September 30, 2005
RIPPLES from Hurricane Katrina will move through America for years. The storm and the following flood drove about a million people from their homes. Even after people resettle, in their old communities or new ones, all will not go back to normal.
Mental health researchers have learned a lot about how people recover from trauma. After Sept. 11, for example, the most resilient people were members of supportive communities. They had neighborhoods to go back to. But many of Katrina’s victims are scattered across the United States because their neighborhoods were washed away. Louisiana authorities say it will be months before the city is safe for children and older residents.
On a recent episode of National Public Radio’s “The Infinite Mind,” Dr. Matthew Friedman, director of the National Center for Post Traumatic Stress, said that about three months after a disaster, most people are OK. They still have bad memories, but most people have normal and understandable reactions to the terrible things that happened. They function and they heal.
But there is always a minority who do not recover normally, he said. Their experiences exacerbate problems they already had or trigger something else.
During the first six to eight weeks after Sept. 11, for example, 7 percent to 9 percent of World Trade Center survivors had post-traumatic stress disorder or depression. But eight to 12 months later, those rates had dropped a lot. What didn’t go down, Friedman said, was substance abuse. There is a predictable problem that mental health professionals and the public should be trying to minimize now.
Of course, all disasters and all people are different. With Hurricane Katrina, thousands of people suffered for prolonged periods without help. It is logical to expect some may develop severe problems, or that their recovery may take longer.
More than ever, the nation needs good and compassionate mental health care. Unfortunately, this nation’s mental care is the unloved stepchild of an already dysfunctional medical system. It does not work for most Americans under normal circumstances. In a crisis, it is worse.
On good days, the safety net for people who are too poor to pay for their own mental health care is Medicaid. But it is already stressed and inadequate for the population it serves.
In New Orleans, the governments’ poor response to Katrina left people in unsafe conditions for days. The rest of the nation watched in horror as thousands of people suffered physical deprivation, injury and death. If there were any group of people for whom the American public would support timely and decent mental health care, surely it would be the survivors of Louisiana, Mississippi and Alabama.
Dr. Thomas Insel, a psychiatrist and director of the National Institute of Mental Health, asks: “Wouldn’t it be timely for us to take this also as an opportunity to ask how can we provide better health care, in particular, better mental health care, as we rebuild, so that this group of people who have already withstood so much, may have a chance to have us do this right with them?”
Sounds great, but we have little hope for Dr. Insel’s suggestion. Unlike broken levees and floating bodies, the quiet, individual suffering scattered across the country after this hurricane will not make good 24-hour-a-day TV footage, so it is likely to slip out of the public’s consciousness.
America’s leadership has shown that it will plunge future generations dangerously into debt to pay for tax cuts for the rich, to pay for a war that has made the world less safe and to give no-bid government contracts to favored corporations. But even before the hurricane, Washington was looking for ways to cut health coverage, not expand it. It is difficult for any responsible person to suggest more federal expense when the nation’s money has been spent for decades to come.
One way or the other, Katrina’s effects will ripple through society for a long time. We expect the people who suffered most immediately after the storm will continue to wait in vain for help.