ABSTRACT
OBJECTIVE: To characterize the experience of volunteer disaster psychiatrists who provided pro bono psychiatric services to 9/11 survivors in New York City, from September 12, 2001 to November 20, 2001. METHOD: Disaster Psychiatry Outreach (DPO) is a non-profit organization founded in 1998 to provide volunteer psychiatric care to people affected by disasters and to promote education and research in support of this mission. Data for this study were collected from one-page clinical encounter forms completed by 268 DPO psychiatrists for 2 months after 9/11 concerning 848 patients served by the DPO 9/11 response program at the New York City Family Assistance Center. RESULTS: In this endeavor, 268 psychiatrist volunteers evaluated 848 individuals and provided appropriate interventions. The most commonly recorded clinical impressions indicated stress-related and adjustment disorders, but other conditions such as bereavement, major depression, and substance abuse/dependence were also observed. Free samples were available for one sedative and one anxiolytic agent; not surprisingly, these were the most commonly prescribed medications. Nearly half of those evaluated received psychotropic medications. CONCLUSIONS: In the acute aftermath of the attacks of September 11, 2001, volunteer psychiatrists were able to provide services in a disaster response setting, in which they were co-located with other disaster responders. These services included psychiatric assessment, provision of medication, psychological first aid, and referrals for ongoing care. Although systematic diagnoses could not be confirmed, the fact that most patients were perceived to have a psychiatric diagnosis and a substantial proportion received psychotropic medication suggests potential specific roles for psychiatrists that are unique and different from roles of other mental health professionals in the early post-disaster setting. In addition to further characterizing post-disaster mental health needs and patterns of service provision, future research should focus on the short- and long-term effects of psychiatric interventions, such as providing acute psychotropic medication services and assessing the effectiveness of traditional acute post-disaster interventions including crisis counseling and psychological first aid.
Subject(s)
Crisis Intervention , Family/psychology , Psychiatry , September 11 Terrorist Attacks/psychology , Survivors/psychology , Volunteers , Adjustment Disorders/diagnosis , Adjustment Disorders/epidemiology , Adjustment Disorders/psychology , Adjustment Disorders/rehabilitation , Adolescent , Adult , Aged , Alcoholism/diagnosis , Alcoholism/epidemiology , Alcoholism/psychology , Alcoholism/rehabilitation , Anti-Anxiety Agents/therapeutic use , Bereavement , Child , Child, Preschool , Crisis Intervention/statistics & numerical data , Cross-Sectional Studies , Depressive Disorder, Major/epidemiology , Depressive Disorder, Major/rehabilitation , Female , Health Services Needs and Demand , Humans , Hypnotics and Sedatives/therapeutic use , Male , Middle Aged , New York City , Patient Care Team , Referral and Consultation , Relief Work , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/psychology , Stress Disorders, Post-Traumatic/rehabilitation , Stress Disorders, Traumatic, Acute/diagnosis , Stress Disorders, Traumatic, Acute/epidemiology , Stress Disorders, Traumatic, Acute/psychology , Stress Disorders, Traumatic, Acute/rehabilitation , Substance-Related Disorders/diagnosis , Substance-Related Disorders/epidemiology , Substance-Related Disorders/psychology , Substance-Related Disorders/rehabilitation , Survivors/statistics & numerical data , Young AdultABSTRACT
Clinical vignettes from the World Trade Center Worker and Volunteer Mental Health Monitoring and Treatment Program at the Mount Sinai Medical Center in New York City are presented. The hospital-based program pairs mental health screenings with federally funded occupational medical screenings to identify persons with mental health problems related to their rescue and recovery roles. The program also provides on-site mental health treatment. The cases illustrate the diverse mental health needs of the rescue and recovery workers, some of whom initially sought treatment years after September 11, 2001. The cases show that in addition to symptoms of posttraumatic stress disorder, workers experienced survivor guilt, distressing memories of childhood trauma, shame associated with intense feelings, substance abuse relapse, psychosis, and problems with family relationships.
Subject(s)
Community Mental Health Services , Crisis Intervention , Occupational Diseases/therapy , Rescue Work , September 11 Terrorist Attacks/psychology , Stress Disorders, Post-Traumatic/therapy , Adult , Community Mental Health Services/statistics & numerical data , Comorbidity , Crisis Intervention/statistics & numerical data , Family Relations , Female , Follow-Up Studies , Guilt , Health Services Needs and Demand/statistics & numerical data , Humans , Life Change Events , Male , Mass Screening/statistics & numerical data , Mental Recall , Middle Aged , New York City , Occupational Diseases/diagnosis , Occupational Diseases/epidemiology , Occupational Diseases/psychology , Psychotic Disorders/diagnosis , Psychotic Disorders/epidemiology , Psychotic Disorders/psychology , Psychotic Disorders/therapy , Rescue Work/statistics & numerical data , September 11 Terrorist Attacks/statistics & numerical data , Shame , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/psychology , Substance-Related Disorders/diagnosis , Substance-Related Disorders/epidemiology , Substance-Related Disorders/psychology , Substance-Related Disorders/therapy , Survival/psychologyABSTRACT
Psychiatric response to disasters over the last 50 years has been sporadic and inconsistent. Psychiatrists have advocated for a place in the disaster response system, and at times they have demonstrated the unique contribution they can add to disaster preparedness and response. Still, it is likely that psychiatrists are overlooked in disaster planning and response. A psychiatrist's ability to respond to disasters requires a knowledge base in the operations of the emergency management system, the responsibilities of the public health system, and the role of voluntary agencies in disaster response. This article provides the foundation for the elements involved in US disaster response and highlights the key organizations, agencies, and disaster response systems to outline the framework in which psychiatrists may bring their professional skills to the people who need them most.