Six months after Hurricane Katrina, Aguillard Sanchez still lives day to day in a hotel. His family is scattered throughout the country. He can't find an apartment. And previous work injury that placed him on disability is irritating him more than ever.

But Sanchez has found hope. He has joined hundreds of other evacuees in getting psychological help.
"Things are going to turn around and get better," Sanchez said with a sure voice.

A month ago, that was not the case.

"I've been feeling like I was dropped in a foreign country, so alienated."

His story is familiar to psychiatrists and counselors throughout Shreveport-Bossier City, who are seeing a steady stream of people displaced by Katrina. All report seeing people experience grief, frustration, loss of their sense of self and almost no resolution.

"Going from one place to another is literally driving people crazy," said Marta Pineda of The Center for Families in Shreveport.

Stage 1: shock and anger

In the first few days after Hurricane Katrina made landfall Aug. 29, the emergency room at LSU Hospital in Shreveport was flooded with requests.

People were seeking not physical but mental help to deal with the shock and stress. Six months later, the story has changed little.

"How long is it taking to clean up New Orleans?" said Dr. Anita Kablinger, associate professor of psychiatry at LSU Health Sciences Center in Shreveport. "They're not even close, and we're not even close to addressing the needs of people."

Each day, about 15 to 20 people come in looking for a spot in its 51-bed psychiatric unit.

Others have made their way to local counselors, particularly those who serve people on a sliding pay scale.

Early on, most evacuees went into a trauma stage, fighting for survival and dealing with life moment to moment. They experienced shock and denial, even if they just watched on TV.

"It didn't sink in that I was watching my house and my life get washed away," Sanchez said.

Emotional and mental health took a back seat to basic, physical needs as counselors became case managers worried about finding food or shelter for clients.

Some local mental health professionals formed an impromptu coalition after the storm and still provide those case management services. At a recent workshop, they expressed frustration with the Federal Emergency Management Agency and the sprawling network of social services.

"We can't even get to mental health issues because they don't have housing and food," said Shirley Olivieri-Mathies of the Louisiana Department of Health and Hospitals.

They would like to have a trailer to set up at some of the mobile home parks to provide a base of operations near their client base. Then maybe they could move past crisis mode.

Single mothers and the elderly are also likely to be at this early stage of grief, Pineda said. Single mothers lack a support system, and the elderly have more difficulty with changing their settled lives.

Cynthia Denley, a 76-year-old from east New Orleans, can't help but show her anger at officials who she believes ignored the warnings and allowed her city to flood. "(We're doing) just as we had been doing right after. New Orleans is still hopeless."

The 3,500-square-foot home her husband built is ruined after water sat in it for three weeks. Denley now lives in Shreveport with her daughter, who talked her into getting some help dealing with her feelings.

"I have too many feelings of despair: What do I do? Where do I live?"

Stage 2: fear and depression

Once the physical needs have been taken care of, many of the displaced have managed to move forward, although it can be an equally dangerous phase of grief.

"A lot are in a status where they don't know what they're going to do next," said Anthony Speier, director of disaster mental health operations for the state. "There's a lot of ambiguity and the sense of not having control. And those are things that don't lead to good mental health."

The state Office of Mental Health began the Louisiana Spirit program, which has been providing crisis counseling for evacuees. So far, it has made more than 80,000 counseling contacts, Speier said.

Those teams are still going strong, meeting about 140 people a week. They travel mostly in the trailer parks, hotels and remaining shelters providing immediate needs and referring people to more long-term counseling if necessary.

"A lot of people just need to vent," said Jenny Reynolds, a counselor working in north Louisiana. "They need to tell their story, their frustration with things. That's a very important part of what we do."

Some evacuees are just so overwhelmed that every time they think one issue is resolved, another takes its place, not allowing them to heal.

At this point, counselors say, the displaced residents are angry, frustrated and often depressed.

That's where Sanchez found himself, particularly after he saw the first pictures of his house in Violet six weeks after the hurricane. Then, he said, he knew he had no reason to return.

"It was so devastating. It was still standing. But inside, the mold looked like it was going to jump off the walls and bite you."

Sanchez started looking for a place to live but has had difficulty finding something affordable, especially since he has no transportation. "I was hitting brick walls, and I felt I didn't have anyone to turn to."

Those inner feelings can manifest themselves through gambling and abusing alcohol and other drugs. Since those numbers were already high in this area, Kablinger said, it's hard to know how much increase there has been.

But she's sure it has happened. Kablinger has diagnosed many of her affected patients with post-traumatic stress disorder.

Like soldiers in wartime, they have been exposed to a horrifying event where their own lives are threatened. She said it can sometimes be overlooked because it often looks like depression.

"It's usually a treatable illness, especially after a natural disaster."

Those reactions run across socioeconomic lines. The already-poor struggle with few resources.

And people of higher income levels often don't know where to turn or how to cope when they have little or nothing. "They live as homeless people do, and they feel dumb and humiliated," Pineda said.

Denley, a retired teacher with a master's degree, said she initally had a hard time accepting charity. "We always worked."

Sanchez said he has experienced some prejudice by those who assume he's taking advantage of the system. The former welder emphatically disputed the claim, describing his four-bedroom home and the comfortable life he had.

"We all didn't come out of jail or out of the projects. Some of us were productive citizens and taxpayers and law-abiding citizens."

Stage 3: acceptance, resolution

Complete healing is months, if not years, away. Pineda asked the rest of the community to have patience as the displaced residents create new lives.

"Six months is nothing."

And as the next hurricane season draws near, the professionals are gearing up for more trouble and panic.

"The minute there's some kind of warning out there, people are probably going to freak out," Kablinger said. "That's why we're preparing people for that."

The Louisiana Spirit counselors are encouraging families to talk about the upcoming season and develop a plan, Speier said.

Sanchez and Denley don't know where the next six months will take them as they continue to deal with their emotions, FEMA and insurance companies. But it probably won't be back to New Orleans, they said.

Meantime, the Center for Families has committed to helping them for as long as needed.

"I think God guided me here to help me through the madness," Sanchez said. "It takes the pressure off so I can go and start another life."