Preparing for the Psychological Consequences of Terrorism A Public Health Strategy (2003) / Chapter Skim
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4. Developing Strategies for Minimizing the Psychological Consequences of Terrorism Through Prevention, Intervention, and Health Promotion
4. Developing Strategies for Minimizing the Psychological Consequences of Terrorism Through Prevention, Intervention, and Health Promotion
Pages 99-134
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From page 99... ...
Combined with varying levels of exposure to a terrorism event, there will be a 99
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, or psychiatric illness will likely affect prevention and intervention needs. Most research studies investigating terrorism and other disaster events provide little in the way of evidence-based prevention and intervention strategies for addressing psychological needs regarding terrorism events.
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The expanded model in Table 4-2 adds an additional dimension within each cell to reflect interventions at the biological-physical, psychological, and sociocultural levels. The table offers an example of a public health plan to assist in preparation for and response to the psychological consequences of a terrorism event utilizing phases and factors adapted from the Haddon Matrix.
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104 o Cal d.
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phase of an event. Adequate preparation and mitigation of risk will be crucial to help decrease the physical, psychological, social, and economic disruptions caused by terrorism events.
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In order to begin integrating mental health principles and needs into the broader public health consciousness with regard to terrorism preparedness and response, these principles must be part of public health disaster plans. Design and Implement Psychological First Aid Training.
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In this way, PFA may provide daily benefit, whether there are terrorism events or not. The development and implementation of PFA as a national strategy can serve as an intervention to provide possible benefits in dealing with the psychological consequences of smaller-scale random acts of violence discussed in Chapter 1 (disgruntled employees shooting and killing coworkers and supervisors, serial killers stalking women or children, racially motivated killings, hate crimes, and murder and violence occurring in most of our major urban areas)
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From page 109... ...
. In the case of a terrorism event involving CBRN, other information should be communicated, including clear guidelines on recognition of symptoms of exposure, reduction of the risk of exposure to infectious agents, reduction of the spread of agents, and whom to contact or where to go if exposure is suspected or when family reunification is not permitted.
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From page 110... ...
Since compulsory education places school-age children in classes for an average of six hours per day, 180 days per year, schools become essential components of community preparedness, response, and recovery. Should a terrorism event occur during school hours, school personnel serve as de facto emergency response workers, responsible for the food, shelter, and physical and emotional well-being of the children in their care.
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Schools should have a comprehensive school safety plan that addresses a wide range of crisis situations. · Develop plans with input from public and private agencies (for example, local law enforcement, emergency services, public health offices, Red Cross, mental health clinics)
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The prime targets for terrorist attacks are often workplace sites. The 1995 Oklahoma City bombing; 1993 and 2001 World Trade Center attacks; 2001 Pentagon attack; and 2001 anthrax attacks that hit news organizations, Capitol Hill, and postal employees are examples.
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Following the September 11, 2001, terrorist attacks, a survey of East African immigrants revealed that 50 percent of respondents reported feeling less safe because of their ethnicity or religion, 65 percent had less faith in the government's ability to protect them, and 67 percent worried about their immigration status (laranson, 2002~. These feelings may affect minority and immigrant community members' responsiveness to prevention and intervention strategies.
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Train All Relevant Health Care Professionals in Disaster Mental Health and Psychological Consequences of Terrorism. Training of service providers in medical, public health, and emergency services to respond to a terrorism event is identified by the committee as another function to be provided by an effective infrastructure.
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From page 115... ...
These also relate to terrorism events: · Prevalence and incidence of psychiatric disorders · At-risk individuals and populations · Health and socioeconomic outcomes of psychological problems · Community perceptions of risk and needs for prevention · Biological, psychological, and social risk and protective factors · Comorbidity Surveillance is crucial to efforts to limit the psychological impact of terrorism because it will allow for the targeting of interventions after trau
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From page 116... ...
Preexisting psychiatric illness, previous trauma, and other negative life events are among factors that may increase the likelihood of a person developing PTSD after a terrorism event (North et al., 1999~. Syndromic surveillance of these population characteristics and types of symptoms may allow for more rapid identification of individuals who might benefit from psychiatric and other forms of intervention and for deployment of services that will meet varying societal needs.
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guidelines should be developed for use in the event of a major incident requiring large public health responses. Independent of the increased demands that may be associated with a major terrorism event, the nation's mental health care system is currently unable to meet the psychological needs of society.
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Psychological Develop an Effective Risk Communication Strategy. Much like the dissemination of educational information discussed above, during the preevent period, timely and consistent communication of information regarding the prevention of terrorist attacks may help alleviate fear and anxiety and provide confidence in the government's ability to protect the public.
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From page 119... ...
In addition to communicating information about physical risk and protection, information regarding the range of potential psychological responses to terrorism events and to the threat of events is important to provide. Much like risk communication provides protective measures, the public would benefit from strategies to increase not only positive personal coping and adaptation, but community resilience as well (for example, volunteering and donating supplies)
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Their expertise will be crucial for integrating needed psychological issues into preparedness plans and may help to improve the coordination of services following a terrorism event. Ensure That the Community Is Appropriately Represented in Pre-Event Planning.
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Surveillance helps to identify areas of need and effective risk communication is provided for the public. Level of Individuals and Populations Affected Biological-Physical Implement Public Health and Mental Health Response.
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Expeditious and appropriately directed dispatch of emergency personnel can reduce physical damage and thereby minimize psychological casualties. Respond to Surveillance System.
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, continuation of interventions that promote individual and community resilience (function 2) , screening of psychological symptoms (function 4)
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Effective risk communication is also part of this effort and is described further below. A CBRN terrorism event will present unique challenges.
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It is important to note that even those with no previous psychiatric illness are at risk of PTSD after terrorism events (North, 1999~. Perhaps as many as 40 percent of those diagnosed will have no previous history.
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. It might be expected that people in the directly exposed group will be more likely to develop psychiatric illness, .
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Numerous studies indicate the potential risk of psychiatric distress and illness in first responders. Although further study is needed, there is some evidence to suggest that rescue workers may not be at greater risk for developing PTSD and major depression after a terrorism event than those directly affected (North et al., 2002a; 2002b)
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Despite the higher interconnectedness of rural social networks as compared to urban counterparts, psychological reactions and stress symptoms that would follow a terrorist attack might be faced in isolation or on family units. In addition, rural dwellers may be skeptical of federal programs and communications.
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Evidence-based treatments for terror-related psychiatric disorders have yet to be determined. However, the literature indicates that cognitive behavioral therapy (CBT)
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Psychological interventions can begin at this stage through the use of accurate and honest risk communication about level of risk and ways to avoid it. The absence of this practice by leaders of the organization may erode trust, which may be difficult to rebuild.
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Some research has indicated that 35 to 95 percent of survivors of disasters report gaining something positive from their experience (McMillen, 1999; McMillen et al., 1997~. Resilience, or positive outcome in the face of adversity, should be actively promoted after a terrorist attack to facilitate healing.
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Because the majority of people will not require individual treatment from mental health professionals, the goal of these strategies is to help bolster communities and give members the resources to help one another. As noted in the discussion of gaps in Chapter 3, evidence-based models for community recovery and resilience building are lacking.
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Although the evidence linking media exposure to traumatic events and psychological consequences is correlational, the public may benefit from very limited viewing of repeated depictions of the violence associated with terrorism events. Adjust Risk Communication, Emphasizing the Positive.
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Psychological interventions are needed for the pre-event, event, and post-event phases of terrorist attacks. Such interventions are necessary to address potentially affected individuals and populations, the injurious agents, and the physical and social environment, as identified in the committee's example public health strategy.
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