Innovation Required to Provide MH Care in New Orleans

Janet Bradley, M.D., sits in a church hall late one fall afternoon talking to a slightly distracted looking lady, a regular, who comes in to tell Bradley her troubles.

Here in New Orleans, people haveplenty of troubles, and Bradley's job is to listen. The lady's tale is familiar. Some people have to tell their story—and tell it again.

Bradley, a third-year resident in psychiatry at Tulane University, has spent one afternoon a week working with people with little money and no health insurance in the two years since Hurricane Katrina hit New Orleans.

“This is part of our training, but I would have volunteered anyway,” she said. “Katrina just provided the opportunity.”

Sometimes she's here at St. Anna's Church; sometimes she's out in the big R.V. that's refitted with an examining room and a tiny office just big enough for a psychiatrist, a patient, and a little privacy.

“We're catching a lot of people who would never see a psychiatrist,” Bradley said. She uses an indirect approach out in the community, not wanting to intimidate people. She might start with a blood-pressure check, then ask if a new patient has any worries about“ stress or nerves.” Sometimes she just talks to people waiting patiently in line outside the R.V., trying to identify the ones with psychotic symptoms. Inside, she'll screen for depression, then ask about other symptoms.

“Most people won't admit they want psychiatric help, or they say they want to talk to a primary care doctor,” said Diana Meyers, R.N., who runs the St. Anna's center, a few blocks from the French Quarter.

Meyers lost her hospital nursing job after Katrina but started the free clinic early in 2006 doing “table-top” screening for high blood pressure or diabetes. The center provides general medical and mental health care to poor residents of the city's hardest hit areas: the Lower Ninth Ward, St. Bernard's Parish, and the center city.

The Episcopal Diocese gave $100,000 the first year and again the next. Meyers used some of the money to fit out the R.V. as a mobile office. She depends on donations of supplies and cash to keep going. She is also grateful for the samples drug reps give her, but chagrined that they are expensive medications that her patients won't be able to afford once the samples run out.

“We don't have insurance issues because we won't turn anyone away,” she said.

St. Anna's is not a primary care site, she said. “We want to connect them with a 'medical home' and change their thinking away from the ER as the place to go for services.”

Psychiatric patients may return for care or get referred to Tulane's clinic. Still, many return to St. Anna's or the R.V. for checkups.

“People are always thankful,” said Meyers. “One lady comes back once a week to check her blood pressure and glucose—it's a contact.”

Making that contact is critical for Bradley now.

“There's little affordable or free care, especially detox or substance abuse,” she said. “Transportation is a problem. Some people don't even have bus fare. The mental health centers only want the sickest people, and the mentally ill are unwelcome in the emergency rooms.”

The two years since Katrina hit have opened her eyes, she acknowledged.“ I've realized how many people are in need of basic medical and psychiatric care,” she said. “The system is really unfair—I always thought so—but more so now, especially to people who can't finesse the system. It's infuriating that it's been two years, and inpatient psychiatric beds are only now opening up in the city.”

Meyers has noticed something else recently.

After two years, depression and stress are starting to show up in health care workers and those on whom others depend. “The people that everyone go to, the pillars of the family and community, are feeling it now,” she said. “We feel good about what we're doing, but it's very disheartening.” ▪