Throw out all the studies on the psychological effects of a national disaster that were conducted prior to September 11, 2001, says child psychiatrist Dr. Barry Herman, an executive board member of the National Coalition for Mental Health Professionals and Consumers. "Get braced for the unknowable," says Herman. "Mental health professionals, especially those who work with children, should be prepared to deal with an epidemic of significant stress reactions."

Post-traumatic stress

Perhaps you’ve heard of Post-Traumatic Stress Disorder.  Veterans of military conflicts can suffer mental problems years after the fighting ends, even if they seem normal when they first return home.

Psychiatrists say the same disorder could affect many of those, who experienced or witnessed the tragic events of September 11th.  Experts say it could be several years, before the full psychological impact of the terrorist attacks is realized.

Are insurers prepared for the mental health fallout from September 11th? Karen Shore, the founder and past president of the National Coalition for Mental Health Professionals and Consumers, doesn't believe so.

"People had a hard time getting mental health treatment before September 11," she says. Shore claims "the managed care system is an affront to mental health patients" and she suspects that’s not going to change any time soon.

Health plans are sensitive to the criticisms being leveled at them, says Leslie Moran, a spokeswoman for the New York Health Plan Association. "Health plans are extremely sensitive to the needs of the public right now," she says. "They're making an extra effort to avoid making it difficult for their members who need help."

No precedent

According to Herman, there is no precedence for this kind of disaster — which is precisely why it's impossible to predict how the psychological aftershocks may evolve. "Time is usually a healer," he says, "but if more bombs go off, it will just revivify the experience." Herman says following the attacks, people exhibited some of the same reactions as victims of rape, including hypervigilance (increased awareness of one's surroundings), depression, and sleeplessness.

"It's the classic rape response," says Herman. "This was the rape of our country."

Shore says she is concerned about the long term. "There is a great outpouring of people offering free services right now, but people are still in shock," she says. "What happens down the road? We're still seeing Vietnam vets coming into VA hospitals for the very first time to get treatment for post-traumatic stress disorder. It's, what — 35 or 40 years later?"