Suicides on the rise in Puerto Rico

The aftershocks of Hurricane Maria have not only taken a serious physical toll on the islands, but a psychological one as well. It’s estimated that at least 103 Puerto Ricans have committed suicide since the hurricane hit on September 20 last year. The end of 2017 saw a 29% increase in the incidence of suicides, compared to 2016. While it’s difficult to determine exactly how many of these cases are directly correlated with the aftermath of the destruction, psychologists agree that natural disasters take a big toll on the mental health of a population. Not having electricity, water, or even a roof over your head is a psychologically straining experience, especially for those who’ve previously struggled with mental health issues.

Post-hurricane rates of mental health issues are at an extreme high, compared with normal rates of mental health disorders among Puerto Ricans. Normally, 7.3% of the islands’ residents suffer from serious mental illness. Even before the Hurricane, this level was relatively high compared to the rest of the US. A study by the Puerto Rico College of Physicians and surgeons attributes high levels of mental illness to the territory’s high level of poverty, unemployment, and crime. Since the devastation of Maria, roughly one-third of Puerto Ricans reported a developing mental health problem. Psychologists have found that even witnessing trauma in strangers from afar can damage mental health. A 2015 study by the Substance Abuse and Mental Health Services Administration found that one-third of disaster survivors experience a post-disaster disorder. Even for those who didn’t lose their homes, the hurricane has left the psycho-emotional state of the territory in fragility.

In addition to the destruction of thousands of homes, the Hurricane ravaged the infrastructure of crucial public services including hospitals and health centers. These services still suffer regular power outages and a shortage of healthcare supplies. Dozens of doctor’s offices in San Juan have closed as a result. It appears that there simply aren’t enough health services available for everyone in need. In a mall in San Juan, a former electronic device-charging center, Recargate, has been turned into a makeshift clinic. From November to February, more than 20,000 visited the shop-turned-clinic for a variety of health and counseling services. Recargate offers mental health screening and counseling for sufferers of depression, anxiety, and grief. Those who needed medication for their disorders before the hurricanes now also have to deal with challenges in obtaining their medications. Many who previously depended on their insurance to cover the cost of medication now must pay out of pocket if their coverage expired during the middle of Maria.

The impact of the hurricanes on health is apparent in San Juan and other urban areas, but the lack of resources is doubled, or even tripled, in rural areas. Rural residents (who make up 30% of the territory’s population) are more likely than urban residents to be living without power and to have less access to transportation. Alfredo Carrasquillo, a psychoanalyst at the University of Sacred Heart in San Juan, says that many rural, poverty-stricken communities currently don’t have access to hospitals. Right now, Puerto Rican health officials are working on improving the situation by expanding access to health service to rural communities. The Medicare Advantage health plan MMM, “Medicare y Mucho Mas”, has set up dozens of mobile clinics. MMM is expanding outreach efforts to conduct more in-home visits, especially to rural and elderly residents in need of physical or mental health support. It will take time, perhaps years of continued efforts at outreach and infrastructure repair, for the health situation in Puerto Rico to return to normalcy