The staff of Mt. Sinai Medical Center on New York City's Upper East Side, like those at many mental health clinics here these days, is stretched thin.
Since Sept. 11, about 20 Mt. Sinai staffers are fielding a growing number of calls to a special World Trade Center mental health hotline. They're counseling more clinic visitors than their usual 60,000 a year. They're preparing brochures and organizing conferences about trauma. And, with the help of about 60 physicians deployed into the field, they're training thousands of teachers and guidance counselors about how to spot kids in distress.
"The staff has put in thousands of manpower hours," said Mt. Sinai's medical director Dr. Deborah Marin. "There's tremendous demand."
And this is only the beginning. Mt. Sinai's clinic, like others across New York, is gearing up for a flood of need as the city approaches a potential mental health crisis.
The scope of the trauma is unprecedented in the United States, and some counselors question whether the system here can handle the numbers of New Yorkers who may eventually need help.
Using formulas derived by the federal government following disasters like the 1995 Oklahoma City bombing, the New York State Office of Mental Health estimates that as many as 1.5 million New Yorkers could need some kind of mental health help in the aftermath of Sept. 11.
New York psychologists say they are already seeing shock, depression and anger in many individuals — the early stages of grappling with trauma. Predictably, those who are closest to the disaster — survivors, witnesses, and those who lost family members, friends and co-workers — are suffering the most.
"We are seeing problems with sleeping, low mood, increased startle response, a sense of foreshortened future, and a sense of doom," said Dr. Gabriella Centurion of the Cabrini Mental Health Center in lower Manhattan, which has seen a 10 percent increase in its clinic population since Sept. 11. Many of Cabrini's clients live in high-rise buildings, and many saw the twin towers burn and collapse after being rammed by hijacked jets.
But mental health experts say it often takes months, or years, for some traumatized individuals to notice troubling symptoms or to seek help.
‘We Haven’t Yet Seen What the Impact Will Be’
"Everybody I know in the mental health community in New York is gearing for later this year, or months from now, for the suicides and nightmares," said Harold Takooshian, a psychologist at Fordham University.
Several months after a mass trauma, people who managed their emotions earlier on may find themselves unexpectedly depressed, irritable, unable to sleep, fighting with partners, unable to enjoy everyday pleasures or filled with a general sense of malaise.
Many may ignore early signs of distress, are not aware of mental health services, or only come forward later as assistance from family and friends, intense in the immediate aftermath of a disaster, begins to wane.
"I think we haven't yet seen what the impact will be," said Dr. Alan Siskind, executive vice president of the Jewish Board of Family and Children's Services, which has dispatched 160 crisis teams so far to corporations, schools and synagogues.