America’s Health Together (AHT) has pioneered a groundbreaking partnership among the nation’s leading mental health and primary care organizations to respond to America’s new exposure to homeland terrorism. Fully supported by the Robert Wood Johnson Foundation, this national initiative seeks to enhance primary care providers’ awareness of mental health issues and strengthen their capacity to care for their patients’ emotional and psychological needs.

Why Now?

The events of September 11 unleashed a mental health fallout for which we have no blueprint. As communities continue to adjust to and cope with unfamiliar and unprecedented levels of anxiety and trauma, experts agree that the impact of the terrorist attacks is far-reaching. Initial studies exploring the mental health consequences from September 11 indicate that as many as 500,000 people in New York City alone continue to experience significant stress. However, the ripple effects extend beyond geographic boundaries and beyond the first year anniversary. As the New York Times put it, the “severest cases are slow to show,” leaving us to wonder how different people, with different histories, will fare as time passes and new threats emerge.

While charitable organizations are offering free counseling for people in need, those deeply affected do not always recognize or acknowledge their own troubles. Many Americans continue to suffer from sleep disturbances, anxiety, depression, and other physical symptoms as a result of 9/11, yet they may not associate their symptoms with the trauma they experienced or witnessed. These burdens, however, require attention and help.

The Front Line of Defense: Primary Care

America’s primary health care system is increasingly recognized as the nation’s de facto mental health system. Whether due to the stigma of seeking psychological support or to inadequate benefits, reports reveal that as many as 75 percent of all primary care visits can be attributed to psychosocial problems that manifest in physical complaints. As Americans grapple with a changed landscape, it is to these family doctors, nurse practitioners, pediatricians, general internists and community health clinicians that many will bring evidence of distress or disorder.

Primary care providers’ insufficient time, training and resources to identify and handle psychological problems too often precludes their proper attention. As a consequence, mental health issues in primary care can go undetected and untreated, allowing for acute reactions to evolve into chronic conditions and for the misdirection of health care dollars.

The Solution: An Integrated, Collaborative Model of Care

To address the widespread effects of trauma, our nation’s primary care providers must be prepared to recognize warning signs, collaborate care, and make vital referrals. Here’s how America’s Health Together is leading the way to fill the gaps in mental health care within the primary care setting:

  • Phase One: Doing Our Homework
    AHT has begun gathering expert and anecdotal information about clinical experiences and best practices in managing waves of increased mental health distress. This research includes a literature review; surveys and focus groups with providers; and a convention of national and international authorities on disaster mental health, who have studied the effects of Hurricane Andrew, the Oklahoma City bombing, ethnic conflict in Bosnia and Israel, and other traumatic events. By integrating expert knowledge and first-hand experience, we are making recommendations for helping those affected and charting a course to recovery. At the same time, we are helping these doctors, nurses, and mental health professionals prepare for the possibility of future natural and human acts of violence and destruction.
  • Phase Two: Creating a One-Stop Comprehensive Clearinghouse
    The results of our research will be compiled into a Blueprint Report and disseminated with the help of our partner organizations to practitioners, government, media, and private and public institutions across the country. Our resources include a Web site, printed materials such as fact sheets and newsletters, presentations at professional meetings, and public briefings.
  • Phase Three: Evaluating Our Work
    AHT will follow up by revisiting early findings and making additions as needed. Our final report will address the broader applications for collaborative health care, the treatment of the mental health conditions associated with disasters and terrorism, and the overall integration of mental health into primary care.

The Big Picture

By building strong ties between primary care and mental health, this campaign positions the nation and its primary health care providers to be better prepared for future acts of homeland terrorism and natural disasters and their emotional effects. In addition, the campaign has broad public health implications for understanding mental health in general, reducing its stigma and improving the quality of life of those afflicted.

Partners For Change

American Academy of Child and Adolescent Psychiatry
American Academy of Family Physicians
American Academy of Pediatrics
American College of Nurse Practitioners
American College of Obstetricians and Gynecologists
American College of Physicians
American Medical Association
American Osteopathic Association
American Psychiatric Association
American Psychiatric Nurses Association
American Psychological Association

American Red Cross (consulting partner)
Bazelon Center for Mental Health Law
National Association of Community Health Centers
National Association of County and City Health Officials
National Association of Social Workers
National Hispanic Medical Association
National Mental Health Association
National Mental Health Awareness Campaign
National Organization of Nurse Practitioner Faculties

Robert Wood Johnson Foundation
The Robert Wood Johnson Foundation was established as a national philanthropy in 1972 and today it is the largest US foundation devoted to improving the health and health care of all Americans.