10 Years After Katrina, What's the State of New Orleans' Mental Health Services?

In the past 2 weeks, as the 10^th anniversary of Hurricane Katrina’s assault on New Orleans approached, Mayor Mitch Landrieu made mobile mental health services available for those whose depression would be triggered by memoires of the storm, which made landfall August 29, 2005.

Residents were encouraged to talk about their feelings, but who would hear their stories remained an unanswered question. In the decade since the hurricane, state cuts to services and Governor Bobby Jindal’s refusal to expand Medicaid has made it hard for the city to help all who need it, after an unprecedented storm displaced almost the entire population. Katrina was directly responsible for 1833 deaths but many more died in the succeeding months, as the stress of losses mounted. The city has never regained all its population.

Despite a federal parity law and protections under the Affordable Care Act (ACA), accounts of the availability of mental health care as the anniversary nears paint a portrait of gaps in care, despite some heroic individual efforts. The loss of many medical facilities and the controversial closing of Charity Hospital, which was replaced by University Medical Center New Orleans just this month, meant that primary care delivery—which was a genuine need—received priority.

Mental health services were threadbare, in part because psychiatrists fled along with everyone else, and as NPR reported earlier this month, many never returned. Today, those who need help might be able to get counseling, but gaining access to prescriptions and inpatient treatment is another matter.

The challenge with mental health service delivery comes not just from cuts to budgets made since 2005; it’s also rooted in Louisiana’s historic lack of investment in mental health services, especially for the poor. Studies published to coincide with the 10^th anniversary, notably an effort by Chan et al¹ that tracked 492 residents in what the authors called 3 successive “waves” of distress, found that the posttraumatic stress that many experienced might not stem just from the lack of support after the storm.

“Rather, pre-existing deficits in social resources might indirectly affect longer-term posttraumatic stress and general psychological distress by increasing risk for disaster-related stressors,” they write.

A joint poll by NPR and the Kaiser Family Foundation found gaps between how white and African Americans experience the healthcare system 10 years after Katrina, with about half of blacks saying they fear not having healthcare available to them. Only 13% of whites felt that way.

Still, there have been some celebrated cases of mental health struggles among the well-connected in New Orleans that are a direct result of Katrina. The best-known is Chris Rose, the Pulitzer Prize winning writer for the Times-Picayune and best-selling author of 1 Dead in Attic, a collection of columns written in the months after the storm. Rose struggled with depression after leaving the paper and at one point was working as a waiter. He now hosts a radio show and has asked mental health professionals to call in this week to help fellow listeners.

If the ongoing struggles after Katrina did not to spur Louisiana’s senior leadership to act, the recent shooting in a Lafayette movie theater did. US Senator Bill Cassidy, a Republican, has joined with Democratic US Senator Christopher Murphy of Connecticut, whose state suffered the Sandy Hook school shooting, to sponsor legislation to retool the distribution of mental health funding to put more into treatment.

Reference

1. Chan CS, Lowe SR, Weber E, Rhodes JE, The contribution of pre- and postdisaster social support to short- and long-term mental health after Hurricane Katrina: a longitudinal study of low-income survivors. Soc Sci Med. 2015;138:38-43.