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Phoenix rising from the ashes: A mental health opportunity
Journal of the American Psychiatric Nurses Association
Policy and Politics
Phoenix Rising from the Ashes: A Mental Health Opportunity Judith Haber, APRN, CS, PhD, FAAN
D
o you remember when President Kennedy was assassinated? How about when the space shuttle Challenger exploded? Both events changed our lives and will never be forgotten. Nor will we ever forget September 11, 2001, the day that millions of Americans watched with horror as the seemingly unassailable Twin Towers of the World Trade Center tumbled before their eyes in a cloud of fire, smoke, and falling debris. The terrorist attacks and the resulting devastation are beyond our comprehension. Journalists compared this tragedy to that of Pearl Harbor, and older Americans relived the horror of that tragic day. Younger citizens faced grief, anxiety, and vulnerability never before experienced in their lifetime. Makeshift memorials against buildings, in doorways, and in railroad stations abounded with flowers, cards, and photographs, each one conveying the magnitude of loss experienced by all. Judith Haber, APRN, CS, PhD, FAAN, is a professor and director of the Master’s and Post-Master’s Programs in the Division of Nursing at New York University. Reprint requests: Judith Haber, APRN, CS, PhD, FAAN, 111 New England Dr., Stamford, CT 06903. J Am Psychiatr Nurses Assoc (2002), 8, 33-34. Copyright © 2002 by the American Psychiatric Nurses Association. 1078-3903/2002/$35.00 ⫹ 0 66/1/122410 doi:10.1067/mpn.2002.122410
February 2002
The word “hero,” often associated with sports figures or entertainers, took on new meaning. The incredible bravery and sacrifice of firefighters, police officers, and emergency medical services (EMS) workers was exhibited over and over during and after the attacks. They have worked around the clock, at great peril to their own health and safety, to rescue and recover bodies from the site in a manner that lends dignity to the death of those who did not survive. Other noteworthy heroes are the nurses, physicians, dentists, social workers, and other health professionals, who, in a crisis, are adept at split-second decision making, organizing triage centers, and treating the physical, emotional, and social needs of survivors and the families and friends of those who died. The ripple effect of this crisis has been felt nationwide; almost no one is without a connection to the tragedy. As a Connecticut resident who works at New York University (NYU), a mere 20 blocks from the disaster, I, along with faculty and students from the Division of Nursing, spent that day volunteering at hospitals near the site; for many of the undergraduate students, it was their first day of clinicals for the new academic year. Our NYU sports complex was immediately transformed into a crisis center ready to receive, triage, and treat the survivors and bystanders fleeing up Broadway to escape the peril of remaining downtown, near the site. We showered hundreds of people caked with mud and ash from the debris, provided them with NYU t-
shirts and shorts, and discarded their ruined clothing. We treated minor injuries—abrasions, lacerations, and eye injuries—and above all, we gave crisis debriefing for the many people who arrived at our doorstep numb and in emotional shock, many of them too frantic to remember to call home to inform family members of their safety. By 2 p.m., we had no more crisis victims to treat; the intake and triage station was empty. It was an ominous sign and a harbinger of the enormous toll on human life that occurred that fateful day. Grief and pain for the victims and their families is only part of this tragedy; the other part has to do with the future of the nation. That our future may be replete with National Guardsmen, police checkpoints, body searches, and permanent sirens is difficult to contemplate. Now anthrax, smallpox, and germ warfare preparations pass for cocktail conversation. Any way you look at it, sadness, worry, insecurity, and myriad other feelings make perfect sense. Americans from coast to coast wonder whether they are brave enough to keep their prebooked plane tickets or walk by the Empire State Building. They speculate about the next terrorist target. People are worried about money and whether their jobs are secure or have any meaning. They wonder why they have not kept in closer touch with their friends and relatives. The families of those who perished are coping with the grief of their tragic losses while trying to reclaim a sense of stability in their lives. Although Americans have united APNA Web site: www.apna.org 33
Haber
Journal of the American Psychiatric Nurses Association
and turned to each other for social support to begin the healing process, the bleak description of the September 11 tragedy and its aftermath suggests that there are numerous populations nationwide who are at short- or long-term risk for mental health problems. This highlights the importance of having sufficient mental health resources to meet the burgeoning mental health needs of the nation, including an adequate workforce supply of registered nurses (RNs) and advanced practice registered nurses (APRNs) who specialize in psychiatric-mental health nursing. Mental health problems will present on a continuum from immediate to long-term sequelae of this tragedy. In the immediate aftermath of a disaster, acute catastrophic stress reactions occur within a few hours or days in response to a catastrophic event and are generally resolved in 4 to 6 weeks. The common symptoms of stress reactions that people report, such as worry, insomnia, heightened startle response, difficulty concentrating, and problems coping with work, have been widespread among those directly and indirectly involved in the September 11 attack. Moving along the continuum, symptoms of an acute stress disorder generally are evident within 4 weeks of the traumatic event. People experience intrusive, avoidance, and hyperarousal symptoms including nightmares, flashbacks, hypervigilance, and loss of interest in significant activities. If resolution does not occur within 4 to 6 weeks, people are at risk for posttraumatic stress disorder (PTSD), anxiety disorders, depression, suicidality, and substance abuse. Acute stress disorder is a mental health problem already evident among survivors of September 11, their family members, and the general population.
34 APNA Web site: www.apna.org
Speaking for New Yorkers, particularly downtown residents and workers who have to see and smell the wreckage every day, regular, repeated exposure to some aspect of the trauma increases the risk of survivor guilt, powerlessness, and lack of control, all of which combine to generate a long-term low level of anxiety and depression. Similarly, for our American citizenry, the same repeated exposure to the risk of another terrorist attack or germ warfare posed by the media or by exposure to heightened security measures can yield the same posttrauma symptomatology. Finally, we have a nation at risk for development of PTSD wherein symptoms generally are not evident for 3 months after the trauma and may not be evident for months or years after the trauma. Then, PTSD may present initially as depression, anxiety disorder, substance abuse, or other physical comorbidity. Each of these mental health disorders exact a high price for the nation in terms of employee productivity, absenteeism, lateness, and use of health benefits for physical and mental health problems of employees and family members. Billions of federal, state, and local public and private sector dollars are being allocated for recovery, repair, and rebuilding of physical damage wrought by the tragedy. However, we must remember we are a nation at risk for mental health disorders that represent the sequelae of trauma, a phenomenon that could cost public and private third-party payors, industry, and educational institutions an unanticipated, astronomic amount of money if a preventive approach is not used. U.S. leaders have initiated important preventive coping strategies to assist the healing process. President Bush’s initiative to declare September 14 a
day of prayer and remembrance gave us all permission to grieve. Nationwide support and gestures are evident in the groundswell of volunteerism, donations, and patriotism. This is a commendable beginning; our leaders must continue to devote resources to healing the nation. We as psychiatric nurses must speak with a united and powerful voice to make sure that this healing agenda remains a top priority. The old saying “a stitch in time saves nine” is appropriate in this context. Resources for preventive mental health services that will reduce the risk of PTSD and related comorbidities must be essential components of health policy agendas, legislative initiatives, and research funding priorities. Similarly, funding for trauma intervention related to the projected increased incidence of PTSD is a mental health necessity. Moreover, federal and state grants to develop and enhance psychiatric nursing undergraduate and graduate curricula that deal expertly with the effects of trauma, violence, terrorism, and its sequelae are of paramount importance, as are scholarships to attract increasing numbers of graduates who choose psychiatric nursing as a specialty. We must use our political skills to influence public and private sector implementation of this agenda. From the depths of tragedy, opportunity often emerges. Psychiatric nurses have an obligation to play a leadership role in meeting the mental health needs of the United States, in promoting recovery from trauma, and in the healing of our citizenry who continue to cope with the threat of terrorism on a daily basis. We can meet this mental health challenge, and, in so doing, be counted among those who stepped up to the plate at a time of national need.
Vol. 8, No. 1
Policy and Politics
Phoenix Rising from the Ashes: A Mental Health Opportunity Judith Haber, APRN, CS, PhD, FAAN
D
o you remember when President Kennedy was assassinated? How about when the space shuttle Challenger exploded? Both events changed our lives and will never be forgotten. Nor will we ever forget September 11, 2001, the day that millions of Americans watched with horror as the seemingly unassailable Twin Towers of the World Trade Center tumbled before their eyes in a cloud of fire, smoke, and falling debris. The terrorist attacks and the resulting devastation are beyond our comprehension. Journalists compared this tragedy to that of Pearl Harbor, and older Americans relived the horror of that tragic day. Younger citizens faced grief, anxiety, and vulnerability never before experienced in their lifetime. Makeshift memorials against buildings, in doorways, and in railroad stations abounded with flowers, cards, and photographs, each one conveying the magnitude of loss experienced by all. Judith Haber, APRN, CS, PhD, FAAN, is a professor and director of the Master’s and Post-Master’s Programs in the Division of Nursing at New York University. Reprint requests: Judith Haber, APRN, CS, PhD, FAAN, 111 New England Dr., Stamford, CT 06903. J Am Psychiatr Nurses Assoc (2002), 8, 33-34. Copyright © 2002 by the American Psychiatric Nurses Association. 1078-3903/2002/$35.00 ⫹ 0 66/1/122410 doi:10.1067/mpn.2002.122410
February 2002
The word “hero,” often associated with sports figures or entertainers, took on new meaning. The incredible bravery and sacrifice of firefighters, police officers, and emergency medical services (EMS) workers was exhibited over and over during and after the attacks. They have worked around the clock, at great peril to their own health and safety, to rescue and recover bodies from the site in a manner that lends dignity to the death of those who did not survive. Other noteworthy heroes are the nurses, physicians, dentists, social workers, and other health professionals, who, in a crisis, are adept at split-second decision making, organizing triage centers, and treating the physical, emotional, and social needs of survivors and the families and friends of those who died. The ripple effect of this crisis has been felt nationwide; almost no one is without a connection to the tragedy. As a Connecticut resident who works at New York University (NYU), a mere 20 blocks from the disaster, I, along with faculty and students from the Division of Nursing, spent that day volunteering at hospitals near the site; for many of the undergraduate students, it was their first day of clinicals for the new academic year. Our NYU sports complex was immediately transformed into a crisis center ready to receive, triage, and treat the survivors and bystanders fleeing up Broadway to escape the peril of remaining downtown, near the site. We showered hundreds of people caked with mud and ash from the debris, provided them with NYU t-
shirts and shorts, and discarded their ruined clothing. We treated minor injuries—abrasions, lacerations, and eye injuries—and above all, we gave crisis debriefing for the many people who arrived at our doorstep numb and in emotional shock, many of them too frantic to remember to call home to inform family members of their safety. By 2 p.m., we had no more crisis victims to treat; the intake and triage station was empty. It was an ominous sign and a harbinger of the enormous toll on human life that occurred that fateful day. Grief and pain for the victims and their families is only part of this tragedy; the other part has to do with the future of the nation. That our future may be replete with National Guardsmen, police checkpoints, body searches, and permanent sirens is difficult to contemplate. Now anthrax, smallpox, and germ warfare preparations pass for cocktail conversation. Any way you look at it, sadness, worry, insecurity, and myriad other feelings make perfect sense. Americans from coast to coast wonder whether they are brave enough to keep their prebooked plane tickets or walk by the Empire State Building. They speculate about the next terrorist target. People are worried about money and whether their jobs are secure or have any meaning. They wonder why they have not kept in closer touch with their friends and relatives. The families of those who perished are coping with the grief of their tragic losses while trying to reclaim a sense of stability in their lives. Although Americans have united APNA Web site: www.apna.org 33
Haber
Journal of the American Psychiatric Nurses Association
and turned to each other for social support to begin the healing process, the bleak description of the September 11 tragedy and its aftermath suggests that there are numerous populations nationwide who are at short- or long-term risk for mental health problems. This highlights the importance of having sufficient mental health resources to meet the burgeoning mental health needs of the nation, including an adequate workforce supply of registered nurses (RNs) and advanced practice registered nurses (APRNs) who specialize in psychiatric-mental health nursing. Mental health problems will present on a continuum from immediate to long-term sequelae of this tragedy. In the immediate aftermath of a disaster, acute catastrophic stress reactions occur within a few hours or days in response to a catastrophic event and are generally resolved in 4 to 6 weeks. The common symptoms of stress reactions that people report, such as worry, insomnia, heightened startle response, difficulty concentrating, and problems coping with work, have been widespread among those directly and indirectly involved in the September 11 attack. Moving along the continuum, symptoms of an acute stress disorder generally are evident within 4 weeks of the traumatic event. People experience intrusive, avoidance, and hyperarousal symptoms including nightmares, flashbacks, hypervigilance, and loss of interest in significant activities. If resolution does not occur within 4 to 6 weeks, people are at risk for posttraumatic stress disorder (PTSD), anxiety disorders, depression, suicidality, and substance abuse. Acute stress disorder is a mental health problem already evident among survivors of September 11, their family members, and the general population.
34 APNA Web site: www.apna.org
Speaking for New Yorkers, particularly downtown residents and workers who have to see and smell the wreckage every day, regular, repeated exposure to some aspect of the trauma increases the risk of survivor guilt, powerlessness, and lack of control, all of which combine to generate a long-term low level of anxiety and depression. Similarly, for our American citizenry, the same repeated exposure to the risk of another terrorist attack or germ warfare posed by the media or by exposure to heightened security measures can yield the same posttrauma symptomatology. Finally, we have a nation at risk for development of PTSD wherein symptoms generally are not evident for 3 months after the trauma and may not be evident for months or years after the trauma. Then, PTSD may present initially as depression, anxiety disorder, substance abuse, or other physical comorbidity. Each of these mental health disorders exact a high price for the nation in terms of employee productivity, absenteeism, lateness, and use of health benefits for physical and mental health problems of employees and family members. Billions of federal, state, and local public and private sector dollars are being allocated for recovery, repair, and rebuilding of physical damage wrought by the tragedy. However, we must remember we are a nation at risk for mental health disorders that represent the sequelae of trauma, a phenomenon that could cost public and private third-party payors, industry, and educational institutions an unanticipated, astronomic amount of money if a preventive approach is not used. U.S. leaders have initiated important preventive coping strategies to assist the healing process. President Bush’s initiative to declare September 14 a
day of prayer and remembrance gave us all permission to grieve. Nationwide support and gestures are evident in the groundswell of volunteerism, donations, and patriotism. This is a commendable beginning; our leaders must continue to devote resources to healing the nation. We as psychiatric nurses must speak with a united and powerful voice to make sure that this healing agenda remains a top priority. The old saying “a stitch in time saves nine” is appropriate in this context. Resources for preventive mental health services that will reduce the risk of PTSD and related comorbidities must be essential components of health policy agendas, legislative initiatives, and research funding priorities. Similarly, funding for trauma intervention related to the projected increased incidence of PTSD is a mental health necessity. Moreover, federal and state grants to develop and enhance psychiatric nursing undergraduate and graduate curricula that deal expertly with the effects of trauma, violence, terrorism, and its sequelae are of paramount importance, as are scholarships to attract increasing numbers of graduates who choose psychiatric nursing as a specialty. We must use our political skills to influence public and private sector implementation of this agenda. From the depths of tragedy, opportunity often emerges. Psychiatric nurses have an obligation to play a leadership role in meeting the mental health needs of the United States, in promoting recovery from trauma, and in the healing of our citizenry who continue to cope with the threat of terrorism on a daily basis. We can meet this mental health challenge, and, in so doing, be counted among those who stepped up to the plate at a time of national need.
Vol. 8, No. 1