Psychiatr News June 15, 2007
Volume 42, Number 12, page 7
© 2007 American Psychiatric Association
Child Victims of Katrina Need More MH Access
Rich Daly
A leading New Orleans psychiatrist tells congressional staff that more
help is needed to reach children and youth before they plunge into mental
health crises.
Almost two years after Hurricane Katrina tore New Orleans apart, the
region's devastated mental health system faces a serious shortage of the
personnel needed to rebuild it.
General health and mental health leaders assessed the city's and state's
mental health needs during a May congressional forum attended by staff from
offices throughout Capitol Hill. They described a city overwhelmed by the
immediate mental health care needs of many residents.
"In the short term the biggest challenge continues to be the [lack of
a health care] workforce," said Frederick Cerise, secretary of the
Louisiana Department of Health and Hospitals. "Hospitals say that if
they had more people they could provide more beds."
The state launched a workforce initiative to recruit medical professionals
nationwide to the area for a minimum of three years, but many professionals
who are coming to the area are filling lucrative positions with private
contractors, Cerise said. Further complicating the recruitment effort is the
"piecemeal" rebuilding in the city, which has insufficient housing
for even its smaller post-Katrina population.
"We've got a lot to do in terms of recruiting people back to the
area," Cerise said.
That dearth of personnel has made it very difficult for the city and state
to offer inpatient psychiatric care. New Orleans has only 20 adult public
psychiatric beds, significantly fewer than the 99 such beds and 40 crisis unit
beds available before the hurricane, according to Howard Osofsky, M.D., Ph.D.,
chair of psychiatry at Louisiana State University Health Sciences Center.
Cerise described an effort by state health officials to get private
hospitals and clinics in the city to accept state funding for inpatient
psychiatric beds, but only one accepted the offer. It will provide 12 new
beds.
The limited public mental health services for children also have shrunk
since the storm. New Orleans has only 15 child and adolescent public
psychiatry beds—half of the number available before Katrina.
The 12,000 evidence-based mental health evaluations conducted by state
mental health workers and the services they provided for displaced youngsters
returning to the city after Katrina have shown that there is an enormous need
for such care.
Data collected by the New Orleans school system indicate, for example, that
45 percent of students screened on their return to school this year displayed
symptoms that qualify them for mental health care, 12 percent of fourth-grade
students asked for counseling, and 25 percent of the students who asked for
counseling showed "significant symptoms of depression," he
said.
"There certainly is an increase in mental illness, some pre-existing
and some new," Osofsky noted. He urged Congress to provide funding to
restore school-based clinics for the city's youth, a population that usually
responds best to preventive care and early interventions. Mental health care
leaders have introduced more group treatment models for children and
adolescents to address the trauma they have experienced and conditions that
may arise from ongoing dislocations.
Extent of Need Documented
The anecdotal evidence presented to congressional staff of the increased
mental health needs was reinforced by a survey of New Orleans area residents
released in May by the Kaiser Family Foundation. The in-person survey of 1,500
randomly selected adults in the greater New Orleans area found that 15 percent
rated their mental health as being worse than before the storm. Four percent
also said they had begun taking psychiatric medication since Katrina.
The storm's impact on children was seen in the response of 4 percent of
parents who said that their child shows signs of behavioral problems. Nine
percent said their children didn't get needed general health care in the
previous six months.
The hurricane's impact also took a toll on physical health. Twelve percent
of those surveyed rated their physical health as worse after the storm, and 11
percent said a chronic condition had worsened since that disaster. Respondents
further reported increased alcohol use, increased verbal or physical conflict
in their relationships, and storm-related stress ending marriages or other
personal relationships.
Residents sent a strong message about the need for additional health care
services in New Orleans. Eighty-eight percent of respondents said there were
insufficient hospitals, clinics, and other health facilities operating, while
89 percent said there were insufficient health care services for uninsured and
low-income residents.
"It's a system in need of immediate help, not just long-term
planning," said Diane Rowland, one of the survey's authors.
Future Plans Described
Cerise said the state's goals include establishing crisis-response
services, adding psychiatric beds, jail-diversion programs, and
supported-living programs. The state, he said, is committed to continuing the
mental health programs started under the $80 billion in federal block grants
provided for Louisiana after the storm.
Disagreements among health care leaders continue over what new form Charity
Hospital should take, Officials are planning to replace the former facility
for the city's poor—and a major teaching hospital—with a
decentralized system of smaller facilities spread throughout the city.
Health officials also are designing a long-term mental health system that
will replace the office-visit-based model of care with the "medical home
model," in which a physician coordinates the overall care of each
patient, Cerise said. The approach should increase the availability of
physician contact through increased use of e-mail consultations and
telemedicine—already in use in a neighboring county of New Orleans.
Osofsky urged funding for counselors and psychiatric nurses who would be
available 24 hours a day and seven days a week. The city also needs to
re-establish a crisis inpatient unit in a New Orleans hospital. The lack of
such services in the city has resulted in increased incarceration of people
with mental illness and mental health providers sending people to other parts
of the state for care, he said.
"This means that children are separated from parents," Osofsky
said.
More information on the Kaiser survey is posted at
<www.kff.org>.
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