Terrorism: Helping Communities Heal (Part 1)
By Rebecca A. Clay
In the aftermath of the September 11 terrorist attacks, millions
of Americans experienced depression, anxiety, and other problems.
Yet the stigma associated with mental health services makes many
people reluctant to seek out the help that could restore their emotional
To help, SAMHSA's Center for Mental Health Services (CMHS)
worked in partnership with the Federal Emergency Management Agency
(FEMA) to award grants funding for immediate public education and
crisis counseling efforts to New York, New Jersey, Virginia, Connecticut,
Pennsylvania, and Massachusetts. CMHS and FEMA are now in the final
stages of reviewing requests for longer-term funding that will allow
projects to continue for another 9 months. SAMHSA's Center
for Substance Abuse Prevention and Center for Substance Abuse Treatment
also provided funds to these states to enhance their capacity to
deliver mental health services to residents needing more intensive
assistance. All three SAMHSA Centers provided funds to Maryland,
Rhode Island, and the District of Columbia for the same purpose.
"Most [disaster relief] volunteers go home a couple weeks after
a disaster, but it's really 3 or 4 weeks later that people need
mental health interventions," said Beth Nelson, M.S.W., formerly
chief of the CMHS Emergency Services and Disaster Relief Branch,
and now a senior policy advisor at SAMHSA. "Without the FEMA/CMHS
grants and SAMHSA's supplemental funds, the traditional mental health
systems wouldn't be able to handle all the increased demand."
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At the heart of the FEMA/CMHS Crisis Counseling Assistance and
Training Program is the belief that survivors, rescue workers, and
others affected by a disaster may need help understanding that their
distress is a normal reaction to an abnormal situation. Instead
of waiting for people to seek help, the program focuses on reaching
out to them wherever they are.
To avoid the stigma often associated with mental health services,
the program relies heavily on paraprofessionals—everyone from
religious leaders to Rotary Club members to neighborhood activists.
Recruited from the affected areas, these crisis counselors may not
have a formal background in mental health, but they undergo training
that orients them to the FEMA/CMHS counseling model. Under supervision
from mental health professionals, they then fan out into their communities
to provide information about stress responses, talk to people about
their experiences, and offer referrals to traditional mental health
services if necessary.
"The idea is that these are neighbors checking in to see
how people are doing," explained Seth D. Hassett, M.S.W.,
a public health advisor in the CMHS Emergency Services and Disaster
Relief Branch. "They don't say, 'I'm here
from the state mental health authority.' They say, 'I'm
here from a project designed to see how people are recovering from
the disaster.' "
SAMHSA provides more than money to these projects, Mr. Hassett
added. Representatives from all three SAMHSA Centers traveled to
New York and other sites to help other Federal agencies, state and
local agencies, and voluntary organizations plan their response.
CMHS staff help train crisis counselors, either providing the training
themselves or suggesting consultants. CMHS also provides a series
of publications and other materials about disaster response.
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The largest FEMA/CMHS grant went to the New York State Office
of Mental Health, which used the money to establish an innovative
program called Project Liberty.
"Clinical experience has shown that in the wake of traumatic events
such as those New York experienced on September 11 and the days
that followed, the most effective intervention is short-term individual
and group counseling like that provided by Project Liberty," said
New York State Mental Health Commissioner James L. Stone, M.S.W.,
C.S.W. "This effort is doubly important because in addition to helping
people get on with their lives, it can identify individuals in need
of more traditional mental health services and refer them for treatment."
. . .What helps me is going out or staying
in with the people who make me smile whether we take
a walk, catch a movie, or talk about nothing just knowing
that they are close makes me feel better.
Marjorie, 24, Bronx
Aimed at every resident of New York City and 10 surrounding counties,
Project Liberty consists of outreach activities almost as diverse
as New York itself. In the city, for example, public service announcements
featuring actress Susan Sarandon and New York Yankee manager Joe
Torre urge residents to call the project's hotline and arrange one-on-one
or group education and counseling sessions. Bus and subway ads feature
New Yorkers' stories and alert commuters to the project. Children
receive a structured program of education and support through a
collaboration between the Board of Education and Project Liberty.
. . .Everyday things became more important because they construct my life. And life is what I'm lucky to have. I was born and raised on this soil. And I stand strong in the knowledge that you can build a lot of new dreams in a whole lot of empty sky.
La Rhonda, 29, Brooklyn
Whether the target audience is immigrants, widows, Orthodox Jews,
emergency workers, deaf and hard-of-hearing individuals, or other
special populations, the project uses "indigenous" crisis
counselors who can tailor their outreach methods to reach that community
most effectively. "They need to know the communities so they
can find people and adjust their outreach efforts," explained
April J. Naturale, M.S.W., the project's statewide director.
The program's flexibility is even more apparent upstate. In Westchester
County, for example, outreach workers advertised the project with
an ad on diner placemats. In Dutchess County, the project invites
residents to an art gallery to paint or draw their experiences and
display the resulting artwork; visitors can also tell their stories
on video. In Orange County, the project has turned to a therapeutic
riding program to help traumatized children heal. "They tend to
talk to the horses," explained Ms. Naturale. "They tell the animals
No matter what approach is used, added Ms. Naturale, it all comes
down to "the hard work of hitting the pavement." She
points to one crisis counselor as the perfect example: An active
PTA member, the woman has contacts in every part of the community
and draws upon them to talk to people at the beauty shops, in the
schools, and everywhere else she goes. She even distributes Project
Liberty information at the local supermarkets.
To determine how well the project achieves that aim, the state
is using a data collection "toolkit" developed by CMHS
and customized to meet the state's unique circumstances.
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