Since the September 11 terrorist attacks, finding more effective psychiatric treatments for trauma-induced disorders has taken on a new sense of urgency. That was one of the messages delivered at APA’s annual Capitol Hill symposium, held in conjunction with Mental Illness Awareness Week last month.
Steven Hyman, M.D., director of the National Institute of Mental Health (NIMH), announced the availability of postdisaster research grants aimed at understanding how many people are affected by trauma, when symptoms occur, and what mental health interventions are effective.
"We all pray that we never have to experience such tragic events again, but we would be derelict in our duties if we did not learn about the short- and long-term effects to ensure appropriate treatment," said Hyman at the symposium, which was cosponsored by the National Alliance for the Mentally Ill.
The purpose of the symposium is to bring timely issues affecting people with mental illness to the attention of Congress and their aides.
APA Medical Director Steven Mirin, M.D., said, "In the aftermath of these terrorist attacks, the integration of psychiatric research and treatment are in the forefront of our national consciousness."
Hyman said that NIMH has already talked to more than 40 teams of researchers interested in studying the impact of the disaster on adults and subpopulations such as the elderly and children. A requirement is that researchers obtain approval from state and local authorities to have access to patients, said Hyman.
"Researchers must balance their need to gather information with being sensitive to the participants’ privacy and need to heal," he said.
These are among the top questions that NIMH wants to have studied:
• What is the mental and physical health impact of the terrorist attacks on survivors, families of victims and survivors, emergency workers, and community members?
• What effect does providing mental health services in nontraditional settings such as churches and community centers have on access, referral, and acceptability of services?
• What are the methods for assessing risk and triaging based on the severity of risk?
• What are the factors that promote or inhibit effective training in screening, assessment, referral, and treatment?
• How were crisis-intervention services organized and delivered by mental health and non-mental health professionals and federal, state, and local agencies?
• What are the social support systems and coping mechanisms that mediate psychological responses to traumatic events?
• What interventions and treatments reduce the risk of psychopathology, symptom severity, and disability?
NIMH will also be collecting information nationally about the indirect or secondary effects of the attacks on people.
"When the television networks aired repeated live footage of the south tower being hit by the second plane, people jumping from burning buildings, and the collapse of the two towers, the entire nation was traumatized," said Hyman.
The long-term goal is to develop better treatments and training manuals to prepare people to assist in future disasters, said Hyman. "Although we now have psychiatric medications and cognitive-behavioral treatments that work in 70 percent to 80 percent of people experiencing trauma, we must find treatments that work for everyone."
Research on people affected by the Oklahoma City bombing provides some clues about the risk of psychiatric symptoms likely to develop after the September 11 attacks. "We know that about 33 percent of the 182 people who were directly affected by the tragedy developed posttraumatic stress disorder [PTSD], and 10 percent developed major depression. People with substance abuse problems tended to relapse, although new cases were not reported," said Hyman.
The media coverage of the bombed federal building in Oklahoma City increased the risk of PTSD in children. One in 6 children living 100 miles away had symptoms of PTSD two years later, said Hyman.
He called the research on the effects of the Oklahoma City bombing meager and hopes that more substantial research will be produced on the effects of the September 11 attacks. "A critical piece is having access to a confidential registry of patients. We are working on obtaining approval from state and local authorities to set up a registry," said Hyman.
Former APA President Herbert Pardes, M.D., president and CEO of New York Presbyterian Hospital System, said the impact of the World Trade Center attacks on New York hospitals has been dramatic. "When the buildings collapsed, three of our emergency medical technicians were killed, and seven ambulances and two vans were destroyed.
"In addition, all the hospitals including ours suspended elective surgery and care to be ready for the emergency. This created a loss of revenue, which might jeopardize the future of hospitals already experiencing financial problems," said Pardes, who is also a former director of NIMH.
It is critical that mental health services are developed, covered, and provided to people with short- and long-term needs, said Pardes. "We also want to ensure that the health care system is ready to deal with any future terrorist risks."
Rep. Carolyn Maloney (D-N.Y.) said many businesses in her Long Island district lost personnel in the World Trade Center attacks. "Employers called my office asking for counselors to come talk to family members and coworkers of missing employees. All the hospitals I called responded generously and sent personnel," said Maloney.
She said that after visiting her constituents who had just lost loved ones, she felt overwhelmed by their sense of loss and sadness and asked to speak to a grief counselor while arranging counseling for others.
"I believe that this incident has instilled a greater respect and appreciation for psychiatrists and the great work you do every day. Parity should be part of our health plans. Mental health is critical to the health and well-being of so many individuals and the country," said Maloney.
Parity legislation has made no progress in Congress since the attacks. The Mental Health Equitable Treatment Act (S 543) was passed by the Senate Health, Education, Labor, and Pensions Committee before the attacks had occurred, but its companion measure in the House is still languishing in committee.
Information about the NIMH Rapid Assessment Post-Impact of Disaster (RAPID) Research Grant Program is posted on NIMH’s Web site at grants.nih.gov/grants/guide/notice-files/NOT-MH-01-012.html. ▪