Puerto Rico near cri­sis on men­tal health

Honolulu Star-Advertiser - - NATION - By Caitlin Dick­er­son

SAN JUAN, PUERTO RICO >> Her me­mories of the storm came in flashes: neigh­bors’ screams, gush­ing wa­ter, swim­ming against the cur­rent with her son.

For Mi­la­gros Ser­rano Or­tiz, a 37-year-old grand­mother with long, curly hair, the night­mare did not end there. Af­ter two days of shel­ter­ing up­stairs in a house across the street, she re­turned home to find the walls caked with mud and a vile stench em­a­nat­ing from her cher­ished pos­ses­sions, which were rot­ting in the heat.

An­guished and over­whelmed, she con­fessed re­cently to a psy­chol­o­gist at an emer­gency clinic that she had be­gun to have dis­turb­ing thoughts and wor­ries that she might act on them. “Like what?” the doc­tor asked.

Like swal­low­ing a bot­tle of pills, she said, “never wak­ing up, and not feel­ing pain any­more.”

The vi­o­lent winds and screech­ing rain 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 10year re­ces­sion that brought soar­ing un­em­ploy­ment, poverty and fam­ily sep­a­ra­tion caused by mi­gra­tion. Pub­lic health of­fi­cials and care­givers say 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,” said 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 to­ward 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 Sept. 20, when the storm came ashore at 6:15 a.m., 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, even though most res­i­dents still do not have work­ing phones. Puerto Ri­can of­fi­cials said that sui­cides had in­creased — 32 have been re­ported since the storm — and many more peo­ple than nor­mal have been hos­pi­tal­ized af­ter be­ing deemed dan­ger­ous to them­selves or oth­ers.

At the emer­gency health clinic in Toa Baja, where Ser­rano Or­tiz lives, Toro said that he had been fran­ti­cally call­ing for help from col­leagues in other cities be­cause the fa­cil­ity was 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 there, and wa­ter lev­els peaked at more than 12 feet. The city of 80,000 west of San Juan flooded mul­ti­ple times, each time that it rained af­ter Maria passed.

In his nearly 20 years of prac­tic­ing psy­chol­ogy, Toro said, he had never be­fore hos­pi­tal­ized as many peo­ple with sui­ci­dal or homi­ci­dal thoughts in such a short time pe­riod. Of about 2,500 peo­ple who had been to the clinic since it opened two weeks ear­lier, more than 90 per­cent were re­ferred for men­tal health screen­ings, Toro said. He and other prac­ti­tion­ers at the clinic had al­ready re­ferred at least 20 peo­ple to psy­chi­atric wards else­where on the is­land. “This is an emer­gency sit­u­a­tion,” he said. “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 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 short­term mem­ory loss, which be­came known col­lo­qui­ally and among re­searchers as “Katrina brain.”


Dr. Car­los del Toro Or­tiz, a clin­i­cal psy­chol­o­gist, meets with a pa­tient at the Pablo Or­tiz Cen­ter in Toa Baja, Puerto Rico. Pub­lic health of­fi­cials on the is­land say they are begin­ning to see signs of a full-fledged men­tal health cri­sis in the wake of Hur­ri­cane Maria’s dev­as­ta­tion.

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