Puerto Rico near crisis on mental health
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.