Steven Steury, M.D. (left), Julia Frank, M.D., and David Fram, M.D.,
stand in front of the D.C. Armory. Steury and Frank were among those who
provided psychiatric services to hurricane evacuees there. Fram, president of
the Washington Psychiatric Society, noted that the shelter had provided
much-needed structure for evacuees. Eve Bender
After facing tremendous adversity in the days following Hurricane Katrina,
for some Gulf Coast evacuees who arrived in Washington, D.C., last month,
psychiatrists were the true heroes.
Two planeloads of survivors fleeing the devastation—about 250
people—arrived at the D.C. Armory on September 6.
Among them were people who had witnessed brutal violence while waiting to
be rescued at the New Orleans convention center or Superdome, gone without
food and water for days, and had lost family members to the flood that
followed the storm.
Steven Steury, M.D., who is chief clinical officer of the D.C. Department
of Mental Health (DMH), told Psychiatric News that upon arrival, many
evacuees were "delighted to finally have a clean, safe, and welcoming
place to live" and that it took several days before people began to
experience symptoms related to their distress, including anxiety, insomnia,
"Some, but not all, were interested in talking about their
experiences immediately," Steury said.
He noted that soon after arriving at the armory, "those with more
resources and resiliency" left to reunite with family and friends.
Others received housing vouchers and were moved to apartments and houses
around the metropolitan area.
By September 20, 140 evacuees remained; a week later, there were fewer than
The DMH took the lead in providing psychiatric services to the evacuees and
worked with volunteer faculty and residents from area medical schools and
hospitals, including Howard University, George Washington University,
Georgetown University, St. Elizabeths Hospital, and Children's National
In addition, private-practice psychiatrists who were members of the
Washington Psychiatric Society (WPS) also volunteered their services.
WPS President David Fram, M.D., toured the armory and observed that"
the mental health services available had been designed to provide
immediate service and at the same time minimize the development of longer-term
He also found that the shelter "was well-organized and able to
provide needed structure for the evacuees, whose lives had become so very
Among the original group were about 15 evacuees who needed treatment for
psychotic disorders, including a young man experiencing his first manic
episode, Steury said. Some had been without their medications for days, and
others had never been treated, he said.
Psychiatrists hospitalized some of the evacuees with psychosis and treated
others at the DMH's Comprehensive Psychiatric Emergency Program just a few
blocks away. Others were treated on site.
Julia Frank, M.D., who coordinated the volunteer efforts of psychiatrists
at the armory, noted that "addressing the needs of the psychotic
evacuees so that they are able to more quickly act like everyone else"
was a major first step in reducing stress levels.
Frank is director of medical student education and an associate professor
of psychiatry at George Washington University and is the WPS representative on
disasters to APA.
Nonpsychiatric mental health professionals working with the DMH, Red Cross,
and Strong Families Program, which falls under the umbrella of the D.C.
Department of Human Services, offered the bulk of the "psychological
first aid" to evacuees, Frank said, and notified psychiatrists when they
identified those in need of more specialized help.
Clinicians who conduct psychological first aid ensure that a person exposed
to a disaster is safe and feels safe and and that basic needs such as food,
water, and shelter are met. Clinicians may also help victims reunite with
loved ones and provide them with information about what to expect of
themselves in the near future, Frank said. The aim is to instill a sense of
calm, connectedness to others, and hope in the person who is experiencing
This means that clinicians do not "debrief" survivors or force
or encourage them to discuss traumatic events. "We teach people that
symptoms like sleeplessness and anxiety can be expected but will not
necessarily continue forever," she said.
Frank and Steury were especially attentive to evacuees who endured serious
losses, such as the death of a family member, and who may be struggling with
continuing or worsening symptoms. "We make sure they know they can get
help" in these circumstances, she said.
As the evacuees are moved to housing throughout the D.C. area, some will
continue to receive mental health services through the DMH.
Psychiatrist Ike Nnawuchi, M.D., realized that the long hours he spent with
survivors of Hurricane Katrina were taking a toll on him when he noticed how
relaxed he was while back at his regular job at the DMH's Comprehensive
Psychiatric Emergency Program. There, though many patients are psychotic,
agitated, or both, "I felt like I was on vacation in the Bahamas,"
he told Psychiatric News.
When he spoke to psychiatrists and mental health professionals volunteering
at the armory, many told him they felt more fatigued than usual, but weren't
sure why. "It was the intensity of the stories we were hearing,"
On many occasions, the evacuees' stories shocked and saddened him (see
story at bottom of page
9). For instance, one man witnessed the suicide of a New Orleans
police officer. "He also saw shootings and stabbings occurring around
the convention center," Nnawuchi said.
The same man told Nnawuchi that he saw a woman swimming through deep water
with two of her young children. As she struggled, "he could tell that
she was trying to decide which one to leave behind" so she could save
herself and her other child, a toddler. After she let go of her 4-year-old,
the man swam over and rescued the older child.
After they spoke, Nnawuchi learned that the man had been crying each day,
in private, and rarely slept. Nnawuchi prescribed medication to alleviate his
insomnia and also prescribed an antidepressant.
Steury, too, has been impacted by his work at the armory. Though he was far
removed from the first responders in New Orleans, he said he felt tense and
experienced mild insomnia during his first week of work at the armory.
He noted that many of the evacuees had difficult lives and were experienced
at overcoming adversity. "It's been a very moving and important
experience to work with so many resilient people with such awful and
life-threatening experiences," he said. ▪