| “Disasters present an opportunity for
growth of the individual as well as for the system.”
On March 13 and 14, 2003, key members of the Facing Fear
Together partnership convened in New York City for a conference focused
on mental health and primary care in a time of terrorism.
Presenters at the conference included:
 |
Margaret Heldring, PhD, President,
America’s Health Together |
|
Randal Quevillon, PhD, Chair, Department
of Psychology, Disaster Mental Health Institute, University of South
Dakota |
|
Yael Danieli, PhD, Past President,
International Society for Traumatic Stress Studies |
|
Roxane Cohen Silver, PhD, Professor
of Psychology and Social Behavior, University of California – Irvine |
|
James James, MD, PhD, Director,
Center for Disaster Preparedness, American Medical Association |
|
Thomas Campbell, MD, Professor of
Family Medicine and Psychiatry, University of Rochester |
|
Susan McDaniel, PhD, Professor of Family Medicine
and Psychiatry, University of Rochester |
|
John Wynn, MD, Medical Director, Department
of PscyhoOncology, Swedish Medical Center |
|
Ezra Susser, MD, Chair, Department of Epidemiology,
Mailman School of Public Health, Columbia University |
|
Deborah McPherson, MD, Assistant Director, Division
of Medical Education, American Academy of Family Physicians |
|
Lisa Witter, Managing Director,
Fenton Communications |
|
Marilyn Edmunds, PhD, NP |
|
Oscar Morgan, Senior
Consultant for Mental Health Policy Program, National Mental Health Association |
|
The Honorable Jerrold Nadler, Congressional
Representative, New York, 8th District |
In an effort to reach a wider audience, AHT premiered a
video and a brief animated film about the primary and mental health care
in a time of terrorism. (Both can be viewed at www.FacingFearTogether.org.)
Participants of the meeting came to consensus on
key points:
| |
 |
| |
Margaret Heldring, PhD, President,
America’s Health Together |
1. Continuum of Trauma:
The health care community must recognize the existence of
a continuum of trauma and stress connected with post-9/11 issues. For example,
patients experience trauma on a continuum. There are relatively mild or
sub-threshold-level symptoms, (e.g., bad dreams), moderate symptoms (e.g.,
pervasive fear and anxiety) and clinically diagnosable PTSD. Doctors need
to be aware of how to address each of these.
“There is the whole issue of sub-threshold symptoms.
We don’t need to look for just a diagnosable mental health problem
or just the psychopathology. We can look also to the normal for exaggerated
normal responses that if left unattended to can deteriorate and become
chronic.”
“Not only are there multiple diagnostic entities
that follow from trauma, but there are symptoms much more subtle than full-blown
diagnostic entities. So how can we as academics and researchers push this
through NIMH in a way that approaches our understanding of trauma as having
much more subtle and diffuse outcomes?”
2.
Resiliency and Response:
 |
|
The Honorable Jerrold Nadler,
Congressional Representative, New York, 8th District |
|
Primary care providers need to focus on resiliency in concert
with response to the mental health care needs of their patients.
“Not only response but preparedness. I’ve been
listening to the flow of the conversation today and it is clearly moving
from let’s not just be about response let’s also be about resilience,
capacity, building and families.”
“I think what’s emerging is our wish to put
a lot of energy and resources into creating capacity, enhancing reliance,
strengthening response so that we minimize the pathology. We may even be
able to move away from a pathology-based model about national trauma to
a resilience building model.”
“One of the different directions we could be taking
is how to build resilience, how to strengthen, particularly from a family
perspective, which is a tremendous resource, rather than what we learn
by studies that show who has become damaged...From the work I’ve
done in Kosovo, it is not helpful to emphasize the people who have been
damaged. In fact, the lead for how to develop a response is actually by
looking at the people who have adapted best and who seem to have some kind
of immunity or have developed certain processes within family life that,
in fact, help them in the face of these kinds of anxieties that we’re
dealing with here”
| |
 |
| |
Barrie Koegal and Hahrie Han |
3. Public Awareness:
The partnership ought to foster public awareness about the
need for collaborative care at the grass roots and legislative levels and
via the media.
“Our nation’s agenda for Homeland Security lacks a critical
component, attention to mental health. Our position is that as the nation
pours money and resources into developing security personnel and teams
of first responders we must remember as it’s made evidently clear
this morning that primary care providers, physicians and nurse practitioners
are those first responders in the health care field. They are on the front
lines.”
“The press wants information. Sure they like pictures
of exploding buildings, etc., but they want factual information. And if
you open up and you give it to them they become your ally, and they help
the public become your ally.”
4. Training:
Primary care providers and medical and nursing students
need, and indeed are requesting, training about disaster mental health
in order to identify and deal appropriately with their patients’
needs.
“I’m not sure I’m trained to know about
anthrax or small pox or Ebola or how these will present. But the other
tremendous ambiguity that besets the primary care provider all the time
is how am I going to know what’s somatization versus real illness.
If I’ve got this really short window of time with the patient, how
do I know?”
“I’m trying to socialize health professionals
and those who work with health professionals to think of health and mental
health as integrated. That’s what I mean by training those already
trained and that’s the kind of training that I feel is needed.”
5. Insurance Industry Change:
 |
|
John Wynn, MD, Medical Director,
Department of PscyhoOncology, Swedish Medical Center |
|
Change needs to occur within the insurance industry, because
profound obstacles stand in the way of patients receiving necessary, and
in the long run cost-saving, mental health care. Doctors need more time
to assess patients’ needs and for patients to feel comfortable disclosing
those needs. Further, with regards to mental health and referral to mental
health practitioners, reimbursement issues abound.
“I’ve got 12 minutes to see this patient and
I’ve six people in the waiting room. I’m going to get overwhelmed...I
don’t want to know those results (of the mental health screening
instrument)...I’ll be there until 10:00 at night.”
“When I hear a physician say I don’t have time
to listen, this is precisely the conspiracy of silence or the second wound
for the patient. So, from the patient’s point of view, being listened
to may save 60 or more visits if a [health care provider] can sit there
for as long as a patient needs to talk.”
“Health and mental health care have to be considered
as one under the law and the reimbursement system. How can we integrate
until we have parity in reimbursement?”
6. Language:
Audiences vary and therefore how the issues are framed with
regards to mental health in a time of terrorism should vary accordingly.
For example, Americans are, in general, uncomfortable using terms associated
with mental health and mental illness. If, however, issues are placed in
a family or community context, then more people will receptive to messages
from the partnership.
“The vast majority of Americans based upon survey
data do not believe that mental health, mental disorders can be effectively
diagnosed.”
“As a psychologist working in New York City post-9/11,
I have developed a program with some colleagues to work in firehouses.
We sit with firefighters talking about mental health issues. They don’t
call it that, but they tell me their dreams. I don’t ask for the
dreams, but they tell me their dreams because they’re not sleeping...It’s
more discussion and more openness about mental health problems than I have
ever seen before.”
|
