Donald A. Schexnayder, M.D., Ph.D., fled from New Orleans briefly before
Hurricane Katrina hit, then returned to help evacuees in the Lamar Exhibition
Center and continue his regular work at the Ascension Parish Counseling and
Substance Abuse Center in Gonzales, La. (shown in background). With his house
in New Orleans destroyed, he decided to move to Baton Rouge.
The days are over when volunteer psychiatrists were dropping into
hurricane-battered Louisiana like smoke jumpers on a forest fire.
"We're in grind-it-out mode now," said David Post, M.D."
There's no adrenaline rush anymore."
In the states hit by hurricanes Katrina and Rita last fall, grinding it out
in the mental health arena means not only finding and treating people, but
also dealing with recovery money, government bureaucracy, and thoughts of an
impending hurricane season starting on June 1.
Physical damage in the region is still widespread. Driving along coastal
roads in Mississippi reveals miles of house foundations, and the devastation
of wind and storm surge can be seen well inland too. In New Orleans, besides
the houses destroyed by flooding, many others were ruined from lack of
electricity to run air conditioning or refrigerators while owners were
evacuated not for days as they had planned, but for weeks. As of mid-March,
traffic lights in much of the city were still not operating. Farther west,
places such as Lake Charles, La., and Beaumont, Tex., suffered heavy damage
from Hurricane Rita.
The dislocation of hundreds of thousands of evacuees is still straining
human services in Texas, Louisiana, and Mississippi in areas away from the
path of the storms' devastation.
Psychiatrists along the Mississippi coast report an increase in cases of
depression, substance abuse, and relational problems, especially among people
sharing accommodations with relatives or among formerly separated couples
thrown together again by the need for housing with their children, said
Elizabeth Henderson, M.D., president of the Mississippi Psychiatric
"Life in FEMA trailers is dreary and bleak," she said."
I'm concerned with what will happen to children this summer when school
is out unless recreational programs are in place."
She has not heard much about increased PTSD symptoms, but like
psychiatrists elsewhere in the region, she fears that even a minor tropical
storm this summer will trigger symptoms among people who have not yet
recovered from Katrina or Rita.
In Gulfport, Miss., at the Gulf Coast Mental Health Center, plastic sheets
still covered holes in the center's ceiling, and the floors were carpetless
seven months after the storms. The center is seeing fewer Medicaid patients
and more middle-class ones, said director Jeffrey Bennett, L.C.S.W. Many
severely mentally ill individuals are now in northern Mississippi, Alabama, or
even Illinois. Staff members have been living in trailers because their own
homes were damaged.
"There's a mass grieving process going on," said Bennett's
colleague, psychologist Steve Barrilleaux, Ph.D. "You lose your bearings
around here. People say, `I'll never be able to show my kids the beach the way
it was.' You can't drive through it without tearing up."
In New Orleans, Dudley Stewart, M.D., is seeing more patients with
adjustment disorders, subthreshold PTSD, difficulty concentrating, or
irritability, no matter what they had before.
"Some people are immobilized, some are resilient," said
Stewart, the APA Assembly representative to the Louisiana Psychiatric Medical
Association. Some are looking for the quick fixes provided by alcohol or
drugs, he added.
"You can see the impact on the elderly just by looking in the
obituary columns," said Howard Osofsky, M.D., chair of psychiatry at LSU
Health Sciences Center in New Orleans. "People who had managed because
they had children, relatives, and neighbors to support them were lost without
them. The destruction of so many parts of the city means that the sense of
community and the part of one's identity that it represents is
Physicians, too, were not immune from the storms' effects, and some have
left the area after offices were destroyed and patients were evacuated."
We're going through our own recovery process," said Stewart.
The number of practicing psychiatrists in Orleans Parish has dropped from
196 to 22, according to the New Orleans Times-Picaynue. Much, but not
all, of that difference is traceable to exodus of medical personnel from
Tulane and Louisiana State University, but other psychiatrists have relocated
to other cities too, said Stewart.
Psychiatrists are not alone. Only 140 primary care doctors now practice in
the city, compared with 617 before Katrina. There are just 77 working dentists
today, down from the 259 before the storm. Ironically, the loss of doctors
means New Orleans is eligible to be named a federal Health Professional
Shortage Area, allowing physicians to charge 10 percent more for Medicare
treatment and triggering incentives (like medical school loan forgiveness) to
attract new doctors to the area.
Some medical residents have departed because Katrina wiped away their
training opportunities along with hospitals and houses, said Martin Drell,
M.D., clinical director of the New Orleans Adolescent Hospital (which is still
waiting for state approval to reopen). Psychiatric residents at Louisiana
State University Health Sciences Center were shifted to the Oschner Clinic,
but 30 percent of the medical faculty had to be furloughed, and flooded
offices won't be usable before March of next year, said Osofsky.
Donald Schexnayder, M.D., Ph.D., used to live in New Orleans and commute
north to the Ascension Parish Counseling and Substance Abuse Center in
Gonzales, where he is the medical director. After his home near Tulane
University was wrecked, he moved permanently to Baton Rouge and now commutes
south to work.
In Lake Charles, La., hard hit by Hurricane Rita, Dewey Archer Jr., M.D.,
reports that his patient census at the Institute for Neuropsychiatry has
nearly rebounded to pre-storm levels, although the population mix has changed.
Today, he's seeing more adults yet fewer geriatric or child patients compared
with before the storm.
Throughout the region, treatment is complicated by structural weaknesses in
existing mental health systems, shifts in funding patterns, and bureaucratic
intrusions from every level of government, according to several sources.
"The public mental health system in Louisiana was underfunded and
overburdened even before Katrina," said Kathleen Crapanzano, M.D.,
medical director of Louisiana's Office of Mental Health. "Now there are
no psychiatric inpatient beds in New Orleans. People wait in emergency rooms
two or three days for a placement in a private setting or a state
Texas's mental health system had been paring services and closing mental
hospitals in the two years before the storms. Then the evacuees began arriving
by the thousands. "FEMA funding is now drying up, but nothing has
changed in the previous state underfunding of mental health services,"
said George Santos, M.D., of Houston's West Oaks Hospital.
Federal emergency funding fills part of the gap in helping evacuees, but
that raises other questions. Arguments have already begun in Louisiana about
who gets what. Health officials outside New Orleans point to relocated
evacuees in their districts and want increased funding based on the new
population served. But that means taking money from already underserved New
Orleans and from rural areas in the northern part of the state. "It's
robbing Peter to pay Paul," said Crapanzano.
Beyond the money issues, said Post, who is medical director of the Capital
Area Human Services District in Baton Rouge, "everything is getting more
bureaucratic and political." He organized field teams under the federal
Stafford Act to go on site to shelters and trailer villages to identify people
who needed treatment. Once the emergency phase was over, FEMA worried about
information collected on patients, told him to stop, and impounded his
records, said Post. He is now awaiting clarification from federal and
Louisiana authorities. In fact, much disaster relief is intended for a
shorter-term response rather than the years it will take to recover from last
"We need to look at the Stafford Act," he said. "It was
set up for crisis management, not for field triage and referral. Now you can't
just be good old Dr. Post, treating people. The new bureaucracy is definitely
affecting the treatment of patients."
What happens next to the people still struggling with the aftermath of
Katrina and Rita was on the mind of every psychiatrist interviewed for this
"Another hurricane will make last year look like a rehearsal for a
disaster," said Susan Sparkman, M.D., past president of the Texas
Society of Psychiatric Physicians.
"Among the mental health staff, the next hurricane season is a
ticking clock," said Crapanzano. All disaster preparation before Katrina
planned for a five-day evacuation. Southeast (Louisiana) Hospital evacuated
for 33 days, she said. Now the state says it will evacuate in the face of a
category 1 or 2 storm (Katrina was a category 4) and make evacuation decisions
72 hours in advance of the storm. But at that time, a hurricane's projected
landfall is so uncertain that there will inevitably be a lot of false alarms,
which may cause many to reexperience last year's events. Staffers also have to
balance their responsibilities to patients with their own families' safety.
Last year, hospital workers on duty evacuated with patients but were never
relieved by other shifts.
Planning by governments and medical groups in all three states for future
disasters is ongoing, but much remains incomplete or uncoordinated.
"We need a system in place that can be quickly and effectively
mobilized," said Sparkman. Organizing a chain of command and uniting
disparate and often competing professional specialties won't be finished
before new hurricanes arrive this summer.
"The need is there and definitely not being met," added
Henderson. "I have no idea how to meet it except in collaboration with
other licensed professionals. This is going to be with us for a long, long