On a Caribbean island like Puerto Rico, rainfall is a usual occurrence. But for many throughout the archipelago, downpour has become a reminder of September 20, 2017, the day Hurricane Maria ravaged their nation, leaving countless people with the loss of homes, cars, jobs, loved ones and their sense of normalcy. As storms erupt — many times leading to the loss of recently returned electricity — each raindrop, flood and thunderclap triggers a people experiencing a severe mental health crisis.
According to the Department of Health in Puerto Rico, suicide on the island is on the rise post-Hurricane Maria. Reports show that self-inflicted deaths are up 29 percent and calls to suicide hotlines have surged by 246 percent, compared to the year prior. Officials believe that the devastation caused by the Category 4 storm, including the massive displacement it sparked and the substandard relief the people received from local and federal governments, is a factor in these increases.
Ivelisse Torres Fernandez, an assistant professor of counseling and educational psychology at New Mexico State University (NMSU), visited her home island twice after the hurricane, providing material aid as well as mental health assistance.
“I feel like we need to keep this issue at the forefront. That it’s not spoken much about anymore doesn’t mean that the people aren’t suffering. For me, I feel like I have a need to advocate for people on the island,” the Las Cruces, New Mexico-based Puerto Rican told Fierce.
Torres Fernandez, whose program at NMSU is rooted in social justice and multiculturalism, recently returned from her second trip to Puerto Rico, where she, alongside Counselors Without Borders, provided locals with self-help tools and also conducted research on the looming mental health plight.
We chatted with her about the spike in suicide, depression, anxiety and PTSD post-Maria, the psychological needs of the people of Puerto Rico, the demands for more aid and how you can help during this crisis.
1. You recently returned from a trip to Puerto Rico, where you were from March 16 to 23, conducting research on the mental health impact of Hurricane Maria as well as providing assistance with counseling, cleaning and rebuilding. Why did you feel an urgency to travel to the island to do this work?
Immediately after Hurricane Maria, Puerto Ricans everywhere felt a need for something to be done. The magnitude of the catastrophe called for that, but with the slow response it was pretty obvious that we had to do something. This was my second trip to Puerto Rico post-Maria. The first one was in early December, and I was there for five weeks doing peer relief efforts, like providing basic needs to the people. During that trip, it was clear to me, though not surprising, that there was a lot of emotional suffering, too. That’s why I decided to come back in March. This spring break trip was focused more on mental health. I did take supplies to communities, but this time around I went with Counselors Without Borders, a group based in George Mason University that offers humanitarian counseling in post-disaster emergency situations, and we worked with counselors, people, camps and churches on the ground, giving them tools to cope, but also collecting data for my research.
2. Who did you speak with while you were there, and in what parts of the island were you conducting this research?
(Courtesy of Ivelisse Torres Fernandez)
I mostly stayed with a community in Maricao, a mountainous area on the western part of the island that was hit very hard. We talked to people of all ages, mostly adults, but also several elderly and children. We separated groups by ages, and I spent significant time with youth, because that’s my speciality. We asked them how the experience was for them, how they’re coping and what would be helpful for them.
3. As you know, studies have already shown an increase in depression, anxiety, PTSD, suicidal ideation and suicides. What, from your research, would you say is triggering this?
It’s a combination of several things. Many of the people are frustrated, and most of the frustration comes from a sense that they feel that the local government and federal agencies have not been good with dealing with the crisis, and some of the people we talked to were very angry with FEMA. There have been a lot of people who were denied claims because they lacked the proper paperwork to claim their homes. There are also undocumented families who can’t prove ownership of many things. So you have people who lost everything — homes, jobs as well as their sense of security and safety — and, in addition to that, now they feel forgotten. That’s where a lot of the frustration comes.
The people are also extremely exhausted, which we consider the third stage of disaster-related trauma. While most of the island has gotten electricity back, about 80 thousand still don’t, six months later. In Maricao, the electricity returned last month, but there are still outages every day. So even if people are wanting and trying to regain that level of normalcy, they can’t. People told us they have panic attacks every day that it rains, fearing their homes will flood again. These are people who lost their jobs because the storm ruined the business they worked at, people who know what it’s like to literally be stuck, waste-deep, in mud. They are terrified that hurricane season is just months away.
So, yes, the level of depression, anxiety, PTSD and suicide has escalated since then. The data is there and I saw it.
4. What are the psychological needs of the people of Puerto Rico following the storm?
(Courtesy of Ivelisse Torres Fernandez)
It sounds simple, but people really need to be listened to. It doesn’t always have to be a mental health expert; they just want to vent. They want to feel like people care about them, that they matter. They need to be understood and validated. They also need someone to reassure them that things will get better. That instillation of hope is core to disaster mental health work. We help individuals be hopeful and identify resources they can use to help themselves. We show them self-care strategies. Then, of course, there are people who still need water, food, a roof, a place to live, the basic needs, because how can you feel safe without that?
5. More than six months later, what are the challenges that remain to serve them?
Not everyone has access to mental health services, whether because they lack insurance or the stigma tied to it prevents them from seeking help. You often hear, “no estoy loco, so I’m not going to see a therapist.” Another problem is that they can’t physically access that help. There are wonderful groups going into the streets, providing free services, but if you have no way there, either because you’re an elder, you lost your vehicle or the roads still haven’t been cleared up, you can’t receive it.
6. Does the mental health impact vary across different regions?
In areas less impacted, the people have been able to go on easier. In places that were hit really hard, it’s been harder to regain that sense of normalcy. There are providers across the island, from FEMA personnel and the Department of Health to crisis hotlines, but, again, sometimes it can’t be accessed. In these cases, churches, of all denominations, have really stepped up and are restoring people with a sense of meaning for life. This is important, especially for the elderly, who have the highest rates of suicide post-Maria. They feel isolated. Their families left, they’ve been displaced and it’s hard to adjust to staying behind.
7. How has this impacted women in particular?
(Photo Credit: Raquel Reichard)
Many of the women I spoke with are single mothers, and they’re depressed and anxious. They are constantly worrying about their kids and grandkids, and about what happens when the next storm hits. There is so much that remains unknown. Oftentimes, these same women are the ones becoming leaders in their community. They are motivating, nurturing and caring for others. When we were there, we were sure to ask them how they were coping for themselves. If you’re not OK, if you’re broken, how can you give yourself to others?
8. What would you say is the most shocking thing you learned or witnessed while there?
Two stories stick out to me. One is of a woman who spent the storm away from her home. After the hurricane hit, she walked 12 hours in the mud to check in on her house and pet. When she got there, she didn’t have a house. She, like so many others, had to collect the valuables she found and just take her homelessness as yet another loss. Imagine walking that long to find that you have nothing. That’s wild. Another story is one I heard from a mental health specialist. He said an elder man had lit himself on fire. He burned himself — he has third-degree burns — because he wanted to die. That’s shocking, and speaks to the desperation that’s there.
Another thing I saw, though, that’s not necessarily shocking but reaffirming, was communities organizing more than ever. There is so much Puerto Rican pride and a will and determination to build and be stronger and better.
9. You’re a scholar. Why was it important for you, in addition to your research, to send a group of students who could also help with counseling, cleaning and rebuilding?
I think that, for me, as a Puerto Rican living in the U.S., this was a no-brainer. Every Puerto Rican suffered. This was horrendous. So in this moment of difficulty and tragedy, I thought, how can I give back in a way that’s meaningful? As an academic, I have the ability to empower others to do good things. For me, that was my students, who took it upon themselves the day after the storm hit to ask how they could help. As a scholar and professor, people want to talk research and pedigree, but, for me, the most important and satisfying part is that I’m mentoring the next generation of mental health professionals. The research is important, but that’s secondary. How I’m providing to my community is first. From there, I use what I learn, my research, to advocate for them.
10. How can readers who want to assist the people of Puerto Rico struggling with mental health after Maria help?
(Courtesy of Ivelisse Torres Fernandez)
If you know someone, displaced on the island or living here, provide a safe space for them to talk about what is happening. Support them, whether they went through it directly or not. Also, if you’re here and are a citizen, advocate for us. Call your representatives and push for things to get done. Ask them why it’s taking so long to get Puerto Rico help. Demand them to remove the red tape. The U.S. government is strangling our economy and killing us slowly. If you want change, use your voice.