Greater Attention to Trauma Sought

Three weeks after Hurricane Katrina, mental health counselors manning crisis lines are expressing mounting frustration at their inability to provide more than words of comfort to callers.

Liz Brown, a counselor who has been fielding 75 calls a day for a hotline in Baton Rouge, La., said most callers feel “a level of isolation that’s almost incomprehensible to outsiders.”

She recently talked to a man housed with 42 other people who felt disconnected after losing all his possessions.

“We can offer compassion,” she said. “But what these people need is also freedom of choice -- the ability to get their psychiatric medications or even some pocket cash to buy a movie ticket.”

Amid the physical carnage of Katrina, mental health professionals say only a trickle of attention and money has been focused on the burgeoning psychiatric problems.

They say they are facing two sets of problems.

The first is caring for the hundreds of thousands of mentally ill people who have been displaced by the hurricane -- a difficult task because so many of them are now scattered across the country in shelters, homes and hospitals.

The second is finding and treating people who have been saddled with new -- and possibly enduring -- trauma from the disaster. A study from the federal Centers for Disease Control and Prevention found that nearly 6% of people in evacuation centers had experienced “a new psychiatric condition.”

“No one is going to tell you the [mental health] system is fully funded anywhere in the country,” said Mark Weber, spokesman for the federal Substance Abuse and Mental Health Services Administration. “Now that much of that capacity has been destroyed in Louisiana and Mississippi, clearly there are going to be unmet needs.”

The agency, which is managing the government’s mental health care response to the disaster, issued $600,000 in emergency grants last week to Louisiana, Alabama, Texas and Mississippi.

Louisiana’s assistant secretary of mental health, Dr. Cheryll Bowers-Stephens, said the disaster had been so overwhelming that she intended to first use the money to counsel her staff and other emergency workers.

They have “had death stare them in the face too many times,” she said.

The most immediate problem has been ensuring that the seriously ill get their medication.

Katrina Gay of the National Alliance for the Mentally Ill said the widespread destruction of prescription and insurance records had made it often impossible for mental health workers to get the authorization to administer drugs.

Gay, who directs field operations for the Arlington, Va.-based group, said the federal government should implement emergency rules to allow psychiatric emergency teams from the Red Cross or other groups to administer medications as needed.

She said the government also should make Medicaid temporarily pay if mentally ill patients must be hospitalized -- a cost usually borne by the states.

Weber, of the mental health services agency, said the government was considering revising drug prescription rules, but he cautioned that such a change could carry its own health risks.

He said the administration’s decision last week to create a “special evacuee status” for every hurricane victim would allow people to receive Medicaid benefits in any state, without documents such as proof of residency.

Thom Bornemann, an expert in the psychological effects of disasters at the Carter Center in Atlanta, said Katrina had exposed victims to multiple traumas -- injury, death, loss of possessions and the perception that authorities were unable or unwilling to help them.

Identifying and treating such victims won’t be easy, said Dr. Anand Pandya, a psychiatry professor at Bellevue Hospital in New York and founder of Disaster Psychiatry Outreach, an institute studying the long-term health of World Trade Center victims.

“We’ve learned from studying disasters ... that the people most traumatized by them are usually the least likely to seek treatment,” Pandya said. “Since they’re not going to come to us, we have to find ways of getting to them.”

The mental health community is divided over what kinds of outreach will work best.

Barry Hong, a psychiatry professor at the Washington University School of Medicine in St. Louis who has studied flood victims, said up to half of those affected might need counseling.

However, Dr. Derek Summerfield, a psychiatrist at London’s Maudsley Hospital, said research after the wars in the Balkans and volcanic eruptions in Japan in the 1990s had shown that helping people rebuild their homes and livelihoods can often be more beneficial than counseling, in which people revisit deep psychological wounds.