Testimony & Statements
AAGP’s Statement on Psychological Trauma Caused by Terrorism
Statement to the Senate Committee Health, Education, Labor, and Pensions on Psychological Trauma Caused By Terrorism
October 2001
The American Association for Geriatric Psychiatry (AAGP) commends the Committee on Health, Education, Labor, and Pensions for its prompt response to the recent terrorist attacks by holding a hearing on the psychological trauma caused by terrorism. AAGP welcomes the opportunity to share its views on this important issue. AAGP is a professional membership organization dedicated to promoting the mental health and well-being of older Americans and improving the care of those with late-life mental disorders. AAGP membership consists of over 2000 geriatric psychiatrists as well as other health professionals who focus on the mental health problems faced by senior citizens.
The horror of the recent attacks affects all individuals and, while many will be able to cope and not suffer long-term effects, there are many who will need professional help in dealing with the psychological trauma on an extended basis. Senior citizens may feel particularly vulnerable and should not be neglected at this time of crisis. Older Americans who are isolated, dependent, previously traumatized or have physical or mental disorders are at risk for suffering anxiety, depression and acute stress syndrome as a result of these terrifying acts. For some seniors the events of September 11 may resurrect memories of past losses and cause them to relive their grief. They may have feelings of fear, sadness, and uncertainty.
There are many actions that seniors, their family members and caregivers can undertake on their own to address symptoms of psychological distress and for most these will be sufficient. However, for some, a stress reaction can become pathological and lead to suicidal thoughts, aggressive acts, alcohol or drug abuse, social isolation, or failure to return to social responsibilities. Individuals expressing such behavior need to be under the care of a psychiatrist, preferably one that is experienced in treating older adults. Early intervention can prevent prolonged disability.
It is unfortunate that policymakers often fail to address social needs adequately until something of a catastrophic nature highlights the problem. Before the events of September 11, Congress had been considering some very critical pieces of legislation intended to address barriers to adequate mental health treatment in the United States. Enactment of these measures are even more critical now, as the number of persons requiring mental health treatment is likely to be much greater.
One of the most important pieces of legislation under consideration relates to requiring parity for mental health benefits under private sector health benefits plans. Today, many health plans discriminate against those with mental disorders by requiring patients to pay higher coinsurance for mental health services, covering fewer office visits, or shorter hospital stays, and/or applying higher deductibles before coverage begins. AAGP has submitted testimony to this committee previously on its strong support for eliminating all such discriminatory treatment for Americans with mental illness, in all types of health insurance programs, public as well as private. Mental health treatments should be placed on an equal footing with physical health treatment in health insurance coverage so that patients may receive the most appropriate treatment for their disease instead of treating those symptoms for which coverage is most generous. Research shows, for example, that older persons seeking care for common medical problems have more visits to their primary care physician, use more medications, and are more likely to have emergency room or hospital care when their problem is accompanied by depression or another emotional disorder. Indeed, evidence suggests that parity in coverage for mental health treatments might reduce, rather than increase, health care expenditures. Better access to mental health care also averts broader, societal costs resulting from reduced productivity and increased disability. In the aftermath of the terrorist attack on the U.S. on September 11, many individuals, including many of our senior citizens, will be experiencing stress related to the events and will find barriers to appropriate treatment unless parity is established. Therefore, we urge Congress to not only act on the legislation establishing parity in private mental health coverage as soon as possible, but, even more importantly for our senior citizens, to also establish parity for mental health treatment in the Medicare program.
To adequately deal with the effects of the recent tragedy as well as being prepared for future such events, AAGP believes the nation must address mental health as part of a comprehensive public health strategy. Such a strategy must include assuring citizens of adequate coverage for mental health disorders, coordinated community efforts to respond in times of distress, and strategies to identify high risk individuals for preventive and early intervention activities. Congress should acknowledge this need by providing funds in the FY 2002 Labor/HHS appropriations act to support the development of a national mental health care infrastructure in communities across the nation. Federal funds should be made available through the Center for Mental Health Services for communities to establish the necessary systems that can be mobilized in times of crisis to identify those at high risk and provide appropriate interventions.
It is the sincere hope of AAGP that Americans will never again be exposed to events as traumatic as those of September 11. However, we recognize that traumatic events may well occur in the future and the nation must be prepared to meets the needs of its citizens when they do. An adequate and appropriate strategy for meeting our mental health needs must be part of any national security strategy.
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