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After 2 Hurricanes, A 'Floodgate' Of Mental Health Issues In U.S. Virgin Islands

Apr 23, 2019
Originally published on April 25, 2019 8:14 am

More than a year and a half after two major hurricanes struck the U.S. Virgin Islands, the effects of the storms are still obvious. Many homes are uninhabitable. On others, blue tarps covering roofs are the only thing keeping the rain out.

But the storms had another, less visible impact: on the mental health of island residents. Vincentia Paul-Constantin, a mental health counselor who works with children in the public schools says, "We see ... regression in behaviors, especially with our little ones who had been potty-trained, reverted to using diapers." Among older children, Paul-Constantin says, "We see a lot of frustration, cognitive impairment, hopelessness and despair."

She traces it back to September of 2017, when two Category 5 hurricanes struck the U.S. territory within a two week period. On St. Croix, St. John and St. Thomas, many people lost their roofs and most of their possessions. Much of the islands went for weeks without power, running water or a reliable food supply. A woman who lived through it says, "It was a bit frustrating to have to go through such a traumatic experience after the hurricanes, not having access to anything."

We see a lot of frustration, cognitive impairment, hopelessness and despair. - Vicentia Paul-Constantin, mental health counselor

Because of concerns about her privacy, she asked that we not use her name. In some ways she says, the storms and recovery were even harder on her 6-year-old son. He was starting school at a chaotic time. Because many buildings were damaged, schools doubled their enrollment, and went to two sessions a day, with each session lasting four hours. Her son, she says, was overwhelmed and unable to adjust. "He was pretty much disoriented," she says. He's getting counseling now and it's helped. But many children have more serious problems.

Schools returned to their normal schedule in October. With the disruption of the hurricanes and a year of shortened class days, Principal Lisa Ford at Cancryn Junior High School in St. Thomas says students have fallen behind where they should be. And behavioral problems, always present, have gotten worse. "Where it would be one or two children," Ford says, "now it is 10 children in the classroom acting up and you're trying to settle all these children. We're also seeing an increase in children that need mental health assistance."

At Cancryn Junior High School, principal Lisa Ford says since the hurricanes, there has been an increase of children with behavioral problems in need of counseling.
Greg Allen / NPR

Ford says she doesn't know if it's because of the hurricanes, the slow recovery, or all the free time students had last year when they were on a half-day schedule. She sees the behavioral issues in a variety of ways: "They show up in defiance, actual defiance to authority. We have children who are sleeping in the middle of the day ... You try to wake them up, they become angry. And maybe that's what we're seeing — a lot of anger and defiance."

It has caused extreme hardship. That equates to stress. Stress equates to depression, anxiety. It's like a floodgate has been opened up. - Dionne Simmonds, counselor

In the days and weeks after the hurricanes in 2017, counselors did outreach at churches, schools and at FEMA centers, working to reach people who needed help in a community that's traditionally been reluctant to talk openly about mental health. Dionne Simmonds, a counselor with Insight Psychological Services, says there's been a big response. "The storms," she says, "ha[ve] literally woken up mental health issues here in the territory and ... people are now seeking help."

Simmonds says many of the problems she sees are related to economics and the high cost of everything after the storms, from food to fixing your roof. "It has caused extreme hardship," she says. "That equates to stress. Stress equates to depression, anxiety." Since the storm, she says, "It's like a floodgate has been opened up."

After a year of shortened classes, students at Cancryn Junior High School are now back to full days in temporary modular classrooms.
Greg Allen / NPR

Recent surveys of mental health in the U.S. Virgin Islands confirm what counselors and teachers are seeing. One study, funded by the Community Foundation of the Virgin Islands, found that stress from the hurricanes and the recovery is a significant health issue throughout the U.S. territory.

Noreen Michael, a researcher with the University of the Virgin Islands in St. Thomas, says the levels of depression and post-traumatic stress they found were startling. "We're looking at six in 10 with depressive symptoms," she says. A similar percentage of residents display symptoms of Post-Traumatic Stress Disorder, PTSD.

Those are the figures for adults.

Among the children surveyed, more than 40% had symptoms of post-traumatic stress more than a year after the storm. Gloria Callwood, another researcher, says their findings are backed up by what they heard from teachers. "When there was weather, when the wind was blowing," Callwood says, "that's when the younger kids become more clingy. That brings back the memory of the trauma they experienced."

Noreen Michael says another survey of high school age students after the storms was even more disturbing. "We saw some pretty high percentages of students who said they had thought about suicide," she says.

The most recent Youth Behavior Risk Survey of the U.S. Virgin Islands, which has not yet been published found that, among students in seventh through twelfth grade, one in 12 reported they'd attempted suicide. More than one in five said they'd thought about it.

Those are pretty close to the national figures on suicidal thoughts among adolescents. But in the U.S. Virgin Islands, a close-knit community where mental health isn't often discussed, researchers suspect the real numbers may be even higher.

Lori Thompson, a psychologist who sees patients at St. Thomas' hospital, says in the first six months after the storms, there was a significant spike in suicide attempts. For many, she says it was related to the aftermath. "People lost their jobs," she says. "A lot of them lost their housing, their support network. The stressors in their lives magnified to such an extent that they just felt they couldn't cope anymore."

Damaged power lines hang over a street after Hurricane Irma hit the U.S. Virgin Islands on Sept. 6, 2017. That same month, another Category 5 hurricane hit the U.S. territory.
Ricardo Arduengo / AP

Thompson and other mental health professionals say they've been overwhelmed by the demand for counseling and psychiatric care. Even before the storms, the area was woefully understaffed in regards to mental health with just one full-time and one part-time psychiatrist for the entire territory.

Albert Bryan, the U.S. territory's new governor, says mental health in the Caribbean on the whole is, "not something that we've had real discussions about." Since the storms, the need has become critical, leading him to declare a mental health state of emergency. The order is intended to expedite recruiting and hiring of mental health professionals.

It's a crisis that's been years in the making. "This is a kind of 'cry in the dark' kind of community," Bryan says. "A lot of that is driven by the stigma. You wouldn't ostracize somebody who had high blood pressure. Why would you ostracize somebody who has some kind of personality disorder?"

In many ways, the U.S. Virgin Islands is the paradise visitors see, with its beaches, palm trees and friendly people. But Bryan says the fact is, it can be difficult to live in an isolated community where costs are high, many live in poverty and hurricane recovery slowly drags on.

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RACHEL MARTIN, HOST:

In the U.S. Virgin Islands, many homes are still uninhabitable. Blue tarps cover the roofs on others. The tarps are the only cover from the rain. That's the reality more than a year and a half after two major back-to-back hurricanes tore through the islands. But the storms had another less visible impact on the mental health of island residents. Researchers, doctors and counselors in the Virgin Islands say it's showing up in higher rates of depression, PTSD and suicide. From St. Thomas, NPR's Greg Allen brings us the story.

GREG ALLEN, BYLINE: Vincentia Paul-Constantin is a mental health counselor who has been working with children in the public schools in the Virgin Islands since the storms. The back-to-back hurricanes and the slow, fitful recovery, she says, have had a big impact.

VINCENTIA PAUL-CONSTANTIN: We see a lot of behaviors - regression in behaviors, especially with our little ones who had been potty trained reverted to using diapers. We see a lot of frustration, cognitive impairment, hopelessness and despair.

ALLEN: Paul-Constantin traces it back to September of 2017, when two Category 5 hurricanes struck the Virgin Islands in a two-week period. On St. Croix, St. John and St. Thomas, many lost their roofs and most of their possessions and then went for weeks without power, running water or a reliable food supply. Many families were hit hard.

UNIDENTIFIED PERSON: So it was a bit frustrating to have to go through such a traumatic experience after the hurricanes - not having access to anything.

ALLEN: This mother says storms and recovery were even harder on her 6-year-old son, who was just starting kindergarten. Because of concerns about their privacy, she asked that we not use her name. He was starting school at a chaotic time. Because many buildings were damaged, schools doubled their enrollment and went to two sessions a day, with each session lasting four hours.

UNIDENTIFIED PERSON: So for him, he had to learn it all over in a four-hour period. He had to meet new friends and do schoolwork. So for him, it wasn't where he was at his comfort level. He was pretty much disoriented.

ALLEN: She got counseling for her son, and it's helped. But many children have more serious problems. Schools in the Virgin Islands returned to their normal schedule in October. Although some students, like these at Cancryn Junior High in St. Thomas, are now in modular classrooms. Principal Lisa Ford charges along the school walkways, where students are congregating after a morning of taking standardized tests.

LISA FORD: Ladies, morning.

UNIDENTIFIED GROUP: Morning.

FORD: How was the testing?

UNIDENTIFIED GROUP: Hard.

FORD: That's what we got brains for.

ALLEN: Ford knows most of the 450 kids at her school by name. A 35-year teaching veteran of Virgin Island schools, she says she loves junior high best. It's where kids discover who they are. But with the disruption of the hurricanes and a year of shortened class days, Ford says students have fallen behind where they should be. And behavioral problems, always present, have gotten worse.

FORD: Where it would be one or two children, now it's 10 children in the classroom acting up. And you're trying to settle all these children. We are also seeing an increase in children that need mental health assistance. Children who need counseling, who need coping skills.

ALLEN: Ford says she doesn't know if it's because of the hurricanes, the slow recovery or all the free time students had last year when they were on a half-day schedule. You see the behavioral issue, she says, in a variety of ways.

FORD: They show up in defiance to authority. We have children who are sleeping in the middle of the day. They're tired. You try to wake them up, they become angry. And maybe that's what we're seeing - a lot of anger and defiance.

DIONNE SIMMONDS: I believe that the storms, out of everything else, has literally woken up mental health issues here in the territory. And I believe that people are now seeking help.

ALLEN: Dionne Simmonds, a counselor with Insight Psychological Services, says many of the problems she sees are related to money and the high cost of everything after the storms from food to fixing your roof.

SIMMONDS: And it has caused extreme hardship. That equates to stress. Stress equates to depression, anxiety.

ALLEN: Since the storm, Simmonds says there's been a dramatic increase in the number of people seeking mental health counseling at government service centers, homeless shelters, clinics and hospitals.

SIMMONDS: It's like a floodgate has been opened up.

ALLEN: Recent surveys of mental health in the Virgin Islands confirm what individual counselors and teachers are seeing. One study, funded by the Community Foundation of the Virgin Islands, found that throughout the territory, stress from the hurricanes and the recovery is a significant health issue. Noreen Michael, with the University of the Virgin Islands, says the levels of depression and post-traumatic stress researchers found were startling.

NOREEN MICHAEL: So we're looking at 6 in 10 with depressive symptoms, almost 6 in 10 with PTSD symptoms.

ALLEN: Those were the figures for adults. Among the children surveyed, more than 40% had symptoms of post-traumatic stress more than a year after the storm. Noreen Michael says another survey of high-school-age students after the storms was even more disturbing.

MICHAEL: We saw some pretty high percentages of students who said they had thought about suicide.

ALLEN: The Youth Risk Behavior Survey of Virgin Island students seventh through twelfth grade found that 1 in 12 reported they'd attempted suicide. More than 1 in 5 said they'd thought about it. Those are pretty close to the national figures on suicidal thoughts among adolescents. But in the Virgin Islands, a close-knit community where mental health isn't often discussed, researchers suspect the real numbers may be even higher. Lori Thompson, a psychologist who sees patients at St. Thomas's hospital, says in the first six months after the storm, there was a significant spike in suicide attempts. For many, she says, it was related to the aftermath.

LORI THOMPSON: People lost their jobs. A lot of them lost their housing, their support network. The stressors in their lives magnified to such an extent that they just felt that they couldn't cope anymore.

ALLEN: Thompson and other mental health professionals say they've been overwhelmed by the demand for counseling and psychiatric care. Even before the storms, the Virgin Islands was woefully understaffed in regards to mental health with just one full-time and one part-time psychiatrist for the entire territory.

ALBERT BRYAN: Mental health in the Caribbean on the a whole is not something that we've had real discussions about.

ALLEN: The territory's new governor, Albert Bryan says since the storms, the need has become critical, leading him to declare a mental health state of emergency. The order is intended to expedite recruiting and hiring of mental health professionals. Bryan says it's a local medical crisis that's been years in the making.

BRYAN: This is a kind of a cry in the dark kind of community. And a lot of that is driven by the stigma. You wouldn't ostracize somebody who had high blood pressure. Why would you ostracize somebody who has some type of personality disorder?

ALLEN: In many ways, the Virgin Islands is a paradise with its beaches and palm trees. But Governor Bryan says the fact is, it can be difficult to live in an isolated community where costs are high, many live in poverty and hurricane recovery slowly drags on.

Greg Allen, NPR News, St. Thomas. Transcript provided by NPR, Copyright NPR.