As many as half a million hurricane survivors may need psychological help, according to the U.S. Substance and Mental Health Services Administration. But experts worry only a fraction of them are getting proper treatment. A report published this month in the Journal of the American Medical Association found that a critical shortage of resources—from programs to providers to facilities—has left many without the aid they need. NEWSWEEK’s Jennifer Barrett spoke with the report’s coauthor, Richard H. Weisler, adjunct professor of psychiatry at the University of North Carolina at Chapel Hill and adjunct associate professor of psychiatry at Duke University Medical Center, about why so many Gulf Coast residents still aren’t getting the mental-health care they need. Excerpts:
Weisler: ‘In a situation like this, everything falls apart’
NEWSWEEK: You estimate that tens of thousands of people affected by Hurricanes Katrina and Rita aren’t getting proper mental-health care. Why?
Richard Weisler: What we’re seeing is a sharp decline in the availability of both providers and treatment facilities. At the same time, there’s an increase in the number of people needing treatment so it compounds the problem.
About 140 of the 617 primary-care physicians have returned to practice in New Orleans—only 22 of 196 psychiatrists returned to Orleans parish … There may be some in different parishes, but a lot of people just moved away. These are really striking numbers. There’s also been an acute shortage of hospital beds for people to be admitted. I know there are a number of people who spent their entire hospital stays—six to eight days—in the emergency room, and they were there for mental-health problems. They may be psychotic or suicidal. So they can’t go home, but there’s no place else for them to go.
In your report, you note that the New Orleans deputy coroner reported a nearly threefold increase in the suicide rate in Orleans Parish, from nine to 26 per 100,000 in the first four months after Katrina. How unusual is that increase after an event like this?
The numbers might not be right. These were the deaths that were classified. But there are some that are still not classified. Also it was hard to know the population at a given time. [But] these numbers are clearly very high.
Why are they so high?
One reason is that in a situation like this, everything falls apart. Normally in a natural disaster, everyone pulls together. There’s a community fabric, a network that helps people get through the disasters. But in this case, people were scattered everywhere. There’s a FEMA document [from June 2006] that estimated about 2.5 million residents were still living outside their home ZIP code.
More needs to be done. Most people can be helped—anxiety and depressive disorders are treatable and we can help people with addictions.
Why aren’t there more resources available to help these people?
There’s the Stafford Act [a federal statute to supplement the state and local governments in speeding up assistance and emergency services to affected areas], which sounds great. But the act stipulates that the grant may not be used “to provide treatment for substance abuse, mental illnesses, developmental disabilities, or any pre-existing mental-health conditions.”
It’s those who have a history with these types of problems who are at the greatest risk [of a relapse]. These problems are triggered by stress. Congress needs to revisit this law, if not for this disaster then for future disasters. The law was written in the mid-’70s, and I think there was fear at some level that the costs would be shifting from states to the federal government. But this was a catastrophe. What should be the issue here is giving people proper and appropriate treatment. The sooner they get this treatment, the better.
What’s happened to residents who struggled with mental illness or addictions before Katrina?
Let’s say someone had schizophrenia but it was pretty well controlled. He was taking medication and going to a doctor. Katrina hits. He loses his house, he loses his doctor. He can’t get his medication. Pretty quickly, he’s hallucinating again. His whole support system failed. Or, if you had major problems with depression, the risk of a relapse is already greater if you go off your medication. But if you also lost your home, maybe your job, a family member or a pet, you are at much greater risk of relapse.
So what’s the solution—who still needs help?
One thing is relaxing Medicaid eligibility at a time of a catastrophe like this. A lot of people might have had the resources before but lost a good portion of it when the hurricane hit. Also, I really believe they need to continue the outreach programs and increase public awareness. And you can never do enough educating of primary-care physicians and pastors and therapists to teach them how to recognize these conditions and reach out to these people.
There are a lot of people trying to do the right thing in state and local government and on the university and private levels. But the needs are so enormous that there are not enough resources. One Louisiana official told me that it cost about $2,900 per person for outpatient [mental-health] treatment. Do the math and it is an enormous cost. And the money is just not there.
Are any programs working?
Louisiana Spirit and Mississippi’s Project Recovery. They are definitely helping people. One problem, though, is that they can make the referrals out for treatment, but if the Stafford Act was modified, they could actually provide the treatment … What’s also worrisome is that, as the anniversary approaches, the number of calls to the hotlines are going up. The crisis continues for many people. They are still looking for work, still dealing with the insurance companies to rebuild their homes, still tracking down family members.
The [U.S. Substance and Mental Health Services Administration’s] Katrina Assistance Project had about 1,200 volunteers—all licensed counselors, therapists. They’d go down and spend a couple weeks or more. They were paid about $100 a day, including all costs. Otherwise they donated their time. But the funding stopped for that on June 30, unfortunately. Here’s this program that is working—they reported 90,000 counseling visits through April alone—and you need to keep things up like that.
Ultimately what has to happen is you have to attract nurses, doctors and therapists back to the area and rebuild the training programs. But it is going to take awhile and we still have to deal with the facilities.
You went to New Orleans recently. How does it look now?
I went in late July. Some sections of town look perfectly normal. While on the other side, where the levees broke, there was massive destruction. It was just one house after another empty. And nothing is happening—still. One report I read said more than 108,000 households had over four feet of floodwater. That’s 50 percent of all New Orleans households. Some of the homes I went to, you could see [that] there were water lines on the roof. There’d sometimes be tires on the roof and debris. You can’t imagine how bad it was. It was really hard to see the areas hit significantly and harder to hear the stories of what people are going through.
How optimistic are you that all the residents in need of mental-health services will get help?
I am definitely very hopeful. I believe that we can help. It’s more a matter of resources and priorities. But there’s no doubt that the vast majority of these people can be helped. If we don’t help them, the costs to these communities and to the region—really, to the country—will be very high.
