With signs of anxiety and depression on the rise, Puerto Rico now faces a major mental health crisis

Nov 14, 2017 by

Elsa Diaz (27) looks through her belongings in a classroom turned bedroom in Barranquitas, Puerto Rico October 31, 2017..Twenty people from Barranquitas have been living for the past 42 days at the Luis Munoz Marin public school, a campus-turned-shelter in central Puerto Rico since Hurricane Maria damaged their homes while waiting for help to replace the homes they lost in the hurricane. / AFP PHOTO / Ricardo ARDUENGO        (Photo credit should read RICARDO ARDUENGO/AFP/Getty Images)

Psychologists say that prolonged displacement and loss of electricity can lead to the onset of mental health crises.

Since Hurricane Maria, the news from Puerto Rico has overwhelmingly focused on restoring power to the millions of residents who remain living in the dark since the hurricane hit on September 20. Now the largest blackout in American history, the lack of power has had an impact on every single sector of society—from business to government to education and more. But as the federal and local governments, contractors and utility workers work to restore the electric grid, an important aspect of the well-being of people in Puerto Rican is being overlooked—their mental health.

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.

There is such stigma around mental health that psychologists say the isolation and social distancing of people with mental health issues is actually making us sicker. And there is an enormous financial cost that is paid when people do not get they treatment they need—resulting in increased costs due to disability and loss of work. Most people who have mental illness do not get treatment at all. Yet, mental illness is not uncommon—with nearly 1 in 5 Americans suffering from some kind of depression, bipolar disorder or schizophrenia.

In Puerto Rico, this is manifesting in a variety of ways—with a number of Puerto Ricans identifying feeling shock, anxiety and paranoia due to the hurricane. And some of those who already have diagnosed mental illness, are seeing their conditions worsen due to a lack of treatment.

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,” said Dr. Carlos del Toro Ortiz, the clinical psychologist who treated Ms. 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.’ ” […]

In his nearly 20 years of practicing psychology, Dr. Toro said he had never before hospitalized as many people with suicidal or homicidal thoughts in such a short time period. […]

“This is an emergency situation,” he said. “It’s still affecting us. There are people that we haven’t seen.”

Last week Daily Kos ran a story about the impact of the hurricane on school-aged children in Puerto Rico. For that story, we spoke to two clinical psychologists, Dr. Cynthia Lubin Langtiw and Dr. Breeda McGrath, who offered their professional expertise on how the disaster will impact the emotional and psychological health of children on the island. In the interview with Dr. McGrath, who is based in San Juan, we asked about what could be done to treat the mental distress of Puerto Ricans in the months after the hurricane. She had this to say:

“People are asking should they send teams of psychologists? They could… but the hotels are full of aid workers…They’d have to be fully bilingual and sometimes talking about trauma isn’t helpful in such a primary situation [where people are trying to meet their most basic needs.] Right now, sending people could be an additional burden on the system.”

This is not to say that Puerto Rico doesn’t need psychologists. This is why it’s a good thing that funds are being designated for mental health. “The mental health division of the Puerto Rican health department received $3 million from the Federal Emergency Management Agency to coordinate a response to Maria, said Suzanne Roig, the administrator of the Puerto Rican agency.” The question is whether or not outside psychologists are helpful in this moment given that some people are struggling with the basic necessities of food, water and electricity.

There likely isn’t one right answer. In addition to increased cases of people with suicidal and homicidal thoughts, local psychologists say that adults are reporting children who have been crying inconsolably when it rains and some who have not spoken since the storm hit. But the longer the island takes to recover, the longer people are at risk for having a mental health issue. “Prolonged losses of electricity, water communications or infrastructure have been linked to the onset of mental health crises, said Dr. Domingo Marqués, the director of clinical psychology at Albizu University, a prominent graduate school of psychology on the island with clinics in two major cities.”

This disaster is of epic proportions and continues to get worse every day. It’s one thing to rebuild infrastructure and buildings. It’s another thing to work to treat the mental health of an entire island full of people. Puerto Rico will be forever changed by this hurricane and this will be an example of one of the worst failures of government and responses to a crisis in decades.

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