / Promotion for Strength, Resilience and Well-Being
 Acute Stress Symptoms, Grief, Depression, Sadness,
Loss
 Normal symptoms
 Identification of mental disorders
 Depression, PTSD, Panic and Anxiety
 Substance Abuse
 Violence against Women
 Referrals for Treatment
Commemorations
Management Consultation and Training
Facing Challenges: Project Liberty
 Initiated by FEMA (Federal Emergency Management
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Agency
Large scale public health intervention
Coordinated outreach and crisis counseling program
for individuals, families and groups
Serviced more than 1 Million New Yorkers
Distributed funds to more than 100 mental health
providers and community service organizations
Service provision in multiple naturalistic community
settings, such as churches and social clubs, through
a large network of trained mental health
professionals and paraprofessionals
Focus:
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Outreach, Crisis Counseling
Economic Hardship, Job or Housing Loss
Handouts and Resources
Provider Training
Facing Challenges: Project Liberty
 NY state-initiated, federally funded service offering free counseling
 Components:
 1-800-LifeNet / Mental Health Association of New York City
 Assess and Referral
 Staffed by Counselors
 Outreach
 Direct Marketing Campaigns urging those struggling with the
effects of the terrorist attacks to call 1-800-LifeNet
 Strategic Timing – Critical Dates, Holidays
 Aimed at 6 audiences: general, parents, senior citizens, rescue
and recovery workers, teen-agers and Hispanics.
 Theme "Feel Free to Feel Better“
 Designed for TV, Newspapers and Radio featuring famous actors
 Targets Groups / Culture / Language
 Internet Technology
 Geo-Target
 Psycho-Education and Resource Links
 Web Chats with Psychologist
Project Liberty: Unmet Needs
 Project Liberty's goals were not met
 Agencies had difficulty navigating Project Liberty
 Funding problems and lack of flexibility
 No funds for psychiatric/psychological mental
health care and high level professional staff
 PL did not adequately address the psychological
and emotional needs of those affected by 9/11
 Missed effective outreach to critical populations
 Immigrants and other special populations
 Major Criticism
 ENDED TOO SOON!
Red Cross Response
 Mass mobilization of all ARC resources
 Titled September 11 Recovery Program
 60,000 families and individuals
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500 living outside US
Cooperation of Red Cross in 62 Foreign Countries
100 NGO partners
Initial Interventions
 Respite center for families and first responders
 Case management
 9/11 Mental Health and Substance Abuse Program
 Ended January 2, 2007
 Partnered with September 11th Fund created by NY
Community Trust, United Way of NY, MH Association of NYC
 Long-term program for psychological distress
 Primarily paid for services for all effected
 Started 8/02 – Almost a year after Terrorist Attacks
 Worked with 9/11 families, first responders, lower Manhattan
community based groups
Red Cross / September 11 Fund
 Flexible treatment options with licensed provider of choice
 Treatment options are:
 Counseling
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 Support, advice and education
Medication
Substance Abuse Programs
 Rehabilitation and detox services for alcohol and drug
abuse
In-Patient Care
 Hospitalization and/or substance abuse treatment
Auricular Acupuncture
 Acupuncture to the outer ear
 Used for alcohol or drug abuse, or for anxiety
Testing and Evaluation
 Assessment of child or adolescent social, emotional
and intellectual functioning
NYC 9/11 Benefit Program
for Mental Health
 Red Cross services ended
 NYC Department of Health and Mental
Hygiene, with benefit access coordinated by
the Mental Health Association of New York
City
 Extended same services between January 2,
2007 and January 7, 2011
 Now what?
 10th Anniversary approaching
 Expectation of reoccurrence of symptoms
Post 9/11 Research
 Unpublished Research: Study of Trauma Exposure and
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Posttraumatic Stress Disorder in Survivors of the 9
September 11, 2001 Attacks on the World Trade Center: A
10-Year Perspective and Implications for Future Directions
Results: Direct exposure zone was concentrated within a
radius of 0.1 mile and completely contained within .75 mile.
PTSD symptom criteria were met by 35% directly exposed
to danger, 20% exposed only through witnessed
experiences, 35% exposed only indirectly through a close
associate
Outside of exposure groups, few possible sources of
exposure were evident among the few who were
symptomatic, most had pre-existing psychiatric illness
Among those with exposures who developed PTSD, 40%
had remitted by three years and 59% by six years
Conclusions: Exposures deserve careful consideration
among populations affected by large terrorist attacks when
conducting clinical assessments, estimating the magnitude
of population PTSD burdens, and projecting needs for
specific mental health interventions
Anticipating the
10th Anniversary of
9/11
 Dedication of the 9/11
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Memorial
Death of Osama Bin Laden
Re-emergence of Trauma
Symptoms and Memories
Grief and Loss
Awareness of Triggers
Media
Designing Interventions
Providing Resources and
Services
Importance of Rituals and
Commemorations
Memorial Lights
Final Thoughts
 Reflecting on a decade of mental health research on the
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9/11 attacks, the unprecedented scope, magnitude, and
devastation created extensive complexities that still
challenge both researchers and disaster response efforts
Requires coordination and collaboration of services
Assessment of needs
Development and funding for short term and long term
mental health responses and interventions
 Interventions to support resilience and strength
 Individual, Family and Community
 Interventions for Psychological Trauma Disorders
Training
Research
 Understanding criteria for PTSD
Evaluation
Contact Information
 Nancy E. Wallace, LMSW
 International Mental Health Consultant
 Adjunct Professor, New York University
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Silver School of Social Work
United Nations Main Representative,
World Federation for Mental Health (WFMH)
Past Chair and Founder, United Nations
NGO Committee on Mental Health
email: [email protected]
tel: +1 917-842-4733