THERE MAY BE A NEW ROOF on the New Orleans Superdome and tourists in the French Quarter, but time is not healing all wounds in the wake of Hurricane Katrina. Even two years after the storm, mental health problems in the region are growing among the nearly 70,000 families still living in temporary housing provided by the Federal Emergency Management Agency (FEMA). The slow recovery, researchers and clinicians are finding, has bred levels of mental distress unseen in the aftermath of other disasters.

“Most of the time, distress emerges early and dissipates over the first year post-disaster,” says psychologist Fran Norris of the National Center for Posttraumatic Stress Disorder at Dartmouth Medical School. Not so with Hurricane Katrina. One year after the storm a Harvard Medical School committee funded by the National Institute of Mental Health reported doubled rates of depression and anxiety in the region.

A team led by David Abramson of the National Center for Disaster Preparedness (NCDP) at Columbia University, in collaboration with the Children's Health Fund, surveyed residents of FEMA-provided trailers and hotels in Louisiana and reported widespread clinically diagnosed psychiatric problems. Sixty-eight percent of female caregivers and 44 percent of children suffered new mental health issues, including depression, anxiety and sleep disorders. When the Columbia team surveyed a similar group in Mississippi six months later, it found even higher rates of distress despite the fact that Mississippi had suffered less damage and had an additional half a year to recover.

“A disaster is an abnormal event, and people being affected by that is normal,” allows Anthony Speier of the Office of Mental Health at the Louisiana Department of Health and Hospitals. “But Katrina falls into the realm of a catastrophic event. We are not set up to help a population recover from that,” he adds.

Katrina differs from other storms not only for the sheer magnitude of havoc it left but also for the stymied rebuilding efforts following it. Most neighborhoods have remained deserted, with negligible visible change in the past year, according to Speier. This open-ended holding pattern and continued displacement have perpetuated feelings of loss of control, which correlate with depression and anxiety.

Mental health investigators favor a recovery policy that goes even beyond long-term counseling to support organizations and initiatives that help communities rebuild themselves. Meanwhile, experts say, sending a public message that balances hope with realistic expectations for recovery is important. People need encouragement to seek professional help such as that offered by the Red Cross Access to Care program, Speier states.

And they need a reliable recovery timeline, along with simultaneous return of schools, hospitals and a justice system so they can more confidently invest in reestablishing themselves. “Most adults will be okay once they have homes and can return to normalcy,” NCDP director Irwin Redlener says. “But thousands of children at critical developmental ages will now have been rootless for upward of two years, with yet incalculable consequences.”