Overwhelmed with emotion, she fanned herself. She took deep breaths, pausing between sentences, staring off into the distance as if she could see the flooded streets of New Orleans. Christina Maria, 23, said that every time she smells the canal, it brings back memories of the day Hurricane Katrina hit.

Christina said she struggled with depression that intensified after Hurricane Katrina. The high school tutor said she constantly battled thoughts of suicide.

“I thought about it because I couldn’t control my life,” said Christina, who chose to withhold her last name because of the nature of her story.

Friends and family have helped Christina cope. But she said there are days when she wakes up saying to herself, “Oh, why couldn’t I have just died in my sleep.”

From the beginning of the year to date, there have been 24 suicides in New Orleans. One occurred Tuesday, when a man jumped off the Crescent City Connection Bridge.

From 2006 to 2008 the number of suicides jumped to 42, from 14. “We have a crisis,” said Dr. Jullette Saussy, the emergency medical services director for New Orleans.

Psychiatrist James Barbee said, “Post-traumatic stress often gets worse in the third to fifth year following the event.”

“The stress level is still quite high in the city,” said Barbee, the director for the Anxiety and Mood Disorders Clinic in New Orleans and a professor at Louisiana State University.

But the number of available mental health clinicians, facilities and services to deal with the high level of post traumatic stress and depression remains scarce.

The National Alliance on Mental Illness gave Louisiana a “D,” citing an urgent need to finance mental health services under Medicaid; to expand crisis, inpatient, and community services; and to address the mental health workforce shortage.

Three years ago, the state received the same grade for a lack of mental health infrastructure, lack of patient information access and portability, and a low per capita mental health expenditure of $51.34 for a population of more than 4.4 million.

This compares unfavorably to Connecticut, which received a “B” grade because its per capita mental health spending was $151.03 for a population of more than 3.5 million. Louisiana’s total mental health care spending was $2.3 million, while Connecticut’s was $5.25 million.

The city is currently facing more than a $2 billion deficit, and, adding to an already crumbling mental health infrastructure, Gov. Bobby Jindal announced earlier this year his plans to close the New Orleans Adolescent Hospital, the only public mental health facility in the city that treats juveniles. Children’s Hospital, also in New Orleans, is private.

In December 2007, Mental Health Weekly reported that more than 45,000 children were experiencing mental health issues resulting from Hurricane Katrina.

Psychiatrist Mordecai Potash, a professor at Tulane University, who has an inpatient and outpatient practice in the city, reported that because of the lack of facilities, many chronically mentally ill individuals were placed in Orleans Parish Prison, making it, by default, the largest psychiatric center in the city

“The access to mental health is not very good,” Saussy said.

Potash added that symptoms of post-traumatic stress persist if left untreated. Symptoms include bad dreams, fear and the inability to stop thinking about the event, according to HelpGuide.org, a nonprofit Web site that helps people “understand, prevent and resolve life’s challenges.”

Retired judge Calvin Johnson, executive director of the Metropolitan Human Services District, said he still has dreams about the bodies he saw floating in the water as he was going back to the Criminal Court building on Tulane Avenue to assist with the evacuation effort during Katrina.

The people on the bridge and interstate who begged Johnson for help still creep into his dreams. According to Johnson, one haunting image is of people he saw as he rode through a city underwater. He couldn’t help. The truck he was in was full and he gave away all of the water he had.

“All those are memories that live with me,” Johnson said.

Symptoms of post-traumatic stress disorder may take weeks, months and even years to develop, according to HelpGuide.org. Symptoms can occur immediately or gradually and may come and go. Post-traumatic stress disorder may be triggered by a reminder such as a noise, smell, words and an image.

In the case of Hurricane Katrina, four years later many New Orleanians are constantly reminded of that dreadful day when they step outside of their homes.

Potash said that people are “re-experiencing visual cues.”

“There are parts I used to go to pre-Katrina, but I don’t go there now,” said Potash. “There is nothing but destruction. I don’t need to be reminded. Some areas look like it just happened yesterday.”

Every day people walk or drive past the skeleton of vacant houses and businesses bearing an X, revealing the date the home was searched, who checked it and the number of bodies found.

“Recovery is slow,” said Saussy. “People are left in a limbo type of position.”

HelpGuide.org and research by Potash also revealed that post-traumatic stress disorder affected emergency workers and law enforcement officers.

Officers who experienced the chaos firsthand had to combat post-traumatic stress and take the place of mental health practitioners and counselors. Every month police officers were transporting 185 to 200 mental health patients to hospitals. Today, the New Orleans Police Department has a crisis unit that consists of volunteers who aid in the transportation of people with mental illnesses.

“Katrina has been a major factor in exposing a serious mental health problem in New Orleans,” said criminologist John Penny, a professor at Southern University of New Orleans.

Penny said that depression is a major issue in the city, and that suicide homicides are increasing as well. The rise in “angry outbursts, murders and substance abuse,” Penny said, are “compounded problems brought on by the lack of treatment facilities.”

The system has been “disabled,” Barbee said, but he has been able to treat everyone.

Potash has a sliding scale fee in his outpatient practice, and he tries to assist patients with Medicaid. But he said there is an urgent need for inpatient facilities.

David Gavlinski, an aide to City Councilwoman Shelly Midura, said that if the community fights to keep the New Orleans Adolescent Hospital open then the state government will cut the Assertive Community Treatment and the Forensic Assertive Community Treatment programs. Both programs have 100 beds for the “most vulnerable.” Gaylinski said there is a need for all facilities.

“Our area needs to make mental health education and treatment a high priority,” said Penny. “It needs to be at the forefront of any endeavor we undertake.”

Last year was the first time Christina saw a counselor for her depression. Every day had been a struggle, she said, but “through encouragement from friends, I manage to tame the thoughts.” Although times can be hard, Christina said, she knows there is “still something special” waiting for her.

“I’ve been given another day, and I should cherish it for the betterment of others,” said Christina. “It’s not about me. It’s the circle of life, and albeit we travel different paths and potholes, we write our own stories. And I want mine to have a happy ending.”