PTSD in Flint shows the cost of ignoring mental health during crises

In response to disasters — especially weather events like hurricanes and disease outbreaks like COVID-19 and HIV/AIDs — mental health services have garnered a painfully obvious second-class status. As we gaze upon TV and social media feeds of decimated homes and overflowing emergency rooms, we’re trained to see “impact” as a calculation of the amount of rubble piled up or deaths amassed, not the heavy frustration and trauma that always bubble-up afterwards. 

Consider the Biden administration’s recently passed $2 trillion COVID-19 relief package. It has admirably earmarked funds for direct financial payments to Americans, funding for K-12 public schools and housing and nutrition assistance, extensions of unemployment insurance and COVID-19-related equipment and vaccines. But of the total package, only $4 billion, roughly 0.2 percent of the pie, was devoted to mental health-related services, leaving a small fraction of what would be needed to adequately address the scale and scope of the pandemic’s clear and growing psychological toll. 

Depression and anxiety are consistent byproducts of disasters, especially for people of color, who are often inequitably impacted by crises. During the COVID-19 pandemic, there has been an increase in suicides among Blacks, who historically have among the lowest rates of suicide compared to their racial and ethnic counterparts. In a recently published study that we conducted in the low-income, predominantly Black city of Flint, Mich., five years after the beginning of its water crisis, we found that 29 percent of residents had associated posttraumatic stress disorder (PTSD) symptoms, with higher rates observed among Black residents.

Our continual inability — or unwillingness — to see mental health impacts like these destroys our ability to effectively respond to disasters’ full effects. With the pandemic poised to be the biggest public health disaster in our lifetimes, there’s no better time than now to focus on deploying mental health resources as a key part of our response and recovery — especially for those most vulnerable to structural oppression, like people of color who disproportionately inhabit under-resourced communities. 

Trauma is the psychological manifestation of the worst outcomes that a disaster can drum-up: It’s not only living through a crisis but reliving it. The idea of providing “relief,” a term politicians frequently plaster onto disaster recovery policy, must return to its literal meaning — restoring a feeling of assurance and internal peace.  

During our research, we also interviewed residents of Flint. A 61-year-old Black man who lived in subsidized housing just outside Flint’s downtown core, described to us the early weeks of the city’s water switch — a cost-saving decision from a state-appointed financial emergency manager — which resulted in widespread contamination of resident’ tap water with lead, carcinogenic trihalomethanes, and various hazardous environmental bacteria. He vividly recounted the skin rashes and lesions he had developed shortly after the city’s water source switch. Like others, he told us he was uneasy and didn’t sleep well for months because he didn’t know what was happening to him. Given his age, he said he also frequently had wondered if he was sick, perhaps even dying.

To date, funding for crisis counseling has represented just several million dollars in the roughly $450 million pot of funds devoted to recovery efforts thus far in Flint, a city of around 96,000 people. As with the COVID-19 funds, the numbers here also don’t add up, nor are the mental health services being served up calibrated to meet the unique strain of trauma that quintessentially American disasters have stirred and accelerated in communities of color. 

Although the Environmental Protection Agency (EPA) and government officials had declared Flint’s water safe to drink in early 2018, and by then most lead service lines in the city had been replaced, nearly 80 percent of participants in our survey, and a higher percentage of Black participants, said that they still used bottled water — which the state gave out for free between 2016 and 2018 at sites scattered around Flint — as their primary drinking water source.  

Residents described going through multiple cases of bottled water each week for drinking, to brush their teeth, wash dishes, and even to prepare meals and make coffee. They often expressed anxiety over what lead exposures may soon do to their young children. The trauma was not just what was, but what could be.  

Even government and health care officials that we spoke with during our research remained shaken and water-avoidant long after Flint’s water had been deemed safe, contradicting their own public recommendations. In the summer of 2019, a White city planning official explained to us that she couldn’t quite bring herself to drink the city’s tap water. She noted how she and other residents adopted a highly intimate coping strategy to forge ahead and use the tap water or came up with an intricate game plan for obtaining and using bottled water, coordinating the timing and logistics based on their broad spectrum of water-related needs. 

The Flint water crisis, and crises like COVID-19 that share its DNA, show us that the most super human capabilities of our times may just be empathy and decency, not the ability to mobilize en masse resources like bottled water, infrastructure, ventilators and vaccines. We must invest now in crisis relief policies that both affirm and preserve the dignity of people, especially those of color, through mental health screening and treatment that is oriented around the unique trauma that natural and manmade disasters forge. Otherwise, disproportionate trauma and distrust will accelerate and continue to harden in our most susceptible communities.

In turn, we, and future generations, will shoulder this enormous weight and see trauma manifest on an infinite loop across our government, health care institutions, workforce, schools and neighborhoods.  

Jerel Ezell is an assistant professor at Cornell University at the Africana Studies and Research Center and the Cornell Center for Health Equity. He is a Fulbright scholar. His research focuses on social and health outcomes in post-industrial communities in the United States.