What 9/11 taught us about behavioral health care after a disaster

Dr. Melissa Brymer reflects back on improvements that have been made since the terrorist attacks 20 years ago.

UCLA Health psychologist Melissa Brymer, PhD, published research a decade ago showing how the Sept. 11, 2001, terrorist attacks redefined and expanded the delivery of behavioral health services after a disaster.

As she reflects on the 20th anniversary of 9/11, she said the improvements can be seen in the immediate delivery of specialized support in recent calamities ranging from Hurricane Ida to the June collapse of a condominium complex in Florida.

“We’ve been able to really think through what were some of the gaps and how could we fill them,” she said. “After 9/11 there needed to be more of an understanding of how to respond in the early aftermath of a disaster. There were some basic principles that were known but they weren’t operationalized.”

Dr. Brymer, director of terrorism and disaster programs at the UCLA-Duke National Center for Child Traumatic Stress, said the last two decades have opened up more research into what kind of intervention and treatment works best.

Additionally, technological advances and recruitment of trusted community resources have been deployed to help.

“We have some really important foundations in place that make us proud that we have done this work,” she said.

First aid for internal wounds

Ten years ago, Dr. Brymer, along with two other scholars, authored a paper for American Psychologist called “Postdisaster Psychological Intervention Since 9/11.” The paper described the evidence-based strategies that emerged after the attacks, including what’s known as psychological first aid.

Just as injured survivors are quickly offered triage for their wounds, psychological first aid consists of techniques to support people immediately after extremely stressful events.

The practice, which was developed by the National Child Traumatic Stress Network and the National Center for PTSD, includes assessing needs and helping people find help, providing comfort and listening in a non-intrusive way.

“We created the most comprehensive, acute intervention and really looked through what was known, and how do we not do harm in communities in the early aftermath,” she said. “That intervention is used by many of our federal partners and was adopted by the World Health Organization.”

Dr. Brymer said disaster workers apply psychological first aid across all kinds of circumstances and can offer virtual support.

“We’ve learned how to adapt those principles for the pandemic, when you can’t be face-to-face,” she said.

Dr. Brymer said advances in technology and the advent of social media over the past two decades have also changed the response. During power outages, communication apps on cell phones have been useful to increase access to disaster relief. For some, self-help apps can combat stigma about seeking help for mental health.

In the post-9/11 era, trusted community stakeholders, such as clergy and teachers, have received training and resources to provide support and help. In one example, she said during Superstorm Sandy in 2012, New York librarians offered front-line assistance to patrons who had lost power.

“They’re great with doing education and people were going to the library to cool off,” Dr. Brymer said. “There’s been a lot of effort since 9/11 to enhance those community engagements, thinking about collaboration and creating coalitions way before disasters happen so we can make sure people get services.”

Expanding trauma support for kids

The National Child Traumatic Stress Network was established in 2000 by Congress to increase services for children and their families through a collaboration between academic and community-based service centers.

The UCLA-Duke University National Center for Child Traumatic Stress provides leadership and organization. The network helps with anything from bullying to school shootings to intimate partner violence.

“We are really the most sophisticated network that deals with all types of child trauma,” Dr. Brymer said. “We have really been able to expand our knowledge and access of care for kids.”

The network opened with 17 centers just weeks after the terrorist attacks, on Oct. 1, 2001. In the aftermath, federal funding increased to expand the reach of the network. This October, there will be more than 140 centers, Dr. Brymer said.

“Because there was additional funding, we could really increase the standards of care,” she said. “We were able to create screenings that can be adapted for hurricanes or mass violence incidents. We were able to test our trauma and grief interventions for young kids, for families.”

Marking the anniversary

Trauma and grief research surrounding the terrorist attacks is more than an academic interest for Dr. Brymer. Her cousin, a New York Fire Department battalion chief, was killed that day.

She said Sept. 11, 2021 will be experienced differently by Americans depending on a range of circumstances. Military veterans may feel the weight of the recent U.S. exit from Afghanistan. Families of first responders, including her own, will remember the lives lost that day.

“The weeks leading up to an anniversary, there’s angst,” she said. “We have to think about what’s the plan we want on that day. For my family, we take that time to reflect on my cousin and we check in on one another. That’s not going to be the same for everyone.”

Other families may want activities for children who are just learning about the attacks for the first time. She said the 9/11 Memorial and Museum has helpful online resources for talking to kids about what happened.

Ideas for marking the day might include community service or expressing appreciation for an essential worker during the pandemic such as a grocery store clerk or food delivery driver.

“That service aspect has been something that has come out of 9/11 that we can all do,” she said.

As the anniversary falls during another time of national stress and grief because of the pandemic, Dr. Brymer noted that Sept. 11 also provides lessons on how to cope.

“How do we create an empathetic understanding in any disaster, including pandemics?” she asked. “How do we understand where someone has come from and give support? In 9/11 there were different reactions on how to respond to things and we’re going through that with the pandemic too.

“The more we try to have shared stories and support and form an empathetic lens, that could help us learn to come together.”

Dr. Brymer recommended the following resources for support with the anniversary or 9/11:

Courtney Perkes is the author of this article.

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