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9/11: The Red Tape of Disaster Recovery |
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Professional Practice |
Sarah Benolken |
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Since February 2002, I’ve seen 14 World Trade Center disaster survivors through the American Red Cross (ARC) Long Term Recovery Program, which is funding 32 psychotherapy sessions at $110/session for rescue workers, close relatives of deceased victims, and residents of an approximately ten block area surrounding the World Trade Center who were displaced from their homes as a result of the attack. I am currently working with 11 of these clients. The clinical experience of working with so many disaster survivors has been rewarding, inspiring, and stressful. Most of my ARC clients are residents of the area immediately adjacent to the Trade Center, who witnessed the attack, escaped and rescued others under extremely harrowing conditions, and were displaced from their homes for many months. Seven of the eleven are currently suffering significantly enough from symptoms of depression and PTSD that they require medication. Five have pre-existing Axis I disorders. One client has required extensive social services advocacy and two others have needed many hours of crisis intervention. Most of these people functioned well socially and occupationally in the past, but suffered staggering losses – of relationships, of businesses, and of health – as a consequence of the disaster. All relate histories of significant previous trauma, including childhood physical and psychological abuse and neglect, rape, and the premature death of parents. As a longtime member of the downtown Manhattan community, I was glad to be able to respond to my neighbors’ needs. And I certainly needed the work. My practice income decreased by over $15,000 in the twelve months following the WTC disaster. Like my patients, for quite some time in 2002 I wasn’t certain how I was going to keep my head above water economically, and the Red Cross program appeared to be a good solution. As I write this, however, I am again uncertain, since the Red Cross owes me $9,760 for work dating back as far as early October 2002. I received two ARC referrals from NYSPA, in February and July 2002. Two more came from a private referral service with which I’m affiliated. The rest were referred to me by Red Cross Family Support Specialist Tanya Melendez. Ms. Melendez, who is sensitive and informed about mental health issues, works closely with 108 clients to secure financial benefits, and has built strong personal relationships with many of them. She received a positive report about me from one of my initial clients, and referred several more, inquiring of each of them as to their satisfaction with my services. Without Ms. Melendez’ encouragement, support and understanding, most of my clients would not have sought out psychotherapy, as desperately as they needed it. If Ms. Melendez’ clients had tried on their own to find psychotherapy, it wouldn’t have been easy for them to find me or any other independent practitioner. LIFENET, the New York State agency charged with making disaster mental health referrals, has long maintained a policy of refusal to refer to “private practitioners working in isolation” (Mental Health Association of New York, 2003), and has only referred to certain agencies and clinics certified by the New York Office of Mental Health. In the late summer of 2002, in response to public and practitioner complaints about the non-delivery of services, LIFENET announced the development of a preferred specialist referral list, agreeing to refer to independent practitioners who supplied evidence of continuing education workshops taught, letters from supervisors attesting to the applicant’s experience working with PTSD, and so on, and who also submitted to credentialing by Aperture. It was estimated that at least 6 months would be required to develop and activate the specialist list. As of this writing, there is no information posted on the LIFENET website concerning the existence of such a list. The proposal has only been publicized through the NYSPA Disaster Response Network, where it was met with chagrin by many highly experienced psychologists who had no trauma therapy CE credentials and no way of contacting deceased supervisors and defunct training programs to verify their competence. The official procedure for accessing disaster mental health benefits is as follows: the prospective client calls a LIFENET 800 number, provides his or her address, and is mailed a benefit application. Clients are advised by the 800 number operator that approximately one month after their completed application is received, they will be contacted by LIFENET for an eligibility determination interview, which consists of questions designed to place individuals in or exclude them from various eligible groups. After eligibility is determined, they are advised of their referral options, as described above. Of course, a wait this lengthy would have been disastrous for many of my patients. Neither NYSPA nor my private referral service have ever sent me any referrals that originated with LIFENET. I considered myself fortunate indeed to have the chance to work with so many Red Cross patients. But then ARC stopped paying me. Part of the problem seems to amount to clerical disorganization in the New York office. Bills I mailed to ARC-NY in September were lost or misplaced. Bills faxed to ARC in early November were lost or misplaced twice. I wasn’t advised that one client had exhausted his benefit before contacting me until I had seen him 12 times. The billing coordinator quit or was fired sometime in late October. During a phone call I placed to ARC at the end of November, the billing department secretary told me that I would just have to wait for an unspecified period of time to receive disbursement orders for my invoices, and further, that I “should be grateful” that I’d received three out of eight. As of the first of February, I’d received five out of 32. In early December, ARC decided that it was necessary to obtain written refusals of all mental health claims from beneficiaries’ insurance plans. (Some clients have Medicaid or low-cost HMO policies which were given to them by charities.) One of my clients who took a job teaching school became eligible for an Oxford plan with a high-deductible out-of-network option in December: ARC is now subjecting any opting-out from MCO networks to review and approval. ARC has also begun to notify prospective therapists that the stated fee of $110 may be reduced at any time without notice, and is requiring clients to sign notarized affidavits stating that they understand that ARC may reduce or terminate their mental health benefit at any time without notice. The explanation I’ve received for this new stance is that ARC is concerned about budgeting. $45-55 million has been allocated for the mental health program over a five-year period. This sum includes funding for the training of mental health professionals in trauma therapy, and additional training to help “teachers, clergy and others to recognize when treatment is necessary (September 11th Fund, 2002). With an approximately $3,000 benefit per person, $55 million would cover treatment for around 18,000 individuals. The population of eligible disaster survivors is undetermined, but considerably greater than 100,000. Early this week I sent a letter protesting ARC’s lack of timely payment to Erica Lowry, director of mental health services for ARC’s New York office. By Wednesday, I’d received frightened phone calls from four discouraged and demoralized ARC case managers. By Thursday, I had four more disbursement orders on my desk, plus credible-appearing information about eleven additional pieces of paper ARC now needs from patients before they can pay any additional invoices. I am happy for any progress, but it is clear that a real solution to current problems can only come with systemic reorganization. And it is equally clear that payment is far from the only problem with the program. In a conversation with one case manager, I made a few suggestions as a stakeholder in this project: ARC-NY needs to stop the current wild proliferation of paper bureaucracy, automate its business operations, improve its outreach and intake components, and stabilize its policies, so that both practitioners and their patients can continue to participate effectively in the recovery process. He wearily agreed, but said he didn’t think ARC was open to suggestions. ARC, of course, can’t be open to suggestions, since it is a corporation and not a human being. A collaborative effort by human beings, including ARC leadership, patients, practitioners, and elected officials, is needed to take the reins of this heroically-intentioned yet runaway effort and ensure it reaches its goal. References Mental Health Association of New York (2003). http://www.800lifenet.com/providers.html. New York State Office of Mental Health (2002). September 11th Fund announces new $200 million ongoing recovery program. Press release, August 16, 2002. |
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