May 2005 · Volume 87 · Number 4 

Coping with Community Trauma
by Marilyn Hajer and Mary Walsh
"When we began to develop our city's safety plan, we realized that whole communities can be traumatized. Multiple incidents, such as violent crimes, can cause whole neighborhoods to be in a state of shock. Neighborhood residents were telling us that they needed to build coping strategies and ways to heal," says Manjit Jheepa, manager of Toronto, Canada's community safety secretariat. As a result, the city is now eight months into developing a community crisis response program. 
The continuum of psychological reactions to a traumatic event ranges from brief stress reactions that get better by themselves to the full-blown post- traumatic stress disorder, which can have severe and long-lasting symptoms. 
We don't have to look far to understand the growing awareness of the need for community-wide crisis intervention in dealing with the psychological traumas that can affect citizens of an entire town or region. These days, 24-hour media and Internet coverage brings all sorts of deep, anxiety-producing events directly into our living rooms: actual and threatened terrorist attacks, civil unrest, war, violent crimes, sexual abuse cases, extreme-weather tragedies, multi-accident vehicle fatalities, and more. And in the need for homeland security, there continues to be a new emphasis on the community-wide impacts of disasters.
Defining and Understanding Trauma
A traumatic event is one that can potentially destroy a victim's fundamental assumptions about the safety of the world and produce feelings of deep fear, horror, and grief. In the presence of such an event, people are temporarily overwhelmed. In the most extreme events, nobody is immune from serious psychological trauma, sometimes lasting years.
It's estimated that 10 percent of Manhattan residents and at least 4 percent of people around the United States suffered serious emotional reactions after the September 11 terrorist attacks. "The South Asia tsunami recovery," notes Dr. Richard Ottenstein, chief executive officer of the Workplace Trauma Center in Owings Mills, Maryland, "will not be measured in days, weeks, months, years, or even decades, but will take generations. The impact will remain within the affected nations' legacies for possibly centuries."
Living with potential disasters like terrorist threats or the mounting evidence of climate change can also cause feelings of intense fear and helplessness. "We have no idea what the psychological effects might be if it becomes clear that we have triggered the melting of the Greenland ice sheet and that we cannot stop it," observes Lester Brown, president of the Earth Policy Institute.
The continuum of psychological reactions to a traumatic event ranges from brief stress reactions that get better by themselves to the full-blown post-traumatic stress disorder (PTSD), which can have severe and long-lasting symptoms. Specifically, PTSD is an anxiety condition that can exist in different intensities and for different durations of time. It can develop immediately after a traumatic event or have a delayed onset at least six months after the event, sometimes years later. 
Local Government's Role
Mental health workers have long recognized the symptoms of post-traumatic stress. And with a better understanding of psychological trauma, local government managers can also more effectively prepare now for citizens' needs during and after a critical incident.
Local governments like Toronto, Ontario, are taking a serious look at how to strengthen communities shaken by tragedy and empower neighborhoods to deal with grief and anxiety. But how exactly can local governments deal with widespread trauma? "We need a new model of crisis intervention that includes whole communities and helps those communities build their own capacity for handling trauma," offers Jheepa.
One of the first steps in developing an effective program for community trauma response is to recognize the seriously stressful nature of disasters and the long-lasting mental health problems that can afflict large numbers of citizens. "Organizations must realize that trauma happens," says David Wee, disaster mental-health coordinator for the city of Berkeley, California. "Jurisdictions already include trauma management as part of their employee assistance programs, but they also need to think about the trauma needs of the wider community," observes Wee.
Fast Facts About Post-Traumatic Stress Disorder (PTSD) 	
•	PTSD can develop after a person is exposed to actual or threatened death or serious injury to themselves or others. 
•	PTSD symptoms include intrusive flashbacks of the trauma in which the victim relives the experience, acting as if the event were recurring. Other symptoms include hypervigilance, emotional numbness, depression, intense fear, helplessness, confusion, and poor concentration. 
•	More than 5 million Americans between the ages of 18 and 54 are diagnosed with PTSD. 
•	67 percent of those exposed to mass violence have been shown to develop PTSD. 
•	People who have experienced a previous trauma have a greater risk of developing PTSD after a later event. 
•	PTSD symptoms usually begin within three months of a traumatic event. 
•	In some cases, years can go by before symptoms appear. 

Source: Adapted from the Web site of the Anxiety Disorders Association of America (www.adaa.org/AnxietyDisorderInfor/PTSD.cfm). 	
That's what Captain James Nelms of the Henry County (Georgia) Fire Department needed to do when a freight train carrying deadly chlorine gas derailed in Graniteville, Georgia, this past January, causing the displacement of more than 5,400 residents. Nelms spearheaded the county's briefings on critical-incident stress-management response and provided some level of crisis intervention services to more than 2,000 people.
Said Nelms, "A veteran child therapist, who assisted at one of the briefings, offered to me that seeing the clinical director from the mental health center on stage with a variety of other community leaders made her profession seem like a normal part of the response to this local disaster, perhaps for the first time in her career."
As part of this emphasis on the importance of dealing with community-wide trauma, local and state governments are including strategies for handling this possibility as an integral part of their emergency preparedness operations.
A Brief History of PTSD 	
In the mid-1890s, Sigmund Freud, a Viennese psychoanalyst, developed his theory of hysteria, in which he described the traumatic stress of his female patients who had been sexually abused as children. 
About 20 years later, "shell shock" from psychological trauma was diagnosed in soldiers who had suffered atrocities in World War I. These men exhibited the same symptoms as Freud's hysterical women, including uncontrollable crying, emotionally frozen and numb reactions, memory loss, and mutism. 
During World War II, studies of combat neurosis received further attention from American psychologist Abram Kardiner. Findings indicated that any soldier could develop traumatic stress depending on the severity and duration of exposure to combat.
In the 1970s, Vietnam veterans returned home angry and demanding attention. Their self-advocacy resulted in a legal mandate for mental health treatment programs to address their psychological trauma. At the same time, the women's movement was gaining its own voice, and disclosures by rape survivors of sexual assaults were reported and discussed in the media. Early research of Vietnam vets' and rape survivors' experiences showed that the psychological aftereffects for the two groups were similar.
In 1980, this research became the foundation of a formal diagnosis called post-traumatic stress disorder (PTSD), which the American Psychiatric Association has included in its official manual of psychiatric disorders.
Source: Adapted from Trauma and Recovery by Judith Henry. 1992. Basic Books, pp. 74-75.	
For example, tornado-prone Tulsa, Oklahoma's widely recognized disaster response program includes such a strategy as an important element in its plan. "A successful and unique part of our program is the attention the city and its partners have paid to the community-wide trauma associated with disasters," says Tim Lovell, public/private program manager of the Mayor's Citizen Corps in Tulsa.
Tulsa's focus on developing a mental health disaster response model had its roots in the 1991 Gulf War. At that time, a large number of military families were hard hit by the stresses of the war. The city formed the Tulsa Human Response Coalition (THRC) to coordinate community support groups working with the community's military families. The coalition now has a Mental Health Rapid-Response Team ready to be dispatched at a moment's notice. Members of the team are fully licensed mental-health professionals who have received critical-incident stress training.
This past January, the Tulsa Human Response Coalition held its second annual "tabletop disaster simulation" exercise. More than 75 participants from 50 agencies engaged in the mock response to a disaster scenario involving a "dirty bomb" detonation in Tulsa's downtown civic center.
Resources 	
This list contains some, but by no means all, of the organizations offering information and support for local government managers wanting to incorporate trauma stress management into their communities' emergency management plans.
American Academy of Experts in Traumatic Stress
www.aaets.org
American Red Cross
Building a Disaster-Resistant Neighborhood Program
www.tallytown.com/redcross/drn.html
Anxiety Disorders Association of America
www.adaa.org
The International Critical Incident Stress Foundation, Inc.
www.icisf.org
Critical-incident stress management (CISM) has been developed for mental health workers and emergency service workers to deal with psychological trauma victims. For a concise explanation of CISM, see A Primer on Critical Incident Stress Management by George Everly and Jeffery Mitchell, available on the International Critical Incident Stress Foundation's Web site. CISM is currently being carefully scrutinized for its effectiveness, especially when victims are brought into CISM sessions before they may be ready and when the session is administered by people who are not trained properly.
International Trauma Studies Program
New York University
www.nyu.edu/trauma.studies
National Center for PTSD
www.ncptsd.va.gov
National Organization for Victim Assistance (NOVA)
www.trynova.org
National Hazards Center
www.colorado.edu/hazards
Clearinghouse of knowledge concerning the social science and policy aspects of disasters.
Workplace Trauma Center
www.workplacetraumacenter.com	
Responders were organized into staging areas and formed a rapid-response team to address issues arising immediately after the incident, two days out, and two weeks out. Developments ranged from exposure to radiation to backlash against multicultural/multifaith groups, questions of water quality, evacuation of the emergency operations center, and coordination of mental health resources.
"We were extremely pleased with the way the group handled the exercise," says THRC Coordinator Carrie Wiggs. "The communication and collaboration between work groups was exceptional. Mental health responders were considered an important component of the exercise." (For more information on the Tulsa program, readers can e-mail Carrie Wiggs at cwiggs@csctulsa.org and can visit the Web site at www.citizencorpstulsa.org.)
Involving Neighborhoods
Another important step that local governments can take in dealing with community trauma is identifying ways that neighborhoods can handle traumatic events and develop resiliency in the aftermath of a disaster.
Toronto's community crisis response program tries to do just this. "We need to build competencies within neighborhoods. However, if we have communities playing a role in crisis intervention, we need to figure out what that support looks like," says Jheepa. As part of this effort, the city's community crisis response program is asking such questions as: What does healing look like for multicultural neighborhoods? What are the cultural competencies for dealing with trauma? How do we attract and keep volunteers? What are the city's liabilities?
Just now, the Toronto program is considered a work in progress. (For further information on Toronto's program, call Michelle Munroe at 416/392-8697.) Key elements of the program include:
•	Coordinated community crisis network. Key service providers come together to develop a crisis response protocol, coordinate services, and furnish community-wide education and training. 
•	Neighborhood crisis response support. In partnership with the community crisis network, this part of the program works with neighborhood associations and community-based agencies to develop neighborhood crisis response teams. 
•	Crisis funding. Monies are made available as one-time financial assistance for initiatives that address neighborhood crises or for establishing neighborhood crisis teams. 
Community training is also a big part of the city of Berkeley's efforts to offer critical-incident mental health support for neighborhoods. Curriculum in handling trauma has been offered on a community-wide basis since 1983. "After September 11, we recognized that we needed to train people throughout city government to provide stress management assistance. Our mental health team was stretched too thin," observes Wee.
Long-term mental health followup is also a hallmark of the Berkeley program. "We provide multiple programs to address traumatic stress. During the East Bay firestorm in 1991, we provided trauma and stress support for 16 months after the incident," notes Wee. (For additional information on the Berkeley disaster mental health model, send e-mail to David Wee at dwee@ci.berkeley.ca.us.)
Conclusion
Rudolf Giuliani explained his disaster management strategy in the aftermath of the September 11 attacks on the World Trade Center by stating succinctly, "We plan for the worst, and hope for the best." Local governments around the United States and Canada are taking this approach to emergency preparedness by designing mitigative strategies to alleviate the impacts of future disasters.
As part of this effort, some local government officials are now thinking ahead to include community-wide emotional trauma management as a way to protect citizens from the short- and long-term psychological impacts of community-wide disasters.
Marilyn Hajer, LICSW, is a psychotherapist in private practice in Brookline, Massachusetts (Mbhajer@aol.com). Mary Walsh is director of the Climate Change Learning and Information Center, Falmouth, Massachusetts (Cclic@aol.com). She is a former city administrator and coauthor of the ICMA IQ Report Crisis Communication for Local Government Managers.