Mental Health Services for Survivors of Mass Violence

Nearly one sixth of the world's population has experienced mass violence, be it abducted Ugandan children who are forced to commit atrocities against their families and serve as child soldiers or Iraqi civilians who daily live with bomb blasts, killings, and sectarian violence.

More than 1 billion persons today have been affected by the experience of war, ethnic conflict, torture, and terrorism, according to Richard Mollica, MD, MAR, director of the Harvard Program in Refugee Trauma (HPRT). Created in 1981 and administered by Massachusetts General Hospital, HPRT has since then cared for more than 10,000 survivors of mass violence and torture.

"Some 25 years ago we were not optimistic that people who had been through extreme violence or torture could recover. Twenty-five years later, the answer is yes, they can and they do," Mollica said, adding that the most up-to-date thinking on approaches to diagnosis and treatment are described in his recent book, Healing Invisible Wounds: Paths to Hope and Recovery in a Violent World(Harcourt, 2006).

Project 1 Billion
To assist survivors of mass violence on a global scale, Mollica, who is also professor of psychiatry at Harvard Medical School, worked with health representatives from a number of affected countries with the goal of producing a science-based, culturally adaptable, and sustainable plan to serve the mental health needs of traumatized populations. The group met in Rome in 2004 and endorsed the Project 1 Billion Mental Health Action Plan (accessible at: http://www.hno.harvard.edu/press/pressdoc/supplements/mentalhealth.pdf) and the science-based Book of Best Practices, to be published by Vanderbilt University Press this year.

Part of this effort was to create a training program to develop a network of global leaders in mental health recovery. The program includes on-site learning in Italy with international experts followed by 5 months of Web-based learning in the students' home countries. Educational and service efforts work with local primary health care systems, traditional healers, and national and international nongovernmental organizations (NGOs). One of the NGOs that has been providing significant support is the Peter C. Alderman Foundation.

Alderman Foundation
The foundation was started by Elizabeth Alderman and Stephen Alderman, MD, after their 25-year-old son, Peter, was killed on September 11, 2001, while attending a technology conference at the World Trade Center.

"We felt we needed to do something to honor Peter's memory, but we really didn't have a clue," said Liz Alderman. "One night I happened to catch a Nightline broadcast about walking wounded victims of terrorism and violence around the globe. It featured Dr Richard Mollica and the [HPRT], and I felt this was the perfect thing for us to become involved in. Peter was killed because of terrorism, and if we could do something to help the people who survived the events but were still unable to live their lives because of their emotional wounds, this would be the perfect memorial for him." They contacted Mollica and 10 days later they met with him.

"I asked the Aldermans if they would fund a master class to train people from postconflict and conflict countries," said Mollica.

To support Mollica's vision, the New York couple formed the Peter C. Alderman Foundation, endowing it with $1.6 million from compensation funds given to 9/11 families, Peter's estate, and their own money.

Master classes train leaders
The first master class to train global leaders in mental health recovery was held in 2003, and 3 have followed. Participants, mostly primary care physicians, come from countries such as Bosnia, Iraq, Afghanistan, Cambodia, Chile, Uganda, and Indonesia. They spend a week in Ovieto, Italy, where they brainstorm about their field experiences, receive training from trauma psychiatry experts, and are supplied with a comprehensive package of training materials called the "toolkit."

The toolkit, developed by HPRT after September 11, includes 11 steps for clinical care of trauma survivors; 2 standard assessment instruments used in the United States (the Hopkins Symptom Checklist 25 and the Harvard Trauma Questionnaire); and discussions of scientific issues and psychotropic drugs for victims of trauma.