9/11: mounting a mental health response in the wake of terrorist attacks
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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 - PowerPoint PPT PresentationTRANSCRIPT
9/11:9/11: Mounting a Mental Health Mounting a Mental Health Response in the Wake of Response in the Wake of
Terrorist Attacks Terrorist Attacks
Presenter: Nancy E. Wallace, LMSWPresenter: Nancy E. Wallace, LMSW
International Conference on Social Work and Disaster RecoveryInternational Conference on Social Work and Disaster Recovery
Conference Theme: Conference Theme: Resilience and Strength in Disaster Recovery and ManagementResilience and Strength in Disaster Recovery and Management
National Taiwan UniversityNational Taiwan UniversityTaipei, TaiwanTaipei, Taiwan
13-14 June, 201113-14 June, 2011
9/11 Post Disaster Mental Health Impact9/11 Post Disaster Mental Health Impact
Expectations of consequencesProfound 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
NationalNational survey conducted weeks after attacks found survey conducted weeks after attacks found 44%44% of adults and of adults and 35%35% children reported one or more children reported one or more substantial symptoms of traumatic stress (not PTSD)substantial symptoms of traumatic stress (not PTSD)
Risk factors for severity included being near or injured Risk factors for severity included being near or injured around the site of the attacks, losing a family member around the site of the attacks, losing a family member of someone close as a result of the attacks, being of someone close as a result of the attacks, being unmarried, having low social support, and reporting unmarried, having low social support, and reporting previous traumaprevious trauma
9/11 Post Disaster Mental Health Impact9/11 Post Disaster Mental Health Impact
Intentionally caused incidents of mass violence Intentionally caused incidents of mass violence characterized by large-scale loss of life, property characterized by large-scale loss of life, property loss and widespread unemploymentloss and widespread unemploymentAssociated with severe, lasting and pervasive Associated with severe, lasting and pervasive
psychological effectspsychological effects Mental health impact of terrorist attacks was Mental health impact of terrorist attacks was
initiallyinitially severe for many individuals within severe for many individuals within commuting distance of the World Trade Centercommuting distance of the World Trade CenterPrevalence of PTSD symptoms declined Prevalence of PTSD symptoms declined
dramatically dramatically 5 months5 months after the attacks, from after the attacks, from 7.5 to .6%7.5 to .6%
17.4 to 4.7%17.4 to 4.7% subsyndromal PTSD subsyndromal PTSD Minority of individuals continued to report relatively Minority of individuals continued to report relatively
severe chronic psychological distress severe chronic psychological distress
Preparing for Post Trauma InterventionsPreparing for Post Trauma Interventions
Major depressionMajor depression Substance abuse Substance abuse
disorderdisorder Generalized anxiety Generalized anxiety
disorder (GAD)disorder (GAD) Panic disorderPanic disorder Acute stress disorder Acute stress disorder
(ASD)(ASD) PTSDPTSD Brief psychotic Brief psychotic
disorderdisorder
PhysicalPhysical Muscle tremors, fatigue, chills, sweating, shock Muscle tremors, fatigue, chills, sweating, shock
symptoms, gastrointestinal distress, dizziness, symptoms, gastrointestinal distress, dizziness, difficulty breathing, chest pain, headaches, elevated difficulty breathing, chest pain, headaches, elevated blood pressure, feeling of hollowness, weakness, blood pressure, feeling of hollowness, weakness, sensitivity to noisesensitivity to noise
EmotionalEmotional Impatience, fear, anxiety, anger, irritability, Impatience, fear, anxiety, anger, irritability,
numbness, loneliness, guilt, shame, lack of numbness, loneliness, guilt, shame, lack of enjoyment in everyday activities, dissociation enjoyment in everyday activities, dissociation
CognitiveCognitive Difficulty concentrating or remembering things, Difficulty concentrating or remembering things,
confusion, limited attention span, decreased ability confusion, limited attention span, decreased ability to make decisions or solve problems, calculation to make decisions or solve problems, calculation difficulties, recurring dreams or nightmares, difficulties, recurring dreams or nightmares, reconstructing events in order to make it come out reconstructing events in order to make it come out differently, repeated thoughts or memories, intrusive differently, repeated thoughts or memories, intrusive thoughtsthoughts
BehavioralBehavioral Overprotecting self & family, isolating, startled Overprotecting self & family, isolating, startled
response, sleeping problems, avoiding activities that response, sleeping problems, avoiding activities that bring back memories, conflicts, keeping excessively bring back memories, conflicts, keeping excessively busy, tearfulness, crying for no reason, changes in busy, tearfulness, crying for no reason, changes in appetite, alcohol/ drug use, discarding treasured appetite, alcohol/ drug use, discarding treasured objectsobjects
SpiritualSpiritual Crisis of faith, questioning basic religious beliefs, Crisis of faith, questioning basic religious beliefs,
anger at God, displaced anger towards authority anger at God, displaced anger towards authority figures, increased faithfigures, increased faith
Normal Responses / Resilience and Strength Based Interventions – Short term
Psychological DisordersPsychological Disorders – – Long temLong tem
Initiating a Corporate EAP ResponseInitiating a Corporate EAP ResponseAssessment Directs the OutreachAssessment Directs the Outreach
Major Financial InstitutionMajor Financial Institution Ties to WTCTies to WTC 24 Hour Operation24 Hour Operation Potential Terrorist TargetPotential Terrorist Target Male Oriented EnvironmentMale Oriented Environment
Direct ViewsDirect Views Planes HittingPlanes Hitting Towers FallingTowers Falling Dust Clouds / People FleeingDust Clouds / People Fleeing
AftermathAftermath Respite CenterRespite Center Exposure to First RespondersExposure to First Responders Frozen ZoneFrozen Zone Trucks hauling debrisTrucks hauling debris
ImpactImpact Deaths of Workers, Family MembersDeaths of Workers, Family Members Direct Exposure / Indirect Exposure Direct Exposure / Indirect Exposure Past TraumasPast Traumas
Post Disaster InterventionPost Disaster Intervention Employee Assistance Program (EAP)Employee Assistance Program (EAP)
Initial Intervention modelsInitial Intervention models What went wrongWhat went wrong
Modified CISDModified CISD Crisis Incident Stress DebriefingCrisis Incident Stress Debriefing
Psycho-EducationPsycho-Education Resource DevelopmentResource Development TriageTriage
Support / Promotion for Strength, Resilience and Well-BeingSupport / Promotion for Strength, Resilience and Well-Being Acute Stress Symptoms, Acute Stress Symptoms, Grief, Depression, Sadness, Grief, Depression, Sadness,
LossLoss Normal symptomsNormal symptoms
Identification of mental disordersIdentification of mental disorders Depression, PTSD, Panic and AnxietyDepression, PTSD, Panic and Anxiety Substance AbuseSubstance Abuse Violence against WomenViolence against Women
Referrals for TreatmentReferrals for Treatment CommemorationsCommemorations Management Consultation and TrainingManagement Consultation and Training
Facing Challenges: Project LibertyFacing Challenges: Project Liberty Initiated by FEMA (Federal Emergency Management Initiated by FEMA (Federal Emergency Management
AgencyAgency Large scale public health interventionLarge scale public health intervention Coordinated outreach and crisis counseling program Coordinated outreach and crisis counseling program
for individuals, families and groups for individuals, families and groups Serviced more than 1 Million New YorkersServiced more than 1 Million New Yorkers Distributed funds to more than 100 mental health Distributed funds to more than 100 mental health
providers and community service organizationsproviders and community service organizations Service provision in multiple naturalistic community Service provision in multiple naturalistic community
settings, such as churches and social clubs, through settings, such as churches and social clubs, through a large network of trained mental health a large network of trained mental health professionals and paraprofessionalsprofessionals and paraprofessionals
Focus: Focus: Outreach, Crisis CounselingOutreach, Crisis Counseling Economic Hardship, Job or Housing LossEconomic Hardship, Job or Housing Loss Handouts and ResourcesHandouts and Resources Provider TrainingProvider Training
Facing Challenges: Project LibertyFacing Challenges: Project Liberty
NY state-initiated, federally funded service offering free counselingNY state-initiated, federally funded service offering free counseling Components:Components:
1-800-LifeNet / 1-800-LifeNet / Mental Health Association of New York CityMental Health Association of New York CityAssess and ReferralAssess and ReferralStaffed by CounselorsStaffed by Counselors
Outreach Outreach Direct Marketing Campaigns urging those struggling with the Direct Marketing Campaigns urging those struggling with the
effects of the terrorist attacks to call 1-800-LifeNeteffects of the terrorist attacks to call 1-800-LifeNetStrategic Timing – Critical Dates, HolidaysStrategic Timing – Critical Dates, HolidaysAimed at 6 audiences: general, parents, senior citizens, rescue Aimed at 6 audiences: general, parents, senior citizens, rescue
and recovery workers, teen-agers and Hispanics. and recovery workers, teen-agers and Hispanics. Theme "Feel Free to Feel Better“Theme "Feel Free to Feel Better“
Designed for TV, Newspapers and Radio featuring famous actorsDesigned for TV, Newspapers and Radio featuring famous actors Targets Groups / Culture / LanguageTargets Groups / Culture / Language
Internet TechnologyInternet Technology Geo-TargetGeo-Target Psycho-Education and Resource LinksPsycho-Education and Resource Links Web Chats with PsychologistWeb Chats with Psychologist
Project Liberty: Unmet NeedsProject Liberty: Unmet Needs Project Liberty's goals were not metProject Liberty's goals were not met
Agencies had difficulty navigating Project LibertyAgencies had difficulty navigating Project LibertyFunding problems and lack of flexibilityFunding problems and lack of flexibilityNo funds for psychiatric/psychological mental No funds for psychiatric/psychological mental
health care and high level professional staffhealth care and high level professional staffPL did not adequately address the psychological PL did not adequately address the psychological
and emotional needs of those affected by 9/11and emotional needs of those affected by 9/11Missed effective outreach to critical populationsMissed effective outreach to critical populations
Immigrants and other special populationsImmigrants and other special populationsMajor CriticismMajor Criticism
ENDED TOO SOON!ENDED TOO SOON!
Mass mobilization of all ARC resourcesMass mobilization of all ARC resources Titled September 11 Recovery ProgramTitled September 11 Recovery Program 60,000 families and individuals60,000 families and individuals
500 living outside US500 living outside US Cooperation of Red Cross in 62 Foreign CountriesCooperation of Red Cross in 62 Foreign Countries 100 NGO partners100 NGO partners Initial InterventionsInitial Interventions
Respite center for families and first respondersRespite center for families and first responders Case managementCase management
9/11 Mental Health and Substance Abuse Program9/11 Mental Health and Substance Abuse Program Ended January 2, 2007Ended January 2, 2007 Partnered with September 11Partnered with September 11thth Fund created by NY Fund created by NY
Community Trust, United Way of NY, MH Association of NYCCommunity Trust, United Way of NY, MH Association of NYC Long-term program for psychological distressLong-term program for psychological distress Primarily paid for services for all effectedPrimarily paid for services for all effected Started 8/02 – Almost a year after Terrorist AttacksStarted 8/02 – Almost a year after Terrorist Attacks Worked with 9/11 families, first responders, lower Manhattan Worked with 9/11 families, first responders, lower Manhattan
community based groupscommunity based groups
Red Cross ResponseRed Cross Response
Red Cross / September 11 FundRed Cross / September 11 Fund Flexible treatment options with licensed provider of choice Treatment options are: Counseling
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 NYC 9/11 Benefit Program for Mental Healthfor Mental Health
Red Cross services endedRed Cross services ended NYC Department of Health and Mental NYC Department of Health and Mental
Hygiene, with benefit access coordinated by Hygiene, with benefit access coordinated by the Mental Health Association of New York the Mental Health Association of New York City City
Extended same services between January 2, Extended same services between January 2, 2007 and January 7, 20112007 and January 7, 2011
Now what? Now what? 1010thth Anniversary approaching Anniversary approaching Expectation of reoccurrence of symptomsExpectation of reoccurrence of symptoms
Post 9/11 ResearchPost 9/11 Research Unpublished Research: Unpublished Research: Study of Trauma Exposure and Study of Trauma Exposure and
Posttraumatic Stress Disorder in Survivors of the 9 Posttraumatic Stress Disorder in Survivors of the 9 September 11, 2001 Attacks on the World Trade Center: A September 11, 2001 Attacks on the World Trade Center: A 10-Year Perspective and Implications for Future Directions10-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 Anticipating the 1010th th Anniversary of Anniversary of
9/119/11 Dedication of the 9/11 Dedication of the 9/11
MemorialMemorial Death of Osama Bin LadenDeath of Osama Bin Laden Re-emergence of Trauma Re-emergence of Trauma
Symptoms and MemoriesSymptoms and Memories Grief and LossGrief and Loss Awareness of TriggersAwareness of Triggers MediaMedia Designing InterventionsDesigning Interventions Providing Resources and Providing Resources and
ServicesServices Importance of Rituals and Importance of Rituals and
CommemorationsCommemorations
Memorial Lights
Final ThoughtsFinal Thoughts
Reflecting on a decade of mental health research on the 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 servicesRequires coordination and collaboration of services Assessment of needsAssessment of needs Development and funding for short term and long term Development and funding for short term and long term
mental health responses and interventionsmental health responses and interventions Interventions to support resilience and strengthInterventions to support resilience and strength
Individual, Family and CommunityIndividual, Family and Community Interventions for Psychological Trauma DisordersInterventions for Psychological Trauma Disorders
TrainingTraining ResearchResearch
Understanding criteria for PTSDUnderstanding criteria for PTSD EvaluationEvaluation
Contact InformationContact Information
Nancy E. Wallace, LMSWNancy E. Wallace, LMSW International Mental Health ConsultantInternational Mental Health Consultant Adjunct Professor, New York University Adjunct Professor, New York University
Silver School of Social WorkSilver School of Social Work United Nations Main Representative, United Nations Main Representative,
World Federation for Mental Health (WFMH)World Federation for Mental Health (WFMH) Past Chair and Founder, United Nations Past Chair and Founder, United Nations
NGO Committee on Mental HealthNGO Committee on Mental Health email: [email protected]: [email protected] tel: +1 917-842-4733tel: +1 917-842-4733