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9 / 11 Research

Gaps in Mental Health Care Seen After Terrorist Attacks

Five years after 9/11, the attacks on the World Trade Center are still taking a toll on the mental health of survivors, as well as on people across the country who were not directly involved in the attacks, and the medical system is struggling to adequately treat these people.
   “We routinely see people who still can’t work, who have spent their life savings seeking relief for their mental health problems,” says Randall Marshall, M.D, associate professor of clinical psychiatry.
   Those gaps, and lessons learned after the attacks, are addressed in a new book, “9/11: Mental Health in the Wake of Terrorist Attacks,” edited by Yuval Neria, Ph.D., associate clinical professor, Department of Psychiatry at P&S and Department of Epidemiology at the Mailman School; Dr. Marshall; Raz Gross, M.D., M.P.H., assistant professor, in the departments of psychiatry at P&S and epidemiology at Mailman; and Ezra Susser, M.D., Dr.P.H., the Anna Cheskis Gelman and Murray Charles Gelman Professor of Epidemiology and professor of psychiatry and chairman, Department of Epidemiology at Mailman. (See book section, p.7)
   Dr. Neria and Dr. Marshall co-founded the Center for the Study of Trauma and Resilience shortly after 9/11 to find ways to improve the medical and psychological treatment of individuals affected by trauma of all kinds, including terrorist attacks and major disasters.
One of the biggest gaps they found was a widespread lack of skills among mental health professionals in diagnosing disorders like post-traumatic stress disorder (PTSD) and major depression. “If a person with PTSD goes to a health clinic, the disorder is missed more than 90 percent of the time,” Dr. Marshall says.
   At the time of the attacks little research was available about which interventions work best for survivors or witnesses of terrorism. Most research on mental health after a disaster focused on natural disasters. “There’s a concern that trauma from 9/11 is harder to treat than other cases of PTSD,” Dr. Marshall says. “Many of our patients’ experiences had an apocalyptic nature: They not only thought their own lives were in danger, but that their entire community was in danger. It was more like a war situation, and that can have a more profound effect.”
   While knowledge about the treatment of trauma and loss is already available in research institutes, this knowledge is not yet fully disseminated to the community. ”We learned many lessons from 9/11” Dr. Neria says. ”I hope that the clinicians, policy-makers, and public health experts who read this book can translate these lessons into concrete methods to help them prepare for the next event, which many think is inevitable.”