The unexpected scale of the disaster, immense infrastructure destruction at
all levels, and difficulties coordinating the medical response turned
Hurricane Katrina into a challenge "even worse than 9/11," said
Anthony Ng, M.D., chair of APA's Committee on Psychiatric Dimensions of
"We were unable to contact the district branches in the affected
areas to find out if members were all right and make sure that everyone
working in disaster-affected areas would be safe," he said at the
plenary session at APA's fall component meetings in Washington, D.C., about 10
days after the hurricane hit. "Many people in the psychiatric community
wanted to volunteer, but the mechanism for coordinating those volunteer
efforts wasn't in place to help get them to do the work."
The CPDD was set up following the September 11, 2001, terrorist attacks and
was active after the Asian tsunami last December and the recent London train
bombings, said Ng. Its Internet list serve circulated information between
district branches (DBs) and the disaster committee, and its Web site offered
updated information. CPDD also maintains contact with federal agencies like
the Department of Health and Human Services (HHS), Substance Abuse and Mental
Health Services Administration, and Federal Emergency Management Agency; state
emergency management agencies and departments of health; international
organizations; and others.FIG1
Anthony Ng, M.D., summarizes APA response to address mental health needs
of Hurricane Katrina victims, including APA members.
At APA headquarters, CPDD staff liaison Erin Dalder-Alpher averaged more
than 100 e-mails and dozens of phone calls each day while serving as the
contact between several APA departments and members and
A man sits with his feet in the floodwaters along Canal Street in New
Orleans and sobs a few days after Katrina devastated the city.
AP Photo/The News & Observer, Chuck Liddy
Even before Katrina struck the Gulf Coast on Monday, August 29, CPDD began
contacting DBs and federal agencies to see what APA could do to help, said
"Then, once the hurricane hit, we began providing situation updates
on the list serve to respective DBs," he said. "We wanted to make
sure that DB members were all right, that everyone working in
disaster-affected areas would be safe, and that the DBs themselves were OK. We
also started rapid liaisons with our state and federal partners to investigate
the response needed. We have also dealt with licensing and credentialing
issues in case members wanted to go to affected areas to help."
APA's hurricane-response Web site, which can be accessed at<www.psych.org/disasterpsych/katrina/resourcecenter.cfm>,
referred members who wished to volunteer to Web sites run by HHS, Medical
Reserve Corps, and Red Cross. The site also offered information on preparing
for potential disasters and included a letter to Congress urging that storm
victims and first responders receive early follow-up mental health services,
that persons with preexisting serious mental illnesses continue to receive
their treatment, and that public mental health systems around the country now
absorbing evacuees get the help they need (see
DBs in Louisiana, Mississippi, and Alabama were disrupted or worse by the
flood or wind damage to the homes and offices of medical professionals and
hospitals, by the loss of power and Internet and phone service, and by the
dispersal of both doctors and patients evacuated from the region.
More than two weeks after the hurricane, the Louisiana DB—the
Louisiana Psychiatric Medical Association—had spotty or nonexistent
communications service. Some psychiatrists and mental health professionals
coming to the state alone or in groups did not inform the DB or mental health
officials of their presence, volunteer location, or intended length of
The failure to coordinate meant some facilities lacked adequate mental
health coverage, according to Harold Ginzburg, M.D., J.D., M.P.H., the
Louisiana DB's disaster response director. On one occasion, the Baton Rouge
convention center, with 5,000 temporary residents, had inadequate mental
health coverage while other facilities had more than enough.
After Ginzburg left New Orleans for an evacuation camp in Mississippi, he
functioned as a general physician first. "I was much more valuable as a
GP," he said, and advised colleagues who wanted to help in future
disasters to remember their basic medical skills.
"That's what makes us different from other mental health
people," he said. "We're medical doctors and should have the
ability to triage, diagnose, and treat basic medical conditions."
Hundreds of thousands of Louisianans fled their state for the Houston
Astrodome and other evacuation centers in neighboring Texas. The Texas Society
of Psychiatric Physicians (TSPP), the Texas DB, helped coordinate the
dissemination of information to members about shelter locations and staffing
needs, according to Executive Director John Bush.
TSPP also worked with the Texas Medical Association to distribute
information about volunteer needs in the emergency disaster relief effort and
assisted out-of-state psychiatrists who volunteered to help. Hundreds of
members from the private and public sectors responded and began staffing
clinics in shelters throughout the state in coordination with state agencies,
medical schools, and community mental health centers.
"Our biggest challenge now is the total destruction of the entire
mental health infrastructure on the Gulf Coast," said Elizabeth
Henderson, M.D., of Ridgeland, Miss., president of the Mississippi Psychiatric
"We're still trying to locate members," she said a week after
the storm. "A quarter of our members live in the affected area, and we
don't know if anyone's missing."
Henderson was especially concerned about disrupted care for mentally
retarded individuals and patients on methadone maintenance. There are no
methadone clinics in southern Mississippi—most patients go to New
Orleans for treatment—and few doctors in the area are certified for
buprenorphine treatment, so transferring patients to that drug will be hard,
"I'm also concerned about mental health care for physicians during
this crisis," she said. "They face a dual dilemma: tremendous
disruption and loss, plus increased work."
Katrina hit Alabama less severely than Louisiana and Mississippi, said
Alabama Psychiatric Society President Christopher Randolph, M.D., of Anniston.
Many members along the coast were back at work within two weeks. In Alabama,
the state department of public health coordinated physician volunteers, while
the United Way organized volunteers in Anniston.
At press time Randolph was working with other local doctors and the
counseling community to set up a general clinic and mental health services at
a former military base near Anniston. Officials were preparing the base to
house 1,000 evacuees, he said.
"We've seen some evacuees with PTSD and psychosis, but we'll see an
increase in cases over time," he said. "It will probably take
months before we get some resolution."
Once the acute crisis is past, the medical community will have to evaluate
the response to Katrina to improve coordination between agencies, the timing
of resources, and how relief plans are conceived and executed, agreed the
"I've spent several years working in resource-challenged places, but
to see this here was quite out of place and disturbing," said Oregon
Disaster Medical Team psychiatrist Lawrence Hipshman, M.D., who has worked in
Zimbabwe, Mozambique, and Uganda, among other places. "Without pointing
a finger, we can say that certain things could have been done a lot
In the meantime, long-term public health and human service needs of
hundreds of thousands of people must be met, said Ng. Many of those needs will
appear in the weeks, months, and years ahead.
As a result of their Katrina experience, Ng and the committee will
recommend that APA take a more active role in coordinating volunteer efforts
in future disasters, he said. For instance, APA worked before the storm with
the Red Cross to improve the integration of psychiatrists into relief efforts.
The Red Cross's previous policy prohibiting volunteer physicians under its
purview from prescribing medications was lifted after Katrina but was
inconsistently applied, he said.
As reconstruction proceeds, APA should take part in rebuilding the mental
health infrastructure and residency programs, Ng said. He added that APA plans
to work on credentialing and temporary licensing of physicians volunteering
after disasters, both to ease the flow of doctors into affected areas and to
allow displaced physicians to work in other states.
"One of the most important things is to take an active role in
supporting our colleagues," he said. "Many of us have lost jobs
and practices in affected areas."
Despite any shortcomings, many on the scene in the four states involved
felt encouraged by aspects of the immediate response.
"The generosity of people in this area is just huge," said Joni
Orazio, M.D., who practices in Lafayette, La. "There was a lot on
television about what went wrong, but not so much was published about what
ordinary people and doctors are doing. People are so appreciative. Loving
things are happening even as you feel grief in the air."
Information on APA's hurricane response efforts, donation and
volunteer information, and resource center can be accessed on APA's homepage
APA's disaster psychiatry Web site can be accessed at<www.psych.org/disasterpsych>.▪