The nation's public health infrastructure would be ill-prepared to meet people's psychological needs after a terrorist attack, concludes a recent Institute of Medicine (IOM) committee report.

"Consequences would result for many people," says clinical psychologist Adrienne Stith Butler, PhD, an IOM program officer and co-editor of the report, "Preparing for the Psychological Consequences of Terrorism: A Public Health Strategy," published by the National Academy of Sciences in June. "And we're not talking solely about psychiatric illness, but the more common consequences ranging from mild to moderate distress responses and behavioral changes."

The report from IOM's Committee on Responding to the Psychological Consequences of Terrorism, part of the Board on Neuroscience and Behavioral Health, is targeted to researchers, psychologists and other health-care providers; staff of foundations; federal, state and local government officials; congressional staff; and policy-makers. The report calls for federal and state governments to improve psychological response by developing the public health infrastructure's capacity to:

* Provide interventions and programs to promote individual and community resilience and prevent adverse psychological effects.

* Provide surveillance for psychological consequences--including distress responses, behavior changes and psychiatric illness--and markers of individual and community functioning before, during and after a terrorist act.

* Coordinate research agendas, cooperate in establishing funding mechanisms and award timely and sufficient funding of research to guide and inform interventions.

* Train service providers, including psychologists and other mental health providers, to address the psychological needs of victims and protect themselves from psychological trauma.

* Address psychological consequences in federal, state and local disaster planning, preparedness and response.

"The committee calls for a comprehensive strategy with mental health issues integrated into a broader public-health model for responding to terrorism, but we're not there yet," says Butler. "Mental health professionals should be at the table when policy and planning decisions are made.

"The committee also hopes that in preparing for terrorism, lessons can be learned and potentially applied to other violent events that cause fear, anxiety and stress in American communities," she adds.

To purchase or download the report, visit www.nap.edu.

--N. CRAWFORD