U.S. Not Ready to Respond To Disasters’ MH Fallout

A report from the Institute of Medicine (IOM) provides a public health blueprint that federal and local agencies can use to address the psychological, social, and medical aspects of terrorist and hazardous events.

The report, titled “Preparing for the Psychological Consequences of Terrorism,” states that the nation’s mental health, public health, medical, and emergency response systems are not prepared to meet a range of emotional, behavioral, and cognitive reactions that are expected to result from a terrorist or hazardous event or threat of such an event.

Among the terrorist or hazardous events defined in the report are detonations of conventional explosives and biological, radiological, chemical, and nuclear attacks.

IOM committee member and psychiatrist Robert Ursano, M.D., explained to Psychiatric News, “People tend to react to traumatic events such as terrorism in one of three ways: Some people may experience symptoms of insomnia, fear, anxiety, vulnerability, and anger. Another group of people respond by increasing their intake of alcohol or tobacco and may avoid air travel. A third, small number of individuals develop psychiatric illnesses such as posttraumatic stress disorder [PTSD] or depression.”

Ursano is a professor of psychiatry and neuroscience and chair of the department of psychiatry at the Uniformed Services University of the Health Sciences in Bethesda, Md., and a past chair of APA’s Committee on Psychiatric Dimensions of Disasters.

Another committee member and psychiatrist, Carol North, M.D., commented to Psychiatric News, “Addressing and managing the psychological aspects of terrorism is an important public health issue. The report lays out a comprehensive roadmap to strengthening Americans psychologically before, during, and after a terrorist or hazardous event.”

North is a professor of psychiatry at Washington University School of Medicine in St. Louis.

The report states that addressing “different terrorist scenarios and different effects on various groups of people will require universal preparedness by all systems responsible for the public’s health.”

Infrastructure Gaps Found

The committee found gaps in five general areas: coordination of agencies and services, training and supervision, public communication and dissemination of information, financing, and knowledge of evidence-based services.

The report explains that coordination of agencies and services includes these activities:

• Organization and management of different services to individuals with different needs and to the same individuals over time as their needs change.

• Licensing and credentialing of professionals providing care, and clarifying the role of various service professionals.

• Communication between different levels of government and the integration of various sources of funding.

A training and supervision issue cited in the report is the shortage of psychiatrists and mental health professionals with disaster training and experience. “Historically psychiatrists have been less active in this arena than mental health professionals, and they are still figuring out what their role should be in settings related to disasters,” said North.

Public Education Critical

“Public communication and dissemination of information are critical following a terrorism event, particularly in the case of chemical, biological, radiological, or nuclear terrorism when instruction is critical for effective management,” states the report.

The issues to be resolved include identifying who will deliver this information to the public, the media, political leaders, and service providers and how it will be communicated, according to the report.

Lt. Col. Cameron Ritchie, public affairs representative for the Society of Uniformed Services Psychiatrists, has an interest in the psychiatric aspects of biochemical and conventional warfare. She told Psychiatric News, “We have enough information from environmental disasters, including Chernobyl, and exposure to biochemical agents, including anthrax, and SARS to know that people generally don’t panic. The exception is when a disaster occurs in a crowded place such as a fire in a nightclub with limited access to exits.”

Ritchie continued, “When people are given consistent messages about appropriate precautions to take in the event of a terrorist attack, they have a greater sense of control and less anxiety. For example, in the event of a biochemical attack, people should ‘shelter in place.’ This means staying put at work, school, or at home, and having enough supplies including food and water to last a few days.”

The IOM committee found that the funding of services and planning for psychological consequences are generally inadequate. The amount of funding, duration of funding, services eligible for coverage, and the inclusion of mental health services in broader terrorism preparedness plans require more attention, the report states.

“There is a clear need for more resources to address the lack of empirically based knowledge and services,” said North.

Workplace Needs Included

The report is unique in that it addresses the psychological needs of workers as part of public health preparedness. “Recent terrorist events—especially September 11, 2001—occurred in the workplace. The mental health needs of certain workers, including construction, utility, and postal workers, and children and teachers in school need to be considered,” said Ursano.

The committee recommended that the National Institute for Occupation Safety and Health and the Department of Labor collaborate on developing guidelines to protect workers from the psychological consequences of terrorism. Another recommendation was that the Department of Education collaborate with state and local education systems to ensure adequate preparedness, according to the report.

NIMH Role

The committee’s work, which included three two-day meetings between last October and February, was funded by the National Institute of Mental Health (NIMH) and the Substance Abuse and Mental Health Services Administration (SAMHSA).

Farris Tuma, Sc.D., chief of the Traumatic Stress Program at NIMH, told Psychiatric News, “The NIMH will use the IOM report to frame and guide our research questions about which interventions are most effective in facilitating resilience and recovery in vulnerable populations.”

Tuma continued, “The research community will collaborate with SAMHSA and the Centers for Disease Control and Prevention in developing effective mental health care strategies for the public.

“A major challenge is identifying the biological and/or symptom profiles of people most likely to develop long-term problems in response to traumatic events. Once we have reliable and valid diagnostic tools, we can differentiate high-risk individuals early on from the majority of victims who experience some acute reactions or symptoms but recover with support and time. Then we can provide appropriate interventions to each group.”

NIMH is also working on interventions that can be applied in a variety of settings. “We have begun preliminary work on developing a Web-based primary care trauma intervention that involves some contact with a health care professional and also has Web-based exercises that can be done independently, which is not traditional cognitive behavioral therapy,” said Tuma.

The IOM report, “Preparing for the Psychological Consequences of Terrorism,” is posted on the National Academy Press Web site at http://books.nap.edu/books/0309089530/html/index.html. ▪