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By Richard Karel
When psychiatrist Neal Cohen, M.D., commissioner of the New York City Department of Mental Health, heard there had been a plane crash the evening of July 17, he froze. Earlier that day his 25-year-old daughter had boarded a flight to Washington, D.C.
"I went limp and immediately started to panic," recalled Cohen. But about 10 minutes later he learned the plane was headed for Europe, hence not his daughter's.
Cohen and others from the department's Mental Health Emergency Response team joined officials from surrounding counties and by early the next morning were providing and coordinating counseling and support for family members of those who had been on the ill-fated TWA Flight 800. From the start, city and county officials coordinated their response with the American Red Cross and the New York State Office of Mental Health.
The team used the Ramada Plaza Hotel at Kennedy International Airport as the crisis center.
Within the first two weeks after the crash, some 150 New York City-based mental health professionals volunteered to assist. At least 20 professionals were scheduled on site each day and 10 each evening, according to Cohen. The majority were brought in by mobil crisis teams from the various jurisdictions, but some showed up on their own.
By the end of the crisis response in early August, 250 mental health care providers had assisted at the crisis center; about three dozen were psychiatrists. The American Red Cross issued a press release lauding the response of local community agencies, including the New York City Department of Mental Health, the New York State Office of Mental Health, Suffolk County Mental Health, Nassau County Mental Health, and the New York State Psychological Association for their role at the Ramada Plaza site.
According to the Red Cross, the agencies will work with the Greater New York, Nassau, and Suffolk units of the Red Cross to provide long-term follow-up mental health care.
Gerard Jacobs, Ph.D., the Red Cross Disaster Mental Health Services officer for the Crash of Flight 800, wrote Cohen a letter in mid-August lauding the New York City Department of Mental Health and other agencies for the support they provided. Jacobs cited the coordinating efforts of Isaac Monserrate, M.S.W., the department's assistant commissioner for crisis intervention services.
One of the biggest boons to families was the setting up of an on-site day care and youth center, according to Monserrate. This allowed parents time to themselves to sort out their own feelings, he noted.
Because there was a dearth of nonpsychiatric physicians, psychiatrists did a substantial amount of general practice medicine in addition to providing counseling and psychiatric medications, Monserrate noted.
Psychiatrists dispensed anxiolytic and sleeping medications but also provided antihypertensive, asthma, and diabetic medications, recalled Cohen. Family members were camped at the center for weeks as the search for bodies continued, cut off from their regular doctors and pharmacists. Providing primary medical care "was definitely a distinct role that distinguished us from the other mental health professionals," said Cohen.
He described the situation that occurred in the days and weeks following the crash of Flight 800 in an August interview with Psychiatric News.
For several days after the crash, there were families arriving "from around the world and around the nation" to the Ramada site, recalled Cohen. TWA provided housing. Within about three days 200 families arrived.
People spent most of their time together in a large ballroom, sitting around tables that seated about a dozen each. Within a short time there developed a sense of "extended families," as those present shared the bond of uncertainty and loss, said Cohen.
All mental health professionals who came to help went through a half-hour crisis orientation program, Cohen said. The orientation included instruction on how to approach families, "how to leave your egos at the door, how not to worry about doing heavy-duty psychological counseling, to perhaps just provide a glass of water" and be supportive, recalled Cohen.
For all those who went to assist, "there was a tremendous experience. . .of sorrow and grief," recalled Cohen. As the families stayed together in the ballroom, there was "a feeling of mutual support that developed among the families themselves, facilitated to some extent by the mental health professionals," Cohen said.
Mayor Rudolph Giuliani came to the crash site as did Governor George Pataki. The mayor personally knew two individuals on the plane and came to the Ramada almost daily, said Cohen. Family members responded very positively to him "and did not feel it was grandstanding," Cohen said.
The recovery of their loved ones' bodies and the determination of the cause of the crash were both high-priority concerns of the families, said Cohen. But "at times there was some tension" between the two as people hungered for closure, he noted.
A visit by President and Mrs. Clinton helped bring closure for some at the center and generally raised morale, Cohen recalled. The President made "a very brief statement to the families in the ballroom" and then stayed for about three hours and talked with people in small groups. Hillary Clinton also stayed and spoke with families and crisis workers.
"Some of the anger about the delay in recovering the victims" was diffused by Clinton's display of empathy, according to Cohen. The anger ebbed tangibly. A number of the families even packed up and went home after the visit, although some still awaited word on recovery of the bodies of family members.
Prior to the visit, some of the family members had "a surreal feeling, that their lives were on hold," said Cohen. Clinton's visit helped them feel that everything possible was being done for them and that they could go home and begin to "get on with it."
(Psychiatric News, October 18, 1996)