- Nearly 20 percent of the U.S. population needs mental health care.
- Almost one in five of us meet criteria for a personality disorder.
- In Baltimore, some 45,000 people have substance abuse problems.
These days, Michael Kaminsky drops statistics that at first shock, then reveal what psychiatry faces in this country. Why he does this is compelling. “What epidemiology tells us,” he explains, “makes perfect sense of what went on in the New Orleans convention center and the Superdome last fall.”
A part of Psychiatry’s community outreach in East Baltimore for 16 years, and the department’s clinical director since 1993, Kaminsky is no green twig. He knows the ins and outs of providing mental health care in the streets. After 9/11, he helped create a Hopkins-wide mental health disaster plan. He’s the university’s mental health disaster incident commander.
But his view of disaster and community psychiatry has become more nuanced, thanks to the sisters-in-havoc, Katrina and Rita.
Last year, as Katrina’s damage became obvious, Kaminsky signed on, first with a large Hopkins volunteer group, then, as federal snafus kept them in Baltimore, with a smaller Hopkins/state-based effort that finally got him and a small crew to central Louisiana. They set up clinic in an elementary school cafeteria, draping sheets over windows, moving tables and file cabinets to give patients some privacy. He treated 45 people in two days. But that stay, he says, “was far too short.” Kaminsky found his way back—arriving where 9,000 evacuees were temporarily sheltered—for another 10 days. Patients, he says dryly, were “diverse.” Two weeks of traumas had brought forth anxiety disorders, post-traumatic stress disorder and major depression. Elderly patients who’d been shuttled about from nursing homes faced relocation stress syndrome, a risk for premature death.
“I saw major mental illness—often pretty complicated—that no one had diagnosed,” Kaminsky says. There was acute mania, major withdrawal syndrome from benzodiazepines—one patient had had seizures and another was psychotic—and lots of insomnia. “On one hand, you’re dealing with expected response to catastrophe and on the other, there’s this huge traditional community psychiatry population. And they’re all in need, all at once.”
So, he says, you stabilize/ assess/connect and communicate: “This isn’t the place for big-time psychotherapy.”
What was extraordinarily useful, he says, was a compassionate presence. “You also explain how to manage stress; you educate.” All told, about 250 patients got his care.
Most challenging, he says, was the large substance-abusing population, which included surprisingly high numbers in withdrawal from pain medications. Police had shut down illegal pain clinics—“pain mills”—just as the storms hit. Except for serious withdrawal, the clinicians had little to offer from their store of supplies and had to post signs saying so. “We saw a tremendous amount of drug-seeking behavior.”
Finding patients was easy; “Almost anybody you’d talk to was suffering.” One elderly man outside Kaminsky’s lodgings wanted to return home to Houston but couldn’t. In the storm’s wake, he’d developed a phobia of driving; he was stranded, anxious and vastly embarrassed. “I talked with him and his wife at length,” says Kaminsky, who found the man reliable enough for a mild tranquilizer. “Then I wrote out a program of exposure therapy, telling the man to drive around the parking lot several hours with short detours outside it. After two days he felt well enough to drive off, the name of a Texas clinician in his pocket.
“Mental health needs are everywhere in these settings,” says Kaminsky. “You’re rarely so needed.”
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