DB Responds Quickly to Flood-Ravaged Iowans

As the waters of the Iowa River rose alarmingly in June, Nancy Andreasen, M.D., Ph.D., former editor of the American Journal of Psychiatry and a professor at the University of Iowa, watched as the U.S. Army Corps of Engineers stacked sandbags near her home one day, got instructions for evacuation the next, and orders to leave the day after.

With the help of her husband, Terry Gwinn, and some friends, Andreasen hauled their belongings up to the second story of their Iowa City condo or out to the farm they own nearby.

Water rose to a height of four feet on the first level, buckling the wooden floors and leaving black sludge on the carpets. Filing cabinets full of article reprints never made it out and were ruined. After the flood receded, they had to clear the second floor as well to make way for mold remediation.

Andreasen counts herself among the lucky, however.

“We've seen great helpfulness, with volunteers helping total strangers,” she said in an interview. “It's been a positive manifestation of the human spirit and makes you feel better about the world. That's one reason I'm not depressed.”

The flooding that devastated towns along the Mississippi River and its tributaries occurred on a nearly unprecedented scale, bigger than the floods of 1993, and perhaps the fifth costliest natural disaster in U.S. history, according to some reports.

Iowa farmers have lost $4 billion in crops, and the University of Iowa alone sustained over $271 million in damage.

There will be some inevitable emotional fallout from the disaster, even with the well-organized response.

The Iowa Psychiatric Society (IPS) offered suggestions to residents on how to minimize the possible mental and emotional effects of trauma caused by destruction and loss of life during natural disasters.

“This type of natural disaster can have tremendous psychological impact on all those directly and indirectly affected,” said a statement from the IPS.

The statement also noted that it was normal during natural disasters to experience a wide range of mental or emotional reactions—from sadness, stress, and anxiety to more severe mental illness, such as posttraumatic stress disorder, anxiety disorders, or a major clinical depression.

“This is a very difficult time for everyone involved,” said Robert Smith, M.D., president of the Iowa Psychiatric Society, in the statement. “Traumatic events affect survivors, rescue workers, and the friends and relatives of victims.... As psychiatrists we understand this disaster can cause significant distress and pose potential threats to the mental health of all those involved. It is important for everyone to know that help is available and treatment does work.”

IPS member Al Whitters, M.D., who has trained in disaster relief, chaired two teleconferences for the society about the disaster. Several psychiatrists in the affected areas expressed interest in donating time and extending hours for those who needed help.

Ironically, Iowa legislators last year authorized the state's Department of Human Services to develop an emergency mental health crisis service program, but it wasn't supposed to start until next January, said Allen Parks, Ph.D., M.P.H., director-administrator of the Mental Health and Disability Services Division, in an interview.

Nevertheless, as the floodwaters rose, his department alerted every case manager in the state to go out and make face-to-face contact with chronically mentally ill individuals to ensure that they had food, medications, and safe places to go. During his own inspection of shelters, Parks found counselors working with seriously mentally ill persons to ensure that they remained stable and continued their medications. He has worked with Medicaid officials to permit immediate refills of prescriptions lost or left behind as people evacuated.

The state has applied for federal funds to cover 60 days of crisis counseling in 30 counties and is preparing to ask for additional funds from a separate nine-month federal program. The money will pay for services provided by nine community mental health centers in affected areas.

“We will see the mental health outcomes happening in phases, as in any disaster,” said Michael Flaum, M.D., director of the Division of Public and Community Psychiatry at the University of Iowa's Carver College of Medicine. “So far, we've seen that many people with psychiatric diagnoses, who had been fairly stable, even if they lived marginal lives, didn't have the resources to rebound after they lost everything.”

Flaum is part of an interdisciplinary group of mental health professionals who have gathered occasionally in person or by e-mail to share their experiences and knowledge about handling the aftermath of the flood.“ This event has taught us that we need a clear, integrated disaster plan—which we did not have.”

Having a member like Whitters with a background in disaster relief helped the IPS's response, said Jerry Lewis, M.D., the Iowa district branch Assembly representative, in an interview. “On the other hand, it was obvious from discussions that if the society were to play an effective role in disasters that it needed to work to develop structure and networking to meet situations like this in the future,” he said.

Meanwhile, Andreasen must decide whether to move back to her condo, but she is buoyed by her fellow citizens' willingness to help their neighbors.

“The sense of social responsibility is completely intact here,” she said.

Information on the Iowa Psychiatric Society and additional resources are posted at<www.iowapsych.org>.▪