WASHINGTON – Today, Congresswoman Ayanna Pressley (MA-07), Senators Elizabeth Warren (D-MA) and Edward J. Markey (D-MA), and Representatives Richard E. Neal (MA-01), James P. McGovern (MA-02), Joseph Kennedy III (MA-04), William Keating (MA-09), Katherine Clark (MA-05), and Lori Trahan (MA-03) sent a letter to the Substance Abuse and Mental Health Services Administration (SAMHSA) asking for information on how they plan to support the mental health needs of Puerto Rico residents in the wake of the recent earthquakes.

Puerto Rico has experienced more than 300 earthquakes strong enough to be felt since December 28, 2019, ten of which were large enough to do damage. This includes a 6.4 magnitude earthquake on Tuesday, January 7, 2020, that killed at least one person and damaged homes, schools, and power plants, causing 93% of the island to lose power. To date, these earthquakes are estimated to have caused $110 million in damage and affected at least 559 structures. This series of earthquakes comes only two years after Puerto Rico was hit by Hurricanes Maria and Irma, which killed nearly 3,000 people and left thousands more without power, food, and clean water for months. Since these disasters, rates of suicide, drug use, domestic violence, and other behavioral health issues have continued to increase, and the ongoing earthquakes are exacerbating Puerto Rico’s underlying mental health crisis.

“Trauma from a life-altering experience like Hurricane Maria can last a lifetime, and symptoms of depression, anxiety, and traumatic stress can continue to surface months or years later,” wrote the lawmakers. “In this context, the past month’s barrage of earthquakes are not just alarming to Puerto Rico’s residents; they compound an existing mental health crisis.”

Because SAMHSA leads the nation’s efforts to reduce the impact of mental illness, which includes coordinating with other agencies to provide services, grants, and technical assistance in areas affected by natural disasters, the lawmakers have requested responses to their questions and a briefing no later than February 26, 2020.

The full text of the letter is below and can be found here.

 

The Honorable Elinore F. McCance-Katz, Ph.D.

Assistant Secretary for Mental Health and Substance Use

Substance Abuse and Mental Health Services Administration

5600 Fishers Lane Rockville, MD 20857

 

Dear Dr. McCance-Katz:

We write today to request information regarding the Substance Abuse and Mental Health Services Administration’s (SAMHSA) efforts to address mental health challenges facing the people of Puerto Rico in the aftermath of the series of significant earthquakes that have hit the island in recent months.

Puerto Rico has experienced more than 300 earthquakes strong enough to be felt since December 28, 2019, ten of which were large enough to do damage.  This includes a 6.4 magnitude earthquake on Tuesday, January 7, 2020, that killed at least one person and damaged homes, schools, and power plants, causing 93% of the island to lose power. The earthquakes are estimated to have caused $110 million in damage and affected at least 559 structures so far. The crisis is ongoing: the U.S. Geological Survey predicts that aftershocks will continue for the next 30 days, with a one-in-ten chance of another earthquake of a 6.0 magnitude or greater. Thousands of people in Puerto Rico have spent weeks sleeping in shelters or makeshift campsites, with limited access to electricity and running water, out of fear that their homes could collapse in another quake. 

This series of earthquakes comes only two years after Puerto Rico was hit by Hurricanes Maria and Irma, which killed nearly 3,000 people and left thousands more without power, food, and clean water for months. The mental health impact of Hurricanes Maria and Irma and their aftermath was significant and widespread: one year after the storm, more than one-fifth of people· in Puerto Rico “reported needing or receiving mental health services,” and 13% reported that they had “started new or higher-dose prescription medicines to treat emotional problems.” In a survey of Puerto Rico’s public school students, 32% of children reported experiencing a shortage of food or water during Hurricane Maria or its aftermath, 30% had perceived their lives to be at risk, and 7% reported clinically significant symptoms of posttraumatic stress disorder. Rates of suicide, drug use, and domestic violence have all increased. Trauma from a life-altering experience like Hurricane Maria can last a lifetime, and symptoms of depression, anxiety, and traumatic stress can continue to surface months or years later. In fact, in the time since the hurricanes, mental health needs have continued to increase: nearly twice as many suicides were reported in Puerto Rico in the first three months of 2019, more than a year after the storm, as during the same time period in 2018.

In this context, the past month’s barrage of earthquakes are not just alarming to Puerto Rico’s residents; they compound an existing mental health crisis. The conditions on the ground – power outages and blackouts; shortages of food, clean water, and fuel; damaged homes, and destroyed infrastructure – are similar to those that residents dealt with for months after Hurricanes Maria and Irma. Some residents have observed that the conditions are even more anxiety-inducing than hurricanes, since earthquakes can come at any time with no warning. A spokesman for the mayor of Guanica commented, “Puerto Rico has never experienced an earthquake this big. You never know when the ground will start shaking again, and if it does you don’t know if it will be a big earthquake or a small one.”

Uncertainty about the coming aftershocks has prevented residents from resuming their daily lives. Several schools have cancelled classes due to damaged buildings, while parents in other areas are reluctant to send their children to school in case of future collapses. The thousands of families who are afraid to sleep in their own homes are choosing to sleep in their cars, outdoor camps, or public shelters, and are experiencing persistent anxiety and uncertainty. Calls to Puerto Rico’s main mental health hotline, Linea PAS, have increased. Adding to this anxiety is a sense that help may not be forthcoming– the Trump Administration’s slow and inadequate response to Hurricanes Maria and Irma, including the delayed reconstruction of the Vieques public community health center, has undermined residents’ confidence that they will have adequate resources and help to quickly rebuild, perpetuating a sense of hopelessness.

SAMHSA leads the nation’s efforts to combat mental illness, which includes coordinating with other agencies to provide services, grants, and technical assistance in areas affected by natural disasters. After Hurricane Maria, SAMHSA and FEMA awarded more than $6 million to Puerto Rico through the Crisis Counseling Assistance and Training Program (CCP), which trains local survivors to conduct outreach and crisis counseling. This grant was used to provide services to more than 130,000 people in the grant’s initial 90-day period and to supplement Linea PAS with eight additional crisis counselors. This initial grant was followed by an additional $12.7 million for the CCP program in FY 2018, but has not continued past the first year after the hurricanes. In addition to the CCP grant funds, SAMHSA’s response to Hurricanes Maria and Irma included providing technical assistance and guidance to grantees in other programs, placing a behavioral health officer in the Joint Field Office to coordinate the response on the ground, distributing informational materials, and working with federal and state partners to identify areas where evacuees had relocated that were in need of additional mental health supports.

The mental health challenges facing Puerto Rico’s residents are ongoing and chronic. Efforts to reach the island’s residents who are in need of support are complicated by severe shortages of qualified providers, and exacerbated by continuing outmigration. As a result, hospitals and emergency departments must often treat patients who would be better served by more specialized care. Mental health providers are experiencing high rates of anxiety, fatigue, and burn-out from working to meet the large needs of their communities. These challenges are compounded by the uncertainty and trauma caused by the recent earthquakes.

To help us better understand the role that SAMHSA is playing in recovery efforts in Puerto Rico, as well as what additional federal resources may be necessary to combat the growing mental health crisis in the region, we request that you respond to the following questions and schedule an in-person briefing for our staffs by February 26, 2020.

1. Please provide a detailed overview of SAMHSA’s role in ongoing recovery efforts for the series of earthquakes in Puerto Rico that began on December 28, 2019.
   • What resources, if any, have Puerto Rican officials requested from SAMHSA?
   • What resources has SAMHSA provided or made plans to provide?
2. Reports indicate that the mental health needs of Puerto Rico’s residents have continued to grow since Hurricane Maria. Please provide any data or other information that SAMHSA has collected on the mental health needs of Puerto Rico’s residents and access to mental health services since September 2017.
3. Have SAMHSA and FEMA received and/or approved any applications for CCP grants to Puerto Rico in the aftermath of the recent earthquakes? If so, please provide a list of such grants, and information on which of these was approved, denied, or is pending.
4. Please describe SAMHSA’ s current support of Linea PAS and any additional federal resources that can be deployed to respond to increased call volume.
5. After Hurricane Maria, SAMHSA noted that connectivity issues prevented some Puerto Rico residents from accessing mental health hotlines such as Linea PAS in the immediate aftermath of the disaster.  What steps have SAMHSA or its grantees taken to provide additional outreach and resources to residents who may experience connectivity problems in future disasters?
6. Please describe current SAMHSA programs or grants that address the shortage of mental health care providers in Puerto Rico.
7. What lessons did SAMHSA and its grantees learn from the aftermath and response to Hurricanes Maria and Irma? How will those lessons learned be applied in the response to the current disaster?
8. What additional federal resources are needed to address the mental health crisis in Puerto Rico?

 

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