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Mental health issues increasing as Sonoma County enters new phase of fires' aftermath
The Press Democrat - 11/26/2017
Nov. 26--Martha Marquez is not prone to cry at movies and usually keeps a tight rein on her emotions. But when a Red Cross worker called her up recently and told her she was checking on her mental health after the loss of her Santa Rosa home, Marquez could not hold back the tears.
"She said to me, 'We know everyone is offering financial assistance and donating stuff, but what about mental health? How are you doing?' and I just started crying," she said.
Marquez, 56, lost her home on Fairway Knoll Court when the Tubbs fire raced up the northern slopes of Fountaingrove on Oct. 9. The firestorm also completely destroyed Paradise Ridge Winery, where she worked as an event manager and where her husband, Fernando, worked as the estate property manager. Her daughter, Brianna, also worked at the winery part time.
For more than a month, Marquez and her family have been dealing with the daunting logistics of recovery, federal aid forms, insurance claims and home reconstruction estimates. But now something else has settled into her life like a thick fog, caused by the overwhelming uncertainty of the future, the loss of control and the inescapable memories of that traumatic night and the days that followed.
"I'm normally a very positive person, usually in a good mood. It's just that I'm a little lost," Marquez said. "First I was saying, I'm taking it day by day, and now I'm just saying, I'm OK."
October's deadly wildfires have left an untold number of North Bay residents battling new levels of stress, anxiety, depression and other mental health issues that experts say are anticipated in the wake of such a profound tragedy.
Therapists and other mental health professionals are seeing an increasing number of people seeking help, and Sonoma County officials are bracing for what could be an unprecedented wave of mental health care issues stemming from the historic disaster and its ongoing aftermath.
They say the growing need for mental health services will require a communitywide response that goes hand in hand with any regional strategy for rebuilding decimated neighborhoods and businesses.
"It's been six weeks since the fires -- the impact on the community has been incredible and it's not going to just go away," said Maryellen Curran, a clinical psychologist and the mental health director for Santa Rosa Community Health, the county's largest system of health clinics.
Curran said the demand for mental health is on the rise in the past few weeks, with many patients exhibiting signs of enduring grief, depression, irritability, anger and sleep disturbance. The level of these symptoms depends "on the exposure they had to the immediacy of the fires," she said.
Curran and other mental health experts say that for those who lost a loved one or fled from visible flames that ultimately consumed their home, the mental health effects will be more profound.
Michael Kennedy, Sonoma County's mental health director, said the number of calls received by his department has doubled since the fires, with many of those calls coming from new patients. Local health care providers and clinics have only now begun to log the increase in patients seeking mental health assistance and it could be sometime before the impact on the local community's mental health is fully assessed.
For Marquez, the fires have left her feeling like a different person.
"It's an emotional roller coaster. I'm not a crier at all ... that's why I know I need help, because my mental health is not getting any better," she said.
Marquez, who lived with her husband and daughter about a mile and a half from the winery where she worked, was awakened the night of the firestorm by a phone call at about 1 a.m. from an elderly woman, a tenant at the winery estate, who said she and others were evacuating the property. The tenant asked that Fernando call the winery owners.
Marquez, who along with her husband decided to drive by the winery, said she got dressed and went outside and saw smoke and ash, and could see cars speeding down Thomas Lake Harris Drive, away from Cross Creek Road and the Mark West Springs area.
"I told my husband, 'I am not going to the winery, I'm getting the hell out of here,'?" she said, adding that the three left in separate cars and embarked on a frightening exodus she knows will haunt her for sometime.
She experienced flames and embers flying in the howling wind, trees and branches in roadways, the smell of heavy smoke and the fear of being burned alive in her car while stuck in traffic.
"My husband and I both feel like we don't have control over our lives," she said. "Your financial future, your home, everything has just kind of been stripped from us. It's hard to make decisions, because you don't feel like you're mentally healthy and you have to make very big decisions."
As Sonoma County and other fire-affected areas approach the second month since the firestorms, experts say we are poised to enter the "phase of disillusionment" -- a period that follows the initial phase of cohesion where an entire community unites, exemplified perhaps by the slogans now seen throughout the county: "Sonoma Strong" or "The love in the air is thicker than the smoke."
Based on research following other natural disasters, the disillusionment phase is defined by a downward slope of emotions that experts say could last six months or longer, depending in large part on the amount of time it takes for the thousands directly affected by the fires to recover and rebuild.
"It's got to be a whole community response," said Kennedy, the county mental health director. "We're going to try to pull together all community members to all be involved."
Kennedy said that includes getting special disaster-related training for health and human services employees and reaching out to local therapists, insurance plans and community-based agencies.
Trauma experts Robert Macy of the International Trauma Center and Melissa Brymer, program director of terrorism and disaster programs at the UCLA Neuropsychiatric Institute, are scheduled to visit Sonoma CountyDec. 5, to help local officials develop a long-term mental health plan.
In a Nov. 21 presentation to the Sonoma County Mental Health Board, Kennedy used a chart describing the different phases of disaster psychology. He said the chart was developed by mental health experts after Hurricane Katrina, which killed more than 1,833 people and caused up to $108 billion in damage.
The chart, which tracks emotional highs and lows, shows the period of disillusionment, with slight dips and rises caused by "trigger events," lasting all the way to the anniversary of the disaster. From then on it's an emotional climb toward the period of "reconstruction."
Doreen Van Leeuwen, a licensed marriage and family therapist and specialist in critical incident response and disaster mental health, said that for many fire survivors, the emotional highs that brought the community and many fire victims together will soon fade.
Van Leeuwen, who lives in Santa Rosa'sSt. Rose neighborhood, said the uplifting and unifying qualities of "Sonoma Strong" begin to wane when people have to face the fact that it's going to take longer than they want to rebuild and that, for some, the money that they're getting from insurance companies isn't going to cover rebuilding. For many if not most renters whose homes burned down, there is no rebuilding in their future, she said.
"The extent of the disaster here is causing a lot of upheaval in every aspect," said Van Leeuwen. She and nearly 100 therapists with the Redwood Empire chapter of the California Association of Marriage and Family Therapists have banded to offer three to five sessions of counseling to anyone affected by the fires.
"I would say we have a whole community that's grieving right now," said Sonoma County Supervisor Shirlee Zane. "There's also a tremendous amount of people beginning to experience the symptoms of grief."
Zane, a former family therapist, said both grief and trauma have physiological effects, such as headaches, panic attacks, diarrhea, stomachachescq, sweating, having chills or being easily startled.
Losing a house in a violent firestorm can leave people feeling powerless, almost insignificant, compared to the raw, indiscriminate power of a natural disaster, Zane said.
"For my wife and I, we're really kind of feeling the reality that people not directly affected by the fire are moving on," said Brad Silvestro, who lost his Rincon Valley home on Deer Trail Road on Oct. 9.
Silvestro, a paramedic with Sonoma Life Support, and his wife, Schiffbauer, a Kaiser Permanente nurse, say they are thankful and overwhelmed by all the community support they've received. But weeks will eventually turn to months, and hurdles and obstacles to rebuilding seem endless, the couple said.
"The lows are lower now," Silvestro said. "Every day you remember something you don't have. Every day you realize you have lost everything ... there's not a day that goes by where what happened is not in my consciousness."
But Silvestro said he finds strength in his refusal to be a "victim" of the firestorm.
"Being a fire survivor gives us that motivation to keep moving," he said. "We're at the bottom of a hill. We have to get to the top; there really is no other option."
Widespread disasters like the fires call for population-level health strategies, said Dr. Jason Cunningham, medical director of the West County Health Centers. Cunningham and mental health staff at WCHC have launched a "mapping" effort to identify all the health center's patients potentially affected by the fires.
The project involved combining "fire maps" with home address data from WCHC's patient database. Cunningham said the mapping identified some 700 active patients who had been seen within the last 18 months by a primary care provider at one of WCHC's health centers.
"People are settling into reality," Cunningham said. "We're seeing a lot of stress, worsening depression, anxiety ... It's no longer, you're running away from a fire, it's what's this going to mean for my family and children going forward."
Aimee Gray, 42, of Santa Rosa has turned to Facebook for what she calls "self-therapy." Gray recently posted a long message to the Santa Rosa Firestorm Update page on Facebook, warning that the "PTSD thing is VERY real."
Gray, who fled her doomed home on Bennett Ridge with her husband and young daughter on Oct. 9, said she's now dealing with the aftermath of what is "officially the scariest night of my life." She's said she's considered counseling as she reflects back on the events of Oct. 9.
Awakened by the persistent barking of her dog at 2 a.m. and then the sound of several explosions, she got out of bed and smelled smoke as soon as she opened her bedroom door. Gray thought her home was on fire and ran to the other side of the house in search of flames. From her view overlooking Bennett Valley, the sky was glowing bright red. She texted her mother an alarming message and minutes later was leaving her home with her young family.
"Embers were flying on top of us as we were getting into our vehicles," Gray said, adding that flames had already come up on their porch when they left. "We knew we were losing that house as we drove away."
They headed toward a friend's house in Windsor, unaware that the Tubbs fire was leveling neighborhoods in north Santa Rosa. Unable to get on Highway 101, they drove into northwest Santa Rosa, near the inferno that was consuming Coffey Park.
"We saw Coffey Park on fire ... we didn't know where to go at that point," she said, adding that somehow they found a way to River Road and then arrived at their friend's house in Windsor.
In her Facebook post, Gray describes recently smelling fireplace smoke for the first time since that night.
"This was very strong since it was so close," she wrote. "The hair went up on the back of my neck from the smell and I couldn't get back in the house quick enough. I started dry-heaving and then sobbing."
Gray said she shared her story because she hopes it will help others who are feeling the same way. She said that as her life is getting back to normal -- "not having to go to FEMA, not having to go to the Red Cross" -- she has more time to reflect and to focus on her emotional state.
"I'm starting to do laundry, a normal life is taking over, you have time to reflect and see what's going on," she said. "That's why a lot of people are like, 'Oh, well I really need to get help.'?"
You can reach Staff Writer Martin Espinoza at 707-521-5213 or firstname.lastname@example.org. On Twitter @renofish.
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