Introduction

The impact of the World Trade Center terrorist attacks has no historical peacetime precedent in the USA in terms of loss of human life, magnitude of physical destruction, adverse economic consequences, and psychological distress and disorder. In this chapter, we review the literature on mental health consequences of disaster, review research findings on the mental health consequences of the 9/11 attacks, describe the large-scale response undertaken by the New York State Office of Mental Health (NYSOMH) to address the mental health needs, and, finally, summarize lessons learned and their public health implications for mental health and homeland security policy.

Historical perspective: long-term mental health impact

Disaster experts have consistently documented the persistence of mental health needs long after the disastrous event itself. The 1995 bombing of the Alfred P. Murrah building in Oklahoma City was perhaps the best-documented mass violence disaster in terms of its impact on mental disorders before the attacks of September 11, 2001. Surveys conducted in the Oklahoma City metropolitan area found that 62% of persons reported experiencing at least one of the following as a direct response to the bombing: increased alcohol use (approximately double their prior amount), increased psychological distress (approximately double their prior level), post-traumatic stress disorder (PTSD) symptoms, and intrusive thoughts related to the bombing (Smith et al., 1999). The psychological effects were prominent and persisted more than a year after the disaster. Two years after the disaster, children who were geographically distant from the disaster site and did not directly experience an interpersonal loss still reported PTSD symptoms and functional impairment associated with increased media exposure and indirect loss (Pfefferbaum et al., 2000).