Published in Nurse.com
Monday, March 10, 2008
Link to original article

Almost three years after Hurricane Katrina, New Orleans’ homes and neighborhoods are slowly being rebuilt, but mental health professionals say the psychological damage is likely to linger and unravel for decades. With much of the city’s pre-Katrina psychiatric beds and outpatient services out of commission, many patients have nowhere to turn. From assisting depressed and suicidal patients to counseling families, nurses in the city are playing a critical role in the mental health crisis.

Joseph Eppling, RN, BSN, MN, MS, CRRN, CNAA, BC, director of psychiatric and behavioral health sciences for East Jefferson General Hospital, said that New Orleans was lacking mental health services long before Katrina. With the closing of Charity Hospital and other facilities, little more than 100 of the city’s original 365 psychiatric beds have been put back into service. Coupled with lack of outpatient services such as group homes and counselors, Eppling said many people with mental problems don’t show up until they’re at the emergency room.

Pre-Katrina in New Orleans, police would often bring mentally-ill patients to Charity Hospital, but that facility’s closing has pushed patients into many of the private hospitals. Many of those who arrive in the ERs are in an active psychotic state or have suicidal thoughts. Others are severely depressed and are suffering mental breakdowns.

“As soon as we discharge one, we have one waiting. After Katrina, we’ve seen longer waits in our emergency department for inpatient beds. We’ve had patients in the ER waiting up to three and four days for a bed,” said Eppling.

Eppling, who recently received the Nurse of the Year honors from the Louisiana State Nurses Association for his dedication to mental health, credits East Jefferson’s success to a well-trained nursing staff in the ER that is able to appropriately screen patients and determine their true needs—whether that is antidepressant medicine or admittance.

At Tulane Medical Center, licensed counselor and director of employee assistance program Ann Wilder said that the working population is still facing the stress, depression and anxiety of trying to get back in their homes and dealing with insurance companies and FEMA. According to her, the amount of stress people have following a disaster is 10 to 25 percent greater than that of everyday life. Tulane has seen it affect not just the patients but even nurses.

“We still have employees living in trailers with damaged houses. Health care professionals are at work taking care of people everyday but still have their own problems to deal with on their days off. The stress level is high,” said Wilder.

To help Tulane handle its influx of mental patients, director of nursing Kathy King, RN, is coordinating the opening of a 10-bed unit at a Tulane facility in March 2008. Staffed by 16 RNs and psych techs, King said that the unit will be more conducive to assisting these patients than in the hectic environment of the ED. With anywhere from one to four psych patients in the emergency department everyday, King has added psychiatric nurses and techs just to handle the influx.

King said that nurses are instrumental in serving the needs of mental patients. Usually the first person a patient sees, the nurse takes the patient’s history, reassures them of their care and helps identify what their issues and needs are. Many nurses work with group and individual therapy sessions and stay with the patient throughout their crisis. Nurses also communicate with mental patients’ family members, a critical element when a patient has severe mental distress or may be contemplating suicide.

“[Nurses] are like the glue that holds it all together. They are that one constant person that is always there next to these patients. They are the ones that are ultimately responsible for making sure that the plans that are going to help these patients and their families are carried out,” said King.