EDITOR'S NOTE: The author originally published this piece at HuffPost and has given us permission to republish the piece. Utuado residents after Hurricane Maria (Eliván Martínez Mercado | Centro de Periodismo Investigativo) Though the media’s attention has been largely focused —legitimately so— on surveying the extent of Maria’s physical destruction and addressing the evolving humanitarian crisis brought on by a shortage of food, water, medicine, electricity, and cell phone communication, little has been said about the growing impact of Maria on mental health. Yet even before Hurricane Maria devastated Puerto Rico, the island was in a critical state of “mental health deterioration,” made worse by a deepening economic crisis, high rates of poverty and unemployment, a cash-strapped Medicaid program, and an exodus of medical professionals to the mainland. According to a 2016 epidemiological study by the Puerto Rico Administration of Mental Health and Anti-Addiction Services, approximately 7.3% of Puerto Rico’s population has a serious mental illness (SMI) compared with only 4% of mainland Americans. And because of the fiscal crisis, patients have to wait longer to receive mental health services, which may help explain why 1/3 of island residents with SMIs are not currently receiving treatment. For those with SMIs and other psychiatric disorders, a growing body of research demonstrates that natural disasters exacerbate mental health conditions, including post-traumatic stress disorder (PTSD), depression, and anxiety. But according to Ignacio Vila, a community mental health and substance abuse counselor who has worked in Puerto Rico for 30 years, “Everyone is at risk. Natural disasters can take a significant toll on one’s mental and emotional well-being, especially when basic needs are not met for an extended period of time, as is the case in Puerto Rico. The cumulative impact of little to no access to food, water, gas, electricity, and communication compounded by an overall lack of physical and financial security can be overwhelming.” And because all of Puerto Rico was impacted —including the airport— evacuating the island is not an option for the overwhelming majority of its 3.4 million inhabitants. As Vila puts it, “There’s no running away from the crisis. Many people are stuck in their houses without anything to distract them from the anxiety, uncertainty, and devastation they feel from seeing their livelihoods, their homes, and the island they love in ruins.” According to Vila, the destruction wrought by Maria is particularly challenging for those grappling with mental illness and substance abuse. Most of his patients receiving inpatient treatment, for example, had to be evacuated before the storm: “How will they fare through all of this? Who can they go to for support? Where will they get their medication? Who can they call when the phones don’t work, when crisis hotlines are down and hospitals are closed?” Vila contends that because resources are scarce, community and familial support is paramount: “It’s important for all of us on the island to surround ourselves with family and friends, to meditate, to pray, to take care of ourselves and each other, to be patient, and to focus on our own resilience and the power of solidarity.” Natural disasters also take an emotional toll on those with loved ones in the affected areas. For the millions of Americans with family and friends in Puerto Rico, feelings of guilt, sadness, heightened anxiety, helplessness, and general distress are commonplace – especially for those still unable to communicate with loved ones. Building community with other Puerto Ricans on the mainland to organize relief efforts and provide support is one way for those in the diaspora to stay connected to each other and to what’s happening on the island. “The road to physical, mental, and emotional recovery will be a long one,” says Vila. “We need all hands on deck.” To assist with Puerto Rico’s relief efforts, consider donating to the Hurricane Maria Community Recovery Fund. *** Maru Gonzalez, Ed.D., is a school counselor, scholar, social justice educator, activist, and co-founder of the Georgia Safe Schools Coalition. Dr. Gonzalez has appeared as a guest commentator on both CNN and CNN Español and regularly writes about politics, education, mental health, and social justice.