Government Efforts Fall Short In Addressing Victims' MH Needs
In the year since the twin disasters of hurricanes Katrina and Rita, the federal government has provided $110.6 billion in aid for relief, recovery, and rebuilding efforts. The vast majority of federal funds were allocated to meet needs unrelated to health care.
The largest segment of health care support came via Congressional approval of $2 billion in Medicaid waivers for hurricane victims, which allowed eight states to reimburse clinicians for uncompensated care they provided to an estimated 325,000 evacuees. In the aftermath of the storms, 32 states provided up to five months of simplified enrollment in their Medicaid plans for displaced low-income individuals.
Based on normal levels of Medicaid spending, significant mental health assistance is believed to have been provided through Medicaid to enrollees affected by the storms to whom the Department of Health and Human Services (HHS) granted special “evacuee” status. HHS extended the public health state of emergency through the end of this year to ease Medicaid access for Gulf Coast residents and evacuees.
States have not yet reported their Medicaid mental health spending totals, said federal officials.
Another large federal health-related aid effort is the congressionally approved $16.7 billion in Department of Housing and urban Development's (HUD) Community Development Block Grants. The grant program—passed specifically to assist states affected by the storms—is designed to help rebuild damaged housing and other infrastructure, but localities may opt to spend some of it on health care needs. Final health care allocations by localities from the largest single housing recovery program in U.S. History will take up to a year for HUD to tally.
Congress also gave the region $550 million in social-service block grants, which states have the flexibility to allocate to health care needs. Louisiana, for instance, allocated $80,000 of the one-time funding for mental health programs.
Critics complained that the largest portion of federal mental health funds appears directed at short-term and crisis-recovery assistance. The historic nature of the disaster should have spurred a federal response of similar scale directed at longer-term interventions.
Among examples of some higher-profile federal health care support is the mobilization of all of HHS's emergency response capabilities to provide the affected states and localities with crisis health care assistance. Experts from all areas of HHS, including the Centers for Disease Control and Prevention and the Food and Drug Administration, augmented state and local public health personnel. The U.S. Public Health Service Commissioned Corps provided crisis care as well as longer-term health care assistance to Louisiana health officials, including a recent assessment of 72 nursing homes and 61 hospitals in the 12 southernmost parishes of Louisiana.
Almaz Oko, a Miami resident who came to Chicago after Hurricane Andrew destroyed her home in 1992, sits in the community room of Deborah's Place, a transitional housing facility for women, in March. Oko said she still suffers from insomnia and flashbacks and thinks Katrina's victims face a long recovery.
AP Photo/Photographer: M. Spencer Green
The Substance Abuse and Mental Health Services Administration (SAMHSA), which is an HHS agency, also arranged for the provision of significant amounts of mental health counseling and referrals to hurricane survivors (see article above).
SAMHSA's center for Mental Health Services, in partnership with the Federal Emergency Management Agency (FEMA), awarded about $110 million for crisis-counseling programs, including $34 million—the second largest grant of its kind—to a Louisiana program.
FEMA also established a program to find and coordinate the services of licensed medical and mental health clinicians in the region as well as nationwide—including more than 50 psychiatrists—who volunteered to provide short-term care.
FEMA said it deployed a record 6,300 personnel, including nurses and physicians who treated more than 165,000 people in the weeks following the storms.
The Department of Veterans Affairs deployed health care personnel, including nurses, radiology technicians, health care technicians, respiratory therapists, and others, to help increase the ratio of those available to provide medical services to those who needed it. The department's health care professionals provided support to several New Orleans hospitals through the end of September.
Although much of the federal health care effort in the wake of the storms was focused on short-term assistance and recovery, an initiative with long-term impact is the HHS-supported effort to revamp Louisiana's health care system, a project known as the Louisiana Health Care Redesign Collaborative. HHS supported the redesign with staff, expertise, and efforts to remove roadblocks. HHS Secretary mike Leavitt pledged to support Medicare and Medicaid waivers to help drive the overhaul. The state aims to present its blueprint for redesign by October.
Another key aspect of a long-term mental health effort is assessing the continuing impact of the storms on the mental health of the survivors. To this end, the National Institute of Mental Health approved a $1 million grant to extend a Harvard study that will use telephone interviews to assess the continuing mental health of more than 1,000 hurricane survivors in the Gulf Coast region and scattered across the country.
Information on the federal response to the 2005 hurricanes is posted at<www.dhs.gov/interweb/assetlibrary/GulfCoast_Katrina1yearFactSheet.pdf>.▪
