As droves of mental health professionals rush in to counsel the thousands of evacuees whose lives have been upended by Hurricane Katrina, some Black mental health care providers say the glaring racial disparities and classism the disaster exposed could severely hamper recovery efforts.
The obliteration of New Orleans and other Gulf Coast communities drew immediate comparisons to the tsunami that overwhelmed Southeast Asia on Dec. 26, 2004. But the graphic images of desperate Black Katrina survivors “was akin to events of Haiti and Kosovo or any war-torn country,” says Denver psychologist Dr. Robert Atwell, president of the Association of Black Psychologists.
Blacks in New Orleans and in other parts of the Gulf Coast “lost everything that makes them who they are” says Atwell of the sub-cultures and social traditions that existed among the Crescent City’s poor and Creole populations. The victims, he says, not only suffered from the disaster, but experienced multiple traumas, compounded by “historical and traditional racism, classism and benign neglect.”
“What happens to a people who have been disposed, despised and disinherited when tragedy occurs?” asks Atwell. “The answer is that they are seen as dispensable and can thus be destroyed and disposed of. The destruction of a people is preceded by the defamation of one’s character.”
Now, says Atwell, “We’re scrambling to get their needs addressed, and it’s important that Black therapists get access to Black people to provide the mental health care they need.
“But the truth is if we sent every Black psychologist, every Black psychiatrist, every Black social worker and every Black nurse into the field, we’d still come up short. There’s just not enough of us,” he says. Most of the hurricane evacuees, including nearly 70 percent of those who fled the flooding and devastation in New Orleans, are Black. The overwhelming majority of the mental health care providers being dispatched to the Gulf Coast region, however, are White. According to the federal Center for Health Statistics, African-Americans comprise less than 5 percent of the professionals in most mental health fields.
The Long-Term Impact It could take up to three years before Katrina survivors begin to experience some level of psychological recovery, says University of Illinois at Chicago psychiatrist Dr. Carl C. Bell, who heads Community Mental Health Council & Foundation Inc., one of the largest community health facilities in the country. He argues that the long-term psychological impact of the hurricane could overwhelm a health care system facing unprecedented challenges, particularly the immediate psychological needs of the evacuees.
“This is very different from anything that we’ve ever seen,” says Bell. “The nation realized that it had not accounted for the poor. There is nobody poor at the planning table when it comes to FEMA or other government agencies. Nobody knows how many poor there are in Louisiana or the whole damn country,” Bell says.
“The grief and stress that many are exhibiting now is not always indicative of PTSD (post-traumatic stress disorder) or an indicator of who will later need formal treatment,” says Bell, who also notes that improper assumptions by clinicians at this stage “can potentially end up doing more harm than good.
“We won’t know what the outcomes [for survivors] will be until the dust settles, and it hasn’t settled yet.”
It has not been business as usual for many White psychologists and psychiatrists on the ground in the Gulf Coast, say some of their Black colleagues. Their traditional treatment approaches have been met with resistance and frustration by Black and Creole populations that have spent decades isolated and impoverished.
Clinicians and health care providers “need to begin to understand why three to four generations of people lived in the projects in [New Orleans’] Ninth Ward, and why some have never ventured far from family ties that keep them bonded,” says psychiatrist Dr. Joseph White, professor emeritus at the University of California, Irvine. White’s 1970 article in Ebony magazine, “Toward a Black Psychology,” was instrumental in beginning the modern era of African-American and ethnic psychology.
Needed: Cultural competency skillsThe American Psychological Association says they are helping to meet the needs of evacuees by partnering with Black professional mental health associations. The APA announced in early September that it would “work to ensure that cultural competency skills training is part of the mental health response to disaster relief efforts” and that it would establish a nine-member Emergency Task Force on Multicultural Training. Four of the task force members would be drawn from ethnic minority associations. APA President Ronald F. Levant will choose the other five members.
The task force includes: Dr. Vicki Mays, a professor of psychology at the University of California, Los Angeles and director of the UCLA Center for Research, Education, Training and Strategic Communications on Minority Health Disparities; Dr. Jessica Henderson Daniel, assistant professor of psychology at Harvard Medical School and author of The Complete Guide to Mental Health for Women; and Dr. G. Rita Dudley-Grant, a psychologist in private practice in Christianstead, Virgin Islands.
The 700-member Association of Black Psychologists is one of the groups that will help provide training and offer recommendations to their colleagues in APA, Atwell says. The ABP will also be posting “cultural competency” tips online as a resource to those providing care to Katrina survivors, and will work through its local chapters and networks to dispatch professionals to shelters, hospitals and other places where evacuees are being housed.
Cultural competency training and understanding must include “the realization and understanding that Katrina survivors have strengths and are resilient. Blacks have survived for 16 generations in this country,” says White. “Whoever does the training has to begin to understand the way of life of a people; the rhythm of a culture.”
For many of Katrina’s survivors — children in search of their parents, schizophrenics and others suffering from mental illnesses — mental health counseling and intervention can help replace the “informal” support networks and buffers that were washed away by the floodwaters, Atwell says.
For many poor evacuees, there will be no returning to the life they knew. Gone are the corner beauty shops “where people went to talk to their [girlfriend] in a time of crisis; the barbershops where you could go and lament what has happened to you; and the churches to have a conversation with your pastor,” Atwell says. “These are the people and places that have historically and traditionally been part of the support networks in the Black community.”
But the long-enduring stigma in the Black community about mental health care and assistance, coupled with the mistrust of government, makes counseling and psychological intervention an additional challenge in the wake of Katrina, experts say.
In times of national and personal crisis and trauma, many African-Americans have often turned to places of worship for support and refuge. But Bell says he doubts this time whether the Black church is prepared to respond to those suffering from PTSD and the range of mental health disorders that may be spawned from Katrina. Not so, says Dr. Harold Dean Trulear, associate professor of religious education at Howard University’s School of Divinity.
“To say that the church is not up to the job following Katrina is to say that God can’t handle the needs of the people in this crisis,” says Trulear, who suffers from PTSD after years working with violent youth. “The Black church has long been a first line of defense for worshipers in need of mental health care. Following Katrina, I think that pastors and the church can support and supplement the work of clinical mental health professionals and vice versa.”
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