As the mental health crisis grows, Puerto Ricans need long-term care

I remember distinctly one of my summer visits to Puerto Rico with my family when I was a teenager. We were sitting at the dining room table having lunch, and in mid-bite, I felt the ground rumble.

I thought it was the subway, forgetting for a moment that I was in Puerto Rico and not New York City. Everyone ran out the door, and as my uncle quickly returned to pull me outside, I saw the terror in his face.

I recall that terror as I think about my family and friends in Puerto Rico now. Still stricken by the recent earthquake and its aftershocks, more than 8,000 residents are reportedly living in 40 shelters; neighborhoods and a school were destroyed, and thousands are sleeping in tents or inside cars. 

For all these reasons, Puerto Ricans are at risk for mental trauma and PTSD. Two years ago, after Hurricane Maria, I witnessed firsthand the devastating impact a natural disaster can have on mental health.

I spent two weeks in Puerto Rico with a team from the Health Department as part of New York City’s hurricane relief missions. I remember the painful stories of children who fearfully clung to their parents when the sky grew cloudy, of Puerto Rican veterans who were reminded of war upon hearing helicopters surveying the damage. 

Puerto Rico’s connection to New York City is so profound. We will always be ready to support the Island.

Today, New York City First Lady Chirlane McCray announced the City is sending nine mental health experts to Puerto Rico to provide crisis counseling, emotional support, connections to mental health services, and help with coping with stressful events. This is in addition to the staff already on the ground, which includes health professionals, building inspectors, engineers, and emergency managers to support the cities with the worst damage. Governor Cuomo also pledged to send extra mental health experts to Puerto Rico as part of the State’s emergency response. 

But we need consistent support from the federal government. Pressured by Democratic leaders last week, the Trump administration declared that “a major disaster exists” in Puerto Rico, and finally approved the $8.2 billion already owed in aid, plus an additional $8.3 billion funding notice. On Monday, Senator Chuck Schumer also rightly called for Health and Human Services to release millions more in aid specifically for mental health providers and outpatient services.

The emergency aid will provide vital support, but temporary assistance is not nearly enough. To address this unprecedented mental health crisis, Puerto Rico needs a stronger Medicaid program.

Approximately 1.4 million low-income Puerto Ricans depend on Medicaid, and it is the largest payer for mental health services in the United States. Medicaid covers inpatient and outpatient mental health services, counseling, case management, supportive housing, and prescription medications.

A key part of the problem is that Puerto Rico receives only a fixed block grant of funding for Medicaid each year that is grossly inadequate to cover the cost of health care for its enrollees. 

Last month, Republican and Democratic members of Congress unveiled a massive budget deal, which included $12 billion in Medicaid for Puerto Rico over four years — enough to cover the Island’s expenses. But in a devastating blow, President Trump intervened and reportedly demanded it is slashed to $5.7 billion over two years. 

With another funding cliff looming in two years under the new agreement, Puerto Rico may continue to lack the certainty it needs to commit to long-term investment in Medicaid. Ultimately Congress should agree on a steady infusion of Medicaid funding for Puerto Rico to be on par with the mainland states.

No matter what the federal government does, New Yorkers will do everything possible to support Puerto Rico during this mental health crisis, so those remaining on the Island—either by choice or lack thereof — have the same opportunity and security as we do. 

Oxiris Barbot is New York City’s Health commissioner.