A Partnership Of America's Leading Health Organizations Issues "Blueprint Report" On Health Impacts Of Terrorism

Facing Fear Together Partnership Offers Tools to
Primary Care Providers Facing Increased Emotional Needs
as a Result of New National Stressors

Blueprint Report:A new report by the Facing Fear Together Coalition
(April 2003)

New York, NY - Twenty-five of the nation's top medical, nurse practitioner, mental health and public health organizations came together this March to put forth the best practices to support America's health care providers as they care for their patients in a time of terrorism and war.

Against the backdrop of the Iraqi war, America's HealthTogether (AHT), a Washington, D.C. based nonprofit, convened the Facing Fear Together coalition to release the results of six months of national research about both providers' and patients' changing needs since the September 11^th attack and events that have flowed from it.

As outlined in the Blueprint Report, AHT and the partners conducted a literature review, interviews with national and international trauma and terrorism experts, 14 focus groups and an online survey of medical and nursing practitioners to take the pulse of America's doctors, nurses, social workers, and psychologists across the country.

Taken together, key findings include:

September 11^th and subsequent stressors have changed our nation's emotional and psychological landscape.
- 80% of survey respondents reported that up to 25% of their patients are experiencing new or exacerbated unexplained medical symptoms or psychological and psychiatric symptoms.
- Focus group participants in every part of the nation gave compelling evidence of new patient concerns.
Currents of anxiety and apprehension are persistent and cumulative
- National stressors such as war, Code Orange alerts, job loss, sniper attacks and the tragedy of the space shuttle Columbia have piled one on top of each other, adding to the psychological burden imposed on Americans and their families.
The mental health fallout from September 11^th highlighted pre-existing gaps in our nation's health care system. As a pediatrician in Peekskill, NY put it, "It's not 9/11 that caused this [crisis in mental health care]. Nine-eleven blew the top off it."
Primary care providers worry they will be unable to handle their patients' terrorism-related health and mental health needs, due to a variety of factors including lack of time, lack of familiarity with infectious diseases and difficulty gauging normal versus abnormal psychological responses.
- As a nurse practitioner in Pittsburgh described the crisis after September 11^th, "There was an immediate reaction on the part of the providers centering around the issue of preparedness. Most people felt like we are not prepared - how can we educate our students to be prepared.a lot of feelings of inadequacy emerged."
  
  These providers note barriers to care such as stigma around mental health, insurance plans that discriminate against mental health treatment and a startling shortage of mental health providers, especially for children.
Primary care providers want more support and education in order to address their patients' mental health issues.
- A Seattle primary care provider commented that "[primary care providers]really felt terribly under-prepared, unequipped to address the type of acute anxiety and strain their patient population was facing ...we tell them, 'Look for the five symptoms of depression and don't forget them. And this is general anxiety and here is the diagnostic for this.' But what do you say after you say, "Here is your prescription?'
Primary care providers want to see increased collaboration between primary care and mental health care.
- 95% of survey respondents believe that integrating mental health services into primary care improves quality of care and nearly 60% believe the need for integration has greatly increased after September 11.

Primary care providers believe that building our nation's psychological resilience is a critical piece of the preparedness equation. Attendees at the March meeting echoed this position, voicing enthusiastic support for a campaign to strengthen this resilience among American families and communities.

"As the nation's de facto mental health system, primary care providers are on the front lines in keeping Americans calm and healthy in the face of ongoing threats," said AHT President Margaret Heldring, PhD. "Whether alarm is triggered by a Code Orange alert or the outbreak of a mysterious disease, our doctors and nurses are constantly tasked with steadying the nerves of a fragile population.

Heldring added, "Terrorists strive to paralyze communities with fear. To defy their intentions, we must ready our primary care providers to handle the impact that their attacks and threats have on Americans' psyches."

Next Step: Practical Tools for PCPs

Based on the requests of PCPs, as well as input from regional, national and international experts in disaster preparedness, the partnership's initial focus is to provide primary care providers, who receive more than 50% of all mental health visits, with the tools and resources required to identify and respond to patients' increased emotional needs. Facing Fear Together is now designing and disseminating new clinical and educational information and developing resources for the primary care community.

These will include educational brochures, fact sheets and waiting room posters providing practical advice about terrorism-related symptoms and where primary care providers can turn for help in diagnosing and treating different cases. AHT and its partners have launched a new Web site, www.FacingFearTogether.org, which offers an animated flash film illustrating this issue as well as a powerful video that features primary care and mental health providers share perspectives and experiences on healing and recovery.

"America's HealthTogether is providing an invaluable service to our nation's caregivers," said Thomas Houston, director of Science and Community Health Advocacy Programs at the American Medical Association. "With their leadership, we can make sure that doctors and nurses are equipped to deal with the new national stressors that are affecting millions of Americans' health and mental health."

Building Resilience

In addition, AHT will work with its partners to reach out to patients and caregivers alike with tips for building emotional resilience. This part of the campaign is designed to complement the Department of Homeland Security's focus on physical preparedness, encouraging Americans to fortify their psychological and emotional health in addition to developing emergency kits and escape routes.

Developing Collaborative Models of Care

As primary care providers around the country respond to emotional distress, they have pointed to the need for more interdisciplinary work. In the coming months, "Facing Fear Together" will develop strategies to encourage and foster collaborative models that integrate care for the mind and body.

About the Partnership

"Facing Fear Together" represents the following organizations:

Affiliate Partners include:

American Association of Community Psychiatrists
American Association for Marriage and Family
American Counseling Association
Disaster Psychiatry Outreach

To download a copy of the Blueprint Report, or learn more about AHT's campaign to build the capacity of primary care providers, visit www.facingfeartogether.org or call 202-544-8455.

Judge David L. Bazelon Center for Mental Health Law
1101 15th Street, NW, Suite 1212
Washington, DC 20005

Phone: 202-467-5730
Fax: 202-223-0409
Email: webmaster@bazelon.org