Coordinating a local response to a national tragedy: Community Mental Health in Washington, DC after the Pentagon attack

Military Medicine, Sep 2002 by Dodgen, Daniel

Concerns about the potential long-term mental health needs created by the Pentagon attack on September 11, 2001 and subsequent events raised concerns about the local system's capacity to respond. These concerns led to the establishment of the Mental Health Community Response Coalition, which has met regularly since September 23. The primary purpose of the Mental Health Community Response Coalition has been to provide vital opportunities for networking and information exchange between military service providers, the American Red Cross, local mental health agencies, and others. Prevention of duplication and overlap of services among different agencies has also been an important focus of the group. This paper outlines the structure of the coalition and lessons learned for the development of a coordinated mental health effort in response to a community crisis.

Introduction

Within hours of the Pentagon attack on September 11, mental health professionals from the metropolitan Washington, DC area were mobilized to respond. Through the efforts of the military, the local Red Cross chapters, local and state mental health systems, and others, mental health professionals were brought to the Pentagon crash site, the family assistance center, and the airport where American Airlines Flight 77 originated to provide services appropriate for the respective settings. These workers were soon supplemented by mental health workers from other regions under the auspices of the military and the American Red Cross (ARC).

Although the outpouring of assistance from mental health professionals was an effective short-term solution to the needs created by the terrorist attack, it quickly became apparent to onsite personnel that the potential long-term mental health needs created by the attack might easily overwhelm the local system's capacity to respond. In addition, the risk of duplication of some services while others remained in short supply was of increasing concern to the early responders. Addressing these issues prior to the departure of nonlocal service providers terminating their assignments was a primary focus for some of the local and nonlocal mental health professionals responding to September 11th.

As ARC disaster mental health volunteers addressed requests for crisis interventions in the community, the fragmentation of the mental health delivery system and the overlap of services provided within it became apparent. With this in mind, Red Cross mental health responders initiated a meeting with key personnel from a number of stakeholders in the affected community to discuss long-term mental health concerns and to develop strategies and networks to address them. The first meeting, on September 23, involved volunteers whose professional affiliations included the Washington, DC and Virginia Disaster Response Network, the Capitol Area Crisis Response Team, the National Mass Fatalities Institute, and the American Psychological Association. By its next meeting, this group had expanded to include representatives from the Pentagon and other critical stakeholders, such as local Community Service Boards and mental health professional guilds. Over time, this group named itself the Mental Health Community Response Coalition (MHCRC). It has met regularly since then, holding a total of 10 meetings before the 6-month anniversary of the event.

The Formation of the MHCRC

Within days of the Pentagon attack, requests for assistance began coming to the ARC from highly impacted groups such as civilian Pentagon workers in departments located outside of the Pentagon, subcontracting companies, and airline employees. During the week after the attack a group of ARC Disaster Mental Health volunteers were assigned to handle requests that were beyond the usual ARC disaster services, such as structured group interventions at worksites, but were still within ARC's purview. As the number of requests grew, however, a more comprehensive approach was clearly needed, including a better triage system to identify whom the ARC should serve, and how referrals should be made to other agencies. The need to determine what agency was serving whom, how referrals could be made, and how to reach out to "hidden" groups formed the impetus for a meeting of stakeholders. The work at the crash site and the family assistance center had already brought many of the various local military and civilian mental health service providers into contact with one another, so it was relatively easy to identify key stakeholders who should participate in this discussion.

Once the need for a meeting was established, it was agreed that the foci for discussion should be coordinating services and addressing unmet needs. Considering the number of volunteer, public, private, military, and other government agencies involved in the immediate emergency response, fragmentation of services was an inevitable result. Some victims and families were almost inundated with opportunities to receive assistance through various mechanisms, whereas others were virtually ignored. Thus, a goal of the meeting was to avoid duplication of effort through developing a better understanding of what each organization was currently doing and how to facilitate collaboration and referral. The discussion of unmet needs focused on potentially overlooked groups such as children, non-English speakers, unidentified witnesses to the crash, and friends of the primary victims. Whereas the first meeting was initially planned as a one-time occurrence, the discussion of both of these topics made it clear that more people needed to be at the table, at a minimum, to facilitate future communication between all the parties.