Are Insurers Prepared for the Mental Health Fallout?

Published December 1, 2001

Throw out all the studies on the psychological effects of a national disaster that were conducted prior to September 11, 2001, says child psychiatrist Dr. Barry Herman, an executive board member of the National Coalition for Mental Health Professionals and Consumers.

“Get braced for the unknowable,” warns Herman. “Mental health professionals, especially those who work with children, should be prepared to deal with an epidemic of significant stress reactions.”

Health insurers are already noticing an increase in the number of requests they normally receive for mental health services, particularly in New York and New Jersey, according to Erin Somers, a spokesperson for Magellan Health Services, a managed behavioral health care company. In response, companies like Magellan have made their employee assistance counseling and “critical incident” stress management programs available to help its employees and their families deal with the terrorist attacks.

Are We Prepared?

But are insurers really prepared for the mental health fallout from September 11? Karen Shore, founder and past president of the National Coalition for Mental Health Professionals and Consumers, doesn’t believe so. “People had a hard time getting mental health treatment before September 11,” she says.

With its phantom networks (an HMO network that lists doctors who are not taking new patients) and treatment limits, Shore says “the managed care system is an affront to mental health patients.” She warns that the terrorist attacks are not likely to change that any time soon.

But health plans are sensitive to the criticisms being leveled at them, says Leslie Moran, the spokesperson for the New York Health Plan Association. “Health plans are extremely sensitive to the needs of the public right now,” she says. “They’re making an extra effort to avoid making it difficult for their members who need help.”

Nation Was Raped

According to Herman, there is no precedent for this kind of disaster—which is precisely why it’s impossible to predict how the psychological aftershocks may evolve. “Time is usually a healer,” he says, “but if more bombs go off, it will just revivify the experience.”

Herman says that following the attacks, people exhibited some of the same reactions as victims of rape, including hyper-vigilance (increased awareness of one’s surroundings), depression, and sleeplessness. “It’s the classic rape response,” says Herman. “This was the rape of our country.”

According to Dr. Robin Dea, chairman of the chiefs of psychiatry for Northern California Kaiser Permanente, the attacks were certainly a personal violation to Americans’ sense of security and safety. “We have been violated in the same way that we were violated at Pearl Harbor, or when John F. Kennedy was assassinated,” she says. “It was the very shock of it happening on our own soil.”

The initial numbers have been sobering. Shore says an estimated 15,000 children have lost one or both parents in the attacks. And according to the Pew Charitable Trust, a nonprofit public policy philanthropy, in the wake of the terrorist attacks:

  • Seven out of 10 Americans have felt depressed.
  • Nearly one in two have had trouble concentrating.
  • One in three have had difficulty sleeping.
  • One-fifth knew someone who was killed, injured, or is still missing from the attacks, or have a friend or relative who does.

Make no mistake about it, says Shore, “there will be more substance abuse, gambling, and other addictive behaviors as people try to anesthetize the pain. In particular, people in New York City are still going to funerals—sometimes dozens of them. You can’t keep doing that and not be affected.”

Private Sector Responds

Many health insurers, particularly those in New York and New Jersey, have responded by loosening treatment caps. According to Moran, Oxford Health Plan has extended by 10 the number of mental health visits a member may make by December 31, 2001.

But Shore says she is concerned about the long term. “There is a great outpouring of people offering free services right now, but people are still in shock,” she says. “What happens down the road? We’re still seeing Vietnam vets coming into VA hospitals for the very first time to get treatment for post-traumatic stress disorder. It’s, what—35 or 40 years later?”

In the wake of the terrorist attacks, Dr. Dea did a quick survey of five of Kaiser Permanente’s behavioral health care facilities in northern California. She says the facilities all reported receiving an increase in the number of telephone calls from their members who work in the financial services and airline industry. “There were also reports that existing patients would call and, before they could address whatever was the usual topic of conversation, they would want to tell the therapist what effect the tragedy was having on them. A lot of it was, ‘I was generally stable, but this thing has really thrown me for a loop.'”

Time Heals

Dea says the first week after the attack the volume of calls coming in was “barely a trickle.” She says it picked up the second week, but “quieted down again” by the third week. According to Dea, Kaiser held mental health help meetings two or three times a week after the Bay Bridge earthquake in 1989 and had planned to do the same after this disaster, “but the demand hasn’t been there this time.” Dea says she believes people are using other outlets for talking about their concerns, such as friends, employee assistance programs, or clergy.

“As a culture, we’re already seeing things getting back to normal,” Dea says, particularly for those who live outside the areas that were attacked. “We’re already seeing airplane traffic pick up.”

Dea says people should take comfort in knowing their emotional reactions to the tragedy are shared by many others and are, for the most part, what mental health experts would expect. “For the first three to five days, everyone was numb,” she says. “Then we were all glued to our TVs. It was all we talked about. By the third week, we were saying, ‘I have to get away from this. I have to get out, go to a movie.'”

Dea suggests that if you aren’t one of the people who lost a loved one or know someone who did and “you’re still feeling numb, it might be worthwhile to have a [mental health] evaluation.”

Vicki Lankarge writes for, the Consumer Insurance Guide.

For more information . . .

See the article at, “Getting mental health help for kids in crisis is tricky.”