Katrina Overwhelms Mental Health System

The mental health system in Louisiana was never in great shape. But after Hurricane Katrina, demands for mental health services throughout the state have increased sharply and people in crisis are not getting care.

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It's no surprise, the demand for mental health services in Louisiana increased dramatically since Hurricane Katrina. Mental health practitioners now say the volume of requests makes it harder to get care for patients in the most severe crisis. Alix Spiegel reports.

ALIX SPIEGEL reporting:

Hurricane evacuee Sharon Briscoe(ph) now lives in the Baton Rouge Motel 6. She shares a second-floor room with her aunt, Jessie Pilson(ph), whose depression in the wake of Katrina has made it difficult for her to leave her bed. From the window of their room Sharon can see a small spindly tree, one of those pathetic little things intended to beautify the land between the parking lot and the interstate on ramp. Briscoe says she visits this ground regularly. It might not be a typical sanctuary but somehow the small tranquil of green helps to cut the fog.

Ms. SHARON BRISCOE, (New Orleans evacuee living in Baton Rouge Motel 6): Everything is so dark now; it's so dark, just like a cloud of sadness. But I can't let it take over me, can't let that take over me like that.

SPIEGEL: After evacuating New Orleans, Briscoe, like her aunt, was diagnosed with major depression and they're not the only residents of the Motel who are struggling. Caroline Mateo(ph) who lives down the hall says that she and her husband Noah are also finding it difficult to maintain their balance.

Before Katrina, the Mateo's went to church every Sunday and Noah made enough money in the restaurant business to support his wife as a full-time homemaker. But now the family has nothing and last week Caroline learned that Noah had begun to have fantasies about walking out of their hotel room into the oncoming traffic of I-10. Noah didn't tell her this himself, he told his 10-year old son about his thoughts and that's how Caroline found out about them, her son told her.

Ms. CAROLINE MATEO, (Katrina evacuee in Baton Rouge motel): He said mama; daddy said something that bothers me. I said what is that and that's when he told me. And I said well, I said your daddy's stronger than you think. You know I don't think he gonna just run out there and do that. I said, he might feel like that sometime but I don't think he's gonna act on it. And, he said okay.

SPIEGEL: Caroline Mateo and Sharon Briscoe have asked for and received help from mental health counselors. They're part of a literal explosion in need. For example in the last four months requests to community mental health clinics in the Baton Rouge area have increased 40 percent. These rates are similar to other parts of the state and psychiatrist Cheryl Bower-Stevens, who has worked as the Director of the State Office of Mental Health for the last two years says that the increased need has put unprecedented pressure on the mental health system.

Ms. CHERYL BOWER-STEVENS (Director, State office of mental health): I believe that the system is in crisis.

SPIEGEL: As mental health problems from Katrina grow she says it is more and more difficult for even those in the most severe need to get help. For example, it used to be that a resident of New Orleans in severe distress could call an outpatient clinic at a local hospital and get an appointment with a mental health professional within 48 hours, now they must wait at least a month.

Wait times to see a private psychiatrist in New Orleans are two or three months. This is what Bower-Stevens means when she says there is a crisis. She means that in some cases people simply can't get adequate medical attention for their mental health needs.

Ms. BOWER-STEVENS: If I'm sitting here and I'm depressed you know, crying spells, so forth and so on, so I call the mental health clinic and they tell me it's gonna be I don't know how many weeks before you can be seen. Okay, so let's say it reaches a crisis where you're either really thinking about harming yourself or harming someone else, you go to the emergency room. Okay, first of all where you gonna go?

SPIEGEL: Today there are only five active emergency rooms in the New Orleans area and the city has lost over 100 inpatient psychiatric beds. This means, even those who are suicidal sometimes wait for two to four days for an actual inpatient bed.

Ms. SUSAN HENRY, (Behavioral Specialist at East Jefferson Hospital in New Orleans): It's just a horrible situation.

SPIEGEL: This is Susan Henry, a behavioral specialist at East Jefferson, one of the few hospitals in the area that's still fully functional. Usually Henry provides care in the East Jeff emergency room but recently she's spent her days sitting at her desk. Hours spent calling other hospitals around the state in a desperate effort to find inpatient psychiatric care for all the people who show up at the East Jeff ER in crisis. She says it's a demoralizing process.

Ms. HENRY: I always know that its futile but we all go through the motions anyway, make those phone calls. Log, you know, no beds, no beds, no beds, no beds.

SPIEGEL: There's just too much need for current capacity. And this bad situation will soon get worse. The State Office of Mental Health, which usually provides care to the poor and those with severe mental health conditions, has been asked by the State government to reduce their budget by 23 percent. This request prompted Bower-Stevens, the Director of Louisiana Mental Health Services; to do something she never thought she'd so.

Ms. BOWER-STEVENS: I stepped down as the Assistant Secretary for the Office of Mental Health.

SPIEGEL: Bower-Stevens says she understands that the State is in crisis and that all areas of government must cut costs. She says she's not blaming anyone, she's just concluded that if she wants to help the mentally ill the best way to do it is through raising money in the private sector. State resources she says, simply aren't there and given the needs facing Louisiana, will not be there any time soon.

Ms. BOWER-STEVENS: You know you look around and you see, uh-oh, I don't think those resources are coming. It's like being on the Titanic about to sink.

SPIEGEL: One mental health administrator who's decided to remain on board is Jan Kasofsky. Kasofsky is Executive Director of the Baton Rouge Area Human Services, which by all accounts has done a miraculous job in the face of difficult circumstances. Because of federal crisis funds, Baton Rouge counselors were able to canvass the evacuee community and identify people in need, including Sharon Briscoe and Caroline Mateo. But crisis funds cannot be used to augment basic services and Kasofsky says, this level of care can't continue.

Ms. JAN KASOFSKY (Executive Director, Baton Rouge Area Human Services): I mean there's no way we can sustain what we're doing. A lot of the medicine that we've been needing is because of donations that were made by the pharmaceutical industry and that's a huge cost. Staff is really feeling it and what we're seeing is being seen all across the State, is people are opting to retire. Because at this point in their career they just can't take this kind of pressure and this intensity of what their day is like.

SPIEGEL: In fact, many mental health professionals themselves ended up in tears when speaking about the current situation. They simply don't know how they're going to meet demand as budgets are slashed. Jan Kasofsky says that she too, knows that she won't be able to meet the coming need that, she is not even able to meet the current need. And in the face of this tidal wave, she simply tries to remind herself of what is possible.

Ms. KASOFSKY: Personally I've gotten a lot of use from the Serenity Prayer and that all I can do is say that I've done my best in keeping the focus on making peoples' lives easier. You know you really, there's really nothing you can do.

SPIEGEL: For NPR News, this is Alix SPIEGEL.

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