ABSTRACT
More than 35,000 individuals are estimated to have responded to the World Trade Center (WTC) site following the terrorist attacks of September 11, 2001. The federally funded WTC Medical Monitoring and Treatment Program (WTCMMTP) provides medical monitoring and occupational medicine treatment as well as counseling regarding entitlements and benefits to the workers and volunteers who participated in the WTC response. A major component of the WTCMMTP is the WTC Mental Health Program (WTCMHP), which offers annual mental health assessments and ongoing treatment for those found to have 9/11 associated mental health problems. In the program's 9.5 years of evaluating and treating mental health problems in thousands of Ground Zero responders, diversity in multiple domains (e.g., gender, family, profession and employment status, state of physical health, cultural identity, and immigration status) has been a hallmark of the population served by the program. To illustrate the types of issues that arise in treating this diverse patient population, the authors first present a representative case involving a Polish asbestos worker with an alcohol use disorder. They then discuss how accepted alcohol treatment modalities can and often must be modified in providing psychiatric treatment to Polish responders, in particular, and to foreign-born patients in general. Treatment modalities discussed include cognitive and behavioral therapy, relapse prevention strategies, psychodynamic therapy, motivational approaches, family therapy, group peer support, and pharmacotherapy. Implications for the practice of addiction psychiatry, cultural psychiatry, and disaster psychiatry are discussed.
Subject(s)
Alcohol Drinking , Emergency Responders/psychology , Occupational Diseases , Psychotherapy/methods , September 11 Terrorist Attacks/psychology , Stress Disorders, Post-Traumatic , Alcohol Drinking/ethnology , Alcohol Drinking/psychology , Asbestos/adverse effects , Combined Modality Therapy , Emigrants and Immigrants/psychology , Ethnopsychology/methods , Humans , Male , Mental Health Services/organization & administration , Middle Aged , Monitoring, Physiologic/methods , Occupational Diseases/diagnosis , Occupational Diseases/etiology , Occupational Diseases/physiopathology , Occupational Diseases/psychology , Occupational Diseases/therapy , Occupational Exposure/adverse effects , Poland/ethnology , Psychotropic Drugs/therapeutic use , Regional Medical Programs/organization & administration , Secondary Prevention , Self-Help Groups , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/etiology , Stress Disorders, Post-Traumatic/physiopathology , Stress Disorders, Post-Traumatic/psychology , Stress Disorders, Post-Traumatic/therapy , Stress, Psychological/complications , Stress, Psychological/physiopathology , Stress, Psychological/psychology , United States , Volunteers/psychologyABSTRACT
Clinical vignettes from the World Trade Center Worker and Volunteer Mental Health Monitoring and Treatment Program at the Mount Sinai Medical Center in New York City are presented. The hospital-based program pairs mental health screenings with federally funded occupational medical screenings to identify persons with mental health problems related to their rescue and recovery roles. The program also provides on-site mental health treatment. The cases illustrate the diverse mental health needs of the rescue and recovery workers, some of whom initially sought treatment years after September 11, 2001. The cases show that in addition to symptoms of posttraumatic stress disorder, workers experienced survivor guilt, distressing memories of childhood trauma, shame associated with intense feelings, substance abuse relapse, psychosis, and problems with family relationships.
