Mental Health During the COVID-19 Pandemic: Lessons Learned from 9/11

A couple of weeks ago we discussed an article that took a look at the most common psychological impacts associated with global health outbreaks. This week, we will be discussing a similar topic. In an article published just a couple of weeks ago in the Journal of Psychiatry Research, authors DePierro, Lowe, and Katz highlight parallels between the mental health needs that were required by 9/11 first responders and the needs of first responders involved in the current COVID-19 outbreak.

Similar to our previous blog post, instead of discussing the study methodology, we are going to summarize the author’s conclusions.

The authors highlight how several of the lessons learned from the mental health response to 9/11 can be used as guidelines to meet the needs of those who are/will be affected by COVID-19. To address those key points, the authors break down their discussion into 4 categories (prevention, short-term treatment needs and barriers, long-term monitoring and treatment, and vulnerable populations).

• Prevention: In terms of prevention, the authors highlight that efforts should be made to ensure that the exposure to trauma of healthcare workers in hospitals is monitored. They explain that much of the trauma endured by 9/11 responders may have actually become worse due to a lack of adequate monitoring. To combat the effects of exposure, the authors suggest social support as a primary protective factor for healthcare and other front-line workers during the COVID-19 outbreak. 

• Short-term treatment needs and barriers: Following 9/11, there were significant issues among mental health providers trying to secure space to see patients. During the current outbreak, with most individuals confined to their homes, a similar issue is arising. Thankfully, modern technology provides a relatively simple solution to this problem. The authors highlight the effectiveness of tele-health based supportive mental health services, including support groups, individual therapy, and crisis lines. As a barrier to treatment access, the authors explain that many individuals may not make use of these services due to mental health stigma, denial, dissociative defenses, conflicting time demands, or general discomfort with emotional disclosure. This barrier was overcome during 9/11 by integrating mental health professionals with medical professionals, a likely solution in the current state, as well. 

• Long-term health monitoring and treatment: As stated by the authors, “The mental health treatment of World Trade Center rescue, recovery and cleanup workers has highlighted the need for long-term monitoring of COVID-19 pandemic survivors, healthcare workers, and other essential personnel.” As we’ve discussed many times, without procedures put in place that explicitly track treatment progress, it is a likely possibility that many individuals could slip through the cracks and will experience chronic mental health consequences that may go unaddressed.

• Vulnerable populations: Here, the authors focused on 2 primary populations: 

First, is the population of healthcare workers. Healthcare workers, even without the presence of a global pandemic, are at baseline considered a vulnerable population due to working in a high stress environment. These individuals are more likely to exhibit high rates of post-traumatic stress disorder (PTSD), clinical depression, and recurrent alcohol use problems. Now, these workers are on the front-lines of the COVID-19 pandemic, resulting in an elevated risk to experience such outcomes. 

The second group is that of non-medical “essential personnel.” This concern, as the authors explain, arises again from parallels to the 9/11 experience. Non-traditional 9/11 responders have consistently higher rates of chronic PTSD than uniformed responders. The authors also highlight the vulnerability of this group, such that these individuals typically do not have any disaster response experience, but are still often tasked with taking on responsibilities that are far outside the scope of their actual expertise. 

Concluding Thoughts

As we continue to battle this global pandemic, it will be important for us to remain several steps ahead of potential downstream negative impacts. The authors provide a really nice framework to help us think more critically about how to prospectively create a supportive mental health system for those who are/will be affected by the COVID-19 outbreak. We must continue to work together and leverage available resources to meet the needs of these individuals. Certainly, 19 years after 9/11, our technological capabilities have become more advanced and we can/should lean on technology as a way to provide assistance and support to anyone and everyone who is affected.