SAN FRANCISCO -- Mental health providers and chaplains who responded to terror attacks in New York, Washington, and Nairobi, Kenya, all had one issue in common: the need to talk with or listen to others.
After intense days of providing whatever service they could in post-Sept. 11 New York, the caregivers found they needed attention as well.
The formal and often informal exchanges, including debriefings, story telling, and listening, appeared to provide the buffer many of those volunteers and professionals needed to ward off compassion fatigue and an otherwise growing ineffectiveness at a time of peak demand, several leaders involved in the response said.
Those personal observations, supported by an American Red Cross study involving hundreds of chaplains, were disclosed in a workshop on the lessons learned from Sept. 11 at the annual meeting of the American Psychiatric Association. And other lessons emerged that will be invaluable for the next time, said the chairman of the session, Dr. David C. Lindy, clinical director and chief psychiatrist of the visiting nurse service (VNS) of New York's Community Mental Health Services.
"We're now very much in the long-term impact phase. At the same time, we are in the preimpact phase," said Dr. Lindy, also of Columbia University, New York. "And we are working to try to be as prepared as possible for a next event, should it occur. We are living with the expectation it is going to occur. The terrorism risk remains."
Among the lessons that became apparent:
* Frequent, even daily communications for those providing mental health care who shared similar experiences are important.
* Organizations or agencies that employ mental health workers in disaster responses need to encourage self-monitoring of those providers as part of the culture of the organization. The goal of such encouragement is to reduce the risk that providers become overwhelmed and symptomatic and lose effectiveness.
* Psychiatrists who want to participate in future disaster responses should align themselves with an agency and develop a full understanding of their role in any response.
* Psychiatrists and mental health responders in the field will have to have a high tolerance for chaos. They might be called upon to assist with an array of nonpsychiatric chores, including handing out water bottles, moving tables, or dealing with fainting survivors in a huge family assistance center.
Dr. Frank Gitau Njenga, a psychiatrist who led the mental health response to the American embassy bombing in 1998 in Nairobi that killed 253 people, attended the APA workshop. "Who heals the mental health healer involved with providing treatment in these disasters, which invariably affect the entire community, including the caregiver?" Dr. Njenga asked. The answer to that question appears to be evolving. But leaders of disaster response groups say some form of debriefing involving peers within their organizations seems to be key.
At Disaster Psychiatry Outreach (DPO), founded in New York in 1998 in an effort to deal with psychiatric services in the wake of disasters, the group has become more sensitive to this question since Sept. 11.
"That's something we struggle with at DPO tremendously," said Dr. Anand Pandya, a cofounder of DPO. "I don't think we did such a good job after Sept. 11 taking care of psychiatrists who worked with us. We are always trying to balance the time the psychiatrists spent with us, versus what we obligated them to do. We wanted to make it a low time commitment. …