Three years after Hurricane Katrina laid waste to much of New Orleans, 53-year-old Mike Gootee still bears the trauma he experienced when he lost his home, his community and his livelihood.
His home, located in the Vista Park neighborhood of the city, ended up underwater when a levy broke, flooding the area with water nine feet deep.
The home had been where he had grown up, and it was where he had resided with his wife and 19-year-old son. He and his family were forced to relocate to nearby Lake Charles until the storm blew over.
"From a personal point of view, it was hard," he said. "Loss of everything -- loss of my practice, loss of my community."
Gootee is not only one of the hurricane's millions of displaced victims; he is also a licensed mental health counselor. And he says that the experience introduced him firsthand to the anxiety and anguish that comes with losing it all.
"It's a lot of 'What do you do?' 'Do you go back?'" he said. "A lot of indecision."
Now, state emergency agencies and residents alike are bracing for the possibility that the killer storm Gustav could follow Katrina's path. Brenda Roberts, a Lake Charles-based mental health counselor who survived both Hurricane Katrina and Hurricane Rita, which hit three weeks later, said lingering fears are indeed taking a toll on mental health.
"Whenever we see anything turn towards the Gulf, anxiety levels rise dramatically," she said. "People become hyper-vigilant -- everything makes them nervous, and any unresolved feelings about past trauma get stirred up.
"What they're going through right now is a reawakening of all of those feelings. Some of those who went through the storm and lost their homes are afraid of losing it again, particularly those who lost everything, are still displaced and still not able to return home."
And new research suggests that even as Gootee and his fellow New Orleans residents brace for what could be yet another encounter with a killer storm, many of the health issues of those most severely affected by Hurricane Katrina still remain three years on.
The report, published Friday morning in the journal Health Affairs, was based on surveys of 610 people who had been displaced by Katrina and were still living in trailers provided by the Federal Emergency Management Agency (FEMA). Researchers from the Johns Hopkins School of Public Health found that of these people, more than half -- 57 percent -- met the criteria for major depression. Altogether, more than 70 percent reported on or more symptoms of depression.
The lingering health effects of the storm appear to have reached beyond impacts on mental health. Eighty percent of those surveyed said at least one adult in their household had a chronic health condition, and of these, 58 percent reported that the condition was worsening. Making matters worse, nearly half of those interviewed lacked health insurance.
But lead study author Dr. Lynn Lawry said access to mental health services is a crucial step -- one without which many of those affected will not be able to achieve other important steps toward a return to a normal life.
She added that the rates of those who are unable to access needed mental health services are perhaps the highest she has seen among all of the disasters she has studied in the past.
"We are learning that ... there is not a lot that has been done to address the mental health needs of those affected," she said.