Months before her death, 16-year-old Madeleine Prevost was hard at work on a high school art project, a self-portrait she did not share because it, like the subject, was a work in progress.
The painting now hangs in her mother's New Orleans home, and in some ways it is a portrait of more than just a single girl. It is a portrait of an entire generation of young people here commonly labeled "the Katrina generation." Instead of childish features, the girl inside the frame "looks like a 40-year-old woman," says Mary Prevost, Madeleine's mother. "It's definitely not a child."
Even with the floodwaters gone and rebuilding efforts in progress, many teenagers in New Orleans are struggling to cope with Katrina's legacy – destroyed homes, schools, neighborhoods, and loss of friends and even pets, says Jullette Saussy, emergency medical services director for the city. At the same time, cheap drugs have flooded the streets of New Orleans after Katrina.
While there are no data linking drug-related deaths or suicides to post-traumatic stress, parents, teachers, and healthcare experts like Dr. Saussy say they are seeing a rise in suicides, high-risk behavior, and clinical depression among young people. Madeleine, for instance, died of a heroin and cocaine overdose in 2008, and more than 45,000 children here are struggling with mental-health issues related to Katrina, according to a December 2007 study by Mental Health Weekly.
"We have a teenage population here that is unlike other areas of country," Saussy says. "You have a lot of kids who have been forced to deal with really grown-up things, and parents have been preoccupied with trying to fill out FEMA forms and dealing with their own depression. I think somewhere along the lines, kids are self-medicating."
The suicide rate in New Orleans tripled between 2006 and 2008 to 42 deaths – a majority of whom were young people, Saussy says. This month, the 2009 rate reached 20 deaths. She said the youngest suicide she encountered was an 11-year-old.
"As a city, I think we're in crisis. I don't think anyone has broken free and gotten back to normal," says Al Sidhom, community coordinator for the Child Adolescent Response Team, a state-managed crisis management unit that dispatches social workers to children 17 and under. He says the New Orleans unit has the highest call volume in Louisiana. In March, it received 90 calls – about three a day.
Margaret Leaf, a high school English teacher in New Orleans, says there was a "huge change in risky behavior" among her students following Katrina, even among top honors students and those who came from supportive families. Ms. Leaf says young people often were given the responsibility of trying to keep broken families together following the divorce of their parents or relocation, which spread members far and wide. Distracted parents also contributed heavily.
"You can't make up a relationship in lost years with a young person. They're going to turn to you less for guidance, and if you're not there, they're going to turn to peer groups," she says.
Zac Moser was 21 when he accidentally overdosed on heroin last year — a casualty his mother, Cathy Moser, says is seeded in Katrina. The hurricane arrived the semester her son had planned to attend the University of New Orleans, which was forced to close.
Instead, he took a waiter job outside the French Quarter, which gave him ample cash, a late-night schedule, and a doorway to a drug culture; the person who sold him the fatal dose was a fellow waiter, according to an FBI investigation.
Drugs became more prevalent in New Orleans after Katrina, says US Drug Enforcement Administration spokesman Warren Rivera. Local dealers relocated to Texas cities like Houston and discovered they could purchase the drugs directly from Mexico. Some 90 percent of the drugs in New Orleans come from Mexico, Mr. Rivera says.
"They cut out the middle man, that's what Katrina taught them," he says.
That direct access is coupled with a diminishing healthcare infrastructure in New Orleans. Charity Hospital, the city's leading medical center, closed indefinitely after the disaster. Faced with a $2.1 billion state budget deficit, Gov. Bobby Jindal (R) earlier this year announced plans to close the New Orleans Adolescent Hospital. That would require adults and children currently treated there to travel 30 miles outside the city to receive mental healthcare.
"Those of us on the front lines talk about people and they talk about dollars and those two conversations are never going to be parallel," says Saussy. "Trying to make case about improving mental health, the silence is deafening."
Yet the death of Madeleine Prevost, known locally as Maddy, rocked the city. It was one of seven overdose deaths of young people related to heroin in the first half of 2008, according to the FBI.
"Maddy's untimely death certainly raised awareness" among parents, says Saussy. Part of the difficulty in addressing the issue is it can go undetected for so long. Madeleine Prevost returned to New Orleans three months after the storm to discover the homes of both her mother and father destroyed and the family dog missing.
"That was big loss for my daughter," says Mary Prevost, a public school social worker.
Prevost says Madeleine spent more than a year conducting online searches for her dog on Petfinder.com as they moved from apartment to apartment. She also started volunteering at the city animal shelter.
Months before overdosing, Madeleine showed signs she had worked through much of her grief through therapy sessions, Prevost says, but there still remained a "greater recklessness."
On the weekend of her death, Madeleine had been out with a friend whom the family knew and trusted. Later, he pleaded guilty to providing her with the drugs that caused the overdose.
Prevost thinks the toxic mixture of drugs with which her daughter experimented was "like taking roller coaster ride, and she did not have a thought about the possibilities. She was putting the top down on the convertible and driving over the big bumps. Maybe that's more attractive to kids here."