Psychiatry - July 2008 - (Page 38)

TABLE 2. Mental healthcare issues in New Orleans after 2005 hurricanes Destruction of hospital infrastructure that provided inpatient mental healthcare Lack of reimbursement for high proportion of uninsured patients needing psychiatric hospitalization Mental health clinicians relocating or recruited out of greater New Orleans area leading to severe shortages in qualified mental health professionals Loss of group homes and residential settings due to property destruction, staffing shortages, and inability to reimbursement programs for services High rate of psychiatric symptoms in returning New Orleans residents leading to increased rates of anxiety, depression, substance abuse, and marital/family strife Exploding homelessness in New Orleans due to damaged housing and lack of affordable rental units Shunting of acute psychiatric patients from healthcare settings to correctional facilities and unfamiliarity of police officers in dealing with seriously mentally ill suspects medications to treat chronic pain and prevent opiate withdrawal in evacuees with chronic pain conditions who were dependent on opiates for pain relief.58 Looking at the whole federal response to Katrina and Rita, the GAO Report recommends more flexibility in the Stafford Act so it can respond to the specific mental health needs of areas impacted by disasters in the future.49 Even for those evacuees without preexisting psychiatric issues, the chronic stressors from Katrina greatly affected emotional wellbeing and important relationships. The Kaiser Family Foundation study found that 23 percent surveyed affirmed that Katrina’s aftermath had endangered important relationships—with 3 to 5 percent filing for divorce. Not surprisingly, there has been a sharp rise in divorce filings in New Orleans.59 Overall, 18 percent in the survey stated they are facing serious mental health challenges. An important study by DeSalvo and colleagues complement many of the Kaiser Family Foundation findings. DeSalvo surveyed more than 1,500 employees of Tulane Hospital and Clinic in early 2006. The surveyed employees had, on average, high levels of education, household income, and property insurance. Despite these seemingly protective factors, nearly 20 percent of those 38 Psychiatry 2008 [JULY] surveyed met criteria for PTSD.60 Less than a third of those with symptoms of PTSD had talked to a health professional about Hurricane Katrina—despite universal health coverage and an employee assistance program available to them. The mental health issues that confronted New Orleans, and all of Louisiana, after hurricanes Katrina and Rita are summarized in Table 2. This article has illustrated that exploding mental health problems in New Orleans, combined with scarce mental health resources, has pushed mental health encounters from healthcare settings to police and correctional settings. This scenario is not new in the United States and not unique to New Orleans. E. Fuller Torrey’s describes this process occurring when deinstitutionalized former patients of Marlboro State Hospital streamed into Ocean Grove, New Jersey.61 Pete Earley recounts Miami becoming inundated with the mentally ill when Fidel Castro encouraged Cuban asylum patients to flee to Miami.58 Perhaps Katrina has accelerated this process in New Orleans, but the situation itself is far from without precedent in the United States. However, there have been recent developments suggesting that these trends are reversing in New Orleans and that the next 1 to 2 years may yield great improvements in access to mental health services in New Orleans. The Greater New Orleans Health Service Corps—modeled on the National Health Service Corp— continues to recruit and retain psychiatrists in New Orleans with attractive financial incentives and flexible terms of service within the New Orleans area.62 Several public hospitals in New Orleans have reopened psychiatric units and are continuing to add more inpatient psychiatric beds as there are staff and renovated facilities to do so.63 The American Red Cross has continued its program, Access To Care, which provides up to $2,000 in reimbursement for mental health and medication expenses, among other services offered.64 The provisions for mental health crisis intervention and case management specified in Nicola’s Law have sailed through committee in Louisiana’s legislature and seem well on the way to being enacted and funded.65 Even the research by the Hurricane Katrina Community Advisory Group, while quantifying the mental health issues some New Orleanians face, show that many of us affected by Katrina have also found new sources of inner strength and abilities to rebuild our lives that have helped to mitigate some of Katrina’s impact.66 SUGGESTIONS TO IMPROVE MENTAL HEALTH SERVICES AFTER A DISASTER This article has illustrated a part of Hurricane Katrina’s impact on the system of mental healthcare in New Orleans. This system, generously described as an “at risk” collection of mental health services before the storm, has fractured even further since Katrina’s landfall. This fractured care has lead to grave issues developing in New Orleans since the storm. These issues include further deterioration and marginalization of the chronically mentally ill, the emergence of untreated serious psychiatric symptoms in residents without mental health issues before Katrina, and the shunting of mental health encounters from healthcare

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Psychiatry - July 2008 Editor's Message Editorial Advisory Board Contents PsychRx Letters to the Editor Reliability of Diagnoses: Do Psychiatrists Use Structured Interviews In Real Clinical Settings? Trend Watch: Use of Atypical Antipsychotics in the Elderly Review: The Struggle for Mental Healthcare in New Orleans-One Case at a Time Psychotherapy Rounds: Psychotherapeutic and Adjuntive Pharmacologic Approaches to Treating Posttraumatic Stress Disorder Original Research: Baseline Dissociation and Prospective Success in Special Forces Assessment and Selection Commentary: Performance-Enhancing Drugs: Where Should the Line Be Drawn and By Whom? Commentary: Psychiatric Diagnosis and the Pathlogist's View of Schizophrenia Journal Watch Classified Advertising Information for Authors

Psychiatry - July 2008

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