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E-News from Washington August 21, 2002 Vol. 02-20
Program to Cover Psychiatric Help for 9/11 Families

Over the years, many AMHCA members have received American Red Cross disaster training and will likely be eligible to provide services mentioned in the article. In addition, AMHCA has offered Critical Stress Incidence Management (CSIM) training at its annual conferences in Boston and Chicago, and in the Washington, D.C. area.

Program to Cover Psychiatric Help for 9/11 Families

By Erica Goode

The American Red Cross and the September 11th Fund said yesterday that they would underwrite the expense of extended mental health treatment for people directly affected by the terrorist attacks last year. The effort may be the most ambitious ever undertaken by charitable organizations to address the emotional needs of disaster victims.

The joint program, which begins this week, will make psychiatric help available to hundreds of thousands of people and is intended to remove many barriers that keep trauma survivors from seeking treatment, representatives of the charities said.

Those who meet the program's eligibility requirements will be reimbursed for the cost of psychotherapy, drug or alcohol treatment, psychotropic medications and, in some cases, hospital care. They can seek help from any licensed mental health professional they choose and are not limited to specific agencies or practitioners. The benefit is available not only to residents of New York or the Washington area, but also to people in other states and other countries.

"We know that many people affected by Sept. 11 will need some form of counseling and that many of them will not realize it for months or even for years," said Joshua Gotbaum, the chief executive of the September 11^th Fund. "We felt we had to design a program which would pay for therapy wherever the victims were and whenever they realized they needed it."

An estimated 150,000 families fall into the eligibility categories designated by the charities, which include family members of people killed in the World Trade Center and Pentagon attacks; people injured on Sept. 11; rescue and recovery workers and their families; residents displaced from their homes; those evacuated from the trade center and other buildings near Ground Zero; and children in schools below Canal Street and their families.

But Alan Goodman, the administrator of the Sept. 11 recovery program of the Red Cross, said that - based on the 1995 Oklahoma City bombing and studies of the use of mental health benefits when available - the charities expected only a fraction of those eligible would use the benefit. It is also expected that of those people who do use the benefit, most will not exhaust its full term.

Even so, mental health experts said the program probably represented the largest effort to provide free psychiatric treatment to a defined population.

"In essence, this is a rudimentary foundation of a mental health system for disasters," said Dr. Darrel A. Regier, the executive director of the American Psychiatric Association's Institute for Research and Education and an expert on mental health insurance coverage. "It's a very interesting social experiment, and it should be studied very carefully for what we can learn from this in terms of a model of disaster care."

Though the Red Cross and the Oklahoma City Community Foundation provided long-term psychiatric care for the families of bombing victims, the injured and those who escaped from the rubble of the Alfred P. Murrah Federal Building, as it turned out the number of people requiring such care was in the hundreds, not thousands.

Unlike Project Liberty, a federally financed free service that offers short-term crisis counseling for anyone experiencing distress related to Sept. 11, the charities hope to reach people at high risk for more severe emotional problems, including depression, aggravated grief, post-traumatic stress disorder, severe anxiety and alcohol or drug abuse.

So far, fewer people have made use of the psychiatric services that have been available than was expected in the fall, though surveys indicate that in New York significant numbers of residents, especially those most directly affected by the attacks, are suffering from depression, severe anxiety or post-traumatic stress disorder.

Such problems, experts say, usually require longer treatment that the intense stress symptoms that are common in the aftermath of a traumatic event. In many cases, people who develop the most serious emotional difficulties delay seeking help for months or years.

The September 11th Fund will pay for psychotherapy and medication up to a limit of  3,000 a person. The Red Cross will cover up to 24 sessions of psychotherapy, pay $500 toward the cost of psychiatric medications and pay for up to 30 days of psychiatric care in a hospital.

The charities said the benefit would supplement private insurance for those with such coverage.

"The goal is to provide free mental health treatment but not to duplicate what others are doing," Mr. Goodman said. "So if you have insurance and it covers 75 percent of what your cost was, we'll make up the difference. If you have a co-pay, we'll pay that, or if you have no insurance we'll pay the whole thing."

He said the Red Cross expected to spend $40 million on the program over three to five years. The September 11th Fund projects spending $45 million to $55 million over five years for treatment and for training professionals how to recognize and treat traumatic stress reactions.

Some other charities and government agencies also offer mental health treatment, though in most cases not on such an extensive basis. The Robin Hood Foundation, for example, has set aside about $2 million to treat people who are grieving or otherwise in distress, including $50,000 to help children who lost a parent in the trade center attack or who saw it take place. The New York State Crime Victims Board will reimburse the cost of psychotherapy not covered by health insurance for some people most directly affected by the attacks.

With the sums offered by the Red Cross and the September 11th Fund, some experts said they were concerned about the potential for fraud.

"There are going to be people coming out of the woodwork to capitalize on this large amount of money that's available, some of whom will be completely legitimate" and some of whom will not be, said Dr. Regier of the psychiatric association.

To protect against abuses, the charities have hired a management company, American case Management, to process claims, check the credentials of the mental health professionals and monitor the quality of care that patients receive.

Applications for the benefit can be made by calling Lifenet, the 24-hour hot line run by the mental health association (1-800-LIFENET), or the Red Cross's Sept. 11 call center (1-877-746-4987). People can also apply through the agencies belonging to the United Services Group consortium, set up after Sept. 11.

The Mental Health Association of New York City will determine the eligibility of people who apply.

In the age of managed care, employers and insurers often work to cut the cost of mental health care and to make sure that people do not overuse benefits. But the charities are taking a different approach.

"By and large, the interest of managed care companies and insurance companies is to limit the use of the benefit for fiscal reasons," said Dr. Gerald McCleery, the director of benefits coordination for the mental health association. "It's in our interest to work in exactly the opposite direction, to make sure that people utilize the benefit to the fullest extent possible."

Mr. Gotbaum said the September 11th Fund, which has raised $503 million from corporations and individuals, had provided cash assistance to more than 100,000 people. Only in a very few cases had people tried to defraud the charity, he said.