First of three parts
NEW ORLEANS | Using his hands, Adam Graff pushed the "floodwater" away from the frantic woman's face.
It calmed her momentarily, but she could still see the brown agitated water, she could feel it rising again, back over her waist, up to her neck, and she cried for help.
Mr. Graff, a mental health technician, gently lifted her chin and assured her that she was in an airtight police van, and he was taking her to a place where the water couldn't reach her: the mental ward at University Hospital.
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In her mind, she was drowning in the fury of Hurricane Katrina's floodwaters — a flashback from nearly four years ago when she spent three days in water up to her waist.
Such dramatic scenes are near-daily experiences for Mr. Graff, a member of a special New Orleans Police Crisis Unit, the only one of its kind in the nation, that responds to 911 calls and transports mental patients to hospitals.
• Click here to visit the interactive Web site accompanying this series of articles about New Orleans' struggles with mental illness post-Katrina.
The unit is fighting a worsening crisis of Katrina-related mental illness that most Americans know nothing about.
"No one sees this on a daily basis like we do. This is all we do. It's a three-ring circus, and I've got a front-row seat," Mr. Graff said.
Almost four years after the massive hurricane inundated much of New Orleans and killed about 1,800 people, millions of words have been written about the devastating physical damage to the city, and hundreds of millions of dollars have been spent on the fitful efforts at reconstruction.
But almost nothing is said — and relatively little has been spent — on a more silent wreckage: the health of New Orleans residents who were pushed over the edge by the terror and turmoil of the storm and have been unable to recover, emotionally or mentally.
The Washington Times spent more than three weeks on the streets of New Orleans this spring chronicling the crisis. Reporters and a photographertraveled with the police crisis unit and conducted scores of interviews with victims, their families and the front-line responders.
In a city that has famously grappled with mental illness for decades, caregivers on the front lines say the problem has grown exponentially since Katrina — and that the number of sufferers still in need of help easily runs into the thousands. Despite the rising scourge, the number of available hospital beds to treat the mentally ill in New Orleans has decreased by more than half.Locals have coined their own name for the mostly silent crisis: post-Katrina stress disorder.
"We all kind of crazy after Katrina," said Judge Arthur L. Hunter, who presides over a special court that reviews the cases of patients who were legally committed to hospitals or now getting treatment.
Many of the new patients held down jobs and led productive lives before the legendary storm. Now they wander the city'sstreets, living from handouts or what they can pick from garbage cans. They sleep amid filth and squalor in some of the 70,000 derelict buildings that still await rehabilitation or the wrecker's ball, or threaten suicide and act out with sudden panic or rage inside their own homes.
Mr. Graff recounted one crisis call about a 40-year-old man who had beaten the family dog to death. "It's the first catatonic case I've ever seen," Mr. Graff said. "His family said he would sit on the levee and stare at the water for hours, or sit at home and stare at the floor. He had no history of mental illness, but his mom said he was depressed." He wasn't that way before the storm, the family insisted.
Even before the storm, New Orleans billed itself as "the city that care forgot." Estimates by city health agencies and a survey by the World Health Organization put the number of mentally ill as high as 15 percent or 16 percent before Katrinain the Gulf region. That figure soared after the August 2005 storm.
The Centers for Disease Control and Prevention reported that half the adults still living in New Orleans seven weeks after the storm had clinically significant psychological distress. One year after Katrina, the WHO survey found, the ratio of Gulf Coast residents with mental issues had shot up to 31.2 percent.
Among those most directly affected, the numbers are even worse. When the Federal Emergency Management Agency surveyed families still living in trailers and hotel rooms in Louisiana in February 2006, it found 44 percent suffering from significant psychological distress.
Those numbers have overwhelmed the treatment capacity of a city that was hard-pressed to cope before Katrina.
Before the storm, New Orleans had 10 public and private hospitals with more than400 beds available for inpatient treatment of the mentally ill. Today, there are just seven hospitals operating with fewer than 170 beds. Some of those beds are located intrailersoutside the hospital facilities.
The number is about to shrink further with the scheduled Sept. 1 closing of the New Orleans Adolescent Hospital (NOAH), the only public hospital still providing inpatient services for the mentally ill. When its facilities are moved 40 miles away to Mandeville, La., the city will be down to just 133 beds.
Volunteers step in
The storm has also taken its toll on the New Orleans Police Department Crisis Unit, an extraordinary crew of volunteers augmented by paid professionalswho respond to police calls of attempted suicides or crimes committed by the mentally ill.
Established in the 1970s as a joint venture between the NOPD and the office of Louisiana Health and Hospitals-Division of Mental Health, the unique unit had about 50 volunteers before Hurricane Katrina struck. When the storm abated, only a dozen came back.
Since then, the unit has been built back up to 30 volunteers who, in the past 12 months, have handled more than 400 calls for incidents involving schizophrenics, nearly 600 calls for people diagnosed with bipolar disorder, depression or schizoaffective disorder, and 500 people whose suspected mental illness had not been diagnosed.
On occasion, they work alongside Unity of Greater New Orleans, a coalition of nonprofit and government agencies founded in 1992 to deal with homelessness in the city. Unity volunteers have taken it upon themselves to make their way through the city's labyrinth of derelict buildings, stepping over shards of glass and dodging dangling electrical wires in search of squatters — a great many of whom are mentally ill.
"I'm the only social worker in the country who goes to work wearing steel-toed boots," said Mike Miller, a Unity volunteer who along with his colleague Shamus Rohn led a Times reporter and photographer through a search of the lightless, mold-draped interior of an abandoned hospital where the sick and troubled once were saved but now hide in confusion and fear.
They find their way to the fourth floor, which once held dormitory-style rooms for on-call doctors and nurses, following a trail of jagged liquor bottles past an abandoned wheelchair and forgotten cell phones strewn on the floor. The phones are plugged into chargers that are no longer attached to any electrical outlet.
The basement is still flooded from the epic storm.
Room after room reveals the remains of the post-Katrina apocalypse: hospital beds stacked on top of one another, operating-room walls spray-painted with obscenities, piles of plaster everywhere.
Unseen items go "crunch" beneath their boots.
One night in late May, Mr. Miller and Mr. Rohn encountered Michael Palmer, a recently unemployed heroin addict who said he suffers from depression. He lives in one of the abandoned dorms with no electricity, water or air conditioning. During his years of squatting in the hospital, he found a key for the room, which he keeps locked during the day while he ventures into the city to search for food and drugs. A burning candle illuminates his clothing hung on an IV stand.
Mr. Palmer led the Unity workers onto a rooftop terrace to share his panoramic view of the city and to discuss his situation. He said he needs a job. He needs a place to live. He needs his life back.
"Yes, I get depressed, it affects you mentally. How … did I get in this situation?" Mr. Palmer mused.
They were joined on the rooftop by Alan Gele, a 53-year-old man who wore his baseball cap turned backward, a bicycle lamp strapped to his head and a beer in his hand.
"I'm tired of living like a bum. I need to get the hell outta here," Mr. Gele said.
He recounted an episode 10 days earlier, when Mr. Palmer overdosed on heroin. Mr. Gele dragged the man down four flights of stairs to the sidewalk, where he could be picked up by an ambulance and taken to a hospital.
The social workers told the two men about vouchers provided by Congress that should be available this summer to subsidize their housing needs. The men declined, saying there are others who need the help more. Besides, they said, they have no jobs to make up the rest of the rent.
Mr. Miller and Mr. Rohn promised to bring the men food the following day, and then moved on to search more buildings. Days later, Mr. Gele was severely beaten and hospitalized.
"In reality, we are completing the last search and rescue work in the aftermath of the storm," said Martha J. Kegel, executive director of Unity. "Mike and Shamus are the only two people still looking for them. …
"We've been forced since Katrina into doing things we would never dream of doing," she added. "It's slow, pain-slogging work to rescue them this way. No other city in America is doing it, but that's where our focus should be."
Danger amid chaos
Mr. Miller said he has searched 1,200 abandoned buildings since Unity successfully closed two homeless camps. One with 300 homeless at Duncan Plaza in front of city hall was closed in December 2007. A second camp, closed in July 2008, had sprawled beneath the underpass of Interstate 10 on Claiborne Avenue.
Unity wiped out the camps by providing housing to the nearly 500 people living there in tents and sleeping bags, with no toilets or water.
"It was just awful," Ms. Kegel said. "Drug dealers moved in, and there was a lot of crime and abuse of women. It got so bad no one would go in without police."
Dr. Craig Coenson, medical director at Metropolitan Human Services District, learned firsthand about the danger. His agency coordinates community services to address mental health, addictive disorder and developmental disability needs in Orleans, St. Bernard and Plaquemines parishes.
He also volunteers his time to go on the late night missions with Unity and sometimes encounters his own patients, including one man who panhandled by day to feed his cat.
"To really understand the system, I wanted to go out and see what they do and where we are missing the boat," Dr. Coenson said. "The number of abandoned buildings, businesses, libraries and schools where sports trophies are still in the cabinets, it was an eye-opener."
In one school, Dr. Coenson and the volunteers from Unity found a couple living in the library. She was dying of cancer and her boyfriend worked during the day to buy her beer to ease the pain. In another school, they found an old man huddled in a closet.
Another school was "home" to 20 to 30 transient teenagers with reputations of violence, often called "gutter punks." The social workers said they no longer approach that property.
"It is dangerous but it's for a good cause. Somebody has to do it," Dr. Coenson said.
"That's what outreach is all about. They aren't going to come to you."
While Unity tries to save people from homelessness, the NOPD Crisis Unit often must save people from themselves, like Ella Monroe. She wanted to kill herself.
"I was not like this, I never been like this before," she tells a crisis unit volunteer as she is transported her from her neighborhood in the Upper 9th Ward to University Hospital.
That's a phrase that Cecile Tebo has heard over and over in the four years since Katrina. As administrator of the crisis unit, she supervises the volunteers as they respond to about 240 police calls a month.
"We're dealing with a population that is so exhausted in their own mental illness — you have families that are so exhausted as they crawl their way through this broken system, they cannot advocate for themselves," Mrs. Tebo said.
Now it's up to the community to do that for them, she said.
Crisis unit in action
At 2 p.m. on June 4, the unit arrived at Mrs. Monroe's home. She said she already had downed a six-pack of beer.
"I'm depressed, I don't know what goes on in my brain, it just scares me," the 46-year-old woman said. "I try to fit in the world and be normal, but I'm scared of people."
"I'm scared of you right now," she told Jamie Runyan, an engineer and a volunteer in training.
Mrs. Monroe said she suffers from depression and hallucinations and hears voices that tell her she does not deserve to live.
She told Ms. Runyan that before the unit arrived, she had a razor blade and was going to "cut my arm."
She said she was institutionalized at NOAH for three months when she was a teenager and that there is a history of mental illness in her family.
"My grandmother had everything," said Mrs. Monroe, who said her illness got worse after Katrina.
Then she began a mantra she would repeat over and over during the 10-minute ride to the hospital.
"I'm tired, I'm tired, I'm tired," she said, rocking back and forth.
Once in the parking lot, Ms. Runyan wrapped up her interview with Mrs. Monroe with a few last questions.
"Why should you care? This is just your job," Mrs. Monroe said.
When told Ms. Runyan is a volunteer for the crisis unit, Mrs. Monroe grew silent for a few moments, then blurted out: "Are you for real?"
Mrs. Monroe's large dinner ring and stone-studded sandals set off the metal detector at the hospital, where a looming sign warns "no weapons" allowed.
Mr. Graff of the crisis unit held Mrs. Monroe's hand as he led her through the crowded emergency room and into a private triage room.
She was crying and didn't want to talk to the nurse, but Mr. Graff told her that was the only way they could help her get better.
Afterward, Mr. Graff led her into the mental ward's holding area, guarded by a police officer, the last stop for Mrs. Monroe before she was herded into one of two trailers across the street.
She covered her face and started sobbing. Mr. Graff put his hands on her shoulders and told her she was safe. Then she whispered something into his ear.
"All she wants is to be normal again," Mr. Graff said.
"What's normal?" he asked.
When the crisis unit returned to the hospital with another patient at 6:30 p.m., Mrs. Monroe was still waiting on a trailer bed.
Mrs. Tebo later described her frustration with the inhospitable trailers.
"It's like a really bad zoo with animals curled up in the corner," she said.
Where to go?
A 16-year-old Algiers teenager was already handcuffed in the back seat of the police cruiser when the crisis unit arrived just after 10 a.m. on June 1.
The teenager, whose name cannot be published because he is a juvenile, banged his head repeatedly on the hood of the car after officers removed him for transfer to the crisis unit van.
Mr. Graff removed the metal handcuffs and secured a worn brown leather restraint that snuggled the man around the waist, and bound his wrists to his sides.
The police said the teen was trying to break into his older, and much larger, brother's bedroom wielding a butcher knife after they had argued over what to have for breakfast.
The officers said it wasn't the first time they had responded to calls at this address.
The teen's mother, who suffers from schizophrenia and bipolar disorder, said her son takes medication for attention-deficit (hyperactivity) disorder and another medication prescribed for schizophrenia, and that he had taken his last dose the previous night.
But once inside the crisis unit van and secured into the rear seat, the youth challenged his mother, who was riding in the front with Mrs. Tebo.
"All the dope and all the weed she's selling, she should not be talking," the teen said. "If you were paying attention, you would know that I haven't taken my medicine in three months."
Mrs. Tebo informed the mother that her son might not be able to get treatment in the future at NOAH. The state is closing the hospital, forcing patients to travel to the other side of Lake Pontchartrain, 40 miles away.
"Would you be able to be a part of your child's health care there?" Mrs. Tebo asked.
The mother does not speak; she shakes her head "no."
• Tomorrow: A system overwhelmed and shrinking in size.