Hurricane Katrina has taken a heavy emotional toll on New Orleans and is hampering the city's rebuilding efforts; the effects will be felt in the city for a long, long time, says a local psychiatrist who was Louisiana's top mental-health officer during the storm.
"The mental-health impact of this disaster has retarded our recovery as compared to other cities" that have been struck by disaster, Cheryll Bowers-Stephens, former assistant secretary for the state Office of Mental Health, told disaster experts at a meeting of The National Academies, a Washington, D.C.-based think tank, during a panel last month hosted by Tulane University's School of Public Health and Tropical Medicine.
Backing up her premise, a report by the state Mental Health Review Commission says Louisiana can expect to see 260,000 more cases of Post-Traumatic Stress Disorder (PTSD) than before Hurricanes Katrina and Rita. Left untreated, these people will be at risk for lower productivity, long-term mental health problems and higher health-care costs in the future, the report states.
Meanwhile, local authorities report increases in substance abuse, relationship difficulties, domestic violence and suicide, despite sharp population drops.
"Everyone in this city and state has had some level of emotional impact as it relates to Hurricane Katrina," Bowers-Stephens told The Academies. Most residents are adjusting and won't require counseling, but in the hard-hit New Orleans area, she says, "The mental-health recovery is going to be slow," and an estimated 30 percent of New Orleans residents will need "a robust mental-health intervention ... for some time to come."
After the storm, for example, some children refused to go to school, instead clinging to their parents who themselves were suffering insomnia and a loss of concentration, says Bowers-Stephens, a clinical child and adolescent psychiatrist who Gov. Kathleen Blanco appointed to head the state's mental-health system in 2004. She was in Baton Rouge during the storm but resigned in January and returned to New Orleans, where she now serves as CEO of the Schopenhauer Group, a consulting firm Uptown. While Bowers-Stephens was in Baton Rouge during the storm, her husband, New Orleans Health Director Dr. Kevin Stephens, was stationed with special needs patients at the Superdome.
"It felt like war ... from the leaders on down ... many people were at a critical moment where they thought they were going to die," Bowers-Stephens told participants at the seminar, which featured grim photos of medical evacuations by helicopter and soldiers patrolling the burning and flooded city in the wake of Katrina. Of the 1,577 Louisiana deaths linked to the hurricane, a recent increase in casualties may be "stress-related," she says. Some 200 people are still reported missing.
Attempts to compare the mental-health impact on New Orleans to other urban catastrophes such as the 1997 earthquake in Kobe, Japan, are "unfair," Bowers-Stephens says. "This was a natural, technological and man-made disaster," with the man-made part being the collapse of levees designed by the U.S. Army Corps of Engineers that flooded 80 percent of New Orleans and destroyed 200,000 homes.
"Because of the scope of the flooding, Katrina's victims cross all demographic lines, but the news media has failed to reflect victims' diversity," says Bowers-Stephens, who is African American. "On the whole, the media portrayed the hurricane as something that happened only to poor blacks. That was not the case."
Although large numbers of residents evacuated safely, they still suffered emotionally from the losses of homes, churches and neighborhoods as well as the scattering of family and friends, she says. Among those victims are middle-class and affluent residents of Gentilly, Lakeview and eastern New Orleans as well as not-so-affluent people. In order to rebuild their communities, Bowers-Stephens says, they all need a sense of proportion and inclusion.
"If you want everybody to have full participation in the recovery, if you want everybody to come back, then everybody's needs must be tended to in some way," she says.
Plenty of people need help. And Katrina left a drastic mental health-care shortage in its wake. Most of the 15 hospitals in the metro area are still closed, and mental-health services are severely limited. The city had only 22 psychiatrists by the end of April, an 89 percent drop since before the hurricane. And the number of primary-care physicians, who psychiatrists call the "gatekeepers to mental health," has plunged by 77 percent to 140 doctors post-Katrina.
The shortage has triggered a federal incentive program designed to attract more medical providers back to the area.
"We are on the leading edge of an emotional and psychological tsunami that threatens the health and the recovery of our community," says John King, executive director of the nonprofit Council for Alcohol and Drug Abuse.
BOWERS-STEPHENS SAYS POLITICAL leaders and the media could improve the public's well-being -- quickly. "If the facts about mental health were as well known as some of the politics we just went through, that would be a significant help," she told The Academies gathering, referring to the recent city elections. "It will be critical to get leadership to understand the significance of the mental health recovery."
In an interview with Gambit Weekly, she offered the following ideas:
The most therapeutic step government can take is to provide a recovery plan -- something concise, yet comprehensive and readable enough to insert in every phone directory distributed in the area, Bowers-Stephens says.
"The biggest thing our leaders can do is to clearly articulate to the public what are the steps that are going to be taken in the recovery and what can our expectations can be." The plan should have a timeline, she says, and cover a broad range of subjects, including education, health care, urban planning, economic development and housing.
"Everybody needs to know the plan, and everybody needs to know their role in the plan," she says.
The public should be kept informed of any progress on the plan and what they can do to help. "People want to help but they don't know where to go." With a plan, she says, leaders can utilize the media to help direct those who are willing to the work that needs to be done.
Another shortfall in the city's mental-health recovery is the lack of "a community grief process," she says. After 9/11, New York City residents posted pictures and brought flowers and candles to the ruins of the Twin Towers. New Orleans has no memorial to Katrina's dead or community rituals for grieving residents' losses. And there are no "symbols of hope" in the hard-hit neighborhoods from Lakeview to the Lower Ninth Ward. "Even on Memorial Day, there were individual group celebrations," but no event for the entire city, Bowers-Stephens says.
GOVERNMENT LEADERS AND AGENCIES have been widely criticized for their generally poor response to Katrina. But Bowers-Stephens says the federal Substance Abuse and Mental Health Services Administration was a "very responsive" exception. All of the psychiatric hospitals in the area were evacuated the Saturday before the storm hit, she says, and 4,000 mental-health responders were dispatched within two weeks after Katrina. Mental health officials also were integrated in the state Emergency Operations Center and manned suicide-prevention hotlines after the storm.
"A lot of the calls we got were from doctors who were contemplating suicide," Bowers-Stephens says. "We were treating first responders so they could keep helping people."
State mental health professionals should be integrated into the top of government emergency command structures for future disasters, she says. Any leader responsible for the well-being of the public should have "psychological first aid" available, a service Bowers-Stephens says could be provided inconspicuously. Reducing the stigma of receiving professional mental-health help could enable a leader to lead more effectively.
There are other mental-health recovery issues that need to be addressed as well, she says. State legislation is needed to help residents cover the cost of psychotherapeutic drugs during a state of emergency. Louisiana is under an extended emergency now.
In addition, Bowers-Stephens suggests that Congress review the Stafford Act, the federal law that dictates how emergency funds are utilized. The act should provide flexibility for mental-health dollars, given the unique origins of Katrina's devastation as being partly a man-made disaster.
Health insurance parity is needed for consumers seeking mental-health treatment. "You can have good health-insurance coverage, without good mental-health insurance," Bowers-Stephens says. In addition, there is no law that precludes federal crisis-counseling dollars from being used to provide funding to hire counselors for private and parochial schools. However, crisis dollars cannot be used to buy medications or "treatment." The feds and the state need to clarify the definitions of "treatment" versus "counseling," she says.
A media dunning of officials who show emotion after a disaster like Katrina is counterproductive to mental-health recovery, Bowers-Stephens says. Instead, reporters should try to feature resilient role models who have overcome adversity. She joins other local mental-health experts in deploring the media's recent, sensational "countdown" to the start of hurricane season and says the media can better help the mental-health recovery by featuring individual and community accomplishments.
"Countdowns make people extremely nervous," Bowers-Stephens says. "People need to be given coping mechanisms. ... You have to have some sense of accomplishment in the recovery process to help you brace for the next season."
The New York Times' coverage of the traumatic effect of the 9/11 terrorist attacks is the best mental-health model for news media covering the aftermath of Katrina, she says. The goal of media seeking to help the mental-health recovery should be to reduce disparities in the community before, during and after a disaster. Today, "if you are in the French Quarter, you can be in total denial of what happened on the Lakefront and the Lower Ninth Ward," Bowers-Stephens says.
Allen Johnson Jr., a freelance journalist and regular contributor to Gambit Weekly, is a native New Orleanian.