By Camilo Smith
By Craig Malisow
By Jeff Balke
By Angelica Leicht
By Jeff Balke
By Sean Pendergast
By Sean Pendergast
By Jeff Balke
Warnings and updates were coming in moment by moment. The city of New Orleans was about to get slammed by a hurricane. At Abstract House, a group home that for 20 years has provided an alternative to homelessness for hundreds of mentally ill and drug-addicted New Orleanians, something had to give.
The clientele is a ragged one. Drunks stumble in around midnight, followed by the crackheads at dawn. It's a place halfway between an institution and living completely independently. For $400 a month, residents get a bed, daily meals, laundered clothes and an opportunity for some structure. They are enrolled in Medicaid programs and administered their medications.
Barrie Byrnes, who owns the housing and adult day-care facility, says she teaches them to bathe, use a toilet and the importance of not spending their entire social security check on candy. Her only rule: "Don't bring in booze and knives -- go hide them in the bushes somewhere."
With Hurricane Katrina on the way, it was time to get out. About 40 residents were enrolled at Abstract House in the days before the hurricane. Some wandered off. The more manageable residents were transported to Baton Rouge. But the 17 who remained were the hard-core psychotics, the ones who "still think there's a lady in the wall who's trying to kill them even after they've taken their meds," Byrnes says.
At a loss for what to do, she dropped them off at the Superdome, less than a mile away. Alone and unsupervised, the men, ages 30 to 70, were told to watch after one another.
Victor Fruge, who has been diagnosed as bipolar, appointed himself the group's pharmacist, figuring that his 30-year-long heroin and painkiller addictions qualified him for the job. He collected everyone's pill bottles and stuffed them into a plastic grocery bag.
"Nobody put me in charge; I just took charge," the 48-year-old says. "Because of me being manic, I make things happen."
When they arrived, the Superdome was still relatively empty. But as the crowds came, so did the voices in their heads. Ray Brown, a 45-year-old alcoholic who is bipolar and HIV-positive, says he spent hours hidden behind a curtain. Leonard Smith, a 56-year-old schizophrenic, says he "went into an isolated place" and didn't speak for nearly two weeks. Still, most of them didn't believe the hype. After all, they never had to evacuate the city when monster hurricanes like Betsy, Camille, Ivan and Andrew blew into town. Outside, the air was calm, the sky blue. They figured the storm would pass them by.
Then one morning the roof blew away. And their adventure began in earnest -- an adventure that ultimately would take them on a 500-mile journey before they landed in Houston.
Hurricane Katrina displaced and upset more than a million Gulf Coast residents. People lost their homes, their neighborhoods, their livelihoods.
Multiply this by a factor of ten and begin to imagine the hardships endured by the mentally ill, who depend on familiarity and routine to keep them halfway sane. Suddenly they were thrust into a constant state of anxiety, forced into large crowds, told to live in squalid and sometimes dangerous conditions, and ordered from one strange place to the next. Many were separated from their caregivers and their psychotropic medications.
"Stress alone will exacerbate any psychotic disorder," warns Dr. Sara Allison, a psychiatrist at Baylor College of Medicine. "Compound that with not having their medications, and I would expect them to become acutely psychotic, which is always dangerous."
It took a week for the unsupervised group of schizophrenics, manic depressives and drug addicts led by Fruge to make its way to Houston. They spent three nights at the Superdome, slogging through foul floodwaters in extreme heat amid crying mothers and occasional gunshots. Seeking better conditions, they fled on foot to the adjacent New Orleans Arena, whose floors they discovered were soaked in urine from stopped-up toilets.
On the fourth day of their expedition, the group rode to higher ground on a National Guard truck that dumped them onto a highway ramp, where they baked in the sun for hours with thousands of others. An evacuation bus eventually brought them more than 250 miles to Fort Polk in West Louisiana. They waited outside the gate for several hours before soldiers sent them yet another 200 miles to the Astrodome. This enraged some of the men, who were veterans.
Somehow they overcame their anxieties, not to mention the bickering among themselves along the way. They stuck together, even partnering off to use the bathroom and walking single-file, with leaders assigned to the front and back of the line.
Not everyone made it. One member of the original group was booted out of the Superdome for fighting and is feared dead. But the other 16, including three who had to be hospitalized along the way, made it safely to Houston.
Allison found them at the Astrodome. It was September 1, early in the afternoon, when she arrived at the mental health clinic set up in a separate building at the Reliant complex. But there were no patients. The Dome was filling up fast, and people feared they would lose their cots if they left. So Allison rode a shuttle van to the Dome and, armed with a medicine bag, went looking.
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."
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.
Liberty Island is the largest assisted-living facility in the Houston area. It offers housing as well as a weekday adult day-care program. Though the roof on the three-story, white-stone building is in disrepair, the interior is clean and inviting. Converted from a hotel and restaurant, it has 209 beds, a gymnasium and spacious dining halls where cafeteria-style meals are served three times daily.
Liberty Island has sheltered 136 Louisiana evacuees displaced by Hurricane Katrina. It was already full when director Aretha Johnson learned about the 16 men who had arrived together from Abstract House. Johnson and her staff of 12 set up temporary beds on the floor of the gymnasium and outfitted eight unused rooms with air conditioners, televisions and bedding. The men were registered, clothed and scheduled their medications.
Johnson says she charges residents on a sliding scale ranging from $850 to $2,000 a month. But some in the Abstract group arrived penniless, while others had only Red Cross checks for $360. She accepted $260 and advanced them $100 apiece. "We're a social service agency, not a business," she says.
The men say they like their rooms, which are simple and neat, with two or three beds, a dresser and a couple of mirrors. Knapsacks and trash bags filled with their belongings line the walls. They mostly stay in their rooms or sit out front and smoke. Once every few days, some of the guys venture out to a nearby burger joint or treat themselves to nachos at the bowling alley next door.
Not all of them get along. Patrick Pitchford, a sturdy-looking 41-year-old with tattoos covering his arms from shoulder to wrist, suffered a car crash ten years ago that put him in a coma for several months and permanently affected his equilibrium and motor skills. "We argued and fought and bickered the whole time," Pitchford says of the trip from New Orleans. Still, he says proudly, they protected one another. "We can fight among ourselves," he says, "but don't you mess with any one of us."
Douglass Heidelberg, who is 48, wears bright white sneakers and ties a purple bandanna through the belt loops of his faded jeans. Heidelberg likes to write poetry and philosophize about history and religion. At one time he was convinced that "Walt Whitman was communicating" through him. He believes fervently in the sacred powers of marijuana and transcendental meditation. The one topic he doesn't like to discuss is his illness. "I'm not a mental patient," he insists. "I'm a hippie."
Many members of the Abstract group agree that Richard Coburn's mood swings were the most difficult to deal with. Frequently hostile and aggressive, Coburn sometimes looks as though his eyes have been forcibly pried open. He's been institutionalized three times since fleeing New Orleans. Though perhaps unconsciously, Coburn, too, has a poetic streak. Recently at Liberty Island, during a lunch of chicken-fried steak, white bread, mashed potatoes and corn, Coburn reflected that Katrina is "Like a pinwheel / you blow on it / that's the hurricane / blue with white stripes."
As it turned out, hurricanes weren't finished with the Abstract House group yet. Two weeks after Katrina, Rita fired up on what seemed to be a collision course with Houston, the group's new home.
Johnson planned to take her residents to a shelter in San Antonio. The state furnished her with four Coach USA buses, each outfitted with air-conditioning and a toilet. Early September 22, 150 residents and four Liberty Island staffers boarded the buses.
They had barely left Harris County when a back tire on one of the buses blew and caught fire. Johnson, who was on a different bus, ran along Interstate 10 to help rescue the residents. "We went into sheer shock," Johnson says. "We had to literally pick people off the bus." They were fortunate that one resident, who carries an oxygen tank for her emphysema, was riding on a different bus. The next morning, 23 nursing home evacuees from Bellaire died outside Dallas in a bus explosion accelerated by the oxygen tanks onboard.
It took the Liberty Island residents 28 hours to travel 200 miles to San Antonio. They first went to a vacant Wal-Mart that was being used as a shelter, then piled back into their buses to stay in a facility for people with special needs.
It was there that Johnson suffered her own meltdown. Eighteen of her residents were unable to get their medications and began to panic. The stress caused another resident to begin having seizures. Johnson says she felt helpless, anxious and humiliated. For perhaps the first time since she opened Liberty Island 20 years ago, Johnson broke down in tears in front of the residents and snapped at some of them.
After returning from San Antonio, Johnson says, she was so distraught that she stayed in bed for three days. She can't imagine the feeling of loss experienced by her residents. "Not only do they have a very devastating illness, but now everything that defined them in their previous structure is gone," she says. "They're super-needy now. Their sense of belonging has been shaken up. They've lost their identities."
Johnson's experiences during the Rita evacuation have led her to relax some of the policies at Liberty Island. Normally, her residents must participate in a set schedule: out of bed by 7 a.m., clean room, take care of personal hygiene, breakfast by 9 a.m., participate in programs and back in room at 3 p.m. to rest before dinner. Now, she lets people stay in their rooms, under the covers, with the door shut all day. In the past, if a fight broke out, the people involved were relocated. Since Katrina, there have been a couple of knockdowns between residents. In one instance, a chair was thrown. But Johnson lets it slide with a stern reprimand. "Things I would usually put people out for, I'm not," she says.
These days, Johnson devotes much of her time wrestling with the Federal Emergency Management Agency. She gets letters from FEMA saying her application has been received. But they don't say anything about when she will begin receiving checks. The vast majority of the 70 Katrina evacuees now living at Liberty Island have gotten no money from FEMA, she says.
Many of those residents lost the paperwork that shows they received health insurance in another state. Some don't know their own birth dates, let alone their personal identification numbers. "I have two people I can't get a dime because I can't get their social security cards," Johnson says. "I don't understand what we need to do to get the checks."
While the government's handling of Katrina has renewed debates about race and poverty in America, Johnson says the most vulnerable segment of the population continues to be neglected. "Katrina exposed the problems of the mentally ill," she says. "The mentally ill are always at the bottom of the barrel."
Wearing baggy, flowing clothes pocked with cigarette burns and a black leather driving cap turned backward, Victor Fruge sits hunched at the edge of his bed, clutching his elbows, eyes fixed on a TV screen. He is watching a Discovery Channel documentary titled Killer Hurricane: Anatomy of Katrina, which details the studies that warned of New Orleans's vulnerability to a powerful hurricane. "You see," he says, slapping his thigh. "They knew all this shit. This just fucks me up."
Fruge has received no money from FEMA, and relies on Aretha Johnson to spot him ten bucks every few days to buy smokes. A self-described hustler, Fruge can usually find ways to scrape together a few dollars. Even during the many years when he was homeless, Fruge peddled fruit outside a food stamp office in New Orleans. Back at Abstract House, he would buy cigarettes for other residents for a small fee. Fruge thinks about returning to Louisiana, where he has family. But for now he plans to stay at Liberty Island. He likes the place, the routine and some of the other guys. "We're a picture of animosity," he says, grinning. "That's how we get down."
Douglass Heidelberg, the poet, can't wait to get back to Louisiana, where he was born. He's trying to arrange to return by bus. When he thinks of it, he starts jumping up and down, his mind characteristically straying from tangent to tangent. "There's nothing like New Orleans," he says. "All those swamps. Of course, I never had to tussle with an alligator. I don't even pick up the water moccasins "
Ray Brown, who has not received any of his HIV medications since fleeing New Orleans, returned to Abstract House a couple of weekends ago to retrieve some clothes, papers and other belongings. But everything was ruined. Some of the building's windows were blown out, he reports, and the place was covered in mold that he feared was toxic.
Barrie Byrnes, the owner of Abstract House, went back to New Orleans several weeks after the evacuation. She says the place was covered in flies and roaches. Since the refrigerators were never emptied out, the smell was overwhelming. Byrnes says that several of her former residents have phoned her from their new perch at Liberty Island. They ask if they should come back. She tells them to decide for themselves.
"Who knows," she says. "Texas may have more to offer them. Or not."