Mental health crisis grips Puerto Rico as rebuilding efforts stumble a year after hurricane

Hurricane Florence has made the U.S. East Coast the centre of attention, and that could make things even harder for those still struggling to deal with the aftermath of another massive storm, Maria.

It's been a year since hurricane Maria tore across Puerto Rico, killing thousands and robbing its survivors of basic necessities and electricity, and in many cases their homes and possessions. Some areas had no power for up to nine months, the grid is still spotty, and remnants of Maria's devastation and the ongoing repairs or lack of them can still be seen right across the island.

"The government said, 'We are ready to face this.' We were not ready," saysTaynaFernandez, a community activist inNaguabo, Puerto Rico. "You have to accept we were not ready as a country. We were not ready as a government agency. We were not prepared in the aftermath."

It was a major catastrophe with an estimated cost to date of $139 billion US, according to the Puerto Rican government.

The human cost was heavy, as well.

President Donald Trump has played it down, tweeting last week that Maria killed "anywhere from 6 to 18" people, but his statement has been widely disputed. Puerto Rico's governor formally revised the toll last week to 2,975 based on a George Washington University study of how many died in the days after the storm due to a lack of things like power, clean water and and health care.

The hidden toll on the state of mind of Puerto Ricans is also a significant concern, especially now that a new hurricane season has started, an ugly reminder of the terrifying ordeal the islanders suffered through.

The anguish of the people who lost their loved ones and their homes to Maria is still very much alive. Added to this is the stress and confusion around complicated U.S. Federal Emergency Management Agency (FEMA) funding applications that are snarled in bureaucracy, home repairs that still need to be done, jobs that have disappeared, families that have been separated, and daily routines that remain badly disrupted even a year after the storm.

Suicide rates increased more than 29 per cent in 2017 in the aftermath of Maria, and they remain high as people struggle to get their lives back on track.

• WATCH:IoannaRoumeliotis' feature forThe Nationalon Puerto Rico's mental health crisis

Suzanne Roig Fuertes is the administrator of mental health and anti-addiction services in the town of Bayamon, near San Juan. Inside is a 24-hour crisis hotline called "Linea Pas" that serves the entire island. With this week marking the anniversary of Maria, it has sparked fear and anxiety in people especially with other storms brewing.

"Right now, a year after Maria, we're receiving around 600 calls a day, and 30 per cent of those calls are related to suicide intentions," Fuertes says.

Calls for help in Puerto Rico

6 years ago

Duration 0:38

Suzanne Roig Fuertes is the administrator of mental health and anti-addiction services in the town of Bayamon, near San Juan. With the anniversary of Hurricane Maria that has caused so much misery for Puerto Ricans, plus the start of a new storm season, its 24-hour crisis hotline is getting about 600 calls a day seeking help - nearly a third of them related to suicidal thoughts.

'None of us were prepared'

To understand the extreme psychological pressure many residents are under, you just need to follow Jerry Kirkland for a day.

Kirkland is the director of emergency management for the municipality of Naguabo on the eastern coast of Puerto Rico. It's known as "El pueblo de los enchumbaos" (the town of the soaked ones), which is fitting in a way because the region is where the eye of Maria hit last year.

Everyone here knows Kirkland. He is a genuinely caring man who is constantly connected with everyone from the town pastor, to local community groups, to FEMA representatives. His two cellphones do not stop ringing.

It's hurricane season again, and it's his responsibility to see how the people of his district are doing. He makes his rounds, going door-to-door.

"Hurricane Maria was a learning process for a lot of people," Kirkland says. "If anybody on this island says we were prepared for a hurricane of this magnitude, they're not telling the truth. None of us were prepared."

The first stop is at Angel's house.

Angel Luis Sandoyal Mendoza lost his roof to Maria, and blue plastic tarps given to him by FEMA and neighbours are all that keeps the wind and rain out of the shell of a house. Angel still has a kitchen to cook in, and lives with his small dog Hank in the back bedroom.

The damage he hasn't been able to repair doesn't just make life hard it breeds constant fear. He bars the rickety bedroom door at night hoping no one will break in.

"If you think about it too much you might get sick, and I don't want that," Mendoza says.

Like many others on the island, Mendoza is waiting for answers and action from FEMA. The U.S. government's emergency-response agency gave him an initial $13,000 US in disaster funding to help get him back on his feet, but it's not nearly enough to fix what's left of his home.

He's still waiting for his claim to work its way through the bureaucracy so he can rebuild. One of the problems is that FEMA is demanding he produce the deed to the house to prove he owns it. But the modest home is an ancestral one (his family has lived there for generations), and that kind of paperwork, even if it did exist, would have been lost when the hurricane tore through his home.

Kirkland tells Mendoza he's not alone.

"They told me they want to rebuild my house out of wood," Mendoza adds, referring to his ongoing negotiations with FEMA. But wood is impractical due to factors like the location and climate.

"That's why we are going to re-evaluate this, because that doesn't make any sense," Kirkland says, handing him a mosquito net for more protection from the insects at night, and adding that he's trying to get him a new water filter.

Mendoza says he's better off than others and insists that he will be fine. It's a common theme our CBC News crew heard again and again from residents who clearly aren't fine.

"The Puerto Rican people are very proud people, and even if we are going through hard times we will smile and say everything's OK. But we're not," Kirkland says on the way to the next home.

'We are a proud nation'

On another visit, Kirkland drops in on Rex Cauldwell and his wife, seniors who live on one of the mountains overlooking the area. A mudslide during the storm blocked the only road with boulders for three months until they were finally cleared, and they had no electricity for nine months.

Cauldwell says people in the community pulled together to support each other after the storm.

"The very next day, everybody is up on that mountain trying to find a way to dam the streams and get pipes down to your house. And we did it all right," he says. "I shared my water with those people up on the hill they came down asking for water and I told them if I had water they had water."

Like Mendoza, Cauldwell tells Kirkland that he and his wife are doing well, but stresses that there was no way of communicating during Maria. He worries about being cut off again during the new hurricane season and not be able to get help.

To ease that fear, Kirkland agrees to track down some radios they can keep handy in case of another storm.

After we leave the Cauldwells, Jerry tells our crew that the couple and their neighbours still need help to rebuild, and infrastructure like the gas lines hasn't yet been checked for damage. There's no sign that this will happen any time soon.

"Then he turns around and says 'but I'm fine.' You know, he's an elderly person, his wife is elderly but we are a proud nation and the people that come to Puerto Rico get that feeling that everything is fine."

Tayna Fernandez is a community activist in the Naguabo area, and the needs of both her family and her neighbours are weighing heavily on her.

She lives with her husband, three children and her mother. Her roof is still in need of repair and she is clearly exhausted.

"FEMA didn't help me in anything, anything. Even though I have a cement roof when it rains, it just starts pouring inside because FEMA didn't help me to put a treatment on my roof," says Fernandez.

"Who's helping me? My family. We don't have everything we need, but at least we have what we need right now in the moment. Next week I'll worry about next week," she says.

Still, Fernandez is fighting to get a school in her neighbourhood, once used as a shelter but now closed, reopened to use as a community centre to provide people with much-needed social services.

"You got to help people. You are going through no job, you have so many things on top of you, but you still want to help, because people are worse than how you are right now," Fernandez says.

'Doctor, I don't want to live like this...'

When Maria hit, the small hospital in Naguabo was the only one open to serve the entire eastern area covering three municipalities Yabucoa, Naguabo and Humacao.

Dr. John Velazquez was the only physician on the whole eastern part of the island, living at the hospital for days because other doctors couldn't get there due to road blockages. He worked tirelessly to heal his patients' physical injuries immediately after the storm, but these days Maria's survivors require a different kind of care.

Now many of the patients who come to see him are suffering from psychological ailments especially post-traumatic stress, despite the brave faces many wear in public.

The hospital has opened a clinic help people with mental health problems, and to try and catch them early before they become more serious.

"They say, 'Doctor, I don't want to live like this. This is terrible for me, I need to move, but I don't know where I'm going. My family wants to move to the States but I don't know English, I don't have an education,'" Velazquez says.

"Most of the people here are very poor people with low education," he adds, and the lack of opportunity for work and a way to rebuild their lives in the wake of Maria is hard to deal with.

The doctor takes calls 24 hours a day from people who want to talk about how they are coping and how they aren't.

"Here [at the clinic], they feel comfort."

It's taking a toll on him, too. Velazquez says he feels frustration, but many of his patients are caught in a bureaucratic and financial limbo that is affecting their psychological health, and they have nowhere else to turn.

"I give more and more from me one time I feel very very sad but every time I come here I say this is my job, these people need me. These people need the hospital and I want to do the best for them."

• WATCH:IoannaRoumeliotis' feature forTheNationalon Puerto Rico's mental health crisis
• LISTEN: To the CBCRadio feature from The Current