The oil that spilled out of BP's Macondo well fouled the waters and shores of the Gulf of Mexico, then disrupted lives and communities along a coastline already devastated by a cascade of disasters.
Many were still struggling to recover from hurricanes Katrina and Rita in 2005 and Gustav in 2008 when the BP well blew up on April 20, killing 11 drilling-rig workers and spewing millions of barrels of oil into the Gulf for the next three months. The blowout stunned the region's economy and stressed its residents psychologically.
Concern for contamination of fish and other seafood led to closing of some fishing grounds in the Gulf, crippling one of the region's major industries. Vacationers cancelled trips after seeing media reports of oil-soaked beaches. Fishermen, seafood processors, and resort workers found themselves without jobs for months, and perhaps longer.
Then the federal government's ban on oil drilling in the Gulf threw yet another segment of the economy out of work. Many people in the region work in both the oil and fishing industries and so were left with no way to pay their bills.
"People down there are beginning to feel just a little snake bit," said David Harwood, M.D., president of the Alabama Psychiatric Physicians Association.
The BP spill differed from Katrina's devastation. The hurricane killed thousands, displaced or left homeless hundreds of thousands more, and left a city in ruins. Fatalities in the BP spill were limited to workers on the Deepwater Horizon drilling rig.
Katrina (and Rita, which followed soon after) also was a single event, after which survivors could respond and begin to recover. The spill was an ongoing ecological and technological disaster, creating actual and potential economic damage and accompanying anxiety among thousands of people worried about their futures.
What would happen next was unclear even after the well was capped on July 15. Dueling articles in Science in mid-August claimed that either a 22-mile-long, 600-foot-thick plume of hydrocarbons lurked 3,600 feet below the surface, or else had already been consumed by resident oil-eating bacteria. But long-term effects on the Gulf, the seafood within it, and the people who make their living on or near the water were still unknown.
Many of those most affected by the spill live in small, isolated communities highly dependent economically and culturally on the sea and its margins.
A volunteer from the Catholic Charities of the Archdiocese of New Orleans offers services and counseling to fishermen and their families in at Breton Sound Marina in St. Bernard Parish in the early days of the oil spill crisis.
Credit: Catholic Charities Archdiocese of New Orleans
"This is a part of America that people who live in metropolitan areas don't know much about," said psychiatrist Elmore Rigamer, M.D., medical director for Catholic Charities in New Orleans. "People along the Gulf have built their lives around the sea for generations. They live close to nature. Their lives are stable, revolving around family and church, and there are not a lot of community stressors. Many never graduated from high school and have no other marketable skills. They can't easily relocate. They're too young to quit and too old to change."
Another group with its own traditions bore an additional burden. Vietnamese immigrants make up a large part of the fishing industry, said Louisiana Psychiatric Medical Association president A. Kenison Roy, M.D. Many were initially traumatized by war and the escape from their homeland.
"Then they lost everything in Katrina and Rita, and now they can't go out to fish," he said. "They don't usually ask for help outside their community, and there are few mental health providers with the cultural or language skills."
Technological disasters like oil spills threaten the resource bases of communities living close to nature, said Lawrence Palinkas, Ph.D., a professor of social policy and health in the School of Social Work at the University of Southern California, who studied communities in Alaska after the 1989 Exxon Valdez oil spill. That disaster caused a decline in subsistence activities, loss of traditions, and conflicts with family members and neighbors over disparities in compensation and other issues.
"The most valuable resource people have is other people," said Palinkas in an interview. "The greatest impact was the destruction of social relations."
People directly exposed to crude oil, such as cleanup workers, can suffer a variety of transient respiratory, dermatological, and other symptoms such as headache, nausea, and dizziness. Such physical exposure may increase rates of depression, anxiety, and posttraumatic stress disorder (PTSD) in the coming months, if studies of prior spills are any indication.
The same studies also found that even people who never catch a whiff of oil may be at higher risk for psychiatric symptoms, which is what health officials are reporting now from the Gulf region.
Both private practitioners and the public mental health system have been "inundated" with requests for services, Harwood told Psychiatric News. "The area is underserved to start with, so we really have more problems than we can deal with."
"There is an increased incidence of depression, anxiety, and PTSD," said Roy.
Louisiana Spirit, the state-run crisis-counseling program, had seen more than 2,000 people by the end of June, most reporting anxiety, depression, stress, grief, excessive drinking, or suicidal ideation.
So far, the federal response has been covered by the Oil Pollution Act of 1990, enacted in the wake of the Exxon Valdez episode. However, that law does not cover funding for the crisis counseling or other mental health services that are included in the Stafford Act, which supported Louisiana Spirit and other counseling work after Katrina.
A report from the Congressional Research Service stated that the Stafford Act has not yet been invoked because of concerns about its effects on possible litigation to recover funds and because of lingering mistrust of the Federal Emergency Management Agency in the wake of its actions following Katrina.
However, BP said early in August that it would pay $52 million into a fund for mental health services, divided among four states and the federal government.
The federal Substance Abuse and Mental Health Services Administration will get $10 million, Louisiana $15 million, Mississippi $12 million, Alabama $12 million, and Florida $3 million. The money will support local outreach efforts and treatment by community providers, who are already in the area and who may appreciate the nuances of regional and ethnic cultures.
"We don't go into those communities with the DSM in our back pockets," said Rigamer. "We need to help them understand their reactions, help them deal with their anger and emotions, and then give them the resources to cope with the practicalities."
Catholic Charities will get $6.6 million of the mental health funds BP gave to Louisiana. Some of the money will go to expand its own services and some will be funneled through other organizations, he said.
There is an ongoing effort to recruit providers of Vietnamese ancestry at Tulane and Louisiana State University (LSU), and to consult with Vietnamese psychiatrists working for the state, said Roy.
Rigamer sees two vulnerable groups: people with preexisting psychiatric conditions and those who develop conditions as a result of spill-related stress—particularly PTSD or drug or alcohol abuse.
Meanwhile, the two New Orleans medical schools, Tulane and LSU, are collaborating to send practitioners to Gulf towns. LSU's Howard Osofsky, M.D., Ph.D., has submitted a proposal for a formal needs assessment.
"We remain concerned about long-term health and mental health effects, but don't really have any data yet," said Tulane psychiatrist Daniel Winstead, M.D.
Bringing mental health services to bear at the outset will be critical, if the Exxon Valdez is any example, said Palinkas.
"The most devastating stress is uncertainty, and the decision to compensate immediately rather than litigate may bring some certainty," he said.
The $20 billion BP has committed for compensation will go a long way to reducing the level of social toxicity, but it won't eliminate it entirely, said Palinkas.
"Apart from the litigation, there may be conflict within communities if there is a perception—and there inevitably is—of an unequal distribution of that $20 billion and some individuals or groups feel they are getting less than their fair share," he said.