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Mental Health

María’s Hidden Toll: Puerto Rico’s Mental Health Crisis

Following the devastating aftermath of hurricane Maria, The New York Times published a video documentary following Puerto Rico’s only suicide prevention hotline Línea PAS. “Inside a Suicide Prevention Center in Puerto Rico” by Caitlyn Dickerson and Ted Bourne was published on January 6th, 2018, four months after the hurricane struck the island. PAS stands for Primera Ayuda Psicosocial, meaning First Psychosocial Help. The purpose of the hotline is to help the caller with orientation and counseling regarding possible emotional crisis. The hotline works 24/7 and 12 people work at a time.

Three months after Hurricane María, Puerto Rico was on the verge of a mental health crisis. Dickerson spoke to survivors on the island who indicated they couldn’t sleep. People spoke about their depression and recurring panic attacks, while hospital emergency rooms were filling up with patients reporting suicidal thoughts. In order to better understand the scope of Puerto Rico’s rising mental health crisis, Caitlin Dickerson spoke with counselors who were fielding calls at Línea PAS.

The documentary opens with a woman counseling a caller, reminding her of the value of her life over material things. This scene is followed by pieces of other counseling sessions, showing how the crisis managers work through their different cases and sometimes having to involve emergency services. The video shows the devastation left by the hurricane and, in a voice-over, Dickerson explains the growing mental health crisis in Puerto Rico.

The focus on the callers grows as one of the counselors explains the reasons behind Ana’s, her most recent caller, suicidal thoughts. Since Puerto Rico was left in the dark after the hurricane struck, she had spent 40 days without electricity, a fridge, or food which led her to a mental breakdown and with a feeling that she didn’t want to live anymore. Not knowing where your next meal will come from can throw anyone into despair, especially after surviving a catastrophic incident like a Category 5 hurricane. Ana’s case was just one of millions who were struggling through the same thing at the time. Many, like her, lost all of their perishable foods because of the lack of electricity and were dependent on care packages given by the government. To not be able to feed yourself or your family, which is one of the most basic necessities we have as humans, creates a sense of defeat and loss of independence that can lead to suicidal thoughts. Her feelings of despair, sense of loss, and desire to escape were shared by many and her case shown here is just one example of a person who was able to reach out and get help, unlike many who could not.


The documentary continues to take a closer look into the counselors themselves, who are struggling with the aftermath of María like everyone on the island. In a conversation between two counselors, one of them expresses how lucky she is to have a power generator for her home. In her case, she thinks the chance of getting electricity restored to her area any time soon is very slim, and says she doesn’t even hold out hope for it. This was a common feeling among many Puerto Ricans, but what makes this comment stand out is that it comes from a health care provider. The workers whose jobs were to convince people on the edge that everything would turn out okay struggled to do so because they were suffering the same circumstances. Regardless, these men and women did their best to help settle the anxiety and depression left in the aftermath of María and helped thousands of victims while they themselves struggled.

Dickerson explains how research shows that the effect of natural disasters can cause permanent psychological damage on the survivors. She mentions studies that were conducted after hurricane Katrina in New Orleans and in Haiti after the earthquake in 2010 that showed how moderate and severe mental illnesses have become more common. In Puerto Rico, three months after the hurricane, there were already signs of a mental health crisis. Experts say the most important step to overcoming trauma is to go back to a routine, as Dickerson states. But it was almost impossible to do since the island was on a very slow start to restoring itself: many people could not go back to work, which meant people were stuck on survival mode and unable to move on.

Before the hurricane, the rates of suicide on the island were on a steady rate of decline, yet, in 2017, suicides spiked by 29 percent according to the Health Department. The calls to Línea PAS tripled in the months of November, December, and January compared to the year before and continued to rise in the months after.

It has been almost a year after Hurricane Maria and its effects are still evident throughout Puerto Rico. There is not a soul in the island who was not affected by the hurricane in one form or another. In my experience, the worst part was the loneliness. My family was quite lucky and everyone went back to work within a week, but as a student, I couldn’t go back to my routine until the University reopened, which happened over a month after the hurricane. I spent entire days alone waiting for my mother to come home and would often get restless when night fell and she hadn’t returned yet. I would eat once a day when my mother brought me food back from work because we had to ration the gas for the burner, since it was on high demand and we could only buy two bottles at a time for very steep prices.

When I eventually returned to University, I spent months without electricity in my apartment and had to rely heavily on friends and family for resources. I was so lucky to have them; people who checked up on me, who cared if I was okay, who often dropped by just to check on me. If it wasn’t for them, I don’t know if I would be here right now. So if you’re reading this and you feel alone, whether it is a consequence of Maria or a consequence of life, just know you are not alone. There are people who care about you and love you. And if for some reason you can’t see or understand that right now, just remember that your life matters and you are important no matter what.


In light of Suicide Awareness Week, we will provide our readers with articles displaying narratives of thought, self-reflection, and the reality of the emotions, actions, and struggles we face as students but don’t often discuss. If you or a loved one are going through a difficult time, you’re not alone.

Línea PAS: 1-800-981-0023.


Natalia M. Betancourt Malavé is currently a fourth year B.A. student in the University of Puerto Rico – Mayagüez Campus. She studies English Literature while minoring in Writing and Communications with special course work in the Italian language and International Relations. "Success is not final, failure is not fatal: it is the courage to continue that counts." – Winston Churchill
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