New York state of mind

It is late afternoon on a sweltering summer’s day and the subway
station is packed. People queue for tickets fanning themselves with
newspapers, tube trains thunder along the tracks and commuters
eager to get home crowd the platforms.

Suddenly the fluorescent lighting flickers and dies, leaving the
station in darkness. There is screaming and mass panic rises as
people rush for the exit, pushing and shoving anyone in their path.
In the desperate scramble a woman is knocked over on the steps and
almost trampled by the surge of bodies climbing towards daylight.

Out on the street panic and confusion grow. Frantic phone calls are
made, traffic is gridlocked and only one terrifying question goes
through everyone’s mind – is this another terrorist attack?

Later, everyone learns there has been a massive power cut,
affecting 50 million people in the US and Canada. New York’s mayor
Michael Bloomberg addresses the city, offering reassurances that
the blackout is not the work of terrorists and promises power will
be restored within the hour.

But as the hours pass and daylight fades, leaving a city famed for
its bright lights in darkness, his words provide little comfort.
Crowds of people block the pavements and many set out for what will
be for some a five-hour walk home. People pore over rushed special
edition newspapers but dismiss what they read, theorising instead
that terrorists are responsible.

It has been two years since Al Qaeda terrorists hijacked two
airliners and crashed them into the World Trade Center, killing
more than 3,000 people and causing the city’s signature 110-storey,
500,000-ton twin towers to crumble.

For months afterwards, everyday things were no more. Only one
television station was available, half-hour car journeys to work
quadrupled in time, car boots were randomly searched as security
was stepped up, and some people were forced to wear masks to
protect them from noxious smoke from burning rubble.

Gradually, life in the city appears to have returned to normal, but
the memory of such a terrible disaster is fresh in the collective
consciousness. Some argue that September 11 was a human tragedy of
such monumental proportions that it has joined the shortlist of
world events that are referred to simply as a date and changed the
world forever. Even if that is not true, its impact on New York
endures.

Despite appearances, and as the reaction to last month’s blackout
testifies, many living and working in New York do so with a
desperately fragile sense of security.

For professionals such as social workers, the past two years have
been uniquely challenging. Not only have they struggled to deal
with the immediate impact on their existing service users but also
with the thousands of new clients it has created. There are the
families adjusting to the death of a parent, people who have lost
friends, and many thousands more who may not have been directly
affected but who have developed a mental health problem as a result
of the disaster.

Just hours after the planes struck, huge numbers of New York’s
30,000 social workers became involved in the recovery effort and
have continued to play a major role ever since. But unlike the
heroic efforts of firefighters, hundreds of whom were killed, the
contribution of an army of social care professionals has gone
largely unnoticed.

Some worked 12-hour shifts at voluntary agencies bagging up
toothbrushes and other personal effects to provide DNA samples.
Others accompanied people as they collected death certificates.
Then there were those dispatched as “scouts”, whose job it was to
informally approach and assist bewildered people wandering the
streets clutching photographs of loved ones and asking passers-by
if they had seen their sister, husband, daughter or friends.

Social worker Kat Hindmand was one of those who volunteered and
explains how overwhelmed service providers were: “At the Red Cross
we band disasters from levels one to five. Level one would be a
house fire, level five would be a hurricane. September 11 was level
25.”

The organisation quickly set up 13 shelters and provided practical
help, such as organising blood donations, as well as support to
families. Hindmand says the most rewarding part of the work was
travelling with victims’ families in navy boats across the Hudson
River from Brooklyn to Ground Zero to help the grieving
process.

Many agencies were deluged with volunteers from all walks of life
wanting to help. But social worker Bea Plasse says: “It was
interesting because all those high-status workers who are normally
the most important in a crisis were not as important this time.
There were doctors and surgeons who were desperate to help. But
they were told ‘we need social workers’.”

Hours after the attack, the government mobilised hundreds of
emergency vehicles to transport thousands of injured people to
hospitals that had emptied their wards of all but the most
seriously ill patients. But neither were needed in the numbers
expected because the attack had left few survivors. It had,
however, left many bereaved friends and families, and professionals
were needed who were able to sit with them, often for hours at a
time, offering emotional support as well as help with practical
arrangements.

A vast array of government, voluntary and private agencies set up
services, especially emergency mental health ones. The New York
City department of health estimates it created almost 1,000
programmes in the weeks following the disaster. Special attention
was given to workers at Ground Zero who in the months they spent
clearing the site would discover body parts.

Plasse was directly affected by the attack. She has a clear view of
the World Trade Center from her living room. On the morning the
terrorists struck she was chatting to a friend on the telephone
when she heard the crash. Rushing to her window, she saw scores of
workmen on a nearby building scrambling down scaffolding. She
looked higher and saw the towers ablaze, people jumping out and
thousands of sheets of office paper floating to the ground.

“My neighbours and I were trying to figure out if the towers would
hit our building if they fell. And then they crumbled,” Plasse
remembers.

Her family was evacuated and only allowed back over the next
fortnight for five-minute visits to feed their cat and collect
clean clothes supervised by a police officer.

“The reality of September 11 was difficult for us living nearby. I
found that my tolerance of other people’s problems decreased. I
would listen to them going on about neurotic obsessions and I would
sit gritting my teeth. We were after all in the middle of a
cataclysmic event.”

When the Plasses returned home life was far from normal for several
months. Their home was covered in a thick layer of dust, their
letterbox was removed because of the anthrax scare and they had to
collect post from a central post office. They had to drink bottled
water and were without land phone lines.

Having witnessed the attack at such close quarters and been
affected by its impact, Plasse began volunteering by talking to
families.

“We knew by the second day that although we were taking missing
person’s reports and DNA samples from family members they weren’t
going to find them. It was more about helping people by talking to
them.”

Plasse believes that social work skills of reading people’s body
language, empathy and eliciting information without being intrusive
were the major strengths that she and colleagues contributed.

Social worker Jessica Klaitman agrees. Like Plasse she was close to
the World Trade Center when it was attacked. “A lot of people ran
out. But I thought it’s totally dark, there’s debris flying through
the air, there were people running and screaming and I thought it
would be safer to be in the office,” she says.

Eventually Klaitman and a friend wetted T-shirts to cover their
faces, grabbed bottles of water and left. What they witnessed were
streets “where the devastation was astonishing” and air that was
thick with acrid smoke.

Her stint as a volunteer, which included shifts on a missing
person’s hotline, began a few days later. She says: “There are a
couple of things that people in the mental health field could
offer. One is the capacity to withstand other people’s suffering in
a way that some people who aren’t trained may not be able to do and
also to set boundaries around that for yourself. It was incredibly
difficult to talk to these people. They would have a glimmer of
hope the second we would call and then to dash that hope was very
difficult.

“I actually didn’t do too much volunteering, especially of that
nature, because it was really hard on me. It would have been hard
anyway but having been down there when it happened made it worse,”
adds Klaitman.

At the time she had been a social worker in the criminal justice
system, but now works as manager of community relations and
advocacy at United Services Group, an organisation established in
the wake of the disaster to co-ordinate the efforts of the many
social services agencies providing services for thousands of
people.

It began as a coalition of 13 major not-for-profit organisations
that included the Salvation Army and is financed by United Way, the
largest funder of not-for-profit organisations in New York, which
set up a fund on the afternoon of September 11.

United Way raised $250m from 105 countries, about 90 per cent was
given as cash assistance to people for rent, bills and food. But
the organisation also met 350 not-for-profit and government
agencies to see what the needs were and how to meet them.

Identifying those in need was difficult because for months there
was no overall list of victims or families so the organisation
funded advertising campaigns to try and encourage people who had
been affected to seek help. Families of the unknown number of
undocumented workers employed in low-paid jobs in the twin towers
or businesses in the surrounding area were particularly hard to
locate. Some had procured other people’s social security numbers,
making it extremely difficult to accurately identify them and
without the security of legal status families were often reluctant
to approach the authorities for help.

Nevertheless, money from the September 11 fund was distributed to
organisations serving those communities. In its first year, the
fund also paid for specialised mental health and counselling
referrals for 20,000 people, and mental health and after-school
programmes for the hundreds of children who had witnessed the
attacks. Project Liberty, a $22.5m national and state programme,
also paid for counselling at workplaces and schools.

Research carried out by Columbia University on children six months
after the attack concluded that 200,000 had developed a mental
health problem. It extrapolated the figure from a study of more
than 8,000 children from 94 schools, which revealed agoraphobia had
tripled, separation anxiety had doubled and rates of depression and
anxiety had also risen.

The New York City administration for children’s services (ACS)
functions as a preventive and protective agency for 1.8 million
children. It is responsible for 24,000 children in foster care.
Each year it investigates allegations of abuse and neglect
involving about 90,000 children.

Commissioner William Bell, who heads the ACS, says it was fortunate
to have an emergency plan in place, which was developed to cope
with the anticipated millennium chaos. It meant it was equipped
with the communication needed to continue its core services. A
back-up generator, some short-wave radios and a bank of alternative
phone lines kept operations running.

Following the disaster, the ACS set up a range of counselling
services as well as extensive community outreach work and a public
education campaign to inform people about the signs of trauma.
Other services included training for foster carers on how to
explain to children in their care what had happened.

Some of the services run by ACS in response to September 11 are
still operating. But New York City, which was in the black before
the attack, now has a $6bn deficit. So the ACS, like other
agencies, has had to cut some non-essential services.

Social care staff were faced with sensitive situations to mediate.
For example, parents not knowing their son was gay until his death,
and a wife and pregnant girlfriend coming forward for the same man.
Families changed overnight and many child protection social workers
had to deal with the resulting difficulties, including custody
cases, says senior vice president of United Way Lilliam
Barrios-Paoli.

“There was one where a mother was killed in the World Trade Center,
the father came to claim their eight-year-old son but the boy
didn’t know him as he had lived with his mother and
stepfather.”

For the Jewish Board of Families and Children, the largest social
services not-for-profit provider in New York, with 2,700 staff and
68,000 clients, this has meant doing outreach work that has
included running lunchtime counselling workshops in banks.

The Red Cross runs a September 11 recovery programme, which has so
far helped 5,000 people. However, it estimates there are at least
15,000 people who need assistance and is doing outreach work to
identify them. And for every potential client agencies are trying
to identify and help, there are other existing ones whose problems
may have re-emerged or been compounded by the unsettling effect of
the disaster. Children in care, for example, who had recently been
placed with a foster family were badly affected. Deprived in the
past of a secure home life, their new-found certainty about their
family was shaken as they began to fear that their new parents
might be killed whenever they leave home.

Ella Harris is a social worker with the New York department of
mental health but also runs a private therapy practice. She says:
“One of my new clients is very upset. He lost his job at the World
Trade Center. He was a stockbroker. He had been a drug addict and
this job had given him a car, a home, a new life. I don’t think he
has ever dealt with 9/11. He is having nightmares and is on
medication.”

A job as a social worker in New York is tough at the best of times.
Levels of poverty are high and if things go wrong many people have
no extended family to turn to because they can be living hundreds
of miles away. As Bell puts it: “Urban social work presents
significant challenges. The term ‘if you can make it in New York
you can make it anywhere’ to some extent goes for social work as
well.”

Clearly that challenge has never been greater. It is estimated that
20 per cent of people who are exposed to trauma develop
post-traumatic stress. Evidence from the Oklahoma bombing in 1995,
which killed 168, has shown that people can begin displaying
symptoms many years later.

Just getting back to routine life is a struggle for many. How long
will it be before Kat Hindmand and thousands like her can hear a
low-flying plane without being gripped by fear? It may take years
but many of the funds raised, including the September 11 fund, are
drying up. Add to that the crippling deficit that is already seeing
government departments cutting services and there are questions
about how agencies will cope with the demand on their services.

Two years may have passed since the World Trade Center was attacked
but the real work for social workers in responding to its impact
could be just beginning. 

Next week Sally Gillen looks at how the terrorist strike on
New York has affected social work education and examines the
lessons for the future development of social work.