In recognition of the lasting psychological consequences of the WTC attack for many New York City residents, the NYC Department of Health & Mental Hygiene launched the NYC 9/11 Benefit Program for Mental Health and Substance Use Services. This benefit helps cover the costs of services specifically for people still experiencing psychological distress or struggling with substance use due to the events of September 2001. Outreach efforts are aimed at finding people who were affected either directly or indirectly by the WTC attacks, with particular emphasis on reaching people who haven’t stepped forward to receive needed treatment.
While the program covers many different services for many different mental health problems, nearly a quarter of those who have filed claims have a diagnosis of PTSD (24%), indicating that individuals affected by 9/11 are still suffering from PTSD 7 years after the event and are in need of services. Further, over one third of the individuals who have initiated enrollment in the NYC 9/11 Benefit Program report they have not previously received treatment. This underscores the continuing need for mental health services among those affected by the WTC attacks, and for outreach activities aimed at reaching individuals who may not have previously stepped forward to receive treatment.
One key feature of the program is that participants are able to receive treatment from a practitioner of their own choice providing the individual is New York State licensed and is practicing in New York State. Choosing one’s own practitioner also reduces barriers an individual may face in obtaining treatment due to geographic location of participating providers, or system-induced difficulties such as not being able to access timely or efficient care.
The NYC 9/11 Benefit Program is addressing the concern clinicians may have about treating individuals with PTSD by collaborating with clinicians from the WTC Centers of Excellence to develop a training protocol to be offered to mental health providers who are treating 9/11 victims. This training will encompass evidence-based treatments for PTSD and provide ongoing support for clinicians who participate in the training.
PTSD is characterized by symptoms such as distressing memories, nightmares, or flashbacks, avoiding reminders of the traumatic event, feeling emotionally detached or numb, and insomnia or poor concentration. The estimated lifetime prevalence of PTSD among adult Americans is 7.8% (National Center for PTSD, 2006). Women (10.4%) are twice as likely as men (5%) to have PTSD at some point in their lives (National Center for PTSD, 2006), and higher rates of the disorder have been found to occur in African Americans, Hispanics and Native Americans.
The effects of PTSD can be devastating. PTSD often leads to problems in familial and other interpersonal relationships, problems with employment, and involvement with the criminal justice system. Deykin (1999) reports that the onset of PTSD in adolescence has a particularly damaging impact since it may impair the acquisition of life skills needed for independence and self-sufficiency. Further, individuals with PTSD may be more likely to develop other mental health disorders such as depression and substance use.
People involved in rescue/recovery work following natural and manmade disasters are exposed to physical and emotional trauma, increasing their risk of PTSD (Perrin, DiGrande, Wheeler, Thorpe, Farfel & Brackbill, 2007). A study conducted of the rescue and recovery workers enrolled in the World Trade Center Health Registry reveals that 2-3 years after the attack the overall prevalence of PTSD among rescue and recovery workers was 12.4%, ranging from 6.2% for police to 21.2% for unaffiliated volunteers (Perrin et al, 2007). A new study released by the NYC Department of Health & Mental Hygiene’s World Trade Center Registry reveals that one in eight (12.6%) lower Manhattan residents likely had PTSD two to three years after the attacks (World Trade Center Medical Working Group Annual Report on 9/11 Health, 2008). These studies indicate that a large proportion of individuals exposed to a traumatic event continue to suffer psychological consequences several months after exposure the event.
Unfortunately, only 7% of those with PTSD seek mental health care within the first year of onset, and the median time delay for seeking help is 12 years (Wang, Berglund, Olfson, Pincus, Wells & Kessler, 2005). Barriers to treatment vary among different people with PTSD. In a study of individuals with probable PTSD following the WTC attack, the primary reason individuals did not seek treatment was that they did not believe they had a problem. Others thought they could handle their problems on their own, had difficulty accessing services, experienced financial barriers, or were afraid of treatment (Boscarino, 2005).
Lessons from Project Liberty indicate that for many individuals traumatized in a large-scale disaster, short term crisis counseling intervention is not enough. About 9% of individuals who received counseling through Project Liberty in the first five months following 9/11 were referred to professional mental health services (Covell et al, 2006). The types of psychotherapy available to treat PTSD patients include cognitive-behavioral therapy, exposure therapy, eye movement desensitization and reprocessing, anxiety management, desensitization, and relaxation techniques (American Academy for Experts in Traumatic Stress). Pharmacotherapy used to treat PTSD mainly includes medications that decrease anxiety symptoms in clients and are particularly helpful in conjunction with psychotherapy. The medications that are generally used to help PTSD patients include serotonergic antidepressants (SSRIs) such as Prozac, Zoloft, and Paxil. Research indicates that individuals who continue on antidepressants for approximately one year are less likely to experience a relapse of PTSD (www.medicinenet.com).
Enrollment and Eligibility
If you or someone you know is still suffering psychological symptoms related to the events of 9/11, you may qualify for coverage under the NYC 9/11 Benefit Program. We also encourage mental health providers who treat individuals for conditions related to 9/11 to share information about our program with their clients. Individuals interested in learning more about the program or enrolling may contact 311 or (877) 737-1164 or visit the web at www.nyc.gov/9-11mentalhealth.
Additional Mental Health Services
Apart from the new benefit program, New York City maintains three World Trade Center (WTC) Centers of Excellence that offer free, integrated physical and mental health care to eligible individuals affected by the attack on September 11:
- The WTC Environmental Health Center provides services at Bellevue Hospital Center and Gouverneur Healthcare Services (both in Manhattan) and at Elmhurst Hospital Center (Queens)
- The Mount Sinai Consortium provides services through the WTC Medical Monitoring and Treatment Program
- The Fire Department of New York also participates in the WTC Medical Monitoring and Treatment Program
- New Yorkers seeking a mental health service provider to assess their condition or provide therapy can call 311 or visit nyc.gov/9-11healthinfo
Trish Marsik is the Assistant Commissioner for Mental Health at the NYC Department of Health and Mental Hygiene and JoAnne Mclean is the Director of the NYC 9/11 Benefit Program for Mental Health and Substance Use Services at the NYC Department of Health and Mental Hygiene.