Neal Cohen, the New York City health commissioner, warned Congress a few weeks after Sept. 11 that despite the city's massive effort to extend immediate mental health relief, the region's long-term needs would be daunting. "The task before us is enormous," Cohen told a Senate panel. "Virtually every New Yorker is experiencing high levels of stress."
The recent anthrax scares only add to the stresses of already shaken New Yorkers, and complicates the work of mental health counselors. "How the specter of bioterror feeds into this is something we're struggling with," Marin said.
Concern About PTSD, Children, and Vulnerable Populations
Trauma experts say up to one-third of those closest to the World Trade Center disaster could suffer from post-traumatic stress disorder, a condition characterized by a persistent re-experience of traumatic events.
"What we know about PTSD is it is long-lasting," says Carol North, a psychiatry professor at the Washington University School of Medicine in St. Louis, who has studied dozens of disasters, including Oklahoma City. "But it is eminently treatable, so it's important to get mental health treatment."
The mental health needs of children also pose a unique challenge for the system. As many as 10,000 children may have lost parents in the World Trade Center disaster, which killed an estimated 4,500 people, and an unknown number of kids were witnesses.
Even children with no direct connection to the terror attacks could show symptoms of trauma, and part of the challenge will be educating teachers, school administrators and parents about recognizing children in distress.
Dr. Steven Marans, who heads the National Center for Children Exposed to Violence at Yale University's Child Study Center, spoke to a mother recently whose 15- and 16-year-olds didn't want to talk about their feelings about Sept. 11. But they were becoming more mesmerized with the HBO series Band of Brothers about World War II. The teens' mother realized this was their way of giving expression to what was going on around them, Marans said.
Reaching children will involve "screening [them] across different dimensions to get a very basic notion of where they're at in terms of psychological adjustment," he said, "not just once but to be able to follow up and see how they're doing down the road so we're not just waiting for the most dramatic symptoms to emerge indicating the need for intervention."
There is also reason for concern, some experts say, about at-risk populations who were already under-served by mental health services. Immigrants with language barriers, the unemployed, those who already had serious mental illnesses and the socially isolated may be more difficult to reach.
Don’t Underestimate This Hard-Hit Community
In the short term, a $22.7 million grant from the Federal Emergency Management Agency is funding mental health outreach programs for up to 60 days after Sept. 11, and the state is applying for more money that should fund services for up to nine more months. This money will largely be used for mental health education and referral services, not for traditional psychological counseling.
Even with the millions in short-term aid, some experts say the system may not be equipped to handle the psychological needs of New Yorkers down the road.