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By Jacqueline L. Salmon and Lena H. Sun
Washington Post Staff Writers
The first suicide was last week, the widow of a World Trade Center
victim who shot herself at her Pennsylvania farmhouse.
It was a tragedy that relief workers had braced for -- a spike in
depression, substance abuse, divorces, suicides -- the sad legacy among
those touched by the Sept. 11 terrorist attacks.
Warned by a pattern that emerged after the Oklahoma City bombing, public
officials and charities have taken perhaps the most aggressive stance
ever in pushing mental health therapy for families and others affected
by the attacks.
For New York City police employees, counseling has been declared
mandatory. The American Red
Cross flew in survivors of the 1995 Oklahoma bombing to talk with
relatives of the Sept. 11 victims. In Washington, anyone who worked at
the Pentagon is eligible for free counseling. In New York City,
officials are launching a massive campaign this week urging counseling.
Subway cars, bus shelters and radio ads will spread the message:
"New York Needs Us Strong."
Charged with doling out an unprecedented $1.4 billion in donations,
charities have become lead players in deciding what kind of help victims
should get. And along with public officials, charities have been
determined to emphasize self-sufficiency and mental health.
But that approach has not been uniformly welcomed. Some victim families
argue that they should decide how to spend money donated in their names.
"Let's not give $40 million to this group for counseling and
another $40 million to another group for counseling," said
Elizabeth McLaughlin, the widow of a World Trade Center victim, who
helped organize the Sept. 11th Victims' Families. "Let's give it as
cash to victims."
The potential for long-term emotional repercussions from Sept. 11 was
underscored last week when Pat Flounders, the widow of a money market
broker who died in the World Trade Center, committed suicide at her East
Stroudsburg, Pa., home. Friends say Flounders, 51, was in poor health
even before the terrorist strike and became inconsolable after her
husband's death. Flounders received some counseling, friends say, but
refused
further psychological help.
"That's why the preventative measures are so important -- we want
to get to people early if they are getting symptoms out there, whether
they are getting depressed or maybe becoming suicidal," said Jane
Barker, an executive at Safe Horizon, one of the major charities
involved in the New York relief effort.
For those who have studied the psychological impact of terrorist acts,
such as Oklahoma City and the Pan Am passenger jet brought down by a
bomb over Lockerbie, Scotland, Flounders's suicide fits into a grimly
familiar pattern.
A study by researchers at Washington University in St. Louis and the
University of Oklahoma of 182 survivors six months after the Oklahoma
City bombing found that almost half had a post-disaster psychiatric
disorder. And one-third of
the 182 had full-blown post-traumatic stress disorder, placing them at
greater risk of suicide, substance abuse, depression and other problems.
Since the bombing, Oklahoma City police have counted at least six
suicides of people directly involved in the disaster -- including a
bombing survivor, two police officers and a Denver federal prosecutor
who participated in the Timothy McVeigh investigation.
Trauma researchers and others say it is impossible to blame the suicides
directly on the bombing of the Alfred P. Murrah Federal Building, but
mental health workers say they aren't taking any chances this time.
"Oklahoma City taught us that months and years later, people still
need that kind of [mental health] support, so we built it in very early
in our recovery process," said Sandra Mullin, a spokeswoman for New
York's public health department.
This week, the city will blanket subway cars, telephone booths, bars,
restaurants and drugstores with public service posters featuring various
messages -- such as "Even Heroes Need to Talk" and
"Feeling Anxious after 9/11 Is Normal" -- and advertising a
toll-free mental health hot line available for any city resident. About
20 radio stations will also air spots describing how listeners are
coping.
In the Washington area, the United Way last week awarded $2.1 million in
grants to area organizations to help those affected by the September
attacks, with $385,000 of that going for counseling and other mental
health services.
Northern Virginia Family Service, which was appointed to coordinate aid
for the survivors' Fund, the largest area Sept. 11 charity, considers
mental health issues so important that it is hiring caseworkers with
experience in severe emotional trauma to work individually with the
families.
The emotional fallout from such trauma can be so profound that families
need help negotiating the complex process of recovery, said Larry Shaw,
chief operating officer for Northern Virginia Family Service.
"Some of them have stacks of paper that they put in a shoe box and
say, 'I'm not going to answer it,' " Shaw said. "It can be a
bill, it might be someone saying, 'Here's something we can offer you.'
They're just overwhelmed. . . . The grief is so intense."
Recovery from such trauma can take as long as a decade for many,
researchers warn, and some people might never bounce back.
Nancy Anthony, executive director of the Oklahoma City Community
Foundation,
which operated a $40 million recovery fund for victims and rescue
workers, said that six years after the disaster, the organization has
dozens of open cases, individuals who are still emotionally or
physically disabled by the bombing.
"I guess we originally thought that we would be out of the
emergency assistance business within the first year," Anthony said.
"But you're dealing with a grieving process, and some people get
through it and go on, and other people don't. And then some people think
that they're doing just fine, and then the holidays hit . . . or
somebody's birthday or the first anniversary of the event comes along,
and then all of a sudden they become unable to function."
Looking back at Oklahoma City, Anthony and the Red Cross said they
eventually realized that rescue workers were among the hardest hit but
among the last to seek help. About three months after the bombing,
Anthony said, some firefighters, police officers and emergency medical
personnel who had worked at the site began showing up with substance
abuse problems. Domestic
violence complaints also increased. Months later, the workers were
struggling to sleep or having emotional difficulties on the job.
With that in mind, Arlington County's fire department is holding private
"all-hands" meetings this week to praise members and reinforce
the message about counseling, said Assistant Fire Chief Jim Schwartz.
"When we look back at Oklahoma City, we look at the people who left
public safety services or had adverse results, such as suicides. We are
trying to be more proactive in staving off those kinds of results,"
Schwartz said.
The New York City police department announced last month that it was
ordering all 55,000 employees to attend educational sessions about the
psychological distress they might experience. The fire department, which
lost 343 members in the attacks, is requiring mandatory physical
examinations for firefighters that include psychological assessments.
A team of Red Cross mental health workers is on duty 24 hours a day to
help firefighters and others at the huge respite tent set up by the city
and charities about a half-block from ground zero. Their job is to
listen to the rescue and construction workers and engineers during
breaks from their recovery work.
"Every day, they find human remains, they're listening to the
pounding of the machines, they're constantly in danger, they're inhaling
things that may be toxic," said Jill Hofmann, coordinator of the
Red Cross team. "All of that is potential for stress, not to
mention looking for their family members, friends, brothers or
civilians."
The counseling is informal, often at the table as workers eat. The Red
Cross also uses pet therapy, in the form of a 120-pound golden retriever
named Nike. The specially trained dog is taken to the respite tent,
especially during night shifts, to comfort workers.
"They pet him, they hug him. Nike rolls over, and they scratch him
and pull his ears. And a lot of times, he's doing the most work when it
looks like he's not doing any work," said Nike's owner, Frank
Shane, head of K-9 Disaster Relief Organization, a nonprofit agency
formed after Sept. 11 to coordinate pet therapy for disaster victims.
The Red Cross is deliveriing another kind of comfort through its
national hot line, 1-866-GET-INFO, which opened 10 days after the
attacks. Based in Fairfax County, the call center operates out of a
warehouse-size former furniture store just off the Capitol Beltway.
Thousands of calls come in each day to phone banks lining the windowless
hallways. When a caller seems in particular distress, which often
happens more than 50 a day, front-line operators wave for mental health
"rovers" to step in and take the call.
One caller last week was a distraught grandmother who had taken in her
four young grandchildren after her daughter, a single mother, was killed
at the World Trade Center. She was receiving counseling, the weeping
woman told the volunteer therapist, but she refused financial
assistance, saying she felt guilty about taking money.
Another call came from a World Trade Center restaurant worker who said
he was feeling depressed and sad. He had lost his job and many friends
in the attacks, and now, he told a mental health worker, neither his
family nor his surviving friends wanted to talk about the disaster.
For many callers, the numbness of the past three months has worn off,
exposing them to the full brunt of their pain and loss.
Listening intently and probing gently, the volunteers look for signs of
post-traumatic stress disorder -- including constant crying, insomnia or
an inability to leave the house or go to work.
Among those devastated by the attacks was Pat Flounders.
She and her husband, Joseph, had recently moved from Brooklyn Heights to
the New York suburb of East Stroudsburg. Friends say that Pat Flounders
had health problems: She was a breast cancer survivor who had recently
had a pacemaker implanted. But she had looked forward to her husband's
retirement in a few years. They were renovating their dream house in the
Poconos and doted on their two dogs.
After Joseph died in the collapse of the second
tower of the World Trade Center, Pat was in despair. A neighbor, fearing
that Pat would take her own life, hid her husband's gun from her,
according to Rep. Kelly Lewis, a state delegate who represents that part
of Monroe County, Pa. The neighbor told her where it was after she
convinced him that she was feeling fine.
Flounders spoke with a number of community mental health counselors, but
"the bottom line was that Pat didn't like people fussing over
her," said Lewis, who befriended her after the attacks. Lewis and
his wife set up more appointments, but "Pat never went to
them," he said. She would cancel them, or she just wouldn't go, he
recalled.
"I don't know why people kill themselves," he said. "I
know her health was definitely not good. I know Pat Flounders was
heartbroken."
© 2001 The Washington Post Company
Beth Powell
AMHCA Director of Public Policy and Professional Issues
801 N. Fairfax Street, Suite 304
Alexandria, VA 22314
703-548-6002, ext. 105
www.amhca.org
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