NEW ORLEANS -- Dispersed across the nation, survivors of Hurricane Katrina are suffering such severe psychological distress that the federal government has launched the broadest - and probably the most costly - counseling program in the nation's history.
An estimated 500,000 people need some form of mental health service, which could include treatment for post-traumatic stress, substance abuse counseling, anti-anxiety medication and art therapy for children too young to talk out their grief.
The federal government has allocated $141 million to serve evacuees scattered among at least two dozen states, said Seth Hassett, who directs the emergency response unit of the federal Substance Abuse and Mental Health Services Administration.
Officials are negotiating a separate grant for Louisiana; it could be as high as $70 million. That would bump the total cost of hurricane counseling well above the $178 million appropriated for the mental health needs of victims of the Sept. 11 terrorist attacks.
Cost aside, the Katrina response is proving to be the agency's toughest challenge ever, Hassett said.
In New Orleans, even people trained to offer solace break down easily and often: A hospital nurse, a school psychologist, a paramedic, a counselor all lose composure as they talk about Katrina.
"The truth is, we are not OK. We are so definitely not OK," said Burke Beyer, 31, who leads a federally funded team of counselors in New Orleans.
Experts recognized from the start that Katrina would be traumatic. The storm killed more than 1,300 people, submerged 80 percent of New Orleans, flattened neighborhoods, and forced friends and relatives apart. But the full scope of the mental health crisis is emerging now.
The half-year mark should be a milestone; many residents expected recovery to be well under way. Instead, their lives are still a mess, their city is still in ruins, and they can see no end to the chaos.
Federal officials estimate that 25 percent to 30 percent of hurricane survivors in hard-hit cities such as New Orleans will suffer what is defined as "clinically significant" mental health problems. An additional 10 percent to 20 percent need psychological help but aren't classified as clinically ill.
Lyn Shraberg, who directs the nonprofit Cope Line in New Orleans, hears the strain in call after call. Before the storm, her counselors handled at most three suicidal or severely depressed callers a day. Now, they get 12 to 14 a day.
Nationally, calls to the National Suicide Prevention Hotline are up 60 percent since Katrina.
Adding to the unease, hurricane season is approaching. Yet it feels as though Katrina has just blown out of town. The streets are still strewn with the moldering remnants of upturned lives: a red teddy bear, a striped blouse, a half-used jar of poultry seasoning. The Red Cross still sends vans through the streets with free food.
"For many people, strange as it may sound, it's still the week after the storm," said Anthony Speier, a psychologist who directs the state's mental health programs for disaster victims. "They have not had a break to regroup, to rebuild resilience."
Professional help is hard to find. Before Katrina, the metropolitan region had about 550 hospital beds devoted to mental health patients. Now there are at most 200, said Joe Eppling, director of behavioral health services at East Jefferson General Hospital.
Much of the region is still thinly populated: Barely 40 percent of New Orleans' population has returned. So in theory the number of hospital beds should be adequate. But mental health crises are so common these days that Eppling has to keep some patients in the emergency room for days before a psychiatric bed opens up.
Even patients who don't need to be admitted to the hospital face long waits for care. Private psychiatrists are booking appointments four to six months out.
To build residents' coping skills, the state has directed its share of federal grants to a program it calls Louisiana Spirit. In the New Orleans region, outreach workers go door to door offering free counseling, distributing self-help guides - and giving plenty of pep talks.
A recent pupil survey at Belle Chasse Primary School in Plaquemines Parish revealed overwhelming anxiety. Asked how they were feeling, kindergarteners drew frowning faces dripping tears. Second- and third-graders wrote down their fears:
"I'm worried that I will never see my family again."
"What will we do? Where will we go?"
Stephanie Simon writes for the Los Angeles Times.