Caitlin Dickerson (Independent) writes that public health officials say signs of a mental health crisis are haunting Puerto Rico two months after Hurricane Maria’s violent winds and screeching rains battered the island.
[. . .] The violent winds and screeching rains of Hurricane Maria were a 72-hour assault on the Puerto Rican psyche. There are warning signs of a full-fledged mental health crisis on the island, public health officials say, with much of the population showing symptoms of post-traumatic stress.
Puerto Rico was already struggling with an increase in mental illness amid a 10-year recession that brought soaring unemployment, poverty and family separation caused by emigration. Public health officials and caregivers say that Maria has exacerbated the problem. Many Puerto Ricans are reporting intense feelings of anxiety and depression for the first time in their lives. Some are paranoid that a disaster will strike again. And people who had mental illnesses before the storm, and who have been cut off from therapy and medication, have seen their conditions deteriorate. “When it starts raining, they have episodes of anxiety because they think their house is going to flood again,” says Dr Carlos del Toro Ortiz, the clinical psychologist who treated Serrano Ortiz. “They have heart palpitations, sweating, catastrophic thoughts. They think ‘I’m going to drown’, ‘I’m going to die’, ‘I’m going to lose everything’.”
With the hurricane nearly two months in the past, the island is still in shock. Its residents are haunted by dozens of deaths caused by the storm, and many more life-threatening near misses. The reminders are inescapable. They lie in piles of rotting debris as tall as homes that still line many streets and in cellphones that are useless for checking on family members.
Returning to a routine is the most important step towards overcoming trauma, according to physicians and public health officials. But for most Puerto Ricans, logistical barriers like scarce water and electricity, as well as closed schools and businesses, make that impossible.
Since 20 September, when the storm came ashore at 6:15am, more than 2,000 calls have overwhelmed an emergency hotline for psychiatric crises maintained by the Puerto Rican health department – double the normal number for that period of time, even though most residents still do not have working phones. Puerto Rican officials say that suicides have increased – 32 have been reported since the storm – and many more people than normal have been hospitalised after being deemed dangerous to themselves or others.
At the emergency health clinic in Toa Baja, where Serrano Ortiz lives, Toro says that he has been frantically calling for help from colleagues in other cities because the facility is overrun with people in need of mental health care.
Because it is in a flood zone, Toa Baja was one of the worst affected areas in Puerto Rico. At least four people died and water levels peaked at more than 12 feet. The city of 80,000, west of San Juan, flooded each time it rained after Maria passed.
In his nearly 20 years of practising medicine, Toro says, he has never before hospitalised as many people with suicidal or homicidal thoughts in such a short time period. Of about 2,500 people who have been to the clinic since it opened two weeks earlier, more than 90 per cent were referred for mental health screenings, Toro says. He and other practitioners at the clinic have already referred at least 20 people to psychiatric wards elsewhere on the island.
“This is an emergency situation,” he says. “It’s still affecting us. There are people that we haven’t seen.”
Health workers are bracing for effects similar to those seen in New Orleans after Hurricane Katrina in 2005 and in Haiti after the 2010 earthquake, where cases of both moderate and severe psychiatric illnesses spiked. In New Orleans, many people experienced insomnia, cognitive impairment and short-term memory loss, which became known colloquially and among researchers as “Katrina Brain”.
Prolonged losses of electricity, water, communications or infrastructure have been linked to the onset of mental health crises, says Dr Domingo Marques, director of clinical psychology at Albizu University, a prominent graduate school of psychology on the island with clinics in two major cities. All of those elements have been relentlessly present in Puerto Rico. [. . .]