Where is hope?

NEW ORLEANS, LA. -- Billy Bob Hopson finds his therapy in rusted lawnmowers, mangled wall clocks and other debris that his neighbors toss on the curbs as they clear hurricane wreckage. "I'm trying to keep my mind busy," he said while hefting junk into his battered trailer. "I've got a hurting thing. ... I lost more than I can handle. It's like someone cut off your arm. You keep looking for your arm, and you can't find it."

The "hurting thing" is an epidemic confronting mental health experts a year after Hurricane Katrina struck. Suicide rates in New Orleans have nearly tripled, and the region's few remaining psychiatrists are swamped with cases of depression, post-traumatic stress disorder and related problems.

By several estimates, half of New Orleans' population needs mental health care, said Dr. Janet Johnson, a psychiatrist at Tulane University.

"We really have a mental health crisis, and we've had it for months," Johnson said.

Most psychiatrists have left, she said, and major hospitals with mental health beds have closed, as have wards for substance abusers.

A few cases have hit the headlines -- two police officers shot themselves in September, a prominent pediatrician hanged himself in November, a news photographer snapped this month and taunted police to kill him.

But those are only the most visible signals of massive and often hidden trauma.

It isn't surprising that serious psychological after-effects would surface now, said Simon Rosser, a University of Minnesota professor who joined the first wave of mental-health experts treating survivors in Louisiana in September.

"Some people are experiencing now what they couldn't afford to experience at the time of the disaster," Rosser said. "If you are in the middle of a bomb blast, you are not experiencing post-traumatic stress disorder. You are just trying to get out of the bomb blast."

In response, officials plan to revamp New Orleans' health care system, including mental health services. Private help is stepping in, too. A project funded by the W.K. Kellogg Foundation, for example, aims to train parents, clergy and counselors to ease anxiety. And officials have asked Congress for clearance to use crisis counseling money for long-term treatment.

Meanwhile, most of New Orleans is handling the "hurting thing" the way Hopson does, treating themselves as best they can, Johnson said.

Let the sweet dreams roll

Hopson's strategy is to call forth pre-Katrina memories in hopes they can overpower flashbacks to a hellish scene at Charity Hospital. A year ago he had sat at the hospital with his wife, who was suffering from colon cancer. After Katrina hit, they and others were trapped for days with no power and little food while looters attacked and snipers fired on the hospital.

When boats evacuated patients, Hopson begged to go with his wife. Instead, he was sidetracked to a plane that landed in San Antonio. Eventually, they found each other before she died earlier this year.

Standing on the lawn of their ramshackle 8th Ward house earlier this month, Hopson, 61, wound into his self-styled therapy. The hum of cicadas rose and fell in the background as he let the sweet dreams roll -- of his wife, Amelia, enjoying the shade of a pecan tree while he worked on his "Zebra," a garish pickup truck adorned with a veritable flea market of ornaments.

"She would sit under the pecan tree," he recalled. " 'What you going to put on there next, Billy?' she would ask, laughing at me."

But Katrina knocked down the pecan tree and left the Zebra a rusty mess. Snakes slither through waist-high debris in the yard.

Hopson tried talking to a doctor about his fear and grief, "but sometimes it can't come out," he said.

"I just got to keep busy," he concluded.

Keeping busy worked initially for most people, said the Rev. Bill Terry at St. Anna Episcopal Church, where scores of survivors have come for counseling.

"You could be heroic in the face of the crisis," Terry said.

Later, though, the rush of the rescue gave way to the grind of life in a wrecked city where corpses were uncovered as recently as last month, 50 million cubic yards of debris remains to be removed, rows of houses stand vacant and the list of the missing sticks stubbornly above 100.

"We started to wake up and realize that this is the way it's going to be for a long, long time," Terry said. "There is not one person living in this city who isn't impacted and experiencing some chronic fatigue, some depression. ... There are many, many children who become very clingy when it rains."

The proportion of Katrina survivors with serious mental illness doubled in Alabama, Louisiana and Mississippi after the hurricane, according to a survey released Monday by the Harvard Medical School. The January-through-March telephone survey did not find thoughts of suicide rising at the same rate, but the researchers cautioned that could have changed over time if survivors lost hope in the chances for recovery. The survey's response rate was a relatively low 41.9 percent, although the researchers tried to reach displaced residents.

Mental health services lacking

In other studies, experts estimated that 44 percent of the children who were displaced to trailers and hotels suffered anxiety, depression and sleeping problems, said a report in the Aug. 2 Journal of the American Medical Association by psychiatrists at Louisiana State and Duke universities. Two thirds of the women who cared for the kids had symptoms of psychiatric disorders.

As of June 14, only two psychiatry beds were available within 25 miles of New Orleans, said the report by Richard Weisler at Duke and James Barbee and Mark Townsend at LSU. And despite unprecedented substance abuse, there were no in-patient detoxification beds closer than Baton Rouge, 75 miles away.

"Mental health services are lacking in the region when they are most needed," the doctors commented.

The shortage has prolonged the normal psychological response pattern, said Rebecca Thomley, a Minnesota psychologist who has made eight trips to New Orleans, working first with the American Red Cross and most recently with the American Psychological Association's Disaster Response Network. Thomley is president and CEO of Orion Associates with offices in Minneapolis, Golden Valley and St. Cloud.

"Up until Christmas, we were dealing with shock. ... Then we moved into a stage where there was a certain amount of energy and hope," she said. "Toward spring we started to see anger and frustration. Now there is despair and hopelessness."

With adequate support, people could hope to move through the pattern more quickly than is happening in New Orleans, Thomley said.

'We're trapped'

In New Orleans' battered neighborhoods, residents have their own terms for their mental states -- "Katrina Mind," and "The New Normal." Dawn Robinson's version of the New Normal explains why trauma is deepening for many in the city.

Few residents have returned to Robinson's shattered 8th Ward neighborhood. She wants to leave, but her parents have too much invested in their brick home. While the parents stay in Atlanta, Robinson, 35, is fighting government and insurance bureaucracies for money to repair a home she hopes to sell. She also is battling insomnia and depression.

"What is this fight for?" she asked wearily. "There is nothing left in this neighborhood. Yet we can't leave. We're trapped."

She slept in her 1990 Acura for weeks, then in the devastated house, using candles for light. She couldn't get a FEMA trailer until May because she needed permission to move it across a neighbor's property, and it took months to find the neighbor, who is in Mississippi.

Robinson rings the trailer with rat poison. Animal lovers keep leaving food outdoors for dogs that may have been stranded, she said, and she can't convince them it's rats, not pets they're feeding.

With electricity restored, Robinson watches officials on television urging residents to drain standing water where disease-carrying mosquitoes breed. But the same officials have ignored Robinson's repeated requests to shut off water at a vacant house across her back fence where a broken pipe has leaked since the hurricane.

A Humvee with two National Guard soldiers rolled along Robinson's street one recent afternoon. By night, though, looters moved in. So Robinson sleeps with a handgun tucked into her waistband.

Her experience, repeated throughout hard-hit areas, forces a twisted question: What's a normal response to an insane situation?

"It's not normal to have a city broken this long," said Johnson at Tulane. "You have to say a lot of the mental health problems we are seeing are normal."

Sharon Schmickle • 612-673-4432