Day4FloodingAerials bf 1317.jpg

Aerials of severe weather flooding in East Baton Rouge Parish on Monday August 15, 2016. A National Guard vehicle turns west on Prescott Avenue off of N. Foster Drive. Looking south southeast.

Advocate staff photo by BILL FEIG < p>

As Louisianians continue to cope with the fallout from last year's devastating flooding, mental health professionals say they worry about their ability to provide adequate care in a state where resources were already stretched.

Adding to their frustration, the federal government has yanked funding for a state health department program that provided counseling and other services to flood survivors. The program, Louisiana Spirit, officially shut down Friday, said program coordinator Nicole Coarsey.

Yet while there is now one fewer resource available to those in need, experts predict that the demand for mental health type services will continue to rise in the next year now that people are transitioning away from short-term survival mode and adjusting to the new normal.

"We haven't seen the spike. We haven't seen the epicenter," said Aaron Blackledge, executive director of the local non-profit Crisis Intervention Center.

He says there’s a huge demand for services looming.

"Unfortunately, organizations like ours don't have the resources to help,” Blackledge said. “I haven't seen anything like it since Katrina. It's a tragedy."

Already, one hospital is reporting a rise in psychiatric admissions.

Dr. Kenny Cole with Baton Rouge General Medical Center said 1,498 people checked into that hospital’s emergency room between August 13 of 2016 and August 13 of this year with a primary complaint that was mental health related — a 14 percent increase over the previous year.

"I think the number is probably much bigger than that," Cole said.

The reason, he said, is that in some people come in complaining of physical symptoms like insomnia or chest pain when the underlying problem might actually be depression or anxiety.

Although there’s ample evidence that links conditions like anxiety, depression and post-traumatic stress disorder both to environmental stressors and genetic factors, there's still a persistent and "arbitrary" stigma against people struggling with mental illness, Cole continued.

And stress also suppresses a body's immune system, the doctor said. For example, Baton Rouge General surveyed its staff and found that about 37 percent of those who had flooded reported an increased need for prescription medication since the storm.

Physical and mental health "are very much intertwined. They very much affect each other. ... It's really just health," Cole said.

Theoretically, anyone can eventually reach a point at which they begin to have difficulty coping with trauma and stress. People just reach the threshold at different times explained local psychologist Donald Hoppe.

Anxiety and depression can occur when the body's self-preservation instincts react out of proportion to stress, he said.

Richard Bryant of the University of New South Wales, an expert on Post Traumatic Stress Disorder, said one way to understand PTSD is to think of a mouse in a cage with a light.

If a researcher turns on the light and shocks the mouse, then eventually it will come to fear the light and exhibit symptoms like an increased heart rate and release of stress hormones when the light is switched on. If the researcher continually turns on the light without shocking the mouse, a healthy animal will come to lose its fear, but some will continue to have a fearful reaction, Bryant wrote in a presentation to the Dart Center, a Columbia University agency that provides information on trauma to journalists.

Human psychology is more complex, Hoppe said, and some of it is biological. Violence, strong or weak relationships and other factors during a child's development can also play a role, he said.

His clients are particularly concerned about the effect the flood has had on their children. He said he's heard a lot of worry about kids who are now fearful of thunder storms.

At Our Lady of the Lake, the number of adult psychiatric admissions actually went down slightly last fiscal year, said behavioral and mental health executive director Denise Dugas. However, the intake of adolescents — those between 12 and 17 years old — went up from 341 to 548.

While the Lake can provide acute care for a few days to help a patient in crisis or who needs to detoxify, "there's a lack of the continuum of care that's needed in this community."

The state cut funding for psychiatric care under former Gov. Bobby Jindal, and now struggles to find adequate longer-term services, Dugas said. As a result, people end up staying in the hospital, which creates a "backlog" of others seeking services. When they are released, they frequently have to go to facilities in New Orleans, Shreveport or Lafayette.

It's tough on families when teenagers have to go to another city to receive care.

"Parents were distraught," Dugas said.

Blackledge, the Crisis Intervention Center’s director, said the crisis line also struggles to keep up with the calls for help. Based on the size of its population, the Baton Rouge area should probably make about 12,000 to 13,000 calls to the center annually. But because services are hard to come by, local residents call about twice that often in years even without a massive community-wide crisis like last year’s historic flooding, the executive director said.

As a result, calls get re-routed to centers from Miami to Seattle, so while people in distress still have an opportunity to talk, the person on the other end of the line is less familiar with how to help them reach local services.

"It's been an incredibly frustrating journey. ... It's really unbelievable," Blackledge said.

Another specific concern for Baton Rouge is that many people have already lived through a natural disaster.

"This has rekindled a lot of the fears they felt after Katrina. ... It opened up old wounds," Hoppe said.

A team of LSU researchers is investigating so-called "re-traumitization," said Katie Cherry, an LSU psychology professor. They're collecting data on subjects' well-being and having them perform memory tests, problem-solving puzzles and other measures of their cognitive ability.

After meeting with subjects over time, they'll compare people who didn't flood, people who flooded for the first time and people who flooded and were affected by a previous storm like Hurricanes Katrina or Rita.

Cherry, who specializes in disaster stress and recovery said she was "terribly disappointed" to see the closure of Louisiana Spirit, which she called "such a good program."

Technically it can be re-authorized, but only if there is a new disaster declaration for a future event, according to Coarsey, the program coordinator.

A year after the flood, Louisiana Spirit conducted 22,401 individual counseling sessions. Representatives also went door-to-door surveying flood victims' mental health. The most common complaint — identified by over 14,000 survivors — was ongoing fatigue and exhaustion, according to a state report.

The program also met with groups including first responder agencies. While most of the concern since the flood has been for the people who actually took on water, experts also expressed concern about those who were indirectly affected. That group includes members of the Cajun Navy who helped rescue flood victims as well as people who watched their family members lose everything or have crowded their houses with friends and relatives in need ot a place to stay.

Doctors are trying to keep an eye out for unhealthy coping methods among everyone touched by the storm.

Cole, of Baton Rouge General, said some people may turn to comfort food while others deal with stress by smoking more, which could increase the number of diabetes or asthma cases.

While he didn't have specific data about substance abuse, Cole remarked that "alcohol especially is a drug of choice for self-medicating."

In addition to forcing people out of their homes, the flood also damaged churches and other meeting spaces where addicts in recovery convene to offer mutual support. Alcoholics Anonymous doesn't take attendance, and each meeting group is fairly independent, but it looks like operations have pretty much returned to normal, said one employee in the Baton Rouge central office who asked not to be identified in keeping with the organization's traditions.

In fact, after the storm, AA groups were some of the ones out cleaning the churches, and members were able to lend help with childcare and provide support to others in recovery.

"It was very much a grass-roots, person to person kind of thing. ... We really did well. I'm proud of us," the AA worker said.

When people begin exhibiting symptoms of psychological distress, it's important to intervene quickly before matters become chronic and lead to more serious issues like drug abuse, domestic abuse self-harm and suicide, remarked Dugas at OLOL.

Louisiana's 2017 suicide rate is higher than the national average, and one person in the state kills himself about every 12 hours, according to the American Foundation for Suicide Prevention. More common than homicide, it is particularly problematic among younger people, ranking as the second leading cause of death among children 10 to 14 and the third leading cause of death for people between the ages of 15 and 34, according to the Foundation.

About 90 percent of cases involve people with mental disorders and/or substance abuse, but the issue is complex, the Foundation wrote in an online explanation to lay people.

"There are almost always multiple causes, including psychiatric illnesses that may not have been recognized or treated. However, these illnesses are treatable," they wrote.

Though they are rare, there have also been calls to the crisis hotline from people in distress who want to turn their anger on others. Last year, there were seven calls Blackledge classified as "homicidal ideation."

"The reason is they aren't getting any support. ... They're hurting and they want to stop hurting."

Cole isn't sure how long the flood will continue to have community-wide effects on mental health. After Hurricane Katrina, the suicide rate in New Orleans doubled and stayed at the level for four years, he remarked. However long the problems persist in Baton Rouge, he expects to measure it in years.

Follow Steve Hardy on Twitter, @SteveRHardy.