Psychiatry - July 2008 - (Page 39)

settings to legal and correctional settings. These issues have been illustrated by real case examples in this article. The purpose of using these cases is to show the complexity of the issues and how they combine to create a crisis in mental healthcare for an entire community struggling to recover, not just those directly affected. But, by rigorously studying Katrina’s impact on mental health services, we can suggest improvements for the future. I would suggest changes in the funding of mental health services and professionals after a disaster. One suggestion is that the Stafford Act can be amended so that it will allow for the funding and provision of mental health services after a disaster beyond the narrow confinements of “crisis counseling.” It can further be amended to provide funds for indirect costs of mental healthcare, such as facility costs and administrative costs. We now know that these types of indirect costs— currently prohibited from reimbursement through the Stafford Act—are significant after a disaster destroys much of a healthcare system’s infrastructure. Another suggestion is to allow governmental agencies that typically reimburse hospitals for healthcare costs, such as the Center for Medicare and Medicaid Services (CMS), to allow for rapid estimated reimbursement of uncompensated costs after a federally declared disaster. Although CMS has offered waiver programs to reimburse hospitals and practitioners for some of the costs of services after Katrina,67 many estimated costs remain unpaid. This has left many New Orleans area hospitals to come to federal legislators with hat-in-hand to ask for funding so that these hospitals can survive. A final suggestion is that federal agencies charged with monitoring the availability of health professionals after a disaster, such as the Health Resources and Services Administration,68 can more quickly provide incentive programs to help TABLE 3. Improving mental healthcare delivery after major disasters Amend Stafford Act and applicable federal legislation to allow for direct funding of licensed, professional mental health services and administrative costs associated with these services Provide prompt reimbursement to hospitals for services provided in immediate aftermath of disaster and allow for estimation of services if patient care was not/could not be recorded Provide software and technical support to psychiatric facilities and mental health providers to facilitate using electronic medical records with automated and off-site back-ups Promptly offer financial support, in the form of retention grants, to local mental health providers so that these professionals can continue to practice in their affected communities Create several mental health response teams that work with law enforcement to treat mental health issues in the community before symptom escalation healthcare providers stay in their communities after a disaster. These agencies need to be more aggressive in assisting healthcare providers in rebuilding their own practices as the community they serve also rebuilds. To use an example in our rebuilding, the establishment of the Greater New Orleans Health Service Corps took years to develop. During that time, more healthcare providers in primary care and psychiatry left the New Orleans area, compounding the shortage in these specialties. Primary care and psychiatric providers were faced with the choice of rebuilding their practices, seemingly on their own, or being relocated and reestablished elsewhere in the country with significant financial assistance by private professional recruiting firms. These suggestions for improvements are summarized in Table 3. disasters, whether natural or man-made. By improving legislation now, we will be able to meet diverse mental health needs that are present immediately after a future disaster. We can also develop resources to help municipalities stop exploding homelessness and substance abuse in the short term after a disaster, while preventing an implosion in healthcare infrastructure through uncompensated healthcare. Finally, we can better prepare responding mental health professionals for the long arc of emotional issues encountered in those struggling to recover and move forward with their lives. ACKNOWLEDGMENTS I would like to thank Daniel K. Winstead, MD, Richard F. Dalton, MD, and Candy Legeai, BM, from the Tulane Department of Psychiatry and Neurology, for their assistance throughout the production of this article. CONCLUSION This article has demonstrated several important mental health issues that have confronted New Orleans since Hurricane Katrina. By using actual case examples, I have attempted to demonstrate the complexity of these problems in a community with serious deficiencies in mental healthcare prior to Katrina’s landfall. I have also made suggestions to facilitate New Orleans’s recovery of mental health services. It is my hope that these suggestions will also help municipalities deal with future REFERENCES 1. Rose C. A tough nut to crack; It has been seven months since The Thing, and in this maddeningly uncertain world we call home, only one thing is for sure: We’re all still crazy. TimesPicayune. March 28, 2006:1(Living section). Moran K. Alarm sounded on psych services; Nagin demands state restore hospital beds. TimesPicayune. May 15, 2007:1 (National [JULY] 2. Psychiatry 2008 39

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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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