Postdisaster Videoconference Links Psychiatrists in U.S., Europe

Although the attack was unprecedented, meeting participants were able to identify factors that helped them respond effectively to the crisis. James L. Stone, M.D., commissioner of the New York State Office of Mental Health, noted that his office had already done substantial disaster preparation in anticipation that the Y2K problem might disrupt delivery of mental health services.

Ann Norwood, M.D., associate chair of the department of psychiatry at the Uniformed Services University of the Health Sciences, said, “It helped a great deal that we in the military had established procedures for dealing with such matters as notifying a family member about a death and about dealing with the aftermath of a disaster. We quickly prioritized members of our population at the Pentagon in terms of their need for mental health services. Family members, search and rescue workers, and coworkers of those who died were at high risk. As the days went on, we learned to add other employees, such as the jogging partners and members of car pools of people who had died in the attack.”

“Collaboration is essential,” said Stone. “A crisis is not a good time to develop relationships.” He had already established trust in his colleagues at the federal Center for Mental Health Services (CMHS), New York City’s department of mental health, and the city’s hospitals through years of working together.

Bernard Arons, M.D., director of CMHS, agreed, saying, “Relationships deepen and strengthen as a result of dealing with a tragedy like this.”

Bornemann said, “The crisis may be global, but the response is local. The real action is in the field.”

Steven Mirin, M.D., APA’s medical director, spoke of APA’s work in providing logistical support for its district branch offices when its members responded to the crisis. CMHS immediately sent a team to help New York state and city officials with grant applications for financial assistance to provide mental health and related services. The American Psychiatric Foundation, APA’s charitable arm, established the Disaster Services Fund to help community and local organizations that are providing psychological support and counseling (see story on page 16). APA also approved grants of $10,000 each for the New York County, Washington, D.C., and Pennsylvania district branches as part of its Erich Lindemann Disaster Grant Program.

Expertise about the complicated issues concerning disaster and trauma proved invaluable in the days immediately after the attacks. Mirin said, “In the first two days alone, we responded to 200 calls from the media. We were able quickly to post material on APA’s Web site that had been developed by APA’s Committee on Psychiatric Dimensions of Disaster and to develop guidelines for parents to use in talking to their children. We held briefings for individual members of Congress [see story on page 4] and a symposium for Capitol Hill staff” (see next issue of Psychiatric News).

Norwood said, “We provided consultation to military command on how to deal with grief.”

Cohen said that New York City Mayor Rudy Giuliani, who has been widely praised for his leadership following the attack, turned to mental health experts for guidance on how to help New Yorkers cope with the psychological fallout.

Robert Ursano, M.D., chair of the department of psychiatry at the Uniformed Services University of the Health Sciences and chair of APA’s Committee on Disaster Psychiatry, noted that professionals in the field of psychiatric aspects of disaster have already developed a body of knowledge.

“It’s important to restore a sense of safety,” he said. Even something as simple as developing a list of the known dead helps alleviate anxiety and creates a sense of order.

Arons said, “I’ve been gratified by the stories of heroism and resilience. We need to say more about the accounts of people supporting each other. They create a supportive environment for those who are continuing to respond to the crisis.”

Ursano said that the attack must be viewed like a wave that continues to reverberate throughout the ocean.

“Remember that overdedication is a risk factor. Our heroes [during this first phase] could become our patients, if we don’t help them protect themselves.” He noted that how people are able to deal with secondary sources of stress, such as loss of a job, transportation, or even a babysitter, will become important to the ability to recover.

As time passes, there can be a separation between those who are able to restore their sense of normality and others who remain distressed. This divide creates a new class of victim. Leaders must effectively allocate the resources that are coming into the system and find ways to convey to the public a sense of appropriate feelings and behavior. They must address the growing fears about bio-terrorism.

Several participants noted the importance of nontraditional approaches to the provision of mental health services. Cohen, for example, said, “We will need to think outside of the box to reach insular groups like firefighters who traditionally do not use mental health services. We need to go beyond clinic walls and to reach people at work and in faith-based organizations.”

Bornemann said, “We must make our voices heard. People must understand that mental health services are an integral part of any public health response.”