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Puerto Rico Ramps Up Mental Health Training


It's beautiful here in Puerto Rico. The palms have grown back. The flame-red flamboyan are flowering again. But the beauty cannot hide a hard fact - just about everyone here has a story of loss - of homes, of property, of loved ones, even of faith. Mental health professionals here say that they've seen an increase in depression, anxiety, insomnia - even suicide.

And yet, people have found ways to cope. In Humacao, the volunteer cooks at the Apoyo Mutuo have become defacto therapists, checking in on the well-being of their neighbors who stop by for a hot lunch. Maria Laboy is one of the ladies working here.

MARIA LABOY: After the storm, everybody was depressed, sad and everything.

MARTIN: She scoops up a huge slice of steamed pumpkin for one of the regulars, Georgie Ortiz, who makes the trip up the hill every day for lunch and conversation. He used to make his living as an auto mechanic, but people around here aren't maintaining their cars anymore, he says. They're saving their money for more urgent expenses like home repair and fuel for generators. He didn't have any documentation to prove that he owned his home, so he wasn't eligible for emergency funds from FEMA. He says he does have a blue tarp.

GEORGIE ORTIZ: (Speaking in Spanish).

MARTIN: But he lives alone, and he can't install it by himself. During the day, he finds ways to stay busy and distracted from his problems. But at night...

ORTIZ: (Speaking in Spanish).

LABOY: He say he sleep depressful (ph). It won't go down.

MARTIN: Over the past few months, Maria Laboy and the other lunch ladies have become friends with neighbors like Georgie.

LABOY: I really worry about him because he just lost his mother, and he's - he don't have work now. (Unintelligible) and he can't survive like that. And he's down because no help - he haven't have no help from nobody. So, you see, it's not a pretty picture right now.

MARTIN: There was a 29 percent increase in suicide on the island in 2017 according to the Puerto Rican Department of Health. The majority were men and people over 50 years old. Researchers are working to determine how many of those were hurricane-related. Calls to the suicide prevention hotline have spiked, but with so many people without phone service months after Maria, that method of getting help was not a reliable option.

Down the mountain from Georgie Ortiz and the community kitchen, five EMTs are gathered at the emergency management center of Humacao.

UNIDENTIFIED PERSON: (Speaking in Spanish).

MARTIN: They're here for mental health and resiliency training to learn how to cope with their own stress so they can help people struggling in their communities. It starts by acknowledging the fact that they're stressed. One exercise near the end of the session brings the point home. The trainers ask everyone to participate.

ELEXIA SUAREZ: I'm going to go through some phrases, and if anyone has - you have experienced it or touch you, please stand up. (Speaking in Spanish). I have lost a loved one through Hurricane Maria or after.

MARTIN: One EMT stands up. But by the end of the list - if you've had damaged property, if you've seen your community impacted, if you worked through the disaster - everyone in the room is standing. After the session, I asked the EMT supervisor, Frank Torres, why he thought this training was important for his employees.

FRANK TORRES: (Speaking in Spanish).

MARTIN: He says the hurricane was difficult on first responders. He has 18 EMTs to cover the whole city of Humacao, and everyone worked around the clock for four days straight responding to emergencies. The stress of working the hurricane was coupled with the personal stresses the EMTs faced at home.

TORRES: (Speaking in Spanish).

MARTIN: And they've still not rested, Torres tells us. Nobody has had any vacation. They work all the time, and on all their days off, they rebuild. Caesar Rosario was one of the EMTs who stood up when asked if anyone lost their home due to Maria. He lost his home of 20 years but didn't find out for a few days because he was on duty.

CAESAR ROSARIO: (Speaking in Spanish).

MARTIN: He walked from the station to his house once the storm had passed.

ROSARIO: (Speaking in Spanish).

MARTIN: He lost everything, says Rosario. It's not easy.

The training these EMTs are receiving today is part of an island-wide initiative from the nonprofit group Americares to address the mental health crisis in Puerto Rico. Ivalis Morales and Elexia Suarez are the two people leading the session. Both of them are psychologists who practiced in the region before Maria. One's office was destroyed, along with her 25-year private practice. The other's home experienced major damage. They agree that these sessions help them feel useful to the island's overall recovery. Elexia Suarez says that strong communities and relationships are essential for surviving a major event like the hurricane last fall.

SUAREZ: As we have seen and again and again and again, the community leaders, the community resources - between one another, people have become so tight, so together. That is a collective hope, a collective support, because you could not have survived this without someone, even if it is one neighbor - you couldn't.

MARTIN: They end the session by passing around a photo of a mango tree. The trunk is completely severed, but one little branch shoots off the stump. Off the fragile shoot hangs a huge, bright mango. Suarez says this is a symbol for post-Maria Puerto Rico.

SUAREZ: Saying that we have been cut, taken away. Even though we're together, we're standing. We're giving fruits, and we're blooming. We're doing it for ourselves, our family, our communities in Puerto Rico. Thank you.

(APPLAUSE) Transcript provided by NPR, Copyright NPR.