CONTENT
Introduction
The Dutch mental health care after the
Bijlmer airplane crash
-
The organization: from inside
out
-
The health care: from diagnosis to story
-
Return to the old way of
working
-
Hopeful
Sources
The fate of the victims of the Bijlmer airplane crash
INTRODUCTION
The Bijlmer
airplane crash. On
October 4, 1992, an El Al Boeing crashed into the Groeneveen and
Klein-Kruitberg apartment buildings in the heart of the Amsterdam
Southeast, region
Bijlmermeer. 43 people were killed. Many eyewitnesses and surviving
relatives were severely traumatized.
The nearby outpatient mental healt care organization, called
Riagg
Southeast, provides
mental help
to the victims. 84% of the
victims have a migration background. They
are primarily of Surinamese and Antillean descent.
Saar Roelofs was working
as a department head at Riagg
Southeast
at
the time of the Bijlmer
disaster.
The Riagg prior to
the disaster: resistance to help for black clients and clients with
current traumas.
In the adult care at Riagg Sotheast in 1992, the
focus was not on the client's request for help, but on the
preference of therapists for treating relatively young,
well-educated, white clients with vague complaints. Treatment was
primarily aimed at the client's intrapsychic problems, i.e., at the
world within the
client. There was resistance to providing assistance to both clients
with a migration background (over 50% of the population in the
Amsterdam Zuidoost region around the time of the Bijlmer disaster)
and clients with current traumas and socio-economic problems. All of
this was also the case in other
Dutch outpatient mental healt care organizations.
After the disaster: more and better help for black clients and
clients with current traumas. After
the disaster, the client's
request for help is central:
help regarding his or her concrete needs, feelings, and cultural
background. A
policy paper
recommending improving
assistance to clients with
a migration background and appointing more black therapists
is unanimously adopted .
Within the organisation a
true metamorphosis takes place.
This metamorphosis demonstrates what the mental health care could look like
if it were truly
aligned with the needs of its clients.
The metamorphosis is temporary.
Do not disturb. In 1997 Saar Roelofs
publishes
Do not disturb.
The text below forms the final piece of her book.
The
mental health care
after the Bijlmer airplane crash
The
organization: from the inside out
In the
immediate period following the disaster, the Riagg is in
turmoil. Therapists managers, secretarial
staff - everyone rushes through the corridors looking for one
another, for stability, for order in the chaos. The dozens
of treatment rooms in the main building, annex, and
emergency barracks are connected by a maze of corridors
within the entirely single-level Riagg. In the center of
this conglomerate of structures, two main corridors form a
crossroads. Here, the most important decisions are made;
here, everyone consults with everyone; here, people ask one
another for advice without distinction as to department,
discipline, or treatment team.
Clients
come and go constantly. They ask for help processing the
shocking event and for advice on numerous practical
problems. Immediate availability for clients is now
considered more important than bureaucratic regulations. In
the first week after the disaster, the Riagg is open until
eleven o'clock at night and also on weekends. On new
registration forms, only the most essential information is
entered. Representatives from diverse disciplines and
methods are working intensively together to create
appropriate support as quickly as possible.
Due to the
enormous influx of clients from ethnic minority backgrounds,
migrant policy is now also gaining momentum. Shortly after
the disaster, a policy
paper is adopted tightening the
existing migrant policy regarding personnel matters, care
provision, professional development, registration, and
research. To bridge language and cultural barriers,
additional therapists from ethnic minority backgrounds
are recruited.
The
attitude towards the outside world is unprecedentedly open.
The scale of the disaster forces all mental health
institutions in the region to collaborate intensively and
flexibly. Within two weeks of the disaster, a joint policy
plan is on the table. The Riagg travels into the region to
provide information. An information leaflet is distributed
in seven languages. The Riagg
Southeast, also known as The Bunker
in the region due to its closed nature and abominable
facilities, breaks open.
The
disaster reveals that the organization harbors a potential
for creativity, flexibility, and inspiration that runs
counter to the conventional system. The qualities of
individual employees are now being utilized to the fullest.
At the same time, a collective goal is being pursued.
Individual responsibility, initiative, and a personal vision
are no longer at odds with the organizational structure. On
the contrary, these qualities are now at the service of a
higher purpose. The air disaster creates a paradoxical
situation: the disintegration of the conventional care and
organizational model means that Riagg employees
can function as integrated individuals. It is no
coincidence that the expression the Chinese use for
'crisis' - wei-ji -
is composed of the characters for 'danger'
and 'favorable opportunity'.
The mental health
care: from diagnosis to
story
The
clients. On
the evening of the plane crash, the lives of numerous people
in the Bijlmermeer were completely disrupted in one fell
swoop. People saw their neighbors jump from balconies, lost
their children in panic, and searched through the wreckage
for family, loved ones, or friends. Still others saw the
plane fly straight into their neighbors across the street
from their flats. They sleep hardly, eat poorly.
Feel nothing anymore. Or perhaps too much: "Even my hair and
nails hurt." They are terrified with every plane flying
overhead. They have nightmares. They no longer leave the
house and survive on leftovers from their refrigerator. They
wander around the scene of the disaster in a daze. People
arrive at the Riagg completely distraught. For instance, an
elderly woman suddenly stands dejected in the hall one
evening: she saw two of her daughters burn to death and
cannot shake off the images. 84% of the clients have a
migration background.
The
care offered. In
the face of the immense suffering with which they are now
directly confronted, the therapists relinquish their
attitude of authority. Advice is sought from external trauma
specialists who point out the necessity of an event-oriented
approach in
which the client's story takes center stage and in which
there is no place for fixating psychiatric classifications.
Within four weeks of the disaster, a support program for
eyewitnesses and local residents is ready. This program is
aimed at preventing disorders in the processing of the
traumatic event. The key features of this support program
are as follows.
The
client's request for help is central. Recounting the
traumatic experiences forms the core process of the
support.
In
some cases, earlier painful or traumatic events that
were typically 'covered up' prior to the disaster are
now also coming to light for the first time.
Attention is paid to both the social and societal
situation and the client's body perception.
For
the client, the diagnosis is clear: his complaints
constitute normal reactions to abnormal events; they are
adequate attempts to cope with stress accumulated in the
outside world and are not signs of an intrapsychic
conflict.
In the
relationship between therapist and client, power is
minimized. The therapists are emotionally affected and
recognize something of themselves in the client. He or
she shares their knowledge and is not the sound and
authoritative expert facing a sick and dependent
client.
The
Therapist emphasizes the healthy and strong part of the
client.
Return to the
old way of working
The
metamorphosis is short-lived. The Riagg views the
developments following the disaster as a danger rather
than a favorable opportunity to break new ground. Three
months after the disaster, the need for a "return to
normal" is greater than the need to incorporate the
achievements of the moment into standard Riagg practice.
The trends towards renewal are nipped in the bud. The
role of the Prevention, Innovation, and Research
department, which had made a significant contribution to
the organization of aid for the victims of the disaster
due to its expertise in the field of innovation, is
played out. The Psychotherapy department resumes its
usual position of power. Due to objections from this
department, Riagg management withdraws the new migrant
policy that had been in use for a short time after the
disaster. The director appoints the head of the
Psychotherapy department as the so-called press
attaché,
to whom all outgoing reports and writings regarding the
disaster must be submitted for review. The press attaché
makes changes to manuscripts intended for publication or
prohibits publication. With this, officially instituted
censorship at Riagg Southeast has become a reality. The
care providers are once again retreating within the four
walls of the treatment rooms with " Do
not disturb "
signs .
Pseudodiagnoses are being made again. The organization
is closing down.
Read more about the return to the old working
method on the webpage No
talent
for conformism under After
the Bijlmer airplane crash.
Read moreabout the fate of the victims of
the Bijlmer airplane crash
(below)
Hopeful
In
1992, with the organization of the support services for
the victims of the Bijlmervliegramp, Riagg
sotheast spontaneously anticipated
the widely recommended developments in
mental health care, in which the needs of
the client take center stage rather than those of the
therapist or organization. It involved a collective
effort by Riagg staff, without any regulations,
strategy, or quality assurance system. In doing so,
Riagg Southeast temporarily served as a model for other
Dutch
Riaggs. Even though the innovations at the Riagg were
nipped in the bud, the fact that these developments
actually got off the ground is nevertheless hopeful.
Love for the profession, passion, creativity, and
respect for the client's perspective are evidently
present within the organization, albeit only
tapped into under extreme circumstances.
SOURCES
Mental
health institutions Amsterdam Southeast (16-10-1992). Aftercare
plan Bijlmermeer aireplane crash.
Mittendorff, Carlo (1992-1993). Series of lectures held as
part of a refresher course on trauma processing for care
providers at Riagg Zuidoost following the Bijlmer
airplane crash. Video recordings, Riagg Zuidoost.
Riagg
Southeast (1990-1993). Client
Files Adult Care 1990-1993.
Riagg
Southeast (April 1990 - April
1993) Minutes & internal
mailings.
Riagg
Southeast
(1992 ).
Immigrant policy gaining momentum. Policy
paper of the Department of Prevention, Innovation &
Research.
Riagg
Southeast
(October 1992 - January 1993). Preliminary
advice and minutes of the project group on Assistance
Offer for the Air Disaster.
Roelofs, Saar. (1992, October
20), on behalf of all mental health institutions in
Amsterdam Zuidoost. After
the disaster: information and advice for adults.
Information leaflet for clients and other residents of
Amsterdam
Southeast
. In seven languages.
THE FATE OF THE VICTIMS OF THE BIJLMER AIRPLANE CRASH
The following is
known about the fate of the victims of the Bijlmer airplane crash:
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Professional knowledge of PTSD in the Riagg southeast was
insufficient
The
Department of Psychiatry at the Academic Medical Center
(AMC) wrote in a 1995 article that one and a half years
after the Bijlmer disaster, 34% of the victims were
still suffering from a processing disorder, even though
the majority of those involved had been treated. The
researchers concluded that the treatment expertise
regarding Post-Traumatic Stress Disorder at Riagg
Southeast was inadequate.
Carlier, IVE, JJ van Uchelen & BPR Gersons (1995b). The
Bijlmermeer air disaster; a follow-up study into the
long-term psychological consequences and aftercare for
the affected persons. AMC,
Department of Psychiatry.
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Six
years after the disaster, at
least 100 victims
still with PTSD.
In
1999, the Parliamentary
Inquiry Committee into the Bijlmer Disaster would
conclude in its final report, Een
beladen vlucht (A Charged Flight),
"that psychological aftercare fell short on a number of
points" and "that in 1998, at least 100 people were
still walking around with Post-Traumatic Stress Disorder
and related complaints, which are a consequence of the
Bijlmer disaster."
* Een
beladen vlucht. Final Report Bijlmer Inquiry.
Sdu Publishers, The Hague 1999.
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After 1999, more
data became available regarding the fate of disaster
victims with PTSD.
Following the Parliamentary Inquiry into the Bijlmer
Disaster, the victims of the disaster were once again in
the public spotlight. The Riagg
Southeast, which in 1998
administratively merged with the Frederik van Eeden
psychiatric hospital under the name De
Meren,
sent a letter in May 1999 to all those involved in the
Bijlmer Disaster.* In it, the institution stated that it
intended to establish a treatment program for the
disaster victims in collaboration with trauma
specialists from the Department of Psychiatry at the
Academic Medical Center, which would address
Post-Traumatic Stress Disorder.
Following the disaster, the Psychiatry department of the
AMC regularly published articles regarding the
(evaluation of) assistance to the disaster victims (for
a list, see the sources in the article below**).
However, there is not a single publication regarding
the intended
collaboration between the Psychiatry department and
Riagg Southeast (De Meren). Even in an article from 2000
concerning all events following the disaster, the trauma
specialists at the AMC make no mention of collaboration
with Riagg Sotheast under the heading 'What next?'.** It
is therefore doubtful whether
the collaboration between the AMC and Riagg ever
materialized. In
an interview in 2012, twenty years after the disaster,
the Professor of Psychiatry at the AMC stated that
it is unknown how many victims are still suffering from
symptoms resulting from the disaster.*** The
fate of the 100 disaster victims who still had PTSD in
1999 therefore remains a matter of speculation.
*Letter dated 3 May 1999 from Ms.
J. Meijer, Operations
Manager of De Meren, to
those involved in the Bijlmer disaster.
**
Berthold Gersons, Ingrid Carlier, Joris IJzermans, 'In
the mirror of emotions': Unforeseen long-term
consequences of the Bijlmer plane crash. In
the Dutch
Monthly
Journal of Mental Public Health ,
2000, 55(10). p.876-888.
***
Jaap Stam (2012, October 4). "The Bijlmer disaster has
taught us a lot. De
Volkskrant
(Dutch national newspaper).
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