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SAMHSA News - Volume X, No. 3, Summer 2002

Responding to Terrorism: Recovery, Resilience, Readiness (Part 1)

"America is coming to grips with a changed world," U.S. Health and Human Services Secretary Tommy G. Thompson told participants attending a national summit in November, "When Terror Strikes: Strengthening the Homeland through Recovery, Resilience, and Readiness."

Sponsored by the U.S. Department of Health and Human Services (HHS) with assistance from SAMHSA, the 3-day summit, held in New York City, focused on planning for the Nation's mental health and substance abuse needs during and after acts and threats of terrorism.

The theme of change, and the need for a new response to it, echoed throughout the summit, held just 2 months after the September 11 terrorist attacks on America.

Opening the meeting, SAMHSA Administrator Charles G. Curie, M.A., A.C.S.W., observed that, "We have a new definition of what 'normal' means, and we're all struggling to wrap our minds around it. From the pain and psychic dislocation of families caused by the wanton deaths of thousands of innocents to the mother who fears taking her children to the zoo or to a movie, 'normal' most certainly isn't what it used to be." Mental health issues are now on everyone's mind, perhaps for the first time, he said.

Forty-two states and the District of Columbia sent teams of senior-level mental health, substance abuse, and related health and human services professionals to the summit. The nearly 650 participants also included representatives from five U.S. territories and two tribal organizations, as well as nearly 100 national public service, faith, and community organizations.

The summit's primary goal was to help the teams craft a state action plan for responding to future acts of terrorism. State teams were requested to submit their action plans as well as summaries of their technical assistance and training needs to HHS at the end of the summit. Participants also provided recommendations for all the HHS agencies in a listening session at the conclusion of the meeting.

In addition to the time set aside for development of the plans, conference sessions included first-person accounts from survivors and first responders to acts of terrorism including the September 11 attacks, the 1995 Oklahoma City bombing, and the 1988 explosion of Pan Am flight 103; disaster-response lessons shared by state mental health and substance abuse officials; presentations on the threat of bioterrorism; discussions of the unique needs of children and adolescents; the contributions of faith-based organizations; and the need for data, research, and evaluation in connection with disaster readiness and response.

Calling HHS the "Department of Compassion," Secretary Thompson told attendees that mental health and substance abuse support must become an integral part of emergency response at every level. "This is a battle against fear," he said. "Life in America is going forward, and that is the ultimate repudiation of terrorism."

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When terrorism strikes, it's natural to focus first on those who have been physically injured or killed. But large-scale attacks produce more psychological casualties than physical ones, some of the conference presenters observed.

According to Robert E. DeMartino, M.D., associate director for the Program in Trauma and Terrorism within SAMHSA's Center for Mental Health Services (CMHS), the ratio of behavioral to physical casualties following a mass biological attack, in a best-case scenario, could be as low as 4 to 1. In a worst-case scenario, it could jump to as much as 10 to 1, he said.

The shocking events of September 11 had an especially profound effect. In a RAND Corporation survey in the days following the attack, 44 percent of American adults reported substantial symptoms of stress, and 9 out of 10 had some degree of stress reactions. More than one-third of children age 5 and older had stress symptoms, and almost half said they worried about their safety or that of their families.1

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First Responders

Six years after the 1995 Murrah Building bombing, a mental health program for first responders in Oklahoma City is still funding services for more than 50 clients, according to Lawrence Johnson, M.A., senior deputy chief of police in Oklahoma City in 1995 and now chief of police in Little Rock, AR.

Trained to cope with fear and stress and to act effectively in emergencies, rescue workers are more familiar with danger and loss of life than many. Yet, while the public holds them up as heroes, those who respond first to disaster are among the most vulnerable to emotional and substance abuse disorders.

"We are just people," Chief Johnson reminded conference participants. "We feel like everyone else." For rescue workers, exposure to the gruesome or grotesque aspects of a disaster can have long-term emotional consequences.

After the Murrah Building bombing, Oklahoma City's firefighters saw a 300-percent increase in their divorce rate, and five of the city's rescue workers committed suicide after the event, according to Chief Johnson.

1Schuster, M.A. & Others at RAND. (2001) A National Survey of Stress Reactions after the September 11, 2001, Terrorist Attacks. New England Journal of Medicine. Vol. 345, No. 20, 1507-1512.

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