The Oklahoma City Bombing: Organizing the Mental Health Response
Betty Pfefferbaum, M.D., J.D.
Paul and Ruth Jonas Chair
Professor and Chairman
Department of Psychiatry and Behavioral Sciences
University of Oklahoma Health Sciences Center
Adjunct Professor, Oklahoma City University of Law



INTRODUCTION

The bombing of the Alfred P. Murrah Federal Building in Oklahoma City on April 19, 1995, killed 168 people including 19 small children. Hundreds more were injured in the building and in the surrounding neighborhood. The bombing was both a terrorist act and a major crime. Media coverage produced powerful images of trauma, loss, and suffering. For days, nothing except bomb-related programming aired on the major broadcasting stations in the area.

ORGANIZATION

Establishing Institutional Roles

The aftermath of a disaster is commonly characterized by chaos and confusion. The Oklahoma City bombing was no different. The community response was dramatic involving over 12,000 individuals. Many wanted to contribute and many felt a need to be involved in the process. Coordination was essential, especially with a response of this magnitude. Local, state, and national professional organizations, public agencies, volunteer groups, and individuals emerged as leaders in the response.

One of the first important individual or institutional tasks in responding to disasters of such magnitude is to determine an appropriate role which should be based on an examination of the individual's or the institution's relative strengths. Failure to identify an appropriate role may result in duplication of services, exhausted personnel, and depleted resources.

In the Oklahoma City bombing, the Governor aided in the assignment of roles among state agencies by designating the state Department of Mental Health and Substance Abuse Services (DMHSAS) as the agency responsible for coordinating publicly-funded mental health services. The bomb-site Compassion Center, established to provide crisis care, was eventually relocated and renamed Project Heartland. Project Heartland remains in operation today, well over one year later. Staff at Project Heartland provide crisis intervention, brief treatment, group work, referral, and outreach. The University of Oklahoma Health Sciences Center (OUHSC) was charged with responsibility for overseeing research activities. The two organizations continue to work closely together, and with the Oklahoma Department of Health, another major public agency responsible for many aspects of the disaster response.

Funding

The Federal Emergency Management Agency (FEMA) provided an immediate services grant to the DMHSAS, which was available within weeks of the bombing. That was followed by a nine-month regular services grant beginning November 1995. The DMHSAS utilized many community providers and institutions by awarding subcontracts for service to special populations such as children, the aged, and minority groups. An extension grant provided new monies and allowed monies already received to be expended over a longer period of time. The extension is crucial in the Oklahoma City disaster because of anticipated problems associated with the criminal trial.

Referral Mechanism

There is often little time to develop and organize services following a disaster. When many individuals are seen for brief periods by providers with different levels of training and experience, pathology may go unrecognized. This is especially important in disasters like the Oklahoma City bombing because: the need was so great, most volunteer providers had little or no experience with disasters of this magnitude, and the federally-funded program relied heavily on non-doctoral clinicians and did not provide for comprehensive evaluation and intensive treatment. When individuals experience more serious psychological responses, they may require referral, making it essential that a mechanism be established early. The professional response in Oklahoma City was impressive; many professionals volunteered their time to treat bomb-related problems for free or at reduced rates.

Long Term Care

Long term care must be considered immediately because federal monies do not cover those services. In Oklahoma City, funding requests to address long term need began within weeks after the disaster. There remains concern, however, that the funds secured will be inadequate to meet that need.

CONSULTATION AND TRAINING

Few mental health professionals have had experiences that would prepare them for disasters of the magnitude of the Oklahoma City bombing. Recognizing this, FEMA provided funding for consultation and for training of professionals. Consultation by a number of individuals and organizations has been useful in anticipating and identifying concerns related to community needs and in organizing the immediate, short term, and longer term efforts. In the immediate aftermath of the bombing, minimal attention was paid to individual training and experience, but within weeks, a mechanism for the screening of professionals was established.

RESEARCH

When the impact of disaster is as great as in the Oklahoma City bombing, it is important to assess individuals at risk for problems due to their emotional and/or physical proximity to the disaster or to preexisting conditions. Screening should identify symptomatic individuals who have not come to professional attention. Screening should also provide information useful for planning service delivery, developing funding requests, and research.

Disaster research is fraught with concern. Victims may be exploited, even traumatized or retraumatized, in the research process and results may not accurately reflect events that occurred, particularly if people are subjected to repeated and leading questioning. Most, if not all, mental health research related to the bombing has been motivated by clinical or service delivery needs, with care taken in the design and timing of our studies. The collection of data following the bombing was particularly important because there had not been a disaster of this magnitude in our country in recent memory.

CONCLUSION

Disaster is rarely anticipated. It burdens individuals and institutions, forces people and agencies into new roles and relationships, alters priorities, and exerts an emotional impact on rescuers and responders as well as victims and survivors. An abundance of support poured into Oklahoma City on April 19, 1995, and the days that followed. That support came from within the community, state, and nation. Both the bombing and the response changed the complexion of our community, proud of the compassion that emerged to support the newly vulnerable.

©1996 by The American Academy of Experts in Traumatic Stress, Inc.