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Executive Summary
ABSTRACT
Terrorism involves the illegal use or threatened use of violence, is intended
to coerce societies or governments by inducing fear in their populations, and
typically involves ideological and political motives. The attacks on September
11, 2001, have made Americans acutely aware of the devastation of terrorism.
As the nation engages in the "war on terrorism." the psychological health of the
public must not be neglected.
, ~ O
Terrorism, whether in the form of a mass physical attack or a chemical,
biological, radiological, or nuclear event, can be psychologically devastating.
Psychological consequences include an array of emotional, behavioral, and cog-
nitive reactions. People may experience insomnia, fear, anxiety, vulnerability,
anger, increased alcohol consumption, or smoking, and a minority will develop
psychiatric illnesses such as posttraumatic stress disorder or depression. The
number of people affected and the severity of consequences will vary according to
the type and intensity of the event. The broad nature of these consequences de-
mands afull public health response.
The nation's mental health, public health, medical, and emergency response
systems currently are not able to meet the psychological needs that result from
terrorism. Gaps exist in the coordination of agencies and services, training and
supervision of professionals, public communication and dissemination of infor-
mation,financing, and knowledge- and evidence-based services.
Management of the psychological consequences of terrorism will require a
range of interventions at multiple levels involving a variety of service providers.
Interventions are needed for the pre-event, event, and post-event phases of a
terrorist attack and will have to address affected individuals and populations,
1
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2 PREPARING FOR THE PSYCHOLOGICAL CONSEQUENCES OF TERRORISM
the broader social environment, and the terrorists who seek to harm. The com-
mittee offers an example for a public health strategy that may serve as a base
from which plans to prevent and respond to the psychological consequences of a
variety of terrorism events can Reformulated. This approach is a strategic vision
for assessing the completeness and effectiveness of plans, and to defining and
addressing gaps in preparedness and response. It is hoped that lessons learned
from preparingfor the psychological consequences of terrorism may serve addi-
tional benefits by being applied to a variety of other violent events that affect the
population. By comprehensively addressing the physical, psychological, and so-
ciocultural needs of the population, the desired end result will be achieved that
is, the limitation of adverse psychological consequences, facilitation of growth
and empowerment, minimization of disruptions to daily life, and enhancement
of community cohesion.
The ongoing threat of domestic terrorism is a critical concern for the
United States. The Oklahoma City bombing, intentional crashing
of airliners on September 11, 2001, and anthrax attacks in the fall of
2001 are recent and gripping examples of the intentional infliction of psy-
chological and physical pain. There is a new sense of vulnerability in this
country, and the uncertainties of where and when the next attack might
occur introduce anxiety and stress in much of our society.
The events of September 11, 2001 multiple attacks on sites that were
symbols of our nation made salient the unpredictable and catastrophic
nature of terrorism. These events and the subsequent anthrax attacks chal-
lenged federal, state, and local systems of response in new ways. As the
nation contends with these new realities, we are reminded that events
which frighten and intimidate communities have existed for some time.
The shootings at Columbine High School, the Unabomber, the fall 2002
sniper shootings in the Washington, D.C., metropolitan area, and the vio-
lence that occurs so frequently in the nation's urban areas are examples of
violent events used to injure and provoke fear. These events occur more
commonly than acts of terrorism. It is hoped that preparing for terrorism
events will allow the nation to be better prepared for the more common
events that also can be devastating to psychological health.
Terrorism is defined as follows:
illegal use or threatened use of force or violence; an intent to coerce soci-
eties or governments by inducing fear in their populations; typically with
ideological and political motives and justifications; an "extrasocietal" el-
ement, either "outside" society in the case of domestic terrorism or "for-
eign" in the case of international terrorism.)
~ National Research Council. 2002. Smelser NJ, Mitchell F. Editors. Terrorism: Perspectives
from the Behavioral and Social Sciences. Washington, DC: The National Academies Press.
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EXECUTIVE SUMMARY
3
Terrorism includes a range of actors (including the perpetrators, those
who are the targets, and those third parities that sponsor, collaborate, and
sympathize with terrorists); a multitude of actions; and results in a vari-
ety of social, psychological, physical, and economic consequences. Terror-
ism has the ability to disrupt numerous aspects of individual and com-
munity functioning. Attending to the psychological needs of the
population is a crucial part of recovery from a terrorism event, and pre-
paredness and response present a challenge for the nation.
Addressing the physical, psychological, and social needs that result
from the range of terrorism events or hazards (conventional explosives,
biological, radiological, chemical, nuclear attacks) will require universal
preparedness by all systems responsible for the public's health. Prepared-
ness and response are required for all hazards, all segments of the popula-
tion, and all phases of the event (pre-event, event, and post-event).
CONTEXT OF THE REPORT
The Institute of Medicine (IOM) was asked to highlight some of the
critical issues in responding to the psychological needs that result from
terrorism and to provide possible options for intervention. This report
identifies gaps in the knowledge necessary to inform policies and proce-
dures for planning, preparedness, and intervention as well as identifies
gaps in planning, preparedness, and the public health infrastructure. The
report also identifies a variety of approaches to intervention to limit ad-
verse psychological consequences and provides recommendations for
options on how to optimize the public health response to the long-term
and short-term psychological consequences of terrorism.
This Executive Summary presents only abbreviated versions of the
study committee's recommendations. For the full recommendations, and
a more extensive justification of each, the reader is referred to the full
committee report.
WHAT ARE THE PSYCHOLOGICAL
CONSEQUENCES OF TERRORISM?
The psychological consequences of terrorism encompass a range of
emotional, behavioral, and cognitive reactions that occur in the popula-
tion as the result of an event or threat of an event. These consequences
include distress responses, changes in behavior, and diagnosed psychiat-
ric illness (see Figure ES-1. No one goes through a traumatic event un-
changed, and psychological consequences are manifested, to varying de-
grees of severity, in the population. Distress responses may include
insomnia and increased feelings of anxiety, anger, or vulnerability. Be-
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4 PREPARING FOR THE PSYCHOLOGICAL CONSEQUENCES OF TERRORISM
Distress / \
responses
For example:
· PTSD
· Major depression
/
Psychiatric Ad\
Iness
/
/
/ Behavioral
changes
For example:
· Insomnia
· Sense of vulnerability
For example:
· Change in travel patterns
· Smoking
· Alcohol consumption
FIGURE ES-1 Psychological consequences of disaster and terrorism.
NOTE: Indicative only; note to scale.
havioral changes may include actions such as avoiding air travel, increas-
ing smoking, or increasing alcohol consumption. Other behavioral
changes may include gathering information about actions to take in re-
sponse to the event or in preparation for future events, increasing com-
munication with loved ones, or volunteering. Psychiatric illness related to
a terrorism event may include posttraumatic stress disorder (PTSD) or
depression. After a terrorism event, it is expected that most people will
experience mild or infrequent behavioral changes or distress responses,
while a smaller number will experience moderate or more frequent symp-
toms. A minority of people will suffer symptoms severe enough to war-
rant the diagnosis of a psychiatric disorder.
The body of literature examining the psychological consequences of
terrorism is growing but remains relatively small. Much of what is used
to determine how individuals and communities may react to terrorism is
derived from the broader trauma literature, including that which exam-
ines disasters. Although there may be some similarities between other
types of disasters and terrorism, the malicious intent and unpredictable
nature of terrorism may carry a particularly devastating impact for those
directly and indirectly affected. Continued investigation of terrorism
events will help to improve understanding of the effects on various seg-
ments of the population and will provide an evidence base for prevention
and intervention efforts.
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EXECUTIVE SUMMARY
5
The committeefinds that terrorism and the threat of terrorism will have psy-
chological consequences for a major portion of the population, not merely a small
minority. Research studies that have examined a range of terrorism events indi-
cate that psychological reactions and psychiatric symptoms clearly develop in
many individuals. To optimize the overall health and well-being of the popula-
tion, and to improve the overall response to terrorism events, it is necessary that
these potential consequences be addressed preventively as well as throughout the
phases of an event.
Recommendation 2-1: The Department of Health and Human Ser-
vices (HHS), including the National Institutes of Health (NIH), the
Substance Abuse and Mental Health Services Administration
(SAMHSA), and the Centers for Disease Control and Prevention
(CDC), should develop evidence-based techniques, training, and
education in psychological first aid2 to address all hazards and all
members of society during the pre-event, event, and immediate
post-event phases of a terrorism event in order to limit the psycho-
logical consequences of terrorism.
Recommendation 2-2: HHS, including NIH, SAMHSA, and CDC,
should develop public health surveillance for pre-event, event, and
post-event factors relevant to addressing the psychological conse-
quences of terrorism and should develop methods for applying the
findings of this surveillance through appropriate interventions for
groups of special interest.
TERRORISM AND THE PUBLIC'S HEALTH
The public's health is dependent on both psychological and physical
well-being. The goal of the nation's public health system is to ensure the
health of the population "through organized, interdisciplinary efforts that
address the physical, mental and environmental health concerns of com-
munities and populations at risk for disease and injury."3 The prevention
and treatment of psychological consequences that result from terrorism
events should be an integral part of public health efforts.
Terrorism events and the threat of terrorism have affected and will
continue to affect the population. Among the primary objectives of terror-
2 Psychological first aid (PFA) refers to a set of skills identified to limit distress and nega-
tive health behaviors (e.g., smoking) that can increase fear, arousal, and subsequent health
care utilization. PEA is described in detail in Chapter 4 of the full report.
3 Association of Schools of Public Health. What Is Public Health. [Online]. Available:
www.asph.org/aa_section.cfm?section_id=3 [accessed February 6, 2003].
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6 PREPARING FOR THE PSYCHOLOGICAL CONSEQUENCES OF TERRORISM
ism are the psychological and physical injury of communities and popu-
lations. Therefore, there is a critical need for a public health approach to
the psychological consequences resulting from terrorism. In order to en-
sure the public's health, efforts must be expanded beyond treatment for
individuals who are most severely affected to comprehensive prevention
and health promotion. The psychological health of the nation is critical to
sustaining the nation's capabilities, values, and infrastructure.
The committee takes a public health approach to the psychological
consequences of terrorism that focuses on prevention and health promo-
tion as well as treatment. It adapts an epidemiologic model of disease
transmission, which has been applied to the understanding and preven-
tion of physical injuries and is termed the Haddon Matrix. In this model,
an agent introduces a disease or condition to a host. Environmental fac-
tors will affect the opportunity for the agent and host to interact. A vector
or vehicle may carry the agent to the host. Pre-event, event, and post-
event phases in the process of sustaining an injury add an opportunity to
understand the factors contributing to injury in each stage, which may
lead to improved prevention and interventions.
Adapting the Haddon Matrix to psychological injuries resulting from
terrorism offers an opportunity to examine what is needed to respond
comprehensively and systematically to the needs of the public. The
Haddon Matrix was a landmark in injury prevention, and is widely used
to help categorize what is known about prevention and control and to
help set priorities in public health approaches to motor vehicle collisions
and other major causes of morbidity and mortality. In conceptualizing
this model for psychological consequences, the committee views the
terrorist's violent act or threat and the resulting fear and dread of future
attacks as the agent affecting the population (Table ES-1. The host is re-
defined as the affected individuals and populations or those persons who are
the targets of the terrorist act. At the level of the vector, or vehicle, the
terrorist and his or her act are fused and become the terrorist and injurious
TABLE ES-1 Application of the Public Health Model to Understand
and Organize Factors Involved in the Psychological Consequences of
~ ~ .
. . errors
Epidemiologic Terms
Psychological Terms
Agent Violent act or threat
Host Affected individuals and populations
Vector or vehicle Terrorist and injurious agent, the way terror is propagated
Environment Physical and social environment
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EXECUTIVE SUMMARY
agent (e.g., individuals crashing airliners, shooting others, or contaminat-
ing food or water supplies). The vector can also refer to the way the terror
is propagated. Thus the media, particularly television, may also become a
vector. The environment is further defined as the physical and social envi-
ronment. It is not only the physical setting, but also the broader commu-
nity and cultural context in which the event occurs.
Responding to the psychological needs of the public that arise as a
consequence of terrorism may provide an opportunity to address the psy-
chological effects of a variety of violent events and other disasters. These
events are associated with a greater incidence of morbidity, including psy-
chological injury, and mortality. The application and practice of strategies
for preparedness and intervention may also assist in preparing the nation
to respond to new terrorism threats.
GAPS IN THE CURRENT INFRASTRUCTURE
Effective preparation and response for terrorism require a strong and
cohesive infrastructure. Currently, a diverse array of individuals, groups,
organizations, and agencies will respond to a terrorism event. Given the
number and variety of these responders and of the public needs, there are
inherent difficulties in planning and coordinating services and preventive
efforts. The nation's infrastructure should provide the following 10 func-
tions to effectively protect and respond to the public's psychological
health as it relates to terrorism:
1. Provision of basic resources including food, shelter, communica-
tion, transportation, information, guidance, and medical services
2. Interventions and programs to promote individual and commu-
nity resilience and prevent adverse psychological effects
3. Surveillance for psychological consequences, including distress re-
sponses, behavior changes, and psychiatric illness, and markers of indi-
vidual and community functioning before, during, and after a terrorism
event
4. Screening of psychological symptoms at the individual level
5. Treatment for acute and long-term effects of psychological trauma
6. Response for longer-term general human service needs that con-
tribute to psychological functioning (e.g., housing, financial assistance
when the event creates job loss)
7. Risk communication and dissemination of information to the pub-
lic, media, political leaders, and service providers
8. Training of service providers (in medical, public health, emergency,
and mental health systems) to respond to a terrorism event and to protect
themselves against psychological trauma
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8 PREPARING FOR THE PSYCHOLOGICAL CONSEQUENCES OF TERRORISM
9. Capacity to handle a large increase in demand for services to ad-
c~ress psychological consequences in the event of a terrorist attack
10. Case-finding ability to locate individuals who have not utilized
mental health services but need them, including underserved,
marginalized, and unrecognized groups of people (e.g., undocumented
immigrants, homebound individuals) and others with unidentified needs
The federal government administers a number of programs and ser-
vices that are initiated in response to disasters. These systems focus largely
on intervention and treatment for immediate needs, rather than on pre-
vention and health promotion before an event or on longer-term needs.
The relationships among the various agencies and programs are complex
and promise to change as the newly established Department of Home-
land Security continues to take form. The nation's response to an emer-
gency situation is currently dictated by the Federal Response Plan, which
coordinates the efforts of 27 federal departments and agencies and the
American Red Cross. Federal assistance typically applies only to large-
scale events that overwhelm local capacity. The range of federal agencies
involved in responding to psychological consequences in the event of di-
sasters include the CDC, Department of Education, Department of Veter-
ans Affairs, and SAMHSA, among others. In addition, the National Insti-
tute of Mental Health plays the crucial role of establishing the research
agenda for federal funding.
Each state is required to have a disaster plan that dictates responses in
the event of an emergency. These disaster plans are required to have a
mental health component, although there is no standard approach for in-
corporating such issues. Most of the actual response is implemented
through local community mental health services. Local mental health
agencies are challenged in the event of a disaster due to the demands of
continuing care for their regular populations in addition to serving the
larger community who may experience disaster-related psychological
consequences.
The private sector includes a wide variety of providers who are im-
portant in delivering services in response to disaster. The largest, and per-
haps most well recognized, is the American Red Cross. The Red Cross
works to meet basic human needs after a disaster, which include the pro-
vision of supportive counseling. Other private-sector systems that may
provide support and services for addressing psychological consequences
include the workplace, primary care settings, faith-based services, and
other private mental health providers. The workplace is a particularly
important setting for response because most acts of terrorism in the United
States have occurred when people are at their places of employment.
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EXECUTIVE SUMMARY
9
The committeefinds that the workplace is a newly recognized and important
environment in which to address public health planning for the psychological
consequences of terrorism. Some examples of new occupationally exposed groups
include construction workers, postal workers, utility workers, public health work-
ers, and children and teachers in schools. Implementation of universal prepared-
ness is required for the workplace, but specific considerations will be needed for
critical occupational sites. Recent terrorism events have involved workplaces and
new categories of responders and have exposed traditionalfirst responders to new
levels of job-related stress and risk exposure.
Recommendation 3-4: The National Institute for Occupation Safety
and Health (NIOSH) and the Department of Labor should collabo-
rate to ensure the existence of appropriate guidelines to protect
workers by incorporating the psychological aspects of disaster pre-
paredness into all planning and interventions. Because schools are
a workplace for staff and students, the Department of Education
should collaborate with state and local education systems to ensure
preparedness.
While the ability of the nation's infrastructure to respond to large-
scale terrorism events has not been extensively tested, the responses to
events such as the 1995 Oklahoma City bombing, September 11, 2001, at-
tacks, 2001 anthrax attacks, and 2002 Washington, D.C., area sniper
shootings can be instructive. These events provide an opportunity to iden-
tify gaps in systems of response and to offer suggestions that may achieve
better integration of systems to respond more effectively to future terror-
ism events, both large and small. The gaps in current systems of services
can be categorized into five general areas:
1. Coordination of agencies and services
2. Training and supervision
3. Public communication and dissemination of information
4. Financing
5. Knowledge- and evidence-based services
The coordination of agencies and services includes the organization and
management of different types of services to individuals with different
needs and to the same individuals over time as their needs change. It
encompasses points such as licensing and credentialing of providers and
clarifying the roles of various service providers. This is a multilevel-
multidisciplinary issue that also involves communication between dif-
ferent levels of government and the integration of various sources of
funding.
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10 PREPARING FOR THE PSYCHOLOGICAL CONSEQUENCES OF TERRORISM
Issues related to training and supervision include the shortage of men-
tal health providers with disaster training and experience. Skilled provid-
ers will help to ensure effective and adequate treatment. Providers who
are unlicensed require additional supervision. Public communication and
dissemination of information are crucial following a terrorism event, par-
ticularly in the case of chemical, biological, radiological, or nuclear terror-
ism when instruction will be critical for effective management. Public
communication and dissemination of information include issues such as
addressing who delivers information and how it is communicated. Fi-
nancing of services and planning for psychological consequences is fre-
quently inadequate. The amount of funding, duration of funding, services
eligible for coverage, and inclusion of mental health services in broader
terrorism preparedness plans are areas requiring attention. One of the
most critical problems in identifying effective prevention and response
plans is that the knowledge- and evidence-base necessary to inform policies
and practice is severely lacking. Models for promoting community recov-
ery and resilience, early interventions, and preparedness are required, as
is a more comprehensive understanding of the psychological impact of
terrorism events.
The committeefinds that many mental health professionals do not have spe-
cific knowledge with regard to disaster mental health. Training and education
emphasizing psychological consequences and methods of response should be pro-
vided to professionals within the mental health fields, including school-based
mental health practitioners such as school counselors, school psychologists, and
school social workers.
Recommendation 3-1: Academic healthcare centers, professional as-
sociations and societies for mental health professionals, and state
boards of education, in collaboration with HHS, including
SAMHSA, NIH, and CDC, should ensure the education and train-
ing of mental health care providers, including community- and
school-based mental health care providers on responding to the
psychological consequences of terrorism.
The committeefinds that a broad spectrum of professional responders is nec-
essary to meet psychological needs effectively. Those outside the mental health
professions, who may regularly interface with the public, can contribute substan-
tially to community healing. These professionals include, but are not limited to,
primary care providers, teachers and other school officials, workplace officials,
government officials, and faith-based and other community leaders. However,
these professionals will require knowledge and training in order to provide effec-
tive support. Basic knowledge of psychological reactions, as well as training in
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EXECUTIVE SUMMARY
11
support techniques and recognizing serious symptoms that necessitate referral,
should be provided.
Recommendation 3-2: Academic centers and professional associa-
tions and societies, in collaboration with HHS, including SAMHSA,
NIH, and CDC, should ensure the education and training of rel-
evant professionals in health fields, including primary care provid-
ers, school-based health care providers, public health officials, and
the public safety sector, in the psychological consequences of ter-
rorism.
Recommendation 3-3: SAMHSA, in collaboration with academic
centers and state and local health care agencies, should ensure the
provision of education and training in the psychological conse-
quences of terrorism for a range of relevant community leaders and
ancillary providers.
The committeefinds that research following terrorism events presents a mul-
titude of practical and ethical challenges. Utilizing findings from research on
other traumatized populations is not an adequate substitute, and support of di-
saster-specific and terrorism-specific research is necessary to provide information
pertinent to the population and its needs for intervention. This research can be
facilitated by improving cooperation and coordination amongfederalfunding and
regulatory agencies as well as by developing the high-quality methodology neces-
sary for the conduct of these investigations.
Recommendation 3-5: Federal agencies such as CDC, NIH,
SAMHSA, and NIOSH should coordinate research agendas, coop-
erate in establishing funding mechanisms, and award timely and
sufficient funding of research on best practices to inform and guide
interventions that will address the psychological consequences of
terrorism.
DEVELOPING STRATEGIES FOR LIMITING THE
PSYCHOLOGICAL CONSEQUENCES OF TERRORISM
Interventions are required to ensure that the priority needs discussed
above are met and gaps are covered. Although most research provides
little in the way of evidence-based prevention and intervention strategies
for addressing psychological needs after terrorism events, this should not
prohibit action. The committee offers suggestions for prevention and re-
sponse strategies based on what is known about responses to disasters,
the small but growing body of evidence pertaining to psychological con-
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12 PREPARING FOR THE PSYCHOLOGICAL CONSEQUENCES OF TERRORISM
sequences of terrorism, and reasonable assumptions regarding ways to
promote and protect the public's mental health. It is noted that many of
these proposed strategies lack evidence of efficacy but represent the
present consensus of experts. A substantial need is to evaluate the efficacy of
each of these interventions.
Adaptation of the Haddon Matrix to the psychological consequences
of terrorism offers a useful way to organize and categorize components of
societal infrastructure for prevention and intervention. Using the matrix
as a base for organization, a range of issues is highlighted in Table ES-2
that will warrant attention in response to a terrorism event and represent
considerations for prevention and intervention at each phase of an event.
The pre-event, event, and post-event phases of the strategy also corre-
spond to the Department of Homeland Security's emergency management
program of preparedness, mitigation, response, and recovery. The com-
mittee has added to the Haddon Matrix an additional dimension within
each cell to reflect interventions at the biological physical, psychologi-
cal, and sociocultural levels. A full discussion of points listed in Table ES-
2 are provided in Chapter 4 of the report. Many of the strategies cover the
ten functions listed as necessary for an adequately prepared infrastruc-
ture and address the five areas identified as gaps (coordination of agen-
cies and services, training and supervision, public communication and
dissemination of information, financing, and knowledge- and evidence-
based services).
Factors related to the terrorist and injurious agent are not addressed
in this report but are discussed in other National Research Council re-
ports (see Discouraging Terrorism: Some Implications of 9/114 and Terrorism:
Perspectives from the Behavioral and Social Sciences5 ). The intent of illustrat-
ing these features here is to offer a comprehensive representation of fac-
tors that will warrant an integrated analysis by those managing the di-
verse systems that ensure the nation's health and safety. The committee
also presents this comprehensive perspective to illustrate the point that
addressing the public's psychological needs is critical to general terrorism
preparedness and response.
The example public health strategy is offered to help organize and
categorize known and hypothesized interventions. It is proposed as a ba-
sic plan from which more detailed and tailored plans can be derived to fit
the variety and complexity of terrorism events that may arise. Methods to
achieve these plans and strategies for coordinating systems will need to
be tested and evaluated. It is hoped that the committee's plan will stimu-
4 National Research Council. 2002a. Smelser NJ, Mitchell F. Editors. Discouraging Terror-
ism: Some Implications of 9/11. Washington, DC: The National Academies Press.
5 National Research Council. 2002c. Smelser NJ, Mitchell F. Editors. Terrorism: Perspectives
from the Behavioral and Social Sciences. Washington, DC: The National Academies Press.
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EXECUTIVE SUMMARY
13
late further development and investigation of elements that will provide
the necessary framework for effective planning and response to protect
the public's health during the ongoing war on terrorism.
The committee finds that management of the psychological consequences of
terrorism (and similar community events) is a pressing public health issue. Psy-
chological interventions are neededfor the pre-event, event, and post-event phases
of terrorist attacks. Such interventions are necessary to address potentially af-
fected individuals and populations, the injurious agents, and the physical and
social environment, as identified in the committee's example public health strat-
egy. The nation's present mental health system is an essential, but inadequate,
resource to meet all the expected needs.
Recommendation 4-1: HHS and the Department of Homeland Secu-
rity should analyze federal, state, and local preparedness for terror-
ism to ensure that the nation's public health infrastructure is pre-
pared to adequately respond to the psychological consequences
across a continuum of possible terrorism events, including weap-
ons of mass destruction. The committee's example public health
strategy should serve as a base from which components of the infra-
structure are evaluated.
Recommendation 4-2: Federal, state, and local disaster planners
must address psychological consequences in their planning and
preparedness and in their response to pre-event, event, and post-
event phases of terrorist attacks. Consideration should be given to
needs associated with different types of terrorism events and to
needs for various segments of the population. Adequate federal,
state, and local prioritization and funding of resources and support
should be provided to ensure psychological preparedness and re-
sponse.
The committee concludes that the infrastructure responsible for pro-
tecting the public's health is unprepared to meet the psychological needs
that will result from a terrorism event and the ongoing threats of terror-
ism and, furthermore, that the public's mental health must be a central
part of the nation's efforts to protect against and counter terrorism. The
committee's public health strategy, as outlined in Table S-2, is devised as
a strategic vision for assessing the completeness and effectiveness of
plans to address the consequences of terrorism. Comprehensively ad-
dressing the physical, psychological, and sociocultural needs of the popu-
lation will help to achieve the desired end result that is, the mitigation
of adverse psychological consequences, facilitation of growth and em-
powerment, minimization of disruptions to daily life, and enhanced com-
munity cohesion.
OCR for page 14
OCR for page 15
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18 PREPARING FOR THE PSYCHOLOGICAL CONSEQUENCES OF TERRORISM
Representative terms from entire chapter:
terrorism events
