Preparing for the Psychological Consequences of Terrorism A Public Health Strategy (2003) / Chapter Skim
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Executive Summary
Executive Summary
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Psychological consequences include an array of emotional, behavioral, and cognitive reactions. People may experience insomnia, fear, anxiety, vulnerability, anger, increased alcohol consumption, or smoking, and a minority will develop psychiatric illnesses such as posttraumatic stress disorder or depression.
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The Oklahoma City bombing, intentional crashing of airliners on September 11, 2001, and anthrax attacks in the fall of 2001 are recent and gripping examples of the intentional infliction of psychological and physical pain. There is a new sense of vulnerability in this country, and the uncertainties of where and when the next attack might occur introduce anxiety and stress in much of our society.
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These consequences include distress responses, changes in behavior, and diagnosed psychiatric illness (see Figure ES-1. No one goes through a traumatic event unchanged, and psychological consequences are manifested, to varying degrees of severity, in the population.
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Although there may be some similarities between other types of disasters and terrorism, the malicious intent and unpredictable nature of terrorism may carry a particularly devastating impact for those directly and indirectly affected. Continued investigation of terrorism events will help to improve understanding of the effects on various segments of the population and will provide an evidence base for prevention and intervention efforts.
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The goal of the nation's public health system is to ensure the health of the population "through organized, interdisciplinary efforts that address the physical, mental and environmental health concerns of communities and populations at risk for disease and injury."3 The prevention and treatment of psychological consequences that result from terrorism events should be an integral part of public health efforts. Terrorism events and the threat of terrorism have affected and will continue to affect the population.
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Adapting the Haddon Matrix to psychological injuries resulting from terrorism offers an opportunity to examine what is needed to respond comprehensively and systematically to the needs of the public. The Haddon Matrix was a landmark in injury prevention, and is widely used to help categorize what is known about prevention and control and to help set priorities in public health approaches to motor vehicle collisions and other major causes of morbidity and mortality.
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Surveillance for psychological consequences, including distress responses, behavior changes, and psychiatric illness, and markers of individual and community functioning before, during, and after a terrorism event 4. Screening of psychological symptoms at the individual level 5.
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Most of the actual response is implemented through local community mental health services. Local mental health agencies are challenged in the event of a disaster due to the demands of continuing care for their regular populations in addition to serving the larger community who may experience disaster-related psychological consequences.
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Because schools are a workplace for staff and students, the Department of Education should collaborate with state and local education systems to ensure preparedness. While the ability of the nation's infrastructure to respond to largescale terrorism events has not been extensively tested, the responses to events such as the 1995 Oklahoma City bombing, September 11, 2001, attacks, 2001 anthrax attacks, and 2002 Washington, D.C., area sniper shootings can be instructive.
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Training and education emphasizing psychological consequences and methods of response should be provided to professionals within the mental health fields, including school-based mental health practitioners such as school counselors, school psychologists, and school social workers. Recommendation 3-1: Academic healthcare centers, professional associations and societies for mental health professionals, and state boards of education, in collaboration with HHS, including SAMHSA, NIH, and CDC, should ensure the education and training of mental health care providers, including community- and school-based mental health care providers on responding to the psychological consequences of terrorism.
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Although most research provides little in the way of evidence-based prevention and intervention strategies for addressing psychological needs after terrorism events, this should not prohibit action. The committee offers suggestions for prevention and response strategies based on what is known about responses to disasters, the small but growing body of evidence pertaining to psychological con
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It is proposed as a basic plan from which more detailed and tailored plans can be derived to fit the variety and complexity of terrorism events that may arise. Methods to achieve these plans and strategies for coordinating systems will need to be tested and evaluated.
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Recommendation 4-1: HHS and the Department of Homeland Security should analyze federal, state, and local preparedness for terrorism to ensure that the nation's public health infrastructure is prepared to adequately respond to the psychological consequences across a continuum of possible terrorism events, including weapons of mass destruction. The committee's example public health strategy should serve as a base from which components of the infrastructure are evaluated.
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