Against All Odds

A group of unsupervised mental patients running from Katrina made it from New Orleans to Houston. Victor Fruge led the way.

It wasn't long before she ran into Fruge. Initially, Allison thought Fruge was the group's care-home manager.

Fruge told her they were all mental patients, and that "the healthier ones were taking care of the sicker ones." Some of the men had already run out of medication, and the group had been rationing supplies for several days.

"The first time I saw them, I thought there were some pretty sick guys in the group," Allison says. "One or two were vocal and obviously having issues. But, in my profession, the silent ones are often more concerning."

Baylor College of Medicine psychiatrist Sara Allison 
treated some evacuees at the Dome who didn't know 
who they were or where they'd come from.
Daniel Kramer
Baylor College of Medicine psychiatrist Sara Allison treated some evacuees at the Dome who didn't know who they were or where they'd come from.
Victor Fruge and another evacuee recap to Aretha 
Johnson their escape from the flooded city.
Daniel Kramer
Victor Fruge and another evacuee recap to Aretha Johnson their escape from the flooded city.

During the next several days, Allison says, she treated dozens of people with an array of mental illnesses, including elderly people suffering from dementia "who showed up at the Dome and had no idea who they were."

But she never again encountered a group like the Abstract residents, who clung together through the crisis. It's an amazing feat, she says. But there was no time to celebrate. She feared that they would soon begin "decompensating," psych-speak for falling apart mentally and emotionally. She needed to get them into a personal care home, ASAP.

"The stress of living in the Astrodome would be horrible for anyone," Allison says. "If you're a paranoid schizophrenic, you cannot live in the Dome around hundreds of people. It would just be too much."

Experts estimate that 500,000 people with serious mental illness lived in the Gulf Coast area devastated by Katrina. It is unknown how many of them were displaced. The federal Centers for Disease Control and Prevention found that nearly 6 percent of people in evacuation centers had experienced "a new psychiatric condition."

After the hurricane, federal officials distributed $600,000 in emergency grants for screening and crisis counseling for mental health patients and substance abusers. The federal government also opened a six-month window in which evacuees can tap into Medicaid benefits. But critics say the federal dollars are not nearly enough.

"Nationwide the system could barely handle the existing people with problems," says Dr. Anand Pandya, assistant clinical professor of psychiatry at NYU School of Medicine. "There are many areas now that are completely overwhelmed."

In Texas, more than 3,700 people have visited crisis-counseling centers as a result of Katrina, according to Joe Vesowate, assistant commissioner for mental health and substance abuse services for the Texas Department of State Health Services. Vesowate says that "repatriation" is central to the state's recovery efforts. "It's important that they go back to environments that address their specific health care needs."

But local officials expect thousands of evacuees with mental illnesses will settle in the Lone Star State permanently. The influx could wreak havoc on what was already a severely strained and underfunded public mental health system, according to Dr. Steven Schnee, executive director for the Mental Health and Mental Retardation Authority of Harris County. Texas ranks 48th in the nation in per-capita spending on mental health, Schnee notes, and the number of psychiatric beds in Harris County hospitals has been slashed by more than 50 percent in recent years.

The state legislature has virtually eliminated substance-abuse benefits under Medicaid, and adults suffering from depression or anxiety are not eligible for services unless they are diagnosed with schizophrenia or bipolar disorders, Schnee says. "Once the federal government goes away, all they have is what Texas offers, which is very, very limited," Schnee says.

After a catastrophe like Katrina, it is common for people with mental illnesses to relapse or develop new psychoses, says Pandya, who heads a national organization that sends psychiatrists to natural-disaster areas. A separate and somewhat less vulnerable category of patients, he says, are those with no history of mental illness who experience post-traumatic stress as a result of the storm. According to Schnee, the Texas public mental health system covers post-traumatic reactions only in rare, worst-case scenarios when the patient is deemed suicidal or homicidal.

Schnee and other Harris County officials remain clueless about several critical financial and bureaucratic considerations. For instance, at what point will evacuees formally enter the local system of care, which is already stretched to serve more than 125,000 patients? When will these patients be reclassified from Katrina refugees to full-fledged Texas residents?

"We need some clear, decisive decisions coming from Austin," Schnee said at last month's MHMRA meeting. Governor Rick Perry "said they're all Texans. We don't know if that's a policy statement or just his way of expressing hospitality."

Some MHMRA board members lamented that Katrina evacuees were lavished with services that Houston's own mentally ill aren't receiving. Lynne Cleveland, chairwoman of the board of trustees at MHMRA, was skeptical about long-term funding commitments from the federal government and fretted that the already cash-strapped agency could become overextended. "It's a catch-22," Cleveland said. "We have to respond to the human need, but we can't provide what we don't have the resources to provide. It won't help anybody to bankrupt ourselves."

The lobby at Liberty Island Community Center buzzes with activity throughout the day. Some anxiously pace back and forth, while others crack jokes to themselves, dance to their own beats, watch a TV that's often stuck between channels or simply stare off into some faraway world. For many, chain-smoking on the weathered front deck that faces Boone Road occupies most of their time.

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