October 10, 2001
The Honorable Senator Edward M. Kennedy, Chairman
The Honorable Senator Judd Gregg, Ranking Minority MemberSenate Committee on Health, Education, Labor, and Pensions
Dirksen Senate Office Building Room 644
Washington, DC 20510Dear Chairman Kennedy and Senator Gregg:
We respectfully request that this letter be added to the record for the Psychological Trauma Caused By Terrorism hearing that took place September 26, 2001, before this committee.
As associations representing behavioral health care organizations and professionals, the American Hospital Association (AHA) and the National Association of Psychiatric Health Systems (NAPHS) fully support the work of the Senate Health, Education, Labor, and Pension Committee and the Congress in addressing the mental health needs of victims of the terrorist attacks, their families, and the many service heroes who have responded to the recent disasters. We also applaud the members of this committee for recognizing that all Americans have been affected by the attacks and that there is a need for both short-term and long-term mental health services to aid the recovery effort.
ASSESSMENT OF NEEDS MUST BE CONTINUOUSLY REVIEWED
As health care providers, we have extensive experience in dealing with trauma and its aftermath.
This is an emotional time for all Americans, and there will be a need for mourning and healing on a national level. Behavioral health care professionals play an important role in this process. As vital community resources, our members recognize the critical role they play not only in direct treatment, but also in providing leadership, education, and reassurance about expected responses.
As time goes on, we recognize that the demands on the behavioral health care system are likely to intensify. Studies have shown that disaster victims have a high rate of post-traumatic stress disorder (PTSD) and major depression – often beginning several months after the crisis. Providers are thus bracing for an increase in the need for a range of services for mental and addictive disorders.
It's also important to note that there will be important learning here. Disaster managers use the term "after action analysis" to describe the kind of activities that will be conducted to study what happened, what worked and what did not. AHA and NAPHS will be working with our members to learn and share the lessons from this experience. However, this will be a delayed activity because those involved in the incidents need time to recover and heal before being asked to review it in their minds and share insights.
OUR ASSOCIATIONS ARE PROVIDING BOTH SHORT- AND LONG-TERM ASSISTANCE TO THE BEHAVIORAL HEALTH FIELD
AHA and NAPHS have worked together to help all hospitals, including the more than 3,400 hospitals and other health care organizations that focus on providing mental health treatment, counseling, and outreach activities throughout the country – and particularly in the most seriously affected areas in the immediate days and weeks following the events of September 11.
For example, on September 14 we distributed to all hospitals in America an AHA/NAPHS Behavioral Health Advisory that provides information to help them respond to this disaster. It also includes a list of key Web sites providing technical assistance that can be immediately accessed and used to share both general and specific information on mental health. Included in these resources are compilations of materials that are also specifically designed to help communicate with children and adolescents.
We have also jointly sponsored a teleconference providing an opportunity for hospitals and other behavioral health care provider organizations to discuss "Post-Traumatic Stress Disorder" as they help to treat these disorders, and an opportunity to share information on crisis response strategies.
Through our Web sites (www.aha.org and www.naphs.org) we are continuously updating and coordinating information for our members and the public.
HOSPITALS AND OTHER BEHAVIORAL HEALTHCARE PROVIDER ORGANIZATIONS ARE TAKING ACTION NOW…
AND WE WILL BE HERE FOR THE LONG HAUL
As specialty behavioral health care provider organizations, our members are vital community resources that deliver a full range of services to children, adolescents, adults, and older adults. Each of our member facilities has strong community links that are proving to be critical as community-based responses evolve.
It is important to keep in mind that all disasters are local. Local institutions and local governments respond. They know their community's resources, needs, and immediate constraints. State and federal resources have much to contribute, but it is local officials, including hospital leaders, who have to manage the scene.
In the days and weeks immediately following the September 11 tragedies, local behavioral health care providers took action. Listed below are some of the ways that hospitals and other behavioral health care providers have contributed.
- Providing Direct Care Services in Affected Communities:
Several psychiatric facilities were major receiving sites for the injured and provided essential physical and mental health care to victims, police, firefighters, other rescue personnel, and their family members. Programs have also been asked to help employers who lost staff working in the World Trade Center. In addition to this workload, extra effort was devoted to providing information and support to the general public and the media. Delivery of direct care services at these programs (particularly outpatient, crisis intervention, and hotline services) continues at an intense level. Affected areas include, but are not limited to, New York; Washington, DC; New Jersey; Connecticut; Pennsylvania; Virginia; and Maryland.
- Volunteering at Crisis Sites:
Behavioral health care organizations all over the country have volunteered their professional staff to travel to New York and Virginia to provide counseling, support, and other necessary resources.
- Supporting Firefighters, Police Officers, Rescue Personnel, and Relief Agencies:
Psychiatric programs have offered crisis counseling and de-briefing for rescuers and their families as well as others who were – and are – on the front lines of the crisis.
- Serving Local Communities:
AHA and NAPHS members have taken specific steps to meet the local demand for help by expanding and enhancing programs such as "crisis hot lines" and "walk in services." Many provide services 24 hours a day, seven days a week. These programs are designed to meet the unique needs of large and small cities as well as rural areas. In addition, programs have offered volunteer counseling and support services to the national and local Red Cross offices. Many behavioral health care facilities are sponsoring programs to collect blood or funds for those impacted by the tragedy.
- Working with the Media to Educate the Public:
Many behavioral health care facilities report extensive work with the media to provide information on how to deal with grief, stress, and fear. Clinicians are addressing questions of specific concern to those who might have been directly or indirectly affected, as well as the needs of children and families. Clinicians suggest positive, structured ways to deal with this tragedy, and they provide guidance on when and how to seek the help of a mental health professional.
- Providing Leadership Through Outreach in Schools, Workplaces, and Community Forums:
Many programs have quickly planned and implemented community forums that allow for a discussion of how to best deal with mental health problems during this sensitive time. Others have experienced a significant increase in the volume of calls from schools and colleges, parent-teacher associations, churches, employers, and community-based organizations. Behavioral health care provider organizations have responded on an immediate basis with on-site counseling, technical assistance and materials, speakers for meetings, and much more.BEHAVIORAL HEALTH CARE PROVIDERS ARE DEMONSTRATING THEIR AMAZING DEDICATION
When faced with a community disaster, hospital and medical staff arrive, stay, work and wait. They are truly extraordinary. Our behavioral health care providers have much to contribute to our nation’s recovery and our communities’ long-term overall health.
CONGRESS CAN HELP
In response to strong Congressional interest regarding what behavioral health systems need to respond to the current crisis and prepare for the future, we asked our members about their communities’ needs. Listed below are a few ideas that we ask you to consider.
- Support Rapid Response Mental Health Services In Affected Communities:
The greatest need is for funding that would flow directly to psychiatric hospitals and facilities to respond to increasing needs. Programs that were designed to serve a limited number of people during specific hours are now being asked to serve a much greater number on a 24-hour-a-day, seven-day-a-week basis. The expertise and services of our members are in place, but the demand for short-term, intermediate, and long-term help is likely to be so great in a disaster of this magnitude that additional resources will be needed. Compounding this challenge is the reality that many of those who need the most help are uninsured or have limits on their mental health coverage that are restrictive. Emergency grants should be made available directly to facilities now and in the event of future crisis.
- Expand Training with a Specialized Disaster Focus and for Specialized Populations:
Within the current mental health work force are individuals and institutions that have experience with virtually every kind of disaster and service that may be needed by special populations, such as rescue workers or children. But their numbers are limited and they may not be located in places where the need is greatest. Training of psychiatric hospital staffs must be greatly expanded so that expertise is broadly distributed. In addition, training must be continuous so that psychiatric facilities are equipped to deal with emerging threats, such as biochemical terrorism, where there is very limited expertise.During this crisis, outreach and education for the general public has been an essential tool in helping workers, parents, and institutions recover from the shock of the attack and begin the recovery process. Again, all psychiatric hospitals and facilities have programs and materials that are designed for these kinds of situations, but the demand has been overwhelming. In addition, funding is extremely limited for most community outreach and education programs. Additional funds to hospitals and other behavioral health facilities to enable them to expand and update their materials or to better access the media and the Internet would have concrete benefits to the public.
- Community Outreach and Education:
Affected communities have been extremely resourceful in providing mental health services and should be asked to analyze and share their experiences. A careful evaluation of what worked and what could be improved would be a valuable tool to all psychiatric hospitals and facilities in terms of preparing for the next crisis.
- Learning From Experience:
WE LOOK FORWARD TO WORKING WITH YOU
We hope that the information and ideas provided here are helpful to the Senate Health, Education, Labor and Pensions Committee in addressing the psychological trauma caused by terrorism. We look forward to working with you on this issue.
Sincerely,
Dick Davidson
President
American Hospital AssociationMark Covall
Executive Director
National Association of Psychiatric Health Systems
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