On Jan. 5, 2001, William Baker, a former employee of the Inter-national Engine Company production plant, visited his old work site at 9:44 a.m., armed with an assault rifle. Walking down a long hallway, he fired at employees as he came upon them for almost 10 minutes. Then he walked into an office, shot a worker there and killed himself.

The tragedy left five people dead, four injured and many of the company's 1,200 employees psychologically wounded. Key to helping them and their families recover has been Randy Georgemiller, PhD, who heads the factory's employee-assistance program. As one of only a handful of psychologists offering on-site services in such an environment, he spends every Friday in his office, a doublewide trailer on the main floor of the factory, which manufactures truck engines.

Georgemiller is a unique mix of industrial and clinical psychologist, labor relations adviser, comrade and counselor. And as the son of a lifelong factory worker, he knows he's working with a tough crowd.

"One challenge to working with the blue-collar population is that this is unfamiliar territory for them in terms of talking through their problems or recognizing they need to talk," says Georgemiller. His goals are to make it easier for them to come to him and to get information about coping with such trauma to hundreds of workers whom he may never see face-to-face.

Being there for support

Before the shootings, Georgemiller provided counseling services on a "drop-in, anonymous" basis. The day of the incident, "the immediate challenge was figuring out how to man the services, for 1,200 employees working around-the-clock shifts," he says.

Georgemiller, who is in private practice with 15 other psychologists, quickly enlisted several of them to be available at the factory. Each worker was routed to a room where there was a union official, a corporate official and a psychologist waiting to talk about what happened. During each shift for the next week, the psychologists were available for confidential meetings. They also hosted group meetings to discuss the symptoms and potential manifestations of post-traumatic stress disorder and to help employees normalize their feelings and reactions to the event.

But the services, says Georgemiller, were underutilized. Despite anonymity and on-site support, some workers have been hard to reach. "We're dealing with a lot of stigma and shame," Georgemiller says.

He continues to provide his services as he had before the incident--on Fridays each week. His door is always open and conversations are confidential and anonymous. "Many times I don't even know people's last names," he notes.

Many employees don't want to focus on the shootings, "they don't want to stir it up more," he says. Sometimes he sees people who have been asked by their supervisor to see him. "Supervisors are really key--lots of them were lineworkers who came up through the ranks and have close personal relationships with workers." And there are generations of employees who work at the plant. "It's like a small city," says Georgemiller.

For some, the community feel of the factory became strained though, after the shootings. "People really thought the shooter was a nice guy," says Georgemiller. "Now they're looking for any sign that someone could be potentially violent. I'm getting people referred to me by their supervisors for putting a cup down or throwing away parts too forcefully."

Zero tolerance for violence can be a good thing, he says, but "factory workers tend to be pretty expressive." The production line is no politically correct office--it can be a loud, rough place. If Georgemiller receives reports of employees exhibiting violence, he often recommends that a formal risk assessment be done--a step that can compromise the anonymity and structure of his services. He tries to maintain a service that workers can access without appointments, he says.

An impingement on patient anonymity is the hierarchy of factory work. "When someone wants to come see me, they have to be relieved on the line. So they have to go to their supervisor and tell them they're going to the medical department. Sometimes the supervisor asks why."

He tries to combat these problems by attempting to erase the stigma of seeing a mental health professional. "When things simmered down, one strategy I used was to walk around the factory and try to get my face out there," Georgemiller explains. "I went to holiday parties. I met people." He's developed a relationship with the union's employee-assistance representative. He's also conscious of his appearance at the factory: "I dress casually so people feel comfortable.

Although the factory atmosphere is very different from his private practice--he competes with overwhelming noise in talking with his patients and building relationships with employees is challenging--the issues he sees are similar. "I see substance abuse, work conflicts, health problems, marital conflicts...."

Now, one year later

In part because of the anniversary of the shooting and in part because of the events of Sept. 11, Georgemiller says his days at International have become busier recently. "It's really interesting. Now, there are people coming out of the woodwork who never approached me before."

He recently facilitated follow-up group meetings. "Some of the workers are still in acute stress. One guy never came to see me individually but came to the group. He was asked to identify the bodies after the shooting and is still experiencing post-traumatic symptoms.

"For some, the events of Sept. 11 gave these guys some reassurance that they weren't alone in their experience of trauma," says Georgemiller. "But for some, they were really put over the edge a bit. It had an additive effect of re-awakening their fears."

The follow-up meetings are helping to build mutual support for workers, says Georgemiller: "Some workers have been really tolerant of those who continue to replay their distress over and over again." He hopes the meetings provide education about the long-term effects of trauma, normalize people's experiences, and give him the ability to target those who are still having problems or who might need help.