By Thomas Cannell
March 2007
Since Hurricane Katrina, the greater New
Orleans area has suffered from a mental health meltdown. The
national media has persistently covered this disaster, and its
dynamics have been well-rehearsed.
The iconic
trauma of the people of New Orleans, displaced from their homes
for months, now years, has led to an upsurge in mental illness
after the mental health infrastructure took a staggering hit.
The system has been overwhelmed; acutely psychotic
patients cycle miserably through clogged emergency rooms.
These journalistic accounts have thrived on
the simplicity of this equation: more mental illness and lower
capacity for treatment equals a crisis. What these accounts miss
is that mental health care in the United States is never a
simple case of matching treatment to disease burden, but instead
a complex function of health care-seeking, social support, and
access. Even before the storm, the majority of New Orleanians
who were mentally ill did not access psychiatric care, whether
out of preference, fear, disempowerment, or confusion. However,
the attention drawn to storm-related mental illness brought to
the city a different concept of mental health—disaster mental
health—defined by its commitment to community outreach, primary
prevention and validating therapeutic social support. Here I
mean to suggest that an adequate response to Katrina’s mental
health disaster will mean integrating ideals of community mental
health into a new system, not merely reconstructing the old
psychiatric structure.
Two credible surveys validate the anecdotal
accounts of increased stress and despair in the New Orleans area
after the storm. The August 2006 report of the Hurricane Katrina
Community Advisory Group, led by Ronald Kessler of Harvard
Medical School and The Louisiana Health and Population Survey (PopEst),
conducted during the summer of 2006, both found the prevalence
of serious mental illness to be two or more times the national
average, up from 6 percent pre-storm to 11 percent among all
post-storm residents.
In Orleans Parish, according to PopEst, the prevalence
rose to 16 percent. “Mild to moderate” mental illness was also
elevated. Those classified as “seriously mentally ill” displayed
the impaired functioning associated with schizophrenia, bipolar
disorder or major depression. If the surveys are to be taken
seriously, then more than one out of ten people of the New
Orleans region is suffering from a mentally illness.
The closure of Charity Hospital, as Chris
Weaver and Adele Shartzer discuss in this issue, deprived the
city of New Orleans of not only 97 psychiatric and substance
abuse beds, but also of its Crisis Intervention Unit, the
psychiatric emergency room.
All told, the storm caused the closure of 346 out of 555
psychiatric and substance abuse inpatient beds. Meanwhile, the
Metropolitan Human Service District, responsible for outpatient
treatment of the uninsured, struggled under shifting leadership
in the year after the storm. Staffing this fragment of the
former system is an even smaller fragment of the psychiatric
workforce. An often-cited account found that in the spring of
2006 only twenty-two psychiatrists out of a pre-storm population
of 196 still practicing in the region.
And so thousands of former patients of
these psychiatric hospital beds have had their system of care
pulled out from under their feet. Still, critics rarely
appreciated that for the average New Orleanian, mental health
resources have been much more accessible than before the storm.
A FEMA-funded counseling effort, Louisiana Spirit, administered
in the New Orleans region by Catholic Charities, has conducted
over 200,000 “wellness” counseling sessions and distributed
almost 10 million pieces of self-help stress management
literature. Thousands of case workers fanned out throughout the
region knocking on doors, spreading the message that it was
normal to be having a hard time and that most people could cope
with help from family and friends. Alongside the woeful state of
the psychiatric infrastructure, this massive low-intensity
mental health outreach has aggressively expanded throughout the
region. Louisiana Spirit is modeled on “Project Liberty,” the
mental health response to 9/11, but also finds roots in the
disaster psychiatry that is practiced in third-world settings
after wars and natural disasters. In fact, Louisiana Spirit has
been supplemented by the entrance of several international NGOs,
such as the International Medical Corps, Mercy Corps and Save
the Children, which transferred their expertise on the mental
health of “internally displaced persons” to the Gulf Coast.
Problematically, all of this disaster mental health programming
is expected to terminate within a year or two.
Continued
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