Healthcare has been a serious concern in Puerto Rico for years. Inequality in federal funding, the continuing loss of medical professionals as doctors and nurses leave the Island for the States, Zika virus and Dengue fever outbreaks, and the additional healthcare issues following Hurricane Maria — these issues have all created healthcare problems much more severe than those faced in any of the 50 states.
Senator Elizabeth Warren (D-MA) and members of the Massachusetts congressional delegation recently sent a letter to Elinor McCance-Katz, the Assistant Secretary at the Substance Abuse and Mental Health Services Administration (SAMHSA) bringing up another health concern relating to Puerto Rico: the mental health of the U.S. territory’s residents in the aftermath of Hurricane Maria.
The Massachusetts delegation
Senator Warren led a congressional delegation trip to Puerto Rico last month to get a first-hand view of disaster recovery efforts on the Island. The delegation returned from this visit convinced that conditions in Puerto Rico were worse than they had been told. In the video below, Warren asks about some of the contradictions she saw.
In the letter, the delegation informs SAMHSA that Puerto Rico is not back to normal. They acknowledge that getting back into a normal routine is key to mental health after a traumatic experience, and that many in Puerto Rico continue to live not only without jobs or school attendance, but also without roofs, drinkable water, or electricity.
Not only does this situation leave individuals vulnerable to trauma and associated mental health issues, but people with pre-existing mental health issues have in many cases lost access to medical care and medication. The delegation emphasized that their concerns were not based on “what if” speculation, but on their direct observations and conversations with health care professionals in Puerto Rico. “Hospitals reported an influx of patients with suicidal thoughts, and the suicide rate increased by 30%,” they wrote.
SAMHSA administers disaster-related mental health services. According to SAMHSA, “overwhelming anxiety, constant worrying, trouble sleeping, and other depression-like symptoms are common responses before, during, and after” hurricanes. In response, they offer a Disaster Distress Hotline, the Disaster Technical Assistance Center, and grants for counseling following natural disasters.
Not in Puerto Rico.
In their letter, the delegation expressed concern that U.S. citizens in Puerto Rico, many of whom have experienced months of ongoing trauma from the Hurricane, do not have access to these services. “SAMHSA operates a national network of crisis centers through its Suicide Prevention Lifeline,” they wrote, “yet Puerto Rico does not have a Lifeline-affiliated call center.”
Puerto Rico has not received grants for assistance from the many grant programs SAMHSA administers, the letter points out, listing three such programs as examples.
The letter expresses concern for the U.S. Virgin Islands as well, and goes on to request information from SAMHSA:
- What resources have been requested by the territories?
- What resources have been supplied in response to requests?
- Does SAMHSA have information on mental health care needs and resources in the territories, including the extent of coverage under Medicare and Medicaid?
- What mental health care resources are provided and what further resources are needed?
Senator Warren has been generally active in supporting disaster support for Puerto Rico.
Read the letter: Warren Letter on mental health