NEW ORLEANS, Sept. 2-Long after the floodwaters here have receded and this critically wounded city has begun to mend, the mental health effects of the nation's worst natural disaster will linger.

The American Red Cross, in recognition that catastrophes also leave mental and emotional damage in their wake, is coordinating and deploying psychiatrists, psychologists, and mental health counselors to storm-ravaged areas of the Gulf Coast.

At the Astrodome in Houston, where about 25,000 refugees from New Orleans have been transported, storm survivors are receiving clean food and water, a place to sleep, and, for those who need it, the services of volunteer mental health workers from Baylor College of Medicine, several campuses of the University of Texas Health Sciences Centers, and other area institutions.

For the survivors, mental and emotional responses to a disaster usually come in waves, beginning with the so-called "adrenaline rush" -- the epinephrine-induced fight or flight response, said a psychologist who specializes in behavioral health.

"People are on overload and are in this basic survival mode for the first day or two or three, but after that, when things are getting worse or not changing, people begin to come to terms with the idea that's everything's gone," said Edmund Neuhaus, Ph.D., director of the Behavioral Health Partial Hospital Program at McLean Hospital in Belmont, Mass. "Then there's major loss, the horror of the current situation, and total uncertainty about the future."

Traumatic events -- natural disasters, accidents, terrorist attacks -- can cause in their aftermath horror, helplessness, and fear of serious injury or death.

Note emergency preparedness guidelines from the Centers for Disease Control and Prevention in Atlanta:

"Traumatic events affect survivors, rescue workers, and friends and relatives of victims who have been directly involved," the CDC guidelines say. "In addition to potentially affecting those who suffer injuries or loss, they may also affect people who have witnessed the event either firsthand or on television."

People who are most at risk for a mental-health crisis following a catastrophic event are those who are at or near the epicenter of an event, those who undergo multiple stresses, those with a history of trauma (especially a history of trauma similar to the current event), and people with chronic medical or psychological disorders, the CDC says.

According to the CDC, traumatic events can manifest in cognitive, emotional, physical and behavioral realms. Cognitive problems may include confusion, disorientation, indecisiveness, shortened attention spans and memory loss.

Emotional responses may include shock, numbness, feelings of being lost or overwhelmed, or a feeling of abandonment.

Trauma survivors may experience nausea, dizziness, a rapid heart rate, gastrointestinal distress, poor sleep, hyperarousal, or jumpiness.

The emotional aspects of trauma can manifest as suspicion, irritability, argumentativeness, withdrawal, appetite changes, and increased drug and alcohol use or abuse.

"Part of being traumatized is having the time to reflect that you've gone through something horrible," Dr. Neuhaus says. "The people sitting down at the Convention Center in New Orleans, if they have nowhere to go, may be getting more fearful and more traumatized. Feeling as if you're not in control worsens the experience, because there's a fear that it might happen again."

"My guess," he adds, "is that the traumatic reactions for most people will probably start a little bit down the road. There's the initial shock, but then the trauma and the realization of what's happened: you've lost your house, you've lost everything -- how do you recover from that?"

The road to recovery often begins by letting victims talk about the event, share their thoughts, and discuss their reactions when they feel ready and able to do so, mental health experts say.

People need to tell their stories, and clinicians need to validate the emotional reactions of patients, with the understanding that some may be very angry at their situation. Trying to reassure patients by telling them that "everything will be all right" won't cut it, because that flies in the face of everything they've experienced, Dr. Neuhaus commented.

The CDC recommends that when dealing with trauma victims, clinicians should "explain that their symptoms may be normal, especially right after the traumatic event, and then encourage patients to:

Identify concrete needs and attempt to help. Traumatized persons are often preoccupied with concrete needs (e.g., How do I know if my friends made it to the hospital?).

Keep to their usual routine.

Help identify ways to relax.

Face situations, people and places that remind them of the traumatic event -- not to shy away.

Take the time to resolve day-to-day conflicts so they do not build up and add to their stress.

Identify sources of support including family and friends. Encourage talking about their experiences and feelings with friends, family, or other support networks (e.g. clergy and community centers)."

Primary source: U.S. Centers for Disease Control and Prevention

Additional source: Edmund Neuhaus, Ph.D., McLean Hospital, Belmont, Mass.

Additional source: Baylor College of Medicine

University of Texas Health Sciences Center at Houston

By M.A.J. McKenna
Cox News Service
Posted on Sun, Sep. 04, 2005

ATLANTA - A second storm is poised to swamp the victims of Hurricane Katrina: a wave of psychological aftereffects with consequences that could last years.

Mental-health experts watching last week's catastrophe, including some working in the disaster zone and others who have taken in storm refugees, are urging that psychological first aid be a priority.

Though relief concerns so far have focused on possible disease outbreaks, they say the storm's victims are equally threatened by traumatic stress, depression, anxiety, family disruption and violence.

The experts are particularly concerned by the effect of the storm on children, whose parents may be so traumatized they cannot buffer or interpret the experience for their kids.

"Children are affected twice," said Dwight Bain, an Orlando counselor who conducts post-disaster debriefings for law enforcement. "They live through it, but they don't know what it means, so they turn to their mother, father, grandmother - but if that person is overwhelmed as well, their safety net gives way."

Federal Emergency Management Agency disaster plans include funding for emergency mental-health services, but some specialists said it is unlikely to be enough because federal appropriations for mental-health services have been cut for a number of years.

"A majority of the people who have been affected by Katrina are poor and don't have much access to mental-health services as it is," said Dr. Jennifer Hartstein of Montefiore Medical Center in the Bronx, N.Y., who works with inner city children and teens. "It's an underserved, fragile population that now will be in worse shape than before."

The storm's effect on previously healthy adults will pile new needs on existing ones, the National Alliance on Mental Illness said Friday.

The nonprofit organization estimates that the hardest-hit states, Louisiana, Mississippi and Alabama, had 580,000 residents suffering from serious mental illnesses likely to be made worse by the storm's disruption of care.

"This will bring us to an unbelievable level of reality in this country regarding mental-health disorders," said Dr. Kathleen Hall, an Atlanta stress-management expert who is sheltering an extended family of storm victims in her counseling center in Clarkesville, Ga. "We are not going to have enough trained people or enough supportive mental-health care facilities to deal with this."

Katrina's effect will be worst on adults and children who lived through the storm, but it will have an echo effect on those who escaped from destroyed towns and on those who lost family or friends in the area, said Dr. Alan Steinberg of the National Child Traumatic Stress Network, which has mental-health teams working among storm refugees.

Children who endured or fled the storm could be upset by any new experience that reminds them of Katrina, such as a rainstorm. They may be hypervigilant, startling easily and having nightmares, or they may become numb and withdrawn.

The urgent need, the specialists said, is to get services - informal counseling for adults, and talk and art therapy for children - to those in relocation centers or who remain marooned in the storm zones.

"If someone has a toxin in their body, our goal would be to get the toxin out," Bain said. "It's the same thing psychologically. If they can talk, talk it out; if they can draw, draw it out. If a child is willing to play, we can use the toy to draw out the pain the child feels."

Suicides Rise After Natural Disasters

NEW YORK (Reuters) -- Suicide rates tend to increase in local areas in the years following natural disasters, according to a US study appearing in the current issue of The New England Journal of Medicine.

Researchers at the Centers for Disease Control and Prevention (CDC) say their study shows that "suicide rates increase after severe earthquakes, floods, and hurricanes and confirms the need for mental health support after severe disasters."

They focused on the suicide statistics of 377 US counties hit by a major natural disaster during the years 1982-1989. Suicide rates for each county were tracked for the four years following each disaster.

According to the researchers, the overall suicide rate for affected areas "...increased by 13.8% during the four years after a severe natural disaster," compared with just a 1% increase for the nation as a whole.

Suicide patterns varied depending on the type of disaster. Increases in the rate of suicide in flood-stricken communities continued to rise each year after the event. Suicides in the 308 counties affected by flood climbed 13.8% overall, the researchers say, with the highest annual increase, 24.3%, occurring during the fourth post-disaster year.

Hurricanes were associated with an overall 18.9% increase in suicides, but the researchers note that "this rate was elevated only for the first two years after hurricanes... and was followed by a decline to the (pre-hurricane) level for the remaining two years."

Earthquake-associated suicides rose by nearly 63% during the first post-disaster year, but then quickly returned to pre-quake levels.

Tornadoes and severe storms had no noticeable effect on local suicide rates.

The researchers note that "victims of floods report four times as many injuries and three times as much financial loss as the victims of hurricanes and earthquakes," which might help explain the comparatively prolonged effect of floods upon local-area suicide rates.

In the aftermath of many cataclysms, "stores, bars, clubhouses, or churches -- places where people found friends and support -- may have been destroyed," according to the study authors. They say previous studies have revealed that rates of depression and hopelessness inevitably rise among communities which have recently faced sudden, destructive events.

The CDC experts believe their study confirms that "mental health support is needed after severe disasters, (and) that it should be available for varying periods."

SOURCE: The New England Journal of Medicine (1998;338(6):373-378)

Source Article

Hurricane Katrina Strikes The Gulf Coast - Arial View

How Do Hurricanes Form?
Tropical storm and hurricane prediction probably never will be an exact science, but the reasons for storm formation are well understood by the scientific community. There are several elements that—when combined at the "right" amount of time and under the "right" conditions—will create a hurricane, according to the National Oceanic and Atmospheric Association (NOAA).

The beginning of life for any hurricane is a pre-existing tropical disturbance—an area of low atmospheric pressure in the air over the tropical Atlantic Ocean near Carribean islands, such as Bermuda and the Bahamas.

The warmth and moisture of the ocean during late summer and early fall months (when ocean waters reach their highest temperatures) energizes the pre-storm conditions and leads to thunderstorms.

If thunderstorms persist and winds pick up to 40 miles per hour, the tropical disturbance officially becomes a tropical storm. At this point, the National Hurricane Center names the storm, working from a pre-determined list of names that is recycled every six years. Meteorologists all over the country know to keep a close eye on the now-named storm, although many tropical storms weaken and die before becoming hurricanes.

'Heat Engine': The Energy Behind a Hurricane
Tropical storms that continue to intensify will keep pulling in warm and humid air from the lower atmosphere while spitting out cooler, drier air into the upper atmosphere. According to Chris Landsea of NOAA's hurricane research division, at this point in its development, the storm system operates like a huge "heat engine."

"The 'heat engine' gets its energy from warm, humid air over the tropical ocean and releases this heat through the condensation of water vapor," said Landsea. This energy release is what drives the powerful winds of a hurricane.

The force of the release is tremendous—the amount of heat energy released by an average hurricane is equivalent to the amount of electric energy produced by the U.S. in an entire year. A small portion of the energy released actually warms what has become the inner core of the storm. As the temperature of the air in the inner core rises, its pressure drops, increasing the speed and intensity of the winds swirling around it. These stronger winds bring more warm, moist air to the clouds surrounding the inner core of the storm further fueling its energy. When the swirling winds reach a speed of 74 miles per hour or more, the tropical storm becomes a hurricane.

Hurricane Ratings
Once a storm officially becomes a hurricane, it receives an intensity rating based on its wind speed and potential to cause damage. The rating system that is used by the National Weather Service is called the Saffir-Simpson scale. As a hurricane develops, its intensity rating often changes. In 1985, for example, Hurricane Opal grew from a Category One into a Category Four hurricane in just 18 hours.

Category One hurricanes have wind speeds between 74 and 95 miles per hour and are expected to cause minimal damage to buildings and homes. Trees, shrubbery and mobile homes tend to bear the brunt of the damage caused by Category One hurricanes.

Hurricane Bonnie, which hit the North Carolina coast in 1998, was a Category Two hurricane and caused both flooding of low-lying areas and considerable damage to trees.

With wind speeds reaching 100 miles per hour, this is typical of a Category Two storm. Category Three and Four hurricanes are characterized by even stronger winds and much more damage to homes, buildings and trees.

The most intense classification of a storm is the Category Five hurricane. A Category Five storm will have sustained winds of 155 miles per hour or more and is capable of extensive damage. Hurricane Gilbert of 1988 was the strongest Category Five hurricane ever, destroying Jamaica with wind speeds upwards of 180 miles per hour.

The inner core of the hurricane is known as the eye of the storm—a calm, often clear-skied patch where winds are lightest and pressure is lowest. Surrounding the paradoxically calm region of the hurricane is a ring of clouds called the eyewall. The eyewall clouds are thunderstorm clouds, and it is in this region of the hurricane where the heaviest rains and winds originate. During Hurricane Camille, which pummeled the Gulf Coast in 1968, winds in the eyewall reached speeds in excess of 200 miles per hour. The outermost ring of the hurricane is made up of bands of heavy rains that swirl inward toward the storm's center, called spiral rainbands.

Weather Report
While the clouds and rainbands are forming in the sky above, the weather on the land below the hurricane turns nasty. The spiraling winds that accompany hurricanes can extend even further beyond the eye of the storm. Typically, hurricanes are about 300 miles wide, so they can affect fairly large areas at one time.

Unfortunately for those in its path, a hurricane's speed of travel is hard to predict and varies greatly from storm to storm. Weather experts have calculated that hurricanes move forward at an average speed of 15-20 miles per hour, but a big storm also has the potential to linger over one area for a while, causing torrential rains, or move so quickly that there is no time to prepare for its arrival.

Eventually, a hurricane's energy begins to dissipate and the storm weakens. Weather experts have identified several factors that contribute to a hurricane's demise, including the storm's movement over cooler water or drier areas. Even when a hurricane appears to have blown over, however, it can potentially reintensify if it hits weather conditions that are favorable for its development.

El Niño Effect
El Niño is a weather phenomenon that causes equatorial Pacific Ocean temperatures to be warmer than usual. El Niño periods occur in cycles, and the most recent El Niño event we've experienced was in 1997-98. During this time, there were fewer Atlantic hurricanes than the average number during hurricane season. Weather experts say that warm El Nño events are characterized by decrease in the number of tropical storms and hurricanes in the Atlantic, Gulf of Mexico and the Caribbean Sea because of the increased wind shear. The wind shear associated with El Niño essentially cuts a storm off during its development, by hindering the formation of a vertical ring of clouds. The shear actually shaves off some of the clouds, which creates a slant in the cloudwall. When a storm is slanted, the heat energy released from condensation is spread out over a larger area and doesn't necessarily feed back into the storm system to strengthen it.

A La Niña period brings weather conditions opposite to those that are associated with El Niño. La Niña brings cooler equatorial Pacific Ocean temperatures and decreased wind shear in the tropical Atlantic region-increasing the chances that a tropical disturbance will in fact develop into a hurricane.

Hurricane Mitch, which caused devastating damage to Nicaragua and Honduras in October 1998, occurred during a La Niña period. However, since Hurricane Mitch followed a lot of media hype about El Niño, said NOAA's Landsea, many people erroneously assumed that El Niño was responsible for Mitch.

"This was definitely not the case," said Landsea. "The big El Niño of 1997-98 caused a reduction in Atlantic hurricanes, with only three forming in 1997. But the El Niño finished by the spring of 1998, and was quickly replaced by La Niña by the time Hurricane Mitch occurred. We have more or less been in that same La Niña-and it has boosted the Atlantic hurricane activity both in 1998 and last year-though it is currently fading."

Preparing for the Storm
No matter how intense a hurricane season turns out to be, it is always good to be prepared for a big storm. Whether facing a hurricane watch or warning, the Red Cross recommends that the public get and stay prepared, which includes developing an evacuation plan.

When a hurricane watch is issued (meaning that hurricane conditions are possible within 36 hours), people in affected areas should tune in to local radio or TV stations for up-to-date storm information. Consider bringing any lawn furniture capable of being picked up by the wind inside and preparing houses for high winds. While many people think that taping windows shut is sufficient to prevent windows from breaking, the Red Cross recommends using something stronger, such as hurricane shutters or plywood.

When a hurricane warning is issued (meaning that hurricane conditions are expected in the specified area, usually within 24 hours), the Red Cross advises being prepared to evacuate to a shelter if local officials indicate to do so.

If the storm hits and it is not necessary to leave your home, the Red Cross advises staying away from windows and continuing to pay attention to the development of the storm. As previously mentioned, blue skies and calm winds do not necessarily mean that the hurricane is over, just that the eye of the storm is moving over the area. Once the eye passes over, the storm will pick up again with winds blowing from the opposite direction.

© Copyright 2001 The American National Red Cross