Various mental health services were provided in New York City in the response to the September 11 attacks. This article describes these services and the subsequent research in disaster psychiatry to identify recommended practices for future disasters.
Method:
A PubMed search identified 198 articles since the 9/11 attacks that included “New York City,” and either “9/11” or “disaster,” and either “psychiatry” or “mental health.” The abstracts of all of these articles were reviewed to identify articles that described clinical services and those articles were then reviewed in detail. Additional reports on 9/11-related services were identified through book chapters.
Results:
Acute services included debriefings and other single-time outreach interventions. Postacute phase interventions included community outreach with the goal of addressing normative psychological sequelae, multisession interventions based on evidence-based treatments, and hospital-based psychiatric services provided in the context of general health screenings for response workers.
Conclusions:
Many programs integrated medical and nonmedical services. The professional literature in the decade since this disaster has shifted recommended practices away from psychological debriefings in the acute phase to the implementation of psychological first aid (PFA). Many of the acute 9/11-related services actually closely resembled PFA. In the postacute phase, resources need to be made available for more resource-intensive psychiatric treatment for the fraction of survivors who develop psychiatric illness.
BiggsQMFullertonCSReevesJJAcute stress disorder, depression, and tobacco use in disaster workers following 9/11. Am J Orthopsychiatry. 2011;80(4):586–592.
2.
SedererLILanzaraCBEssockSMLessons learned from the New York State mental health response to the September 11, 2001, attacks. Psychiatr Serv. 2011;62(9):1085–1089.
3.
NorthCPollioDSmithRA study of trauma exposure and posttraumatic stress disorder in survivors of the September 11, 2001 attacks on the World Trade Center: A 10-year perspective and implications for future directions. Disaster Med Public Health Prep. 2011;5(Suppl 2):S205–S213.
4.
BoscarinoJA. Introduction to special issue commemorating the 10th anniversary of September 11, 2001. Int J Emerg Ment Health. 2011;13(2):65–67.
5.
GrafEEHurtadoAMatroneK9/11, trauma, and personality: A case discussion. Psychiatr Ann. 2011;41(8):403–407.
6.
OldhamJM. September 11, 2001 and its aftermath in New York City. In: UrsanoRJFullertonCSNorwoodAE, editors. Terrorism and disaster: Individual and community mental health interventions. New York (NY): Cambridge University Press; 2003. p 23–30.
7.
HermanDBAaronBPSusserES. An agenda for public mental health in a time of terror. In: CoatesSWRosenthalJLSchechterDS, editors. September 11: Trauma and human bonds. Hillsdale (NJ): The Analytic Press; 2003. p 239–253.
8.
NorthCSNorrisFH. Choosing research methods to match research goals in studies of disaster or terrorism. In: NorrisFHGaleaSFriedmanMJ, editors. Methods for disaster mental health research. New York (NY): The Guilford Press; 2006. p 45–61.
9.
NorthCSNixonSJShariatSPsychiatric disorders among survivors of the Oklahoma City bombing. JAMA. 1999;282:755–762.
10.
LehmannC.Psychiatrists rush to aid of World Trade Center victims. Psychiatr News. 2001;36(19):1.
11.
HeathD.The World Trade Center disaster and the setting up of Kids' Corner. In: PandyaAKatzCL, editors. Disaster psychiatry: Intervening when nightmares come true. Hillsdale (NJ): The Analytic Press; 2004. p 203–210.
12.
JonesK.September 11 in the ER: Brief disaster intervention and compassion stress. In: PandyaAKatzCL, editors. Disaster psychiatry: Intervening when nightmares come true. Hillsdale (NJ): The Analytic Press; 2004. p 37–52.
13.
PandyaAKatzCLSmithRServices provided by volunteer psychiatrists after 9/11 at the New York City family assistance center: September 12-November 20, 2001. J Psychiatr Pract. 2010;16(3):193–199.
14.
PandyaA.Reconsidering the role of a disaster psychiatrist. Psychiatr Serv. 2010;61(5):449–450.
15.
NapoliJC. Life at the pile. In: PandyaAKatzCL, editors. Disaster psychiatry: Intervening when nightmares come true. Hillsdale (NJ): The Analytic Press; 2004. p 17–29.
16.
MerlinoJP. The other Ground Zero. In: PandyaAKatzCL, editors. Disaster psychiatry: Intervening when nightmares come true. Hillsdale (NJ): The Analytic Press; 2004. p 31–36.
17.
CoatesSWSchechterDSFirstE.Brief interventions with traumatized children and families after September 11. In: CoatesSWRosenthalJLSchechterDS, editors. September 11: Trauma and human bonds. Hillsdale (NJ): The Analytic Press; 2003. p 23–49.
18.
GroopmanJ.The grief industry: How much does crisis counselling help-or hurt?The New Yorker. 2004 Jan 26. p 30–38. Annals of Medicine.
19.
GriegerTABallyRELyszczarzJLIndividual and organizational interventions after terrorism: September 11 and the USS Cole. In: UrsanoRJFullertonCSNorwoodAE, editors. Terrorism and disaster: Individual and community mental health interventions. New York (NY): Cambridge University Press; 2003. p 71–89.
20.
HermanRKaplanMLeMelleS.Psychoeducational debriefings after the September 11 disaster. Psychiatr Serv. 2002;53(4):479.
US National Institute of Mental HealthMental health and mass violence: Evidence-based early psychological interventions for victims/survivors of mass violence: A workshop to reach consensus on best practices. National Institutes of Health publication no 02–5138. Washington (DC): US Government Printing Office; 2002.
23.
HobfollSEWatsonPBellCCFive essential elements of immediate and mid-term mass trauma intervention: Empirical evidence. Psychiatry. 2007;70(4):283–315.
24.
NorthCSPfefferbaumBNarayananPComparison of post-disaster psychiatric disorders after terrorist bombings in Nairobi and Oklahoma City. Br J Psychiatry. 2005;186:487–493.
25.
SommersCHSatelS.September 11, 2001: The mental health crisis that wasn't. New York (NY): St Martin's Press; 2005.
26.
KantorEMBeckertDR. Psychological first aid. In: StoddardFJPandyaAKatzCL, editors. Disaster psychiatry: Readiness, evaluation, and treatment. Washington (DC): American Psychiatric Publishing, Inc; 2011. p 203–212.
27.
SickingerCT. A woman named Katherine. In: PandyaAKatzCL, editors. Disaster psychiatry: Intervening when nightmares come true. Hillsdale (NJ): The Analytic Press; 2004. p 3–15.
28.
FletcherSCreamerMForbesD.Preventing posttraumatic stress disorder: Are drugs the answer?Aust N Z J Psychiatry. 2010;44(12):1064–1071.
NorrisFHFriedmanMJWatsonPJ60,000 disaster victims speak: Part I. An empirical review of the empirical literature, 1981–2001. Psychiatry. 2002;65(3):207–239.
31.
FeltonCJ. Project Liberty: A public health response to New Yorkers' mental health needs arising from the World Trade Center terrorist attacks. J Urban Health. 2002;79(3):429–433.
32.
DonahueSAJacksonCTShearKMOutcomes of enhanced counseling services provided to adults through Project Liberty. Psychiatr Serv. 2006;57(9): 1298–1303.
33.
HenleyRMarshallRVetterS.Integrating mental health services into humanitarian relief responses to social emergencies, disasters, and conflicts: A case study. J Behav Health Serv Res. 2011;38(1):132–141.
34.
NorrisFHFriedmanMJWatsonPJ. 60,000 disaster victims speak: Part II. Summary and implications of the disaster mental health research. Psychiatry. 2002;65(3):240–260.
35.
BoscarinoJAAdamsRE. Overview of findings from the World Trade Center Disaster Outcome Study: Recommendations for future research after exposure to psychological trauma. Int J Emerg Ment Health. 2008;10(4):275–290.
36.
BoscarinoJAAdamsREFigleyCR. Mental health service use after the World Trade Center disaster: Utilization trends and comparative effectiveness. J Nerv Ment Dis. 2011;199(2):91–99.
37.
WangPBerglundPKesslerR.Recent care of common mental disorders in the United States. J Gen Intern Med. 2000;15(5):284–292.
38.
NgoVKCentanniAWongEBuilding capacity for cognitive behavioral therapy delivery for depression in disaster-impacted contexts. Ethn Dis. 2011;21(3 Suppl 1):38–44.
DowlingFGMoynihanGGenetBA peer-based assistance program for officers with the New York City Police Department: Report of the effects of Sept 11, 2001. Am J Psychiatry. 2006;163:151–153.
41.
ChiuSWebberMZeig-OwensRPerformance characteristics of the PTSD Checklist in retired firefighters exposed to the World Trade Center disaster. Ann Clin Psychiatry. 2011;23(2):95–104.
42.
StellmanJMSmithRPKatzCLEnduring mental health morbidity and social function impairment in World Trade Center rescue, recovery, and cleanup workers: The psychological dimension of an environmental health disaster. Environ Health Perspect. 2008;116(9):1248–1253.
43.
BerningerAWebberMPNilesJKLongitudinal study of probable posttraumatic stress disorder in firefighters exposed to the World Trade Center disaster. Am J Ind Med. 2010;53(12):1177–1185.
44.
GaleaSAhernJResnickHPsychological sequelae of the September 11 terrorist attacks in New York City. N Engl J Med. 2002;346(13):982–987.
45.
NorthCSTivisLMcMillenJCPsychiatric disorders in rescue workers after the Oklahoma City bombing. Am J Psychiatry. 2002;159:857–859.
46.
GabbardGOFreedmanR.Psychotherapy in the journal: What's missing?Am J Psychiatry. 2006;163:182–184.
47.
TeagueGBBondGRDrakeRE. Program fidelity in assertive community treatment. Am J Orthopsychiatry. 1998;68(2):216–233.
48.
BondGREvansLSalyersMPMeasurement of fidelity in psychiatric rehabilitation. Ment Health Serv Res. 2000;2(2):75–87.
49.
BeckerDRSmithJTanzmanBFidelity of supported employment programs and employment outcomes. Psychiatr Serv. 2001;52(6):834–836.
50.
NorthCSPfefferbaumBTuckerP.Ethical and methodological issues in academic mental health research in populations effected by disasters: The Oklahoma City experience relevant to September 11, 2001. CNS Spectr. 2002;7(8):580–584.
