The anxiety of staff and patients in the wake of the shooting rampage Thursday in Western Psychiatric Institute and Clinic of UPMC will vary greatly depending upon life experiences, connections to the victims and what a person saw and heard that day, so the hospital's response to those affected by the incident is crucial, a trauma expert said.
"Some people will weather it quite well, and some people won't," said New York City psychiatrist Roy Lubit, who specializes in post-traumatic stress disorder.
For staff and patients, he said, "The most important thing [UPMC] can do in the short term is to counsel, to talk to people about the meaning of the event to them."
UPMC has been doing just that. "Planning for behavioral health response to provide support for the staff, patients and families began within minutes of the beginning of the event and support services were available and active in the WPIC main building within four hours of the event," said Claudia M. Roth, Western Psych president and chief executive officer, in a statement emailed to the Pittsburgh Post-Gazette.
Police said John F. Shick, armed with two handguns, walked into the first floor of the Oakland hospital where he killed geriatric therapist Michael Schaab, wounded five other people, and caused injuries to two more before police fatally shot him. Most of the nearly 300 patients and hundreds of staff in the 17-story building remained in locked units; others were evacuated to the Petersen Events Center. After the shooting ended, heavily armed police searched the entire facility to make sure there were no further threats.
The response of those involved will vary "depending upon their emotional makeup, how fragile they are, how and what they witnessed, and if they experienced emotional traumatic events in the past," said Dr. Lubit.
"It's also based on the meaning that they give to the event. Some people walk away from the event, saying, 'Wow, I went through a horrible thing and nothing happened, look how well people cared for me, fate was on my side.' Another person will think, 'Look how vulnerable I am.'"
Experiencing flashbacks, sleeplessness or frightening thoughts, or feeling irritable, on edge and even guilt are normal reactions after experiencing a dangerous event, according to the National Institute of Mental Health. The condition, called acute stress disorder, can last for several weeks. If it lasts for more than 30 days, it is classified as post-traumatic stress disorder.
Dr. Lubit said anyone who saw the violence or its bloody aftermath or who knew Mr. Schaab or any of the other victims -- five staff members and two police officers -- would be more susceptible to those disorders than those who only heard about the incident and didn't know any of the victims.
"Seeing something in front of you is far, far more likely to cause problems. To have that picture in your mind is much harder to put aside."
As for the patients, Dr. Lubit said, "having emotional problems makes someone more vulnerable and less resilient" to dealing with traumatic events but that likely would be mitigated by the fact patients remained out of harm's way.
Crisis support for WPIC staff, patients and families includes a Critical Incident Stress Management team and crisis clinicians from re:solve Crisis Network -- part of Western Psych -- and partner agencies from throughout the region, including Allegheny County MHMR, Mon Yough, and National Alliance on Mental Illness, Ms. Roth said.
In addition to providing services to staff in their specific work locations, a staff drop-in center with crisis support staff, food and refreshments is available from 7 a.m. to 11 p.m. A drop-in support center for families and visitors of Western Psych patients is in place and is staffed by family members from the National Association for the Mentally Ill.
"Teams are posted in the front lobby during daytime and evening shifts to greet staff and visitors and offer support," she added. "Teams are circulating through clinical and non-clinical areas around the clock.
"We are providing individual and group interventions. Approximately 300 staff have participated in group sessions. Specific interventions are in place for residents and medical students, as well as other providers in the community who have been impacted."
By 8 p.m. Friday, more than 400 hours of support services had been provided, Ms. Roth said.
Off site, she said, those affected by the incident can use re:solve, the Employee Assistance Program and the Staff Support Pager program, both in the short term and the long term.
"We are also providing systemic support to all of the staff and volunteers involved in providing the support for the primary responders -- that is, we have debriefers for the debriefers (and they have debriefers for themselves)," she said. "A lesson learned from the Flight 427 response was that the debriefers were also at high risk for traumatization."
The hospital's chaplain is with other chaplains to provide support as well, she said.
A member of Western Psych's staff said that before meeting with patients Friday, UPMC called in experts to meet with leadership, faculty and staff to discuss how all of them were dealing with such a violent tragedy and how they would deliver information and answer questions from the patients.
While Friday was "a very sad day" for all of the employees, the staff member said, "they're all professionals" and they had a job to do to help the patients.
Then, staff and faculty met with all of the nearly 300 patients in small groups "and gave them the facts as we knew them," said the staff member, who asked to remain anonymous for fear of being disciplined by UPMC because the hospital was not authorizing any employees to talk with media.
"The patients are dealing with it," the staff member said. "All the patients here knew it happened on Thursday. The SWAT team was in every room on every floor."
But the staff member said the SWAT team did not barge into patients' rooms shouting or pointing weapons; they seemed to be cognizant of the fact that they were in a hospital and did the search as calmly as possible, even though they were searching for a possible second gunman.
On Friday the patients talked about the scene from the searches, "and they were OK with what happened," the staff member said.
As a result, the discussion with patients was not overly emotional or fraught with fear, the staff member said.
"Even though these are people who may be having trouble dealing with real-life problems, when there is a real-life problem like this, most of them come back to reality pretty quickly," the staff member said.
Staff writer Sean D. Hamill contributed. Michael A. Fuoco: firstname.lastname@example.org or 412-263-1968.