A heart that keeps on beating: despite the challenges during and after Hurricane Katrina, Memorial Behavioral Health finds ways to provide services.

On August 27, 2005, 5,100 people gathered for the annual American Heart Association Heart Walk at Jones Park in Gulfport, Mississippi. The bright, hot, humid day was like any other Saturday in late August along the Gulf of Mexico. Yet if you looked south, you could see ominous dark blue clouds on the horizon. Katrina, at one point a category five storm, was too close for comfort. I wondered what this park would look like if the storm hit this area. Would we be here again next year for the Heart Walk?

At the walk's conclusion everyone left to make final preparations for the storm. I boarded up my home before heading to Memorial Hospital in Gulfport. Memorial is a multispecialty medical complex approximately 3,300 feet (0.6 miles) from the Gulf Coast, and it has more than 260 physicians and 445 beds. Memorial Behavioral Health (MBH) operates 80 of those beds. MBH is the sole provider of child and adolescent inpatient services and one of three providers of adult inpatient services for six counties in southern Mississippi.

On August 28, 50 employees on the MBH Hurricane Team reported for duty to care for patients who could not be discharged. Katrina hit the next day.

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The Mississippi Gulf Coast endured the storm's wrath for 12 hours, but Memorial never closed. Our buildings sustained $13 million in damages from 130+ mph winds and flying debris, but the floodwaters did not reach us. Other healthcare facilities nearby were not as fortunate. A psychiatric hospital, the holding facility for the state hospital, and almost all of the outpatient mental health sites in the coastal counties had to close. The state Department of Mental Health's facilities suffered $23 million in damages. So for three months, MBH was the sole provider of inpatient mental health services in four counties.

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In Katrina's aftermath, access to healthcare was very difficult. Curfews and checkpoints hampered access and freedom of movement. Individuals with severe psychiatric needs were taken by the military, police, and emergency responders to hospital emergency rooms or disaster medical assistance locations. Our ER experienced three times the normal traffic for weeks after the storm.

Access to prescription drugs for patients who lost homes and belongings was a significant problem. In the first five days after Katrina, Memorial filled more than 5,000 prescriptions for free. During the next six months, medical and psychiatric access to care was assisted by the disaster relief efforts of many generous groups of volunteers from all over the country. But by the spring and summer of 2006, many of the larger volunteer groups demobilized their efforts along the coast, resulting in fewer professionals to provide medical and mental healthcare.

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One of our outreach efforts to help offset the loss of services this past year was to place licensed therapists in 13 school clinics during the school year. Three therapists were assigned to the schools full time to provide access to mental healthcare. This program, funded by a grant from the McCormick Tribune Foundation, has been very successful in reaching children who otherwise might not have had access to care.

At Katrina's second anniversary, the mental health community is struggling with care delivery, hampered by service gaps, infrastructure needs, lack of human resources, and funding shortfalls. The shortage of mental healthcare professionals for both inpatient and outpatient settings remains care providers' number-one concern. For example, six psychiatrists are being recruited to fill positions left vacant after Katrina, two at MBH; it's difficult to recruit psychiatrists even without the challenges we face. Licensed nurses, licensed social workers, and other support staff are in demand as well.

As many as 25 to 33% of healthcare staff along the coast are estimated to have left their jobs after Katrina due to a lack of adequate housing and/or spousal unemployment. Of Memorial's staff alone, approximately 400 employees (including 40 physicians) lost their homes, with many more sustaining significant damage. Many positions have been filled, but more healthcare workers are needed. In outpatient mental health services, the waiting time for an appointment is approximately four to eight weeks, depending on the professional.

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Since Katrina, the rate of completed suicides is well above historical levels on the coast. The Harrison County Sheriff's Department reports an increase in the incidence of illegal drug use, and we have seen an increase in violence, physical abuse, depression, and PTSD in patients presenting for treatment. ERs are the most common access point for mental healthcare. They have taken the place of primary care providers and disaster response organizations that have moved to other areas. With fewer provider resources on the coast, mental healthcare providers are searching for ways to provide care to the community.

This summer, leaders in the mental healthcare community have worked together with outside consultants to assess the system's needs and service gaps. Our objective is to develop a plan for an innovative, effective, integrated delivery system to address both short- and long-term mental, emotional, and developmental needs of children and families of coastal Mississippi. If we stick to our timeline, we will deliver our plan to community stakeholders by January.

The Heart Walk did return to Jones Park on October 14, 2006, with more than 5,500 walkers participating. We walked the same four-mile course but in a very different setting than the year before. There was plenty of destruction and debris, but also some rebuilding too--showing the resiliency of the many hearty people of the coast. We are looking forward to another Heart Walk next month.

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Michael A. Zieman, FACHE, is the Director of Behavioral Health Services for Memorial Hospital Gulfport, a 445-bed multispecialty medical complex in Gulfport, Mississippi. He is also the Administrator of Memorial Behavioral Health, an 80-bed inpatient and outpatient facility serving adults, adolescents, and children. He is an active member of the National Association of Psychiatric Health Systems and served on its board from 1990 to 1993. To contact the author, e-mail mzieman@mhg.com.

BY MICHAEL A. ZIEMAN, FACHE