Responding to Terrorism: Recovery, Resilience, Readiness (Part 1)
By Jane Tully
"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
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
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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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
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.
& 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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