commentary

(Newsday)

October 3, 2005

Healing Storm Victims' Mental Health

by Kenneth B. Wells and Greer Sullivan

A massive federal effort is needed to treat the psychological wounds of the survivors of Katrina and Rita

Victims of Hurricane Katrina and Hurricane Rita are now faced with the task of coping with the psychological aftermath of the nightmare storms. Without a major national effort, many may not have the help they need to recover fully.

We propose a systematic approach be immediately developed to ensure that all those displaced by Katrina and Rita are evaluated for mental and emotional injury within three to six months. The federal government also should provide assistance to survivors for at least three years to support recovery from short- and long-term mental disorders.

A ballpark estimate of the cost of mental health assistance to Katrina victims alone is about $1 billion, out of an estimated $200 billion in expected federal assistance. But that amount could be higher because the emotional trauma for many Katrina survivors was immediately followed by the threat of Rita and for some a second displacement after a profound loss.

Although people are naturally resilient even in the face of profound stress, mental disorders and psychological reactions to disasters are common and have an enormous impact that extends to quality of life and economic recovery. Disorders such as depression are among the most disabling of all health conditions. Left untreated, they eat at the fabric of communities.

What's needed to help people in need?

Widespread education about the common psychological symptoms after disasters and reassurance that most will recover as circumstances improve.

Emergency assistance for those with prior serious mental disorders whose care was disrupted by the storms.

Clinical, health plan and community agency partnerships in the next three to six months to provide mental health education, prevention and treatment services to hurricane survivors and to provide support for agencies and staff assisting them.

Training in assessing, referring and treating depression, anxiety and post-traumatic stress disorders following evidence-based models. This training should be made available to health professionals, community caseworkers and others such as faith leaders in storm-damaged areas and regions harboring survivors.

Consistent and generous health insurance for at least three years that covers mental health services on parity with care for physical conditions.

Public education to improve attitudes concerning mental disorders so people don't fear being labeled "crazy" or have difficulty finding jobs if they seek treatment.

Most people &mash; including disaster survivors &mash; never seek help from mental health professionals. So primary care and school clinicians should provide screening, education, referral and brief treatment with consultation and supervision from mental health professionals, and support from paraprofessionals and case managers.

The U.S. Department of Veterans Affairs offers comprehensive services for mental disorders for military veterans. But there is no other agency in the nation that provides mental health education and prevention services in a method comparable to how the U.S. Public Health Service combats infectious diseases and promotes physical health. This makes it challenging to deal with mental health problems after a widespread disaster in a comprehensive manner.

Our publicly funded mental health care systems for the poor focus on severe mental illness, rather than on disorders that arise after a disaster. The private sector treats common disorders but provides relatively little mental health care to the poor. This means it's difficult to fit disaster recovery for mental health of the poor into existing systems.

In addition, given the high numbers of African-Americans and poor people in areas affected by the recent hurricanes, it is important to implement programs that are both effective and trusted by minorities and low-income people. Past discrimination and poor access to health care have understandably left many skeptical of the current system. This problem can be addressed by relying more on minority professionals, enlisting trusted community organizations and developing programs responsive to the needs of minority and low-income survivors.

Even when survivors stop filling our TV screens and the rebuilding begins, fellow Americans will still need our continued and vigilant help. This will require adequate resources and manpower, along with our collective and persistent efforts, energies and humanity.


Kenneth B. Wells and Greer Sullivan are psychiatrists affiliated with the RAND Corporation, a nonprofit research organization. Wells is also affiliated with UCLA, and Sullivan is affiliated with the Department of Veterans Affairs health system. Loretta Jones, executive director of Healthy African American Families, also contributed to this article.

This commentary originally appeared in Newsday on October 3, 2005. Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis.