Map of life expectancy at birth from Global Education Project.

Monday, September 12, 2005

An oddly ignored fairly big problem

We hear a great deal about how people affected by natural disasters often suffer trauma and may have long-term symptoms. Oddly, it is very seldom mentioned that the population of the evacuated regions of the Gulf Coast included what is presumably a typical proportion of people with serious mental illness, mental retardation, addictions, adult onset dementia and neurological disorders such as traumatic brain injury. People with such problems were also certainly among disproportionately among those who could not evacuate on their own ahead of the storm and ended up in the chaotic public shelters.

The late Irving Kenneth Zola, whose work I often refer to, was assigned to produce an ethnographic documentation of Boston's West End, before it was destroyed as part of the '60s campaign of Urban Removal and its residents scattered. Irv found that the rate of psychiatric crises, hospitalization and institutionalization went up sharply among the displaced residents, but he also had a surprise for us. This had almost nothing to do with previously healthy people being traumatized. The vast majority of people who showed up in those statistics had long-term mental illness or disability, but they required relatively little professional support and certainly did not require institutionalization, because their families and community provided an environment in which they could function. With their extended families broken up, the neighbors dispersed, the corner store and the pizza parlor and the barber shop where the proprietors knew them all gone, they could no longer function successfully.

The mental health care systems in places with large numbers of evacuees are under tremendous strain. People with mental illness, cognitive impairments, neurological disorders, when suddenly placed in unfamiliar environments, often decompensate and may become severely delirious. Many went for long periods without their medications. They are now separated from their mental health providers, and it is undoubtedly impossible right now to get their records or contact those providers in most cases. The people need to be reassessed, rediagnosed, given new prescriptions, housed, re-enrolled in disability or SSI if they are eligible (probably with new representative payees found to manage their finances), counseled. Some may need supported housing or even institutionalization now that their natural supports are gone. I expect quite a few will fall through the cracks -- or more likely the gaping chasms -- and wind up homeless in unfamiliar cities, or dead from suicide, victimization, or misadventure.

The only resource I have found that is seriously trying to report on and discuss this problem is Dr. Peter Kramer's Infinite Mind radio program. As my thousands of loyal readers know, I disagree sharply with Kramer about some issues (he's the Listening to Prozac guy), but he's doing a public service here. We worry about so-called "surge capacity" for hospitals in cases of disaster, but there is little or no discussion about mental health and substance abuse treatment. (Oh yeah, what about all those folks cut off from their methadone? Their counselors and 12-step programs? There's a whole other set of major problems. . . .)

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