When you have PTSD (Post-Traumatic Stress Disorder), it's the same kind of thing they see in combat situations. If someone wasn't put together very well in the first place, they are more likely to develop more serious (mental) disorders.'' That's what retired, 33-year New Orleans Police Department veteran David Benelli sees among the ranks of first responders almost three years after Hurricane Katrina. "It's like they've come home from a war, but the war is right here. It's still going on.''
Benelli's observation mirrors three scientific studies that show a 40 percent spike in the number of people with moderate to serious mental disorders related to Katrina. Scientists are discovering that people from all walks of life and all socio-economic strata are just now developing diagnosable symptoms. It's not just first responders or those who experienced the horrors of staying in the city during the hurricane and the levee breaches. It's the woman in the next cubicle, the man fixing your roof, the attorney, the housewife, the guy who mows your lawn, the cab driver, the engineer, the executive.
The studies indicate the costs are varied: marital discord, absenteeism at work, tumbling work performance, increases in the use of antidepressants and tranquilizers, and a surge in alcohol and illegal drug use. One study also indicated a 37.7 percent increase in depression, PTSD and anxiety. Although suicides appeared to rise immediately following the storms, rates have now declined to pre-Katrina levels.
The number of New Orleans-area residents who are seeking mental health help is increasing, and Gov. Bobby Jindal in June signed sweeping reform bills he had backed during the Louisiana legislative session. The $89 million package of bills authorize creation of crisis centers and eventually permanent mental health centers that will provide continuous care, make it easier to commit dangerous patients, and allow teleconferencing counseling sessions in the state. The bills provide funding statewide, but the bulk will be spent in the New Orleans area.
The need is obvious. Ronald Kessler, professor of Healthcare Policy at Harvard Medical School and principal investigator for the Hurricane Katrina Community Advisory Group (CAG) conducted a survey between January and March 2006 and the same months in 2007 concerning the well-being of Katrina survivors. The CAG study, paid for by the Rand Corporation and the National Institute of Mental Health, is ongoing and now has a base of 3,000 Katrina survivors. The study Web site contains hundreds of recorded histories, including this one from a New Orleans woman who rode out the storm with friends:
'The water rose to four-and-a-half feet in a matter of minutes. We went into the attic. The first thing [my friend's husband] did was chop a hole in the attic so if it did keep rising we had a way out, because we just sat there unknowing. (Her own home took only 6 inches of water.) The scariest, stressful thing is all the people that I know and care about telling me they had lost everything. They had lost loved ones. It's not losing possessions; it's the devastation. It will never be like what they say is normal. It will never be normal here again."
'Initially it was just (that) everybody wanted to come in and tell their story,'' says William Brasted, a clinical psychologist who practices in Algiers and specializes in crisis management, PTSD, stress, anxiety and mood disorders. "What has happened since then is that [problems] are much more subtle. The people we are seeing now are often people who are just basically worn out. It's the usual gamut of problems: contractors, Road Home money and job loss every mental pressure imaginable that Katrina and Rita forced upon people along the Gulf Coast. Schools are gone, insurance premiums tripled, each and every issue (made their mental state) as precarious as a toddler stacking blocks. The risk is that it all could come tumbling down with a little nudge."
Kessler's survey shows mental disorders among people who were in the path of Katrina are taking longer to subside and are overwhelming a crippled mental health system that state Department of Health and Hospitals Secretary Alan Levine says "was neglected for 20 years" before it was nearly destroyed by the storms.
A Ninth Ward woman who stayed for the storm described her experiences to investigators: "I stayed. I didn't evacuate. I noticed a lot of things that I didn't think I'd ever have to experience. It was very sad. I was very upset. It was stressful. I cried for two, three weeks after the storm. I'd seen a lot of dead bodies old, elderly people passing and dying in front of me. The Army people took us to the Interstate to get on a bus to go to Texas. We were there two or three days, no food. My most stressful experience? Seeing little babies dying in front of me, and elderly people, and then I lost my father."
In October 2007, Kessler and others including Psychologist Anthony Speier, head of the Office of Mental Health, a division of DHH warned a congressional committee that mental problems could continue in the years following the disaster and eventually could develop among even the heartiest of residents.
Kathryn Power, director of the federal Substance Abuse and Mental Health Services Administration (SAMHSA), testified that two weeks after Katrina hit, the agency's National Suicide Prevention Hotline received 1,400 calls weekly from displaced Katrina survivors a 600 percent increase in calls before the storm.
Levine, who took office at the start of this year, says he was shocked by the magnitude of the problem.
'I arrived in January, literally days within which New Orleans Police Department officer Nicola Cotton was shot 15 times by a diagnosed paranoid schizophrenic, someone who has been in and out the revolving door of the state's mental health system and was released only hours before killing her." He blames most of the problem on years of budget cuts and inattention. "This is a system that has been neglected for 20 years,'' he says.
The most recent survey on post-Katrina mental health was released by the Population Studies Center at the University of Michigan Institute of Research. Written by UM psychologist Narayan Sastry and Tulane University School of Public Health and Tropical Medicine Professor Mark VanLandingham, the survey was conducted during the last six months of 2007. It is the latest data available, although Kessler began collecting data in July for a three-year study.
VanLandingham and Sastry found that 20 percent of New Orleans-area residents affected by the storm showed signs of serious mental illness and another 19 percent showed indications of minimal to mild mental illness. Across all demographics, they found that 60 percent of those displaying signs of mental disorders either had their homes destroyed or severely damaged. Another finding was that there were "major disparities in mental illness by race, education and income.'' African Americans were the single largest demographic "with higher levels of psychological stress." The study found that 31 percent of African-American respondents were in the "high-distress" category compared to only 6 percent of the white survivors who were surveyed.
Sastry says he and VanLandingham are expanding the survey to include up to 2,000 people so they can continue to evaluate mental health status and needs.
A study by the Tulane School of Public Health and Tropical Medicine found that compared to 2003 the last year reliable data was available the number of people who died in New Orleans increased 47 percent in the last six months of 2006. Experts say the high death rate affected the elderly, those with chronic medical conditions and other existing medical problems. They say the stress of evacuation, a lack of medical care and other stressors worsened their conditions and hastened early death.
Much of the $89 million spending package Jindal signed will fund a new comprehensive mental health system with clinics in Orleans, Jefferson, St. Bernard, Plaquemines and other parishes. The bulk of the spending $31.5 million will fund a Metropolitan Human Services Authority covering Orleans, St. Bernard and Plaquemines parishes, while $27.1 million will go to establish the Jefferson Parish Human Services Authority.
The first priority will be to establish crisis clinics to release pressure on emergency rooms and law enforcement agencies. The number and locations of permanent facilities are yet to be determined. The mental health centers will diagnosis and provide continuing care, including medications, for substance abuse or medical disorders.
At the direction of Jindal, Levine pushed hard for the reforms, and freshman Sen. David Heitmeier, D-New Orleans, introduced the legislation.
'We had terrible, terrible utilization of our resources, especially in (dumping) patients at emergency rooms or parish prison (even prior to 2005)," Heitmeier says. "It's a sweeping reform. It's an unprecedented rebuilding of what was a bad system, then (Katrina) destroyed the system. (My) first thought was Katrina just exacerbated (it).''
In an interview in June, Kessler said that compared to survey samples of survivors of tornadoes, earthquakes and manmade disasters, "We find the recovery trajectory for Katrina (survivors) is considerably slower than other disasters or traumatic events.'' The study found that 31.2 percent of a sample group showed "evidence of mood or anxiety disorder (and) among those, only 32 percent had used any mental health services since the disaster, including 46 percent of those with serious disorders.'' It breaks down the severity of the mental disorders: mild to moderate, 11.9 percent; serious, 19.9 percent.
'The difference between this disaster and other disasters is that people didn't just lose their homes, they lost their community,'' says Algiers clinical psychologist William Brasted. "Their church is often gone, their neighbors are still gone, and a lot of them are still in the grief process, frustrated that it hasn't come back.''
Depression, suicide, substance abuse and fights among couples are rising in a region still ill-equipped to handle the number of people who need psychological help, says Dr. Robert Dahmes, a psychiatrist in Algiers. "It applies to people who have never thought of having a mental health issue to those with pre-existing conditions exacerbated by the storms. Stress contributes to existing underlying mental illness. The depression rate goes up and the suicide rate goes up.''
Many people who were on low doses of antidepressants or anti-anxiety medications before the storm are on much higher doses now, he says. In addition, many of his patients who were stable before Katrina are now chalking up high absenteeism at work, and are applying for disability or medical leaves of absence. "These are patients that ... never would have asked for them before (the storm),'' Dahmes says.
He estimates there were about 290 psychiatrists in the metropolitan area before Katrina and that only about 50 have returned to their practices. Psychotherapists with doctorates in psychology have returned in greater numbers, he says.
"The issues we are seeing are lingering effects continuing to express themselves in adverse circumstances,'' says the Office of Public Health's Speier. Some people, he says, are experiencing something akin to flashbacks triggered by severe rain or thunderstorms. "People have increased arousal (of emotions) and anxiety'' during such events, Speier says.
Just as the rebuilding of New Orleans continues with stumbles and successes, so does the recovery of thousands of Katrina survivors. For many, the black clouds, the howling winds and rising water are still swirling.