"Nothing could have prepared us for this," says Steven Crimando, a mental health clinician and educator for UMDNJ’s University Behavioral HealthCare (UBHC). He specializes in traumatic event response and has provided care for people affected by a number of disasters, including Hurricane Floyd in 1999 and the crash of TWA Flight #800 off the coast of Long Island in 1996. Cramando also was a consultant on the Oklahoma City bombing.

"What happened on September 11 is termed a disaster of human intention, which was brought about by purposeful acts of violence," he explains. "It affected people on so many different levels. Even as a mental health professional, it was hard to grasp that thousands of people were murdered in the span of one hour."

Mobilizing the Caregivers

Within 10 minutes of learning that an airplane had crashed into the World Trade Center Christopher Kosseff, president and chief executive officer of UBHC, contacted his senior management to discuss how UBHC should respond.

"At that point we thought we were dealing with an airplane disaster; we did not know the complexity of the tragedy that was to come," he recalls.

As the events unfolded over the next hour, Kosseff and the others realized that the disaster plan that UBHC has in place at all times would not be adequate. Although the University’s behavioral health services division is prepared to help people cope with a variety of disasters, from floods and hurricanes to bus accidents and explosions, there is no blueprint for responding to a disaster of this magnitude.

Kosseff’s first step was to open the phone lines of UBHC’s Access Center in Edison. Under normal circumstances, callers to the 24-hour Access Center are screened by mental health professionals and can schedule appointments at one of UBHC’s 20 outpatient offices throughout the state.

"I knew that I would need every one of our 25 desks filled to answer calls," recalls Karen Marcus, LCSW, director of the Access Center. "We brought in extra clinicians from other offices because we expected that many people would want to use the Access Center as a hotline."

Starting September 12, 1-800-969-5300 appeared in newspaper ads and flashed across television screens.

When there was still hope of finding survivors, many of the callers asked for information about how to locate someone. Other callers were survivors who were having symptoms of post-traumatic stress disorder and didn’t know how they were going to handle going back to work. Some were older people who began experiencing memories of the air raids of World War II. One caller was distraught over being displaced from her home in Battery Park City.

"Many callers were anxious, depressed, and having trouble sleeping, and they just wanted to talk," says Marcus.

Over the first five days, she and her team took 500 calls related to the disaster. By September 27, that number had reached 785. By the beginning of October, the Access Center was still receiving about 20 calls a day related to the disaster.

Many callers to the Access Center wanted to talk with others experiencing the same emotions, and so they were directed to group therapy sessions set up at 11 of UBHC’s outpatient centers in convenient locations throughout the state. Since September 11, the centers have offered free grief and anxiety counseling with no appointments needed. About 100 adults and children came to the centers for help within the first two weeks following the tragedy.

Caring for the Front Line

UBHC also sent mental health clinicians to Liberty State Park, Newark’s Marriott Hotel, ground zero itself, and the Jacob Javits Center in New York City, to provide crisis intervention and debriefing to 765 rescue workers, survivors of the attacks on the World Trade Center, construction workers involved in the clean-up, families of the missing, Port Authority workers, and others, including the people responsible for security checks on flight #93, which crashed in rural Pennsylvania after being hijacked from Newark Airport.

Training Others to Administer Support

UBHC also handled numerous requests from schools, churches, and other organizations that asked for guidance to assist those who came to them for answers. From September 12 to 17, Steven Crimando trained 656 teachers, school counselors, clergy persons, and other professionals to help children and adults cope with what he says "was something so devastating that no degree of psychological preparation was possible."

"We had four airliners turned into weapons of mass destruction that were aimed not just against buildings but at innocent human lives," says the man who has trained thousands of people in violence prevention, compassion fatigue (care for the caregivers), and disaster mental health. He is also volunteering at the Family Assistance Center that has been set up at Liberty State Park to provide victims’ families with one-stop convenience so they can file missing persons reports, provide DNA evidence of their loved ones, and use on-site crisis counseling services.

"It’s heartbreaking," says Crimando, "to see all the young widows pushing baby strollers. You’d think they were waiting for a baby sale at Macy’s, but instead they’re waiting to file for death certificates for their missing husbands."

Crimando says that it has been estimated that out of the approximately 5,000 people who perished in the rubble of the World Trade Center, almost half were New Jerseyans, and that people in the state – and the entire nation, too – will be experiencing the psychological effects of the tragedy for many years to come.

"Studies have shown that after a natural disaster the number of people seeking psychiatric services typically goes up about 20 percent for about five years," he says. "After Oklahoma City, which was also a disaster of human intention – the number rose to 50 percent. With the September 11 disaster, we have no model to go by. We expect a dramatic increase in the need for mental health services, so we will need to prepare our mental health professionals to be addressing the issues raised by this tragedy for at least the next five years."

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