The last five years have been a mental health roller coaster for many among the Mississippi Gulf Coast's post-Katrina population.

Suicides are up since Katrina. More people are seeking treatment for substance abuse, therapists say, and post-traumatic stress disorder is on the rebound.

Though suicide numbers were higher in 2004 than in the years immediately after the storm, they have climbed in the years that followed. In Harrison County, the largest county on the Mississippi Coast, the number of people who committed suicide has increased since the storm from 30 in 2005, 32 in 2006, 36 in 2007 and 44 in 2008. The numbers dropped to 25 in 2009, then accelerated by mid-2010 to 23, almost matching last year's total, based on records by Harrison County Coroner Gary Hargrove.

Because of the impact of Katrina, people haven't gotten their lives back, said Dr. Sherman Blackwell, executive director of Singing River Services in Pascagoula, which serves Jackson and George counties.

"Katrina not only changed the face of the Gulf Coast," Blackwell said, "but the soul of it, the way people live. That impacted population has an increased risk for suicide and other risk-taking behaviors: alcohol and drugs, especially among middle-age men and adolescents."

The people who kill themselves, however, are generally not the same people who receive mental health treatment, said Jeff Bennett, director of the Gulf Coast Mental Health Center, which serves Harrison, Hancock, Pearl River and Stone counties.

"Because they are actually invested in treatment," Bennett said. "About 99.9 percent of the time (suicides) are not involved in the mental health center. They see no resolution in treatment and put an end to it. People who are at the greatest risk for suicides are substance abusers ... not thinking clearly, they put inhibitions aside."

Gulf Coast Mental Health's new cases spiked following the hurricane, rising from 20 or 25 percent of total cases to about 60 percent, said Michael Maxey, director of the crisis-stabilization unit. He says the increase was "largely caused by anxiety over Katrina, over future storms, over the oil spill, over economics."

Its residential treatment center, the former Live Oaks, has increased from an 18-bed program before the storm to a 40-bed program today, though the population of the four-county area it serves has decreased, approximately 296,632 today compared with a pre-Katrina 308,312.

Across time the stressors that trigger PTSD continue. Three years into the area's hurricane recovery, the economy plummeted. Just when that was looking up, the Deepwater Horizon oil spill happened, followed a little more than a month later by the uncertainty of another hurricane season.

"Think about PTSD like the water level in a river," said University of Mississippi Medical Center researcher Dr. Scott Coffey, who was part of a two-year study published in 2008 on Katrina-related PTSD in lower Mississippi.

"If the river is running high and there is a rainstorm," he said, "the river may flood because there is very little room for error. That's kind of how it is with PTSD. Your stress is high, then when a little rain comes along, it goes over its bank. With PTSD the river is constantly running high."

"With the current stresses going on," Coffee said, "it may make it more likely they will continue to have PTSD. Predictors include financial stressors and significant social stressors, which are particularly relevant right now for folks on the Coast."

"A large number of parents report that kids are still having mental health issues, ongoing problems," said Dr. David Abramson, who's the director of research for Dr. Irwin Redlener's National Center for Disaster Preparedness at Columbia University Mailman School of Public Health. The center's ongoing Gulf Coast Child and Family Health Study follows 399 households in Mississippi's lower six counties in the aftermath of Katrina.

"It's not just that a child in him- or herself is having a psychological consequence that is entirely internal to the child," Abramson said. "We suspect it's not just the kids; it's everything around them. Kids within households within communities within systems that are not back up to speed enough to support the family as they might in a normal situation."

Symptoms are anything behavioral (and) might have been initially triggered by the hurricane but have certainly been made worse by ongoing circumstances; the chaos that followed for a number of years, the lack of stability in people's lives played a huge role.

"We had the economic recession and now you're going to have another looming economic effect with the oil spill," Abramson said. "It can have an equally devastating effect on the population as Katrina did and it may be longer lasting."