Promoting mental health recovery after hurricanes Katrina and Rita: what can be done at what cost.
BACKGROUND
Concerns about mental health recovery persist after the 2005 Gulf storms. We propose a recovery model and estimate costs and outcomes.


OBJECTIVE
To estimate the costs and outcomes of enhanced mental health response to large-scale disasters using the 2005 Gulf storms as a case study.


METHODS
Decision analysis using state-transition Markov models for 6-month periods from 7 to 30 months after disasters. Simulated movements between health states were based on probabilities drawn from the clinical literature and expert input.


METHODS
A total of 117 counties/parishes across Louisiana, Mississippi, Alabama, and Texas that the Federal Emergency Management Agency designated as eligible for individual relief following hurricanes Katrina and Rita.


METHODS
Hypothetical cohort, based on the size and characteristics of the population affected by the Gulf storms. Intervention Enhanced mental health care consisting of evidence-based screening, assessment, treatment, and care coordination.


METHODS
Morbidity in 6-month episodes of mild/moderate or severe mental health problems through 30 months after the disasters; units of service (eg, office visits, prescriptions, hospital nights); intervention costs; and use of human resources.


RESULTS
Full implementation would cost $1133 per capita, or more than $12.5 billion for the affected population, and yield 94.8% to 96.1% recovered by 30 months, but exceed available provider capacity. Partial implementation would lower costs and recovery proportionately.


CONCLUSIONS
Evidence-based mental health response is feasible, but requires targeted resources, increased provider capacity, and advanced planning.
Schoenbaum
Michael
M
RAND Corporation, Arlington, Virginia, USA. schoenbaumm@mail.nih.gov
Butler
Brittany
B
Kataoka
Sheryl
S
Norquist
Grayson
G
Springgate
Benjamin
B
Sullivan
Greer
G
Duan
Naihua
N
Kessler
Ronald C
RC
Wells
Kenneth
K
D000328:Adult; D002648:Child; D003365:Costs and Cost Analysis / Q000706:statistics & numerical data; D055867:Cyclonic Storms / Q000191:economics / Q000706:statistics & numerical data; D003661:Decision Support Techniques; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration*; D004189:Disaster Planning / Q000191:economics / Q000458:organization & administration*; D004190:Disasters / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D008016:Life Change Events; D008297:Male; D008390:Markov Chains; D001523:Mental Disorders / Q000523:psychology / Q000534:rehabilitation* / Q000628:therapy; D020380:Needs Assessment / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D012066:Relief Work / Q000191:economics* / Q000706:statistics & numerical data*; D018635:Rescue Work / Q000191:economics / Q000706:statistics & numerical data; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology; D017741:Survivors / Q000523:psychology / Q000706:statistics & numerical data; D014481:United States