Experts: Public Isn't Ready for Psychological Impact of Terror Attacks

The nation has done much too little to prepare for the terror in terrorism — the fear, panic and misinformation that could spread after a biological attack, mental health experts said Tuesday.

For every person who gets physically ill from a bioterrorist attack, there probably will be at least 50 to 100 who are so distraught that they cannot function normally in their daily lives, said Dr. Robert DeMartino, who directs the Program on Trauma and Terrorism at the Department of Health and Human Services.

If anything, the number of people traumatized could be much higher, he said. But mental health issues have not been fully incorporated into the massive preparation under way by federal, state and local authorities for a possible bioterrorist attack.

"The lack of preparation has been an enormous frustration for me. People don't think about it. It simply is not on people's screen," said Brian Flynn, an expert on traumatic stress, an adviser to federal agencies and a former assistant surgeon general.

The principal goal of terrorism is to terrorize the public, meaning a strong handle on mental health can undermine their goals. "Terrorism only wins if you respond to it the way the terrorist wants you to," DeMartino said. "The power is in your hands."

There are also practical concerns. A traumatized public can overwhelm hospital emergency rooms, demanding treatments even if they aren't sick. If there's a system to reassure people and help those who are scared, while treating those who may have been exposed to a biological agent, there will be less panic and a more orderly response to chaos.

Flynn noted that HHS has several requirements for states that are receiving $1 billion in bioterrorism grants, but working with mental health providers is not among them. Rather, it's a vague suggestion, he said.

Most states and cities have disaster plans, DeMartino added, but usually they include something vague like "call the mental health department if there's an issue," rather than incorporating mental health issues into the central plan.

Also, there's little training that would help mental health counselors assist during an attack. "Even those who are available to help are not trained for the nuances and complexities of bioterrorism," Flynn said.

DeMartino added that the risk of panic is reduced if public officials provide accurate information — "even if it's not good news."

Dr. Jerold Post, an expert in political psychology at George Washington University, said he has often asked whose responsibility it is to address these issues, and no one seems to know.

"It's not on anybody's watch, really," he said.

All three experts, who spoke at the BioSecurity 2002 conference in Las Vegas, said that when they raise the issue among their colleagues, all agree that it is important, yet there is little follow-up.

"They say, 'Of course we know it's an issue,' but it never seems to jell," DeMartino said.

He guessed that's because issues of mental health naturally take a back seat to life-and-death questions such as ensuring an adequate supply of drugs and vaccines.

Other solutions, like buying drugs, are also more tangible, Flynn said. Government officials "can say, 'I've done something."'

There's also the stigma associated with mental problems, a suggestion that someone should be able to just get over it, Flynn said. A person is not blamed for a physical ailment, he said, "but if you're depressed or you can't sleep, it's your fault."