Afew months ago I took a tour of the physical destruction in New Orleans, but I ended up feeling more disturbed by the persistent sense of despair. Our driver and guide, Joe Gendusa, a 67-year-old native, zigzagged through the abandoned buildings, fighting off tears as he spoke. "My parents' graves were under seven feet of water," he said. "They never rebuilt the cemetery." A nurse I spoke with later, Diane Graham, who has been treating patients in New Orleans since 1978, said there are thousands of people like Gendusa in the city, many of whom have sunk into clinical depression or worse, and yet the city lacks the services to handle their psychiatric needs. "The ER is always full," she said, "and we never have the staff to take care of them."

New Orleans lost most of its mental health infrastructure in the storm, as clinics and hospitals were destroyed and healthcare professionals relocated. Pre-Katrina New Orleans had 225 working psychiatrists; according to the Orleans Parish Medical Society, there are seventeen left. Last fall the Louisiana Department of Health and Human Services received $80 million in federal aid for behavioral health. But facilities have not been rebuilt, and basic services have not been restored. Instead, a mental health crisis has taken shape.

The state's Office of Mental Health was able to serve only about 40,000 people in all of Louisiana the year before Katrina. Immediately after the storm, health officials estimated that 250,000 people needed services in areas affected by the storm--a need that has not diminished. According to researchers at Louisiana State University, there has been a dramatic increase in depression, anxiety and post-traumatic stress. The Society for Research in Child Development found that 40 percent of children who have returned to school suffer such psychological problems as sadness, clinginess, difficulty concentrating, irritability and risk-taking behavior.

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