As the immediate life-or-death aftermath of Tropical Storm Helene recedes, a mental health crisis is rising in Western North Carolina.
From those who lost their homes to the first responders who discovered gruesome scenes, residents suffered all sorts of individual and collective traumas.
The impact of a mental health crisis in the region cannot be underestimated: suicide rates tend to increase dramatically in the first three years following a severe natural disaster.
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Western North Carolina is already known for its weak mental health care infrastructure, particularly in the region’s very rural areas — which is most of it. Half of its counties do not have a single practicing psychiatrist, according to UNC Asheville health sciences professor Fabrice Julien.
Still, mental health providers across the region are stepping up to help people process what happened to them and get their lives back on track.
Delayed stress peak
“When a natural disaster like this occurs, we see acute stress reactions,” Ed Kelley, medical director at Mission Health’s Sweeten Creek Mental Health and Wellness Center in Asheville told Carolina Public Press.
“But that is not usually the peak. During a crisis, people are just so busy surviving that they don’t tend to fall apart. We are just getting into the delayed trauma phase. That is much more common and much more intense for most people. People lost houses, jobs, loved ones, friends, family, pets. It’s all starting to sink in.”
Helplessness is the word that sticks out to Kelley the most in the wake of Helene. He believes helplessness is the core of depression, as well as a natural reaction to something as powerful as a natural disaster.
“People just feel so overwhelmed that they’ll curl up and go into paralysis,” Kelley said. “They’ve got a million things to do to get their life back on track, but can’t figure out where to begin.”
In the aftermath of Helene, an influx of people have come to Sweeten Creek in search of mental health care, according to Kelley. He’s seen increased numbers of panic attacks and other severe stress reactions.
Outreach amid mental health crisis
Some mental health groups have been doing outreach, meeting people where they are post-disaster across Western North Carolina.
One of these is All Souls Counseling, which provides counseling services for the under- or uninsured in the region. After Helene, the organization hired 10 additional therapists to expand care capabilities.
Since Oct. 8, All Souls Counseling has had a therapist on site seven days a week in Swannanoa, one of the hardest hit communities in the region.
“People who have never seen a therapist before are calling us because they recognize that this crisis has created trauma in their life, and they need a way to process it,” Meredith Switzer, executive director of All Souls Counseling, told CPP.
This type of in-person outreach is crucial in a place like Western North Carolina. Many mental health providers may be considering transitioning to virtual care due to damage to their facilities and roads, but Julien warns against this move.
“It is documented that folks who end up hurting the most from the switch to a virtual model are rural patients who struggle with connectivity issues,” Julien said.
Many in the region struggled to connect to high-speed internet before Helene. Now, the problem is compounded by cut fiber lines, loss of power, and damage to road infrastructure. Approximately 28,000 of Western North Carolina’s Spectrum customers remain without their Wi-Fi service, for example.
To those struggling with their mental health, Kelley recommends counseling first and foremost.
“People who have become depressed have a tendency to hide inside themselves,” Kelley said. “They don’t process it. It just dwells and festers. Talking to friends and family is one thing. But talking with a professional who can help you learn coping skills and ways to work through it is tremendously useful.”
He also recommends other steps to take back control of your life: making a prioritized to-do list, getting back to self care rituals like hiking or meditation, or reimposing structure and routine in daily life.
But for many, recovery will not be that simple.
Grieving your home, your friends, your pets, your family, your job can take months, if not years. Displacement from one’s home — even temporarily — can be extremely traumatic. The simple fact of being surrounded by destruction and devastation daily can impair your ability to care for yourself and others.
Many are feeling emotions they’ve never felt before, and are struggling to categorize them.
“The stress of a natural disaster is almost like grief,” Robin Payne, executive director of Western North Carolina’s branch of the National Alliance on Mental Illness, told CPP.
“A lot of new emotions come up around losing things, losing normalcy, losing possessions. In the first few days, there was a fear that I don’t think I’ve ever felt before: the fear of not having water, power, gas or cash. People don’t know how to process the loss of being able to meet your physical needs.”
Children, in particular, may be facing complex trauma that affects their mental health.
“Kids watched their parents, who they know as all-powerful, all-knowing people, suffer and struggle,” Kelley said. “To see those who are supposed to be in control lose it is always difficult on kids.”
Culture compounds mental health crisis
The culture of the mountains may compound the mental health crisis in the wake of Helene, according to Adam Hege, director of Appalachian State University’s public health program.
“People in this region come from a rural culture,” Hege told CPP. “They are less likely to reach out for assistance or talk about mental health needs. Our culture preaches resilience and being tough. Sometimes, those are harmful social norms.”
Still, mountain county governments are trying to reach out to their residents who may be facing a mental health crisis. AppHealthCare, the public health department serving Ashe, Alleghany and Watauga counties, has launched a partnership with CredibleMind to make mental health resources freely available to the public.
“There’s no magic amount of recovery time that fits everyone,” AppHealthCare director Jen Greene told CPP. “Watching out for depression and anxiety is a key part of your overall health.”
The trauma Western North Carolinians experienced during and after Helene increases the risk of substance abuse and alcohol abuse disorders, according to Richard Zenn, chief medical officer at VAYA, a managed care agency.
Another concern public and mental health professionals have is medication adherence. People may be so consumed with figuring out how to return to normal life that they forget to take their antidepressants or antipsychotic medications.
“It’s harder to adhere to your medication regimen when your power is going on and off, your roof is leaking, and you’re just trying to survive day-to-day,” Julien said.
“You may have to consider: ‘I have this little bit of water left. Do I cook with it? Do I boil it for my child? Or do I use it to swallow my medication?’”
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