"I had three children, and I could only hold onto to two."
That statement from a Katrina survivor is typical of the images storm victims have described to workers at Memorial Behavioral Health in Gulfport, Miss., according to Michael Zieman, the facility's administrator. Parents and spouses have shared their anguish and relived the horrible memories of holding onto their loved ones, only to have the current pull them apart.
"We're dealing with grief and loss issues" and post-traumatic stress disorder, Zieman said. Unlike the physical damage of the storm, which can be repaired, the mental and emotional repercussions for residents could linger or worsen.
Today, Zieman said he and his staff are seeing more volatile behavior in adults and a lot of drug abuse. "It's like the patient population is taking a shift of `more ill' than `less ill,' " he said. After disasters, behavioral health centers in what Zieman called a "disaster theater" should focus on outreach because transportation issues could prohibit people from traveling to mental health facilities for counseling. If a center is outside the disaster theater, it should send clinicians to help, if possible.
"Katrina was a horrible storm, but it was over in a few hours," said Philip Merideth, medical director at Brentwood Behavioral Healthcare of Mississippi in Jackson. "The biggest long-term public health problem that has occurred will be the mental health of the populace."
It is also important for people to understand the link between major depression and other chronic illnesses, said Richard Weisler, adjunct professor of psychiatry at University of North Carolina at Chapel Hill. "When people have mood or anxiety disorders, they tend to smoke, and (there is) a decrease in medical regimen," of diet, exercise and medication, Weisler said, who added that churches and schools -- often seen as support systems -- were destroyed, which compounded the problem. In an Aug. 2 commentary in the Journal of the American Medical Association, Weisler argued that Congress should allow states to use federal crisis counseling funds for continuing treatment of individuals beyond immediate crisis management after disasters.
According to a January summary from HHS, the Substance Abuse and Mental Health Services Administration provided $600,000 in emergency response grants to Alabama Louisiana, Mississippi and Texas to ensure that mental health assessment and crisis counseling would be available in the Katrina-affected areas. Louisiana established a team of behavioral health specialists to provide counseling to disaster workers and first responders; Alabama created a pool of funding to support clinical assessments and direct services; Mississippi provided emergency support in mental health treatment facilities; and Texas supported existing methadone providers to allow for services to evacuees in shelters, the summary said. To date, the agency has dispersed more than $109 million to all states affected by the storm (including those that took in evacuees) for both immediate and regular services, an agency spokeswoman said.
Since the storm, many in the Mississippi area have agreed to crisis counseling with Project Recovery, a program by the Mississippi Department of Mental Health to help people deal with the stress of Katrina's aftermath. The program arranges for counselors to travel door to door to inquire if people need services. Project Recovery counselors have seen nearly 195,000 people, said Jennie Hillman, project director.
The program was divided into two sections: the immediate services program, which received $4.5 million and began in early September, and the regular services program, which received $19.8 million and began Feb. 15 and is scheduled to end on Nov. 15.
In Louisiana earlier this month, the state's Department of Health and Hospitals said it would open 10 adult acute-care beds at New Orleans Adolescent Hospital, which provides mental health services for children and adolescents with serious emotional and behavioral problems. Another 10 beds are expected to open in coming weeks. In early June, the department reopened 15 child and adolescent beds at the facility.
At the recent annual meeting of the American Psychological Association in New Orleans, LSU professors Howard Osofsky and Joy Osofsky presented results of two mental health studies conducted in Louisiana in the past year. In one, which surveyed nearly 600 first responders, 44% said they do want mental health services, 40% reported an increase in alcohol consumption and 41.2% reported an increase in marital conflict. The other study surveyed more than 2,700 children in Orleans, St. Bernard and St. John the Baptist parishes, and found that 95% had witnessed damage or destruction to their home or neighborhood, 75% lost their toys or clothing and 37% said they avoided thinking, talking or having feelings about the hurricane.
"We expect people to relive the horror on the anniversary," Hillman said. "They're afraid. They're anxious. That's to be expected, but it's a normal reaction and part of the healing process."