Hurricanes impair services for mentally ill in La.

State's mental health care system `pretty overwhelmed' after storms reduce number of public hospital beds by more than half


PINEVILLE, La. -- For some of society's most vulnerable, a hilly patch of pine forest along this stretch of the Red River in central Louisiana has become a last refuge.

More than half of the state's public hospital beds for the severely mentally ill were closed or lost during hurricanes Katrina and Rita, health professionals say, leaving them with few places to turn for treatment.

Many have ended up here at Central State Hospital, on the shaded grounds of a century-old psychiatric center. All 92 patients from Charity Hospital in New Orleans, which was heavily damaged by the flooding after Katrina, were transferred to Central State. So were 20 patients evacuated from a psychiatric unit in Lake Charles before Hurricane Rita.

The influx forced hospital Chief Executive Officer Tommy Davis to reopen several wards, hire dozens of new workers and hope that the state will pick up the added costs. He has also opened a shelter on the hospital's campus for discharged patients, rather than releasing them, homeless, into the small communities of Pineville and Alexandria, which together have 60,000 residents.

Along with their acutely ill patients, some 95 Charity staffers and their family members were trapped at the hospital for five days after Katrina. All were evacuated to Pineville, where the staff members have been offered jobs and given temporary housing on the hospital grounds. Now some say they need psychological counseling themselves.

"I don't want my daughter to see me crying, because when I cry, she cries," said registered nurse Marva Guillemet, 58, as she twisted a paper napkin between balled fists and a single tear slid down her right cheek. She said she planned to join group therapy sessions at the hospital.

Cheryll Bowers-Stephens, a psychiatrist who runs mental health services for the state Department of Health and Hospitals, said the loss of about 120 psychiatric beds has strained the state's mental health care system. She pointed to a sharp increase in recent weeks in mentally ill patients who show up at emergency rooms for treatment.

"People are struggling to make the situation work," said Dr. Michael J. Kaminsky, an associate professor of Johns Hopkins School of Medicine, who is providing mental health care in the Pineville area as a volunteer.

Another volunteer, Kenyon Knapp, a counselor and college teacher from Montgomery, Ala., said he struggled to find hospital beds for several mentally ill and terrified evacuees after they began menacing fellow residents at a large shelter at the state fairgrounds in Shreveport. Eventually beds opened up, but the state was "pretty overwhelmed," he said.

The federal Substance Abuse and Mental Health Services Administration recruited Kaminsky, Knapp and others on behalf of several Gulf states to help with displaced psychiatric patients and stunned evacuees. Three-member teams mostly visit shelters, where they talk to patients, advise staff and write prescriptions.

They've found patients with schizophrenia or bipolar disorder who went for days without their medications. They've tried to console people who saw loved ones die or who waded through chest-deep water for blocks to escape drowning.

Many of the storm's victims are now at risk for post-traumatic stress disorder.

"Probably at least 20 percent of the population here is in need of some psychiatric intervention," said Kaminsky. "Literally everywhere you turn there is a case."

Like most big state psychiatric hospitals, Central State Hospital - once called the Louisiana Hospital for the Insane - had been shrinking for decades, due to new anti-psychotic drugs and public outrage over the former practice of warehousing mental patients.

Now, Louisiana plans to add 60 permanent beds here. But Bowers-Stephens said not all the lost beds will be replaced. Instead, the state will try to move more patients into supervised living quarters or other community-based treatment.

Many of those displaced by the hurricanes will escape psychologically unscathed by their experiences, mental health workers here said. "The reaction of most people to something like this is resilience and not pathology," said Harold Perl, a clinical psychologist with the National Institutes of Health in Bethesda, one of the volunteers.

But some - especially those who have experienced mental illness or previous shocks - are likely to suffer long-lasting effects.

Some National Guardsmen who fought in Iraq told Hopkins' Kaminsky that the streets of New Orleans reminded them of Baghdad, and that worried them. "Some of them say they weren't feeling the way they should about the American people," he said. "They were afraid of what they might do."

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