Mental Health Services At The Compassion Center: The Oklahoma City Bombing
By Karen A. Sitterle, Ph.D.
NCP Clinical Quarterly 5(4): Fall 1995
Editor's note: Dr. Sitterle served as the American Red Cross Mental Health Services Coordinator at the Compassion Center following the bombing in Oklahoma City.
It was the most deadly terrorist bombing in American history. A massive truck bomb went off in front of a nine-story federal office building in Oklahoma City leaving 168 people dead-- 18 of them children--and an additional 400 injured. In the hours following the blast, families of the three hundred thought to be missing, silently gathered at the First Christian Church searching for answers and information in a state of anguish and shock. As rescue workers attempted to formulate lists of those reported to have been in the federal building, family members faced grim requests for detailed descriptions, photographs, and medical/dental records of their missing relatives. Although chaos initially permeated the church, a multi-agency effort was quickly organized to provide accurate information about the rescue effort, facilitate the efforts of the medical examiner's office, and provide emotional support. This site became the Compassion Center.
For the three week period until all 168 death notifications could be completed, the Compassion Center provided sanctuary for those keeping vigil and eventually provided the heartbreaking news when a body was recovered and positively identified. Day by day, families waited in hope. Unfortunately, all came to the same grim end: their loved one had not survived.
As a highly complex operation, the Compassion Center involved numerous emergency and community organizations working together to respond to the overwhelming physical and psychological trauma. During the three weeks following the bombing, literally thousands of volunteer workers and hundreds of family members passed through the center. To facilitate the work of the medical examiner's office, the National Guard military, police, clergy, American Red Cross, Department of Veterans Affairs Oklahoma Medical Center, Department of Veterans Affairs Emergency Management Preparedness Office, and Salvation Army were able to integrate and work in a coordinated fashion to deliver immediate services. Mental health services were provided by mental health professional volunteers with the American Red Cross. Nearly 350 to 400 mental health professionals a day provided the multifaceted and anguishing task of providing support, solace and death notification to the families.
All mental health operations were guided by a number of principles (1). First, it was important to provide a sense of structure through leadership and communication at a time of overwhelming chaos and helplessness. Second, every effort was made to empower families by providing information in a truthful, respectful and non-intrusive manner. Third, family members were treated as normal people experiencing an abnormal event.
Not using stigmatizing mental health labels and providing nontraditional and practical services that emphasized active outreach and empowerment of the individual were key. In keeping with this notion, mental health professionals were labeled "escorts" rather than "therapist/counselor" (2). The third principle was to provide a safe and protective environment for families to share their pain with people who cared. Fourth, an understanding of the emotional climate and how it differed from an outsider watching on television was at the heart of the crisis intervention response at the Compassion Center. As optimism had waned outside the center and the rest of the country began slowing realizing that there was virtually no hope for more survivors, the family members continued to hold vigil under what appeared to be a blanket of denial against the realization of their worst fear. It seemed critical for families to remain hopeful, to be vigilant, to not abandon or betray their loved one until the death notification was made.
Mental health services were organized into four primary functions: support services, family services, death notification, and stress management services. Each mental health function was headed by a coordinator, and who reported to an overall mental health supervisor. All coordinating staff had cellular phones to facilitate communication and quick decision-making.
Support Services
The convergence of volunteers, motivated but often untrained or unsuited to the job at hand, is a universal phenomenon in disasters (1). Thousands of individuals called or simply arrived at the Compassion Center to offer assistance, creating an overwhelming logistical problem for the center.
Support services were developed to devise a system to ensure that qualified professionals were selected, to prevent unauthorized persons from entering the center, and to handle many of the pragmatic aspects that arose.
This tragedy brought together volunteers who had never before worked together, had varying skill levels, and were unfamiliar with the procedures of the many organizations and agencies working at the Compassion Center. Mental health professionals were thus screened for ability and experience and then placed in a suitable position.
Given the stressful nature of providing death notifications, professionals with Ph.D.'s and M.D.'s or those with extensive counseling experience with death, grief and bereavement were selected to participate as members of the death notification teams. Individuals with debriefing experience, particularly training in Critical Incident Stress Debriefing (CISD) techniques, were recruited to staff the stress management/debriefing function. An attempt was also made to use mental health professionals from the Oklahoma City community and to place them in key coordinator positions. An extensive data base was also created where information about the professional's area(s) of specialty, address, hours available to volunteer, and phone numbers for accessing them were entered. A daily schedule was then created to provide coverage for all mental health functions for what was often an 18 hour day. Such coverage usually involved 200 to 350 mental health professionals a day.
In order to ensure that authorized persons were entering the center, a complex identification process was developed. All Compassion Center staff and family members wore identification with color-coded name tags. Each service or organization (e.g., clergy, mental health, medical, medical examiner, and media) was identified by a different color. Similarly, family members were designated with either a blue dot for next of kin or a yellow dot for extended or immediate family members. This identification system allowed both staff and families to easily locate each other when needed. To ensure privacy, the building was secured by the National Guard and the military. At no time was the media allowed into the building; however, a separate area was arranged for the media where regular briefings were made by the medical examiner and other staff at the center. In this way, families could meet with the media only if they chose, but it was done outside the center to protect the privacy of the rest of the families.
Family Services
Upon their arrival to the center, each family was given an escort (mental health professional) whose function was to provide an information link between the medical examiner's office and that family. Their job was to be aware of the families' whereabouts in case information was needed or became available. These escorts worked four hour shifts and up to two shifts per day. A two hour break between shifts was mandatory. Escorts were briefed prior to their shift as to current developments, problems, and available resources.
A family room was created to provide a meeting area for families to obtain information and support. Our goal was to create a safe, protective environment to meet the physical and emotional needs of the families and to provide protection from intrusions from the press and outside world. An attempt was made to keep families together in a single location where they could provide support to each other and be with other families that truly understood their situation. The emotional climate, particularly in the family room, was dominated by a mood of anguished waiting, emotional limbo, rapid change, and at times, conflicting information. Attempts were made to organize and structure the family room to be responsive to the ever changing needs of families.
Cards and posters from school children and individuals from all over the country wallpapered the room with loving support. Flowers sent from strangers decorated the tables set up as a gathering place for the families. Often a family would return to the same table, claiming it as their own and covering it with photos and mementos of their missing loved ones. Inside this huge room an area was set up to provide three daily hot meals for workers and family members. A constant supply of donated sandwiches, snacks, sodas, and baked goods were also available to families and staff. An area was established for families to make private phone calls using donated long distance service. Additionally, a cellular phone company donated hundreds of portable phones to families so they could be quickly reached if they left the center to go home or to work.
One corner of the room was set aside as a children corner, filled with stuffed animals, colors, paints, toys, videotapes, and floor mats. This area was both separate but a visible part of the room, allowing children to venture into their own activities but still remain physically proximate to their caretakers. This area also allowed parents to take needed time away from their children to deal with their own feelings or to provide assistance to the medical examiners' office. The children's center was always staffed by a mental health professional with expertise in working with children.
As the days of waiting increased, activities were developed for the children to provide structure, distraction, and opportunities to be physically active. Animals were a part of these healing activities. Local mental health professionals with certified pet therapy animals, including rabbits, a sheltie, a Dalmatian, and an infant spider monkey staffed the room. Many of the children at the center were withdrawn or hyperactive and feeling as vulnerable as their parents. The opportunity to care for and play with pet therapy animals helped the children engage and focus as well as engendered a sense of control.
Another invaluable intervention for the families was the help of a victim advocate, Victoria Cummock who had lost her husband in the terrorist bombing of Pan Am Flight 103. She met with families offering comfort, support, and her common experience. She visited homes, read stories to the children, and provided advice to both the mental health staff and rescue officials. Editor's note: Ms. Cummock's observations are described in the previous issue of the Clinical Quarterly (3).
Use Of Briefings
A critical feature of family services was the establishment of an ongoing information link with the official rescue effort at the federal building. It was important to dispel rumors and provide accurate, official information. Regular briefings were conducted by the medical examiner's office two or three times a day to provide updates and to answer questions. Additionally, the government designated a state trooper to address any and all questions from the families. This uniformed representative met frequently with the families, to report up-to-date information about the rescue effort. A constant link to the rescue effort had a calming effect on the families and reassured them that every effort was being made to address their needs, to keep them informed, and to recover their missing loved ones.
Interaction Between Families And Rescue Workers
Another helpful intervention that evolved over time was the interaction between the families and the rescue workers at the federal building. Images of a ribbon held together by a guardian angel pin, a fireman hugging a family member, a child petting a search and rescue dog, and a fire chief searching the building site to find rubble for family members capture the special relationship that developed between families and rescue workers. The courage of the bereaved and the heroism of the rescuers bonded the two with mutual admiration and respect.
Clearly one of the most difficult tasks for families was not only having to wait but not being able to help directly with the rescue effort at the federal building. The bombing site was heavily secured by military and FBI, and only authorized personnel were allowed inside the perimeter. Families were therefore totally dependent upon the efforts of the rescue workers and reports from outside the center on the status of the search. To express their appreciation for the rescue workers, several of the families requested a machine to make ribbons for the firefighters and rescue workers. These families worked long hours fashioning thousands of ribbons held together by a gold guardian angel pin. The purpose of the ribbons was to recognize the valor and courage of the rescue workers and provide guidance and support for them as the search continued. The fire- fighters were thankful and in fact, insisted on wearing the ribbons before entering the downtown site. One firefighter was known to become so upset when he was unable to find his pin that he tore apart his hotel room until he found it.
Several days into the search, families made a formal request to the mental health staff to have some of the firefighters meet personally with them at the center. When staff made arrangements for this visit, the firefighters expressed concerns that the families would be angry and disappointed with them for not having rescued any survivors. Much to the their surprise, the families were deeply grateful and gave them a standing ovation when they entered the room. Family members waited to touch the rescue workers, to hug them, to talk with and put a face to those doing the search. This seemed to be healing for both the families and the firefighters.
This bond became particularly important when newspapers were delivered one morning with the large headline announcing, "All Hope is Gone: The Search is Over". The firefighters were reportedly discontinuing their search, and large machinery was going to be used to search through the rubble. This news spread like a shock wave through the family room. At this point, many families had still not been notified and became hysterical that the body of their missing loved one would never be recovered. To add to the turmoil, many families visualized the building site as a tomb, and the thought of remains being shoveled by machinery was very disturbing. To address these concerns, an emergency briefing was scheduled for families to meet with the governor, the fire chief, assistant fire chief, and the police commissioner to discuss how important decisions were made about the direction of the rescue effort. The officials were encouraged to share information in a straightforward, truthful fashion even though to do so was difficult.
This process culminated in a private ceremony and tour at the federal building for the families and recovery teams. Each individual scanned the building, often stooping, standing still, and staring. Mental health professionals, rescue workers, volunteers and chaplains lined the short route to provide privacy from onlookers, comfort and support. Police officers representing over twenty-seven departments, members of the military and fire department formed the honor guard. The Governor of Oklahoma and his wife also met with each family to offer their condolences. Families brought flowers, wreaths, balloons with messages, photos, stuffed animals, and crosses and rosaries to place at the building.
Death Notification Process
One of the most devastating moments that family members will remember is receiving notification of their loved one's death. In an attempt to make this horrific moment more tolerable, systematic death notification procedures using trained staff were established. Proper death notification can be one of the tools to assist surviving family members and speed the healing process. The notification staff was briefed on specific guidelines before participating in the notifications. For a list of death notification guidelines, please see Young (4).
The death notification process was clearly one of the most difficult jobs facing staff, particularly if it involved the loss of a child. The death notification team was headed up by two representatives from the medical examiner's office and included a mental health professional and a member of the clergy.
Once a body was recovered and positively identified by the medical examiner's office, the file was transferred to the center and protected by the National Guard. The family was then located and discretely escorted to a quiet, private area in the church. The medical examiner's representative identified himself/herself and the next of kin before informing the family that their loved one had been positively identified as dead. After being notified, family members inevitably asked questions such as "are you sure?" "How do you know?" And "did they suffer?" The medical examiner responded by explaining how identifications were made and that the deceased had died immediately. Questions about the condition of the body and whether they could view the body were referred to funeral home representatives. The clergy member then offered a brief prayer to those families requesting one. Families were required to make a number of decisions about funeral home arrangements, when information could be released to the media, and whether other family members needed to be contacted. Finally, the team inquired if the family needed assistance or wished to be left alone.
Families responded to the news differently. Many seemed relieved that the wait was finally over, others were stunned, some became hysterical. Several family members returned later to the family room to help their new friends with what was to come.
Stress Management Services
The scope of human suffering at the Compassion Center was often unimaginable, creating a highly stressful and emotionally-charged environment. Given the unique stresses at the center, it was critical to provide stress management services for staff members as a separate function of the overall mental health operation.
Just like other emergency personnel, mental health professionals can be adversely affected by stresses. They are also normal people reacting to abnormal events. No one is prepared for the anguishing tasks and heartbreaking exposure to human suffering that was experienced during those weeks. This function was staffed by a coordinator and other mental health professionals experienced in with disaster mental health and CISD techniques (5).
Defusings were one of the frequently employed techniques among the staff working at the center. Lasting 20-25 minutes, these sessions are short versions of the more formal debriefing process and are intended for a small group. All mental health and volunteer staff at the center were required to participate in a defusing after serving their shift each day. These defusings were held every hour so that staff could attend when convenient. Structured as a conversation about a particularly distressing event, the defusings contained three main components: introduction of the process, description of each person's role and their reactions, and suggestions to protect staff from further harmful effects. Pamphlets and handouts on stress reduction exercises, coping strategies, and stress management were also provided to staff. Members of the stress management team were also available to address staff difficulties on an individual basis.
In closing, perhaps what was most remarkable in the aftermath of Oklahoma's sorrow was the courage of the bereaved and the heroism of the rescuers triumphing over this vicious act of terrorism. The overwhelming outpouring of compassion and support at the Compassion Center prevailed in the face of suffering and unspeakable sadness. While firefighters and search and rescue teams were hailed as heroes, the mental health volunteers who spent long, anguishing days at the center were also heroes. These were men and women from Oklahoma and around the country who put their personal and professional lives on hold to come to the aid of those in dire need. The common thread of all those who were present was their willingness to put themselves on the line for strangers and the belief that one person can make a difference.
References
1. Myers, D. (1994). Disaster Response and Recovery: A Handbook for Mental Health Professionals. U.S. Department of Health and Human Services, Publication No. (SMA) 94-3010.
2. DeWolfe, D. (1992). Final Report: Regular Services Grant, Western Washington Floods. State of Washington Mental Health Division.
3. Cummock, M.V. (1995). The necessity of denial in grieving murder: Observations of the victims' families following the bombing in Oklahoma City. National Center for PTSD Clinical Quarterly, 5, (2-3), 17-18.
4. Young, M. (1985). Survivors of Homicide Victims. (1985). National Organization for Victim Assistance Network Information Bulletin, 2, 3.
5. Mitchell, J.T. and Bray, C. (1990). Emergency Services Stress: Guidelines for Preserving the Health and Careers of Emergency Services Personnel. Englewood-Cliffs, New Jersey: Prentice-Hall, Inc.
Acknowledgment
The work at the Compassion Center would not have been possible without the expertise and dedication of hundreds of mental health professsionals and volunteers. Special acknowledgements go to the following individuals for their unwavering commitment to the people of Oklahoma City: Tamara Vargas, M.S., Dana Foley, Ph.D., John Tassey, Ph.D., Ellie Lotterville, Ph.D., Barbara Cienfuegos, L.C.S.W., Dusty Bowencamp, R.N., and Cindy Besecker. The author wishes to thank Catherine Campbell for her comments and help in editing this paper.
Karen Sitterle is a licensed psychologist and a member of the clinical faculty of the Department of Psychology, University of Texas Southwestern Medical Center. She maintains a private practice in Dallas treating children, adolescents, and adults with emotional problems and specializes in the treatment of post-traumatic stress disorder.
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