NEW ORLEANS – Mental health problems soared after Hurricane Katrina, just as the city's ability to handle them plummeted, creating a crisis so acute that police officers say they take some disturbed people to a destination of last resort -- jail.
Because of the storm damage, only two of New Orleans' 11 hospitals are fully functioning. What's more, one of the closed facilities is the sprawling Charity Hospital, which police officers had relied on to drop off people at any hour.
"You knew they were safe. You knew they would get the care they needed. You don't know either of those things now," said James Arey, a psychologist who commands the police crisis negotiation team.
People who need medication can't find it or can't afford it, and the storm's aftermath has made life more stressful, as well, Arey said.
"Life is hard in this town now," he said.
A federally funded study published in the Bulletin of the World Health Organization found that mental health problems in the region roughly doubled in the months after Katrina, to 11.3 percent.
Take Kenneth Breaux, who said he was diagnosed with a form of schizophrenia years ago. Breaux, 44, was jailed in June 2005 but got caught in the judicial vacuum following Katrina and languished behind bars until last April, when he pleaded guilty to simple criminal damage and was released for time served.
Advocates say Breaux hasn't been able to get the medication he's taken for years because he's been homeless and unemployed since the storm, and he cannot find family members.
"He's getting no help," said Katie Schwartzman, an attorney for the Louisiana American Civil Liberties Union who spoke with Breaux after his release in April. Today, he's back in jail on a theft charge.
Getting help has perhaps never been more challenging. Before Katrina there were 480 psychiatric beds in the New Orleans area. Now there are perhaps 200, said Dr. Jeffery Rouse, deputy psychiatric coroner for Orleans Parish.
Arey said police officers typically become involved if a person is disabled, suicidal or homicidal. "I'd say most of those are going right back onto the streets with no help," he said.
Police are answering an average of 185 mental-health calls a month, Arey said. That's down from a pre-Katrina monthly average of 350. But before the storm, the city's population was 454,000 compared to fewer than 190,000 now.
The downsized police force finds itself shopping for hospitals willing to accept the mentally distressed among five area hospitals with working emergency rooms, one in New Orleans and four in neighboring Jefferson Parish. None specializes in mental crisis, and officers say most appear hesitant to deal with mental cases.
Although federal law requires hospitals to examine and stabilize people regardless of ability to pay, Arey said it's frequently ignored.
"We routinely have officers sitting in these hospitals two, four, six, eight hours trying to talk some nurse -- with her arms folded -- into taking this patient," Arey said.
Complicating the problem, Arey said, is that many people handled by police, especially the poor, do not have health insurance. Often, he said, they are discharged by hospitals without long-term treatment.
The problem for emergency rooms is just as tough, said Dr. Richard Manthey, an emergency room doctor at Ochsner Hospital in Jefferson Parish.
Before Katrina, his emergency room examined about one patient a day undergoing a psychiatric crisis, Manthey said. Now, it frequently sees 12 a day.
"The amount of upheaval it causes is pretty dramatic," Manthey said. "These are disruptive patients, often violent, usually loud, yelling, not wanting to stay in a room."
Without Charity Hospital, police can book a psychiatric suspect into Orleans Parish Prison. While it keeps someone who is potentially harmful to themselves or others off the street, it doesn't guarantee they'll get the proper treatment.
A prison spokeswoman said the jail spends $10,000 to $12,000 a month on psychiatric medication -- 21 percent of the total it spends on pharmaceuticals. There are one full-time, board certified psychiatrist, and two part-time psychiatrists to treat 2,000 inmates.