Kathy and Mark Michaels huddled in the attic of their Long Beach home as Superstorm Sandy turned streets into canals, ripped apart the iconic boardwalk and snapped electrical lines. As blue police lights flashed in the howling wind, the acrid stench of burning buildings wafted through the air.
"I was very worried the whole roof was going to come down on us," Kathy Michaels said. "We were holding hands. We thought it would maybe be our last night on earth."
Michaels has tried antidepressants, psychotherapy and weekly support group meetings to cope with her trauma. She's back in her home now, but says she is forever changed.
"You don't like things like this to define your life but I don't think I'll ever be the same," said Michaels, 60. "I'll never be psychologically the same."
New York health officials estimate about 700,000 residents are still experiencing mental health problems from the storm, which hit on Oct 29, 2012. New Jersey officials did not have a similar estimate but in the 15 months after Sandy, the state supported a disaster mental health program that served 500,000 people.
"There's just this sort of cumulative stress that has taken a toll on people," said Renee Burawski, director of Office for Sandy Recovery in the New Jersey Division of Mental Health and Addiction Services.
It manifests in different ways, such as children avoiding showers because they remind them of rain or an inability to track bills or paperwork. And sometimes it's a forecast of bad weather.
"It's left me in a very panic-stricken state of mind," said Connie Livolsi of Long Beach. "I've never been this frightened. I don't feel safe anymore."
The sooner people get help, the easier the recovery. The Mental Health Association of New York City launched a program last week called iHelp: Sandy Stress Relief. It offers access to counselors and resources to help with anxiety, substance abuse and other issues. The program is free and available 24 hours a day in English or Spanish. The goal is to give people coping skills so they can be more resilient in future traumas, said association executive vice president Kathryn M. Salisbury.
"Shelter, safety and basic needs are the ones that get dealt with before you begin to seek help for emotional issues," Salisbury said.
Dr. Kerry Symon, director of the disaster distress response program for The Visiting Nurse System of New York, said her agency is working with 450 clients in the region through 10-week programs that teach behavior modification and relaxation techniques. "It really is about what else in their lives can help them," Symon said.
Breezy Point resident Marty Ingram says exercise, eating right and doing something constructive has helped. The former chief of the Point Breeze Fire Department was leading one of three volunteer fire departments when Sandy pushed ashore. A fire fed by gusting winds burned 130 homes and flooding stalled vehicles. Now Ingram is working with a partner in Canada to build fire vehicles that can operate in floodwaters. "That's helped me," Ingram said. "Sometimes I get upset that we lost so many homes on my watch."
The Mental Health Association in New Jersey Inc. had about 250 counselors going door-to-door in the 10 most affected counties after Sandy. About 25 are still making visits. Vice president and chief operating officer Robert Kley said there has not been a large demand for mental health services recently. Kley said large outreach efforts initially may have helped but people may also still be focused on getting home.
"The recovery process is taking a longer period of time," Kley said. "We're kind of feeling we're going to see some of the longer-term impacts coming out a bit more."
Symon said clients were initially depressed and anxious but anger over city and state recovery programs has become the focus. "I don't think (the depression) is gone but I think the rebuilding process is taking over," she said.
Psychotherapist Laurie Nadel, whose home also flooded, has hosted two support groups in Long Beach, and the meetings focused on trauma and ways to heal. Each meeting had tips, from breathing exercises to how to organize rebuilding paperwork. "Everyone is feeling a sense of loss or sorrow," she said. "The grief is realizing that the emotional depth of the loss we have experienced is more complicated than the physical loss."