Tanzina Vega: I'm Tanzina Vega, and you're listening to The Takeaway. Now there's something else that's weighing on people's minds; natural disasters. We've been covering the record-breaking wildfires in the western United States, the active Atlantic hurricane season, and the floods in the Midwest.

This year, in particular, we're starting to see the accelerating effects of climate change and new disasters hitting before there's even time for communities to properly recover from past ones, especially when we think about places like Puerto Rico, Louisiana, and Texas. Right now, as parts of the southeast reel from the impact of Hurricane Sally, other storms are threatening that region. The mental health toll of these disasters upon disasters can be significant.

Corinne: Hi, this is Corinne from Miami, Florida. Hurricane Andrew in '92, it's always been a memory of sheer fear for me. I was six at the time, and I felt so much panic and anxiety. It affected the way that I viewed weather, especially thunderstorms, and here in Miami, it's a lot. All throughout my teenage years, severe weather would send me into a closet with a pillow, a flashlight, a radio, and a whole lot of panic. As an adult now, I've become more rational about my fear. However, I still continue to become hyper-vigilant and worrisome when severe weather, or when it's hurricane season.

Tanzina: We've heard from many of you about the mental health effects of living through experiences like hurricanes, and we're going to talk about it now, with Jamie Smith Hopkins, a senior reporter at the Center for Public Integrity. Jamie, welcome to the show.

Jamie Smith Hopkins: Thanks for having me on.

Tanzina: With Karen Martinez, the chair of the Department of Psychiatry at the University of Puerto Rico, and the director of the Center for the Study and Treatment of Fear and Anxiety. Karen, welcome to the show.

Karen Martinez: Thank you,

Tanzina: Jamie, what are some of the mental health issues people told you they suffered from after disasters?

Jamie: It ranges, but our newsrooms did a survey in partnership with 10 other newsrooms around the country, and we heard from about 200 survivors along with mental health professionals on top of that. The things we heard about included in a lingering effects years after the disaster, the sense of fear when rain would happen. Just the sound of rain could set people off. For people who perhaps are on the west, and dealing with wildfires, the smell of smoke, or even the sense that maybe they might be smelling smoke, the phantom smoke kind of issue could set them off. It's traumatic and stressful dealing with disaster, dealing with near misses. As you point out, there are more and more disasters happening, and so it's getting harder and harder for people to have some time to recover.

Tanzina: Karen, a lot of your research has looked at the mental health effects of women who were pregnant during Hurricane Maria, and their children. I personally know. I'm a pandemic mom. I gave birth a month before lockdown, and pregnancy and postpartum is already a challenging time. What did you find about the effects of experiencing that moment during a natural disaster?

Karen: We have been looking at a cohort of women who were pregnant, or got pregnant around Hurricane Maria. Unfortunately, we found that the effects on their mental health is incredible and terrible. We found that around 52% of our moms have significant symptoms of depression, and around 44% have significant symptoms of post-traumatic stress disorder. This is really much higher than what you would expect in general population. It's much higher than other studies that have been done after hurricanes.

The most terrible thing that we found is that those moms, especially who have high symptoms of depression, then that's been correlated with having kids with a more difficult temperament, which means that our kids who are more difficult to calm down, they have difficulty having routines. This cohort that we have now, the anniversary of Hurricane Maria, third year anniversary was yesterday. We're following them through toddlerhood, and we want to see how these cohort of babies were born around Maria, and see if that correlates then with the developmental psychopathology.

Tanzina: Jamie, are there resources available to people who are struggling with emotional distress after a natural disaster?

Jamie: Yes. In fact, the federal government runs something that's usually called the crisis counseling program that's specifically aimed at helping people with mental health after disasters. That's it's whole purpose. It's run by FEMA, and the Substance Abuse and Mental Health Services Administration.

We looked into that, and what we found is that it makes a lot of sense. It's intended to help people for up to a year after disaster, but it doesn't have a lot of funding. It helps some people after disaster, but it's often a very small percentage like in the case of Houston after Hurricane Harvey, which had widespread effects. Less than 1% of residents there saw counseling. It was higher in Puerto Rico but still, we're talking about 18% of the island. Again, the impacts were widespread and long lasting.

Tanzina: Karen, what are the roadblocks to people seeking counseling? As Jamie just mentioned, it was 1% of the population after Hurricane Harvey that sought counseling, and Puerto Rico was 18% but still, those numbers are very, very small.

Karen: Yes. I think we're doing a good job, at least preventing suicide and preventing acute manifestations of mental health. When we're looking at the long term, and people have rehabilitate from these mental health effects of disasters, that's when we're really not doing a great job. There's consistent literature about people not having access to the evidence-based care that is needed after these disasters.

As clinicians, we know what needs to be done. We have the tools. It's just really hard to get people into those treatments because it's expensive. The most health care plans don't really cover the level of intensity of mental health care that is needed in order for people to really get better after natural disasters, which is probably psychotherapy that is at least weekly or bi-weekly, and that's just not covered by most health care plans.

Tanzina: Karen, can you explain-- We heard a call or talk about how, after Hurricane Andrew in the '90s, she, for many, many years, still had a response that was very triggering for her whenever she would expect a storm to be coming. Is that trauma, and how do you define trauma or post-traumatic stress after a natural disaster?

Karen: Yes. That's definitely trauma. One of the main symptoms that you see in post-traumatic stress disorder is that you have triggers that make you go back to the day where the trauma happened. Just as that person was describing like anything that had to do with bad weather, lightning, rain, or even in the weather reports, talking about weather, it triggers them for that memory of trauma, it gets triggered, and the person feels like they're back on that day that the trauma happened.

Other symptoms that people can have, and she also said that, it's just being hyper-vigilant, being always on, your trauma system is triggered all the time, like something bad is going to happen, and also having flashbacks, having nightmares of what happened. Eventually, if this goes on for a long time, it gets to a point where your alarm system just doesn't work anymore, and you get numb, and you can get depressed. That's when you have long-term post-traumatic stress disorder that also is comorbid, with depression, and sometimes even with substance use, because people try to look for ways of feeling better. In the long term, it gets very complicated and more difficult to treat.

Tanzina: Jamie, what about state and local resources given that the federal resources you mentioned are so strapped and underfunded? Do state and local resources exist to fill some of the gaps?

Jamie: We talked to a number of states around the country that have seen multiple disasters in the last decade. Overwhelmingly, what we heard is that there's not much else. They have departments in place to focus on mental health, or offices in some cases, but they're set up for days or normal day-to-day needs. They really rely on the funding from the crisis counseling program. They're often very creative in the way that they go about trying to get the word out to people that the help was available, but again at a certain point, the help stops. It stops long before the symptoms stop for a number of people.

Tanzina: Jamie, did you find that people were not accessing help because they didn't think they needed it, or because it wasn't available? Were they not able to define what they were feeling in a way that signal to them that, "Wow, I need to talk to someone?"

Jamie: Yes, it's a mix of things. In our survey, and this and talking to people, we definitely saw that there's a threat of people saying, "Oh, well, this is just stressful. That's just the way it is. I don't need help. I'm fine." Based on the way they describe their symptoms, in some cases, people did seem to feel a lot better in a couple of years. In other cases, years after disaster, people were still indicating that they really felt stressed, or had trouble sleeping, or other symptoms related to the disaster. That suggests that help would have been helpful, in fact.

We talked to state officials in Louisiana about their Crisis Counseling Program, and one of the things that they mentioned is that after Hurricane Katrina, they would set up crisis counselors outside of, say, like a home depot where they knew people were going to be going to try to clean up and repair. They had a sign that said free crisis counseling, and nobody would stop for that.

When they changed the sign to tell us your hurricane story, suddenly people stopped because I felt like, "Oh yeah, I want to tell you about that." Then just in the conversation, they would say we have these resources, this could help you cope. That was sort of overcome this barrier, the sense of, "Oh, I don't need that." Or somebody else needs it more, or just the sense of stigma sometimes that mental health care has unfortunately.

Tanzina: Karen, what about in Puerto Rico in terms of what access people have for mental health services? Is it enough?

Karen: No, it's definitely not enough. We did have a lot of funding come in for these crisis helplines, which were great. They really help at least get people through the crisis and not having severe outcomes such as suicide or a suicide attempt, but in terms of really getting the help they need and just getting better from the post-traumatic stress symptoms, that takes a long term. Like here, we're at three years after Hurricane Maria, and still in our cohort, these women are having significant symptoms.

One of the good things about the pandemic has been that we've transitioned to telehealth, and we've actually seen more of the moms we're seeing getting into treatment because they can do it from home, and that has been really helpful. I think mental health professionals, we need to think outside of the box.

Tanzina: Karen Martinez is the chair of the Department of Psychiatry at the University of Puerto Rico, and Jamie Smith Hopkins is a senior reporter at the Center for Public Integrity. Thanks to you both.

Jamie: Thank you.

Karen: Thank you.

Copyright © 2020 New York Public Radio. All rights reserved. Visit our website terms of use at www.wnyc.org for further information.

New York Public Radio transcripts are created on a rush deadline, often by contractors. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of New York Public Radio’s programming is the audio record.