JOPLIN, Mo. — When 30 percent of a town is blown away, something is bound to give.

Local psychologists say they are seeing increasing numbers of people with agitation, anxiety and depression. Patricia McGregor, a psychologist with Thompson and McGregor, of Joplin, has seen a significant increase in adult clients in the wake of the May 22 tornado.

“A lot of these people are direct survivors who have lost family members to the storm,” she said. “They have lost their homes, lost their vehicles, lost their jobs. And, there are the health care workers who were at one or the other of the hospitals who were not prepared to experience what they went through.”

So far, three suicides have been linked to the tornado, according to Ozark Center, the mental health arm of Freeman Health System. In a given year, Joplin has six to 12 suicides, said Rob Chappel, coroner of Jasper County.

Calls to the local mental health crisis hot line — 347-7720 — have increased significantly. Between May 22 and July 6, the crisis hot line received 1,752 calls, according to Debbie Fitzgerald, crisis intervention coordinator with Ozark Center. Of those, 40 involved people who were having suicidal thoughts. By comparison, the hot line received 371 calls in the month of April.

Assaults on women and other acts of domestic violence are up. In June 2010, Freeman logged seven assaults against women and nine against men. In June of this year, assaults involving eight men and 16 women were logged, according to Karen Scott, coordinator of the sexual assault nurse examiner program at Freeman Hospital West.

On May 22, Lafayette House in Joplin, a domestic violence shelter for women and children, had five women and six children under its wings. As of June 15, that enrollment had grown to 11 women and 19 children, according to Alison Malinowski Sunday, director of Lafayette House.

NO ONE UNTOUCHED

“I am seeing people who consider themselves not impacted by it, but they are having post-trauma experiences and they feel guilty about it,” McGregor said. “They did not lose their house, but their neighbor did. They did not lose their job, but someone they know did. That’s survivor guilt.

“I personally am grieving the loss of Dillon’s (grocery store). We have lost some of the touchstones that ground us — those things that are familiar to us. They are not there anymore.”

“We sometimes don’t want to acknowledge it, but we all have been impacted in one way or another. I know that losing a loved one is not the same as losing a grocery store, but you don’t want to minimize the effect it has had on each of us. We need to acknowledge that loss.’’

Even people who did not experience the tornado directly are dealing with vicarious traumatization because they have heard so many stories, and seen so many photos and videos of the tornado.

McGregor said it is not surprising that acts of violence are starting to show up.

“Right now is when we should expect to see an increase in those kinds of things,’’ she said. “We’re moving out of the shock and denial phase into the ‘Oh my God, this is going to last forever’ phase.

“There is going to be a long-term struggle for some people for quite some time. If they had problems before — marital strife, depression and anxiety — those will be magnified. People need to assess those things and not put them off. They will only get worse. They will not evaporate if you tell yourself to shape up and get over it.’’

IMPACT ON CHILDREN

Steps are being taken to minimize the impact of the disaster on children. On Wednesday, Gov. Jay Nixon unveiled a $2 million proposal to establish the Joplin Child Trauma Treatment Center to provide critical mental health services to children and families affected by the tornado. The center also will look at sexual trauma, physical abuse and emotional abuse.

Dr. Charles Graves, a psychiatrist who works with children and adolescents at Ozark Center, said some children will have difficulty adjusting to a world where they may have lost a parent, a home or a school.

“Some children may refuse to return to school,” he said. “Some may shadow their mother or father around the house, be sort of clingy. Some may have persistent fears related to the catastrophe, including sleep disturbances, nightmares, bed wetting, changes in the way they concentrate, and irritability. Some will be easily startled or spooked. Some will have behavioral problems where none were before.’’

These are normal reactions to a disaster of this magnitude, Graves said.

“It’s what humans do,” Graves said. “It’s not abnormal to react in those ways. But when it persists for a month or longer, when the symptoms impair function, that’s when you call things a disorder. That’s when you need therapeutic intervention.

“PTSD (post-traumatic stress disorder) is not a diagnosis that is only associated with war. It very readily can occur after an event of this magnitude. With PTSD, they re-experience the event in some way. They have flashbacks, intrusive memories or nightmares. They may feel like it’s happening to them again.

“Because of where we live, there will be other storms. These could be terrifying for children and adults.’’

ANGER, DEPRESSION

Anger and depression are normal human responses to be expected after an event like this.

“People will abuse alcohol and drugs, but it only impairs their ability to manage their emotions,’’ he said. “You will feel differently, but it only prolongs and worsens the experience.’’

What should one do if someone is struggling?

“What you should do is start with an honest, straightforward and gentle approach, and reflect to them what you have noticed about their behavior,” he said. “Practice patience. Make it OK for them to talk, and be honest and age-appropriate when you talk with them.’’

Calling a crisis hot line is a good way to start, he said. The person on the other end of the line can help segue the caller to the appropriate level of care.

“Do it sooner than later because it becomes harder to correct down the road,” Graves said. “Research has shown that people who are at risk benefit from early intervention.’’

Steps also are being taken to reach out to people who might be experiencing emotional distress.

Fitzgerald, the crisis intervention coordinator for Ozark Center, said “Healing for Joplin,’’ a project funded with Federal Emergency Management Agency money, is reaching out to people who might not otherwise seek help.

To date, 11,067 people have had contact with someone from the project.

“We have six teams of eight that are canvassing in pairs of two,” she said. “They have been going to businesses, the Red Cross recovery centers, child care centers, to places where people are in restaurants and convenience stores. They are going door to door.

“The goal is contact large numbers of people affected by the disaster through face-to-face outreach, linking them to mental health resources and disaster-relief services.”

Though the Hawthorn Unit, the mental health wing of St. John’s Regional Medical Center, was taken out by the tornado, behavioral health nurses like Judy Lauck and Angie Appleby are still providing one-on-one support at the mobile unit St. John’s is operating as it works to rebuild the hospital.

“We are seeing people come in who are depressed,” said Lauck, a senior staff nurse with the Hawthorn Unit. “We refer them to suicidal resources if they need that. We are still doing one-to-one counseling as it’s needed.

“Among the signs of depression we are seeing is not sleeping, appetite changes, not wanting to talk, spending more time with themselves, isolating themselves, and avoiding social functions and things they used to do. These signs should be expected after something like this.’’

Now that the shock has worn off, people are focusing on real-life priorities and issues.

“They don’t have a home,” Lauck said. “They don’t have a job. They have lost their place of business. They have all kinds of things going on. They’re dealing with a lot of uncertainty, which can turn to anger over a long period of time.”

Said Appleby: “It can also turn into a sense of helplessness and hopelessness. That can cause marital problems, which only adds to the depression and loneliness.’’

Appleby, a therapist with the Hawthorn Unit, said she expects to see more examples of PTSD in the days ahead.

“They have been so busy cleaning up and suddenly they are not doing that anymore. They have too much time to think now about what has happened,” she said. “That’s when all of the symptoms of PTSD will come up.’’

VIOLENCE

Malinowski Sunday said research clearly shows “a community will become distressed after a natural disaster like this, and that can lead to an increase in domestic violence. It happened with Hurricane Katrina.

“Early on, we were pulled aside by FEMA and told to prepare for an increase in domestic violence six to eight weeks out,” she said. “By the middle of June, our numbers were increasing significantly. We have had a sharp uptick in sexual assault and substance-abuse calls.

“One woman told a domestic violence worker here: ‘My husband was never violent before the tornado.’ If you are experiencing verbal abuse and never had issues before, get help now before it gets worse. We’re looking at the long haul here. This is not going away a month from now.’’

Said Scott: “We’re just beginning to see the long-term consequences of this disaster. As the situation wears on, we will see the stress that comes from coping with a long-term situation. It will increase the risk of violence of all kinds.’’

Fitzgerald said: “As time goes on, people will become more frustrated as they try to navigate overwhelming tasks and the deadlines set by federal and local agencies. Depression will set in.

“We must come to terms with the fact that it’s going to be here for the long haul and that the emotional impact will continue on for an indefinite amount of time. People need to know we have the resources and help available to make them feel better. We don’t want anyone to suffer in silence alone.’’





Numbers for help

Here are some numbers to call if you need help:

The national mental health crisis hotline is 1-800-273-8255. The suicide prevention lifeline is 347-7720. The toll-free number is 800-247-0661.

Source: Ozark Center