Terrorism: Helping Communities Heal (Part 1)

By Rebecca A. Clay

In the aftermath of the September 11 terrorist attacks, millions of Americans experienced depression, anxiety, and other problems. Yet the stigma associated with mental health services makes many people reluctant to seek out the help that could restore their emotional well-being.

To help, SAMHSA's Center for Mental Health Services (CMHS) worked in partnership with the Federal Emergency Management Agency (FEMA) to award grants funding for immediate public education and crisis counseling efforts to New York, New Jersey, Virginia, Connecticut, Pennsylvania, and Massachusetts. CMHS and FEMA are now in the final stages of reviewing requests for longer-term funding that will allow projects to continue for another 9 months. SAMHSA's Center for Substance Abuse Prevention and Center for Substance Abuse Treatment also provided funds to these states to enhance their capacity to deliver mental health services to residents needing more intensive assistance. All three SAMHSA Centers provided funds to Maryland, Rhode Island, and the District of Columbia for the same purpose.

"Most [disaster relief] volunteers go home a couple weeks after a disaster, but it's really 3 or 4 weeks later that people need mental health interventions," said Beth Nelson, M.S.W., formerly chief of the CMHS Emergency Services and Disaster Relief Branch, and now a senior policy advisor at SAMHSA. "Without the FEMA/CMHS grants and SAMHSA's supplemental funds, the traditional mental health systems wouldn't be able to handle all the increased demand."

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Emphasizing Outreach

At the heart of the FEMA/CMHS Crisis Counseling Assistance and Training Program is the belief that survivors, rescue workers, and others affected by a disaster may need help understanding that their distress is a normal reaction to an abnormal situation. Instead of waiting for people to seek help, the program focuses on reaching out to them wherever they are.

To avoid the stigma often associated with mental health services, the program relies heavily on paraprofessionals—everyone from religious leaders to Rotary Club members to neighborhood activists. Recruited from the affected areas, these crisis counselors may not have a formal background in mental health, but they undergo training that orients them to the FEMA/CMHS counseling model. Under supervision from mental health professionals, they then fan out into their communities to provide information about stress responses, talk to people about their experiences, and offer referrals to traditional mental health services if necessary.

"The idea is that these are neighbors checking in to see how people are doing," explained Seth D. Hassett, M.S.W., a public health advisor in the CMHS Emergency Services and Disaster Relief Branch. "They don't say, 'I'm here from the state mental health authority.' They say, 'I'm here from a project designed to see how people are recovering from the disaster.' "

SAMHSA provides more than money to these projects, Mr. Hassett added. Representatives from all three SAMHSA Centers traveled to New York and other sites to help other Federal agencies, state and local agencies, and voluntary organizations plan their response. CMHS staff help train crisis counselors, either providing the training themselves or suggesting consultants. CMHS also provides a series of publications and other materials about disaster response.

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New York

The largest FEMA/CMHS grant went to the New York State Office of Mental Health, which used the money to establish an innovative program called Project Liberty.

"Clinical experience has shown that in the wake of traumatic events such as those New York experienced on September 11 and the days that followed, the most effective intervention is short-term individual and group counseling like that provided by Project Liberty," said New York State Mental Health Commissioner James L. Stone, M.S.W., C.S.W. "This effort is doubly important because in addition to helping people get on with their lives, it can identify individuals in need of more traditional mental health services and refer them for treatment."

Aimed at every resident of New York City and 10 surrounding counties, Project Liberty consists of outreach activities almost as diverse as New York itself. In the city, for example, public service announcements featuring actress Susan Sarandon and New York Yankee manager Joe Torre urge residents to call the project's hotline and arrange one-on-one or group education and counseling sessions. Bus and subway ads feature New Yorkers' stories and alert commuters to the project. Children receive a structured program of education and support through a collaboration between the Board of Education and Project Liberty.

Whether the target audience is immigrants, widows, Orthodox Jews, emergency workers, deaf and hard-of-hearing individuals, or other special populations, the project uses "indigenous" crisis counselors who can tailor their outreach methods to reach that community most effectively. "They need to know the communities so they can find people and adjust their outreach efforts," explained April J. Naturale, M.S.W., the project's statewide director.

The program's flexibility is even more apparent upstate. In Westchester County, for example, outreach workers advertised the project with an ad on diner placemats. In Dutchess County, the project invites residents to an art gallery to paint or draw their experiences and display the resulting artwork; visitors can also tell their stories on video. In Orange County, the project has turned to a therapeutic riding program to help traumatized children heal. "They tend to talk to the horses," explained Ms. Naturale. "They tell the animals their stories."

No matter what approach is used, added Ms. Naturale, it all comes down to "the hard work of hitting the pavement." She points to one crisis counselor as the perfect example: An active PTA member, the woman has contacts in every part of the community and draws upon them to talk to people at the beauty shops, in the schools, and everywhere else she goes. She even distributes Project Liberty information at the local supermarkets.

To determine how well the project achieves that aim, the state is using a data collection "toolkit" developed by CMHS and customized to meet the state's unique circumstances.

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