Disaster Psychiatry: Lessons From 9/11 and COVID-19

On September 11, 2001, Craig Katz, MD, had begun as director of the psychiatric emergency service at Mount Sinai in New York City just 1 week earlier. He was in morning rounds when a colleague called and told him to turn on the television. That day's rounds were canceled, and instead convened an impromptu session on acute trauma response, a topic Katz said he had never been formally trained on. But contrary to expectation, patients did not present to the main emergency department that day. Exposure came instead through fieldwork: Katz’s group Disaster Psychiatry Outreach ultimately coordinated approximately 300 psychiatrists at Ground Zero and the family assistance center, where clinicians conducted informal debriefs with colleagues coming off shift.

The attention 9/11 drew to mass trauma reshaped views on formal group interventions. Katz said the period highlighted that "a strict model of making people speak and making people share and doing it in a group is not necessarily helpful and could be harmful."¹

Katz distinguished disaster psychiatry from reactive, clinic-based care. "As a mental health professional, you have to be proactive. It really has to be outreach oriented," he said, noting that people affected by mass trauma typically focus on safety, employment, grief, and spiritual needs rather than psychiatric treatment.² During the COVID-19 pandemic, this meant sending teams from Mount Sinai directly into high-pressure units, including intensive care units and emergency departments, to check on staff rather than waiting for them to seek care.

Katz framed disaster response as inseparable from community psychiatry, since a person's pre-event mental health history and prior trauma exposure shape how they respond to a new traumatic event. The most effective disaster psychiatry, he argued, starts with strong, consistent day-to-day psychiatric care, since far more people are affected by the traumas of daily life, including motor vehicle accidents, muggings, sexual assault, and violence, than by large-scale disasters. Broader access to trauma-informed clinicians and mental health care, Katz said, would leave the field better prepared for future mass trauma events and yield a mentally healthier population overall.

Dr Katz is a psychiatrist at the Icahn School of Medicine in New York City.

References

1. Rose SC, Bisson J, Churchill R, et al. Psychological debriefing for preventing post traumatic stress disorder (PTSD). Cochrane Database Syst Rev. 2002;(2):CD000560.

2. Hobfoll SE, Watson P, Bell CC, et al. Five essential elements of immediate and mid-term mass trauma intervention: empirical evidence. Psychiatry. 2007;70(4):283-315.