The Flint water crisis, mental health, and lessons for other disasters

Years after the water crisis began in Flint, Michigan, many residents struggle with post-traumatic stress disorder and depression.

Researchers examined the toll of the crisis, when the city’s residents were exposed to unsafe drinking water in a scandal that drew national attention. Roughly a quarter (24.4%) of the residents met the criteria for PTSD, while 22% were experiencing depression, and 14% were found to have both disorders, according to the study published in JAMA Network Open.

Researchers found that many Flint residents need mental health services, and aren’t getting them, said Dean Kilpatrick, a professor at the Medical University of South Carolina and principal investigator of the study.

“If you still have PTSD or depression five years after something happens, it’s pretty much evidence that you either didn’t get the right treatment or you still need more treatment,” Kilpatrick said in a university news release.

• Read more: Mental health disparities lead to nearly 117,000 deaths

The toll of the water crisis in Flint carries implications for responding to other disasters, researchers said.

“National disaster preparedness and response programs should consider psychiatric outcomes,” researchers said.

Researchers sent surveys to Flint residents and received 1,970 responses. Roughly one in three respondents (34.8%) said they were offered mental health services. Most of those who were offered mental health treatment (79.3%) took advantage of those services.

The Flint water crisis generated outrage nationwide, as many assailed the response of city officials in a city where more than half the residents are Black. Residents faced the trauma of exposure to unsafe drinking water and misinformation from city officials, the authors of the study noted.

• Read more: Health groups say it’s time to integrate behavioral health with primary care

In 2014, the city of Flint began using water from the Flint River as a cost-saving measure, while a new pipeline to Lake Huron was being built. However, city officials didn’t treat the river water, and lead from the old pipes contaminated the system. Lead exposure can be harmful, particularly in children.

Officials initially told residents the water was fine and didn’t advise the public to stop drinking the water until September 2015. While the water supply was moved to Lake Huron in 2015, the city’s water-led levels didn’t drop below federal standards until 2017.

Flint was home to 100,000 people in 2010, and the authors estimate 25,000 may have had PTSD, while more than 22,000 residents are battling depression. Flint’s population dropped to just over 80,000 in the 2020 census.

Flint residents with lower incomes, those lacking social support, and those who had suffered previous traumatic events were more likely to demonstrate symptoms of PTSD and depression, the study found. Those factors should be considered in assessing mental health needs in other crises.

“For policy makers, it suggests that incorporating brief screening measures for this type of PTE and for social support could lead to better identification of individuals most in need of mental health services after disasters,” the researchers said.

Salma Abdalla, a research fellow at Boston University who participated in the study, said the Flint research offers important lessons for responding to other events.

“Our study adds to the growing body of evidence about the long-term substantial population mental health toll of environmental disasters,” Abdalla said in a news release.

“The findings highlight the importance of early action following environmental disasters such as the current Jackson, Miss. water crisis, and they showcase the importance of coupling efforts to fix the water supply system with clear communication by officials, to restore trust in the safety of the system,” Abdalla added. “Efforts should also include mental health resources to those who need it.”

The water crisis could have worsened mental health disparities in Flint, and the researchers said that merits ongoing study.

The researchers said it will require a coordinated effort from federal, state and local governments, working with healthcare organizations, to meet Flint’s mental health needs.

“These findings suggest that community-level public works environmental disasters have large-scale and lasting psychological sequelae,” the authors wrote. “The Flint community may require more concerted mental health resources to meet continued psychiatric need.”

It’s encouraging that so many of those who were offered mental health services accepted the health, researchers noted. Those who did get help were less likely to indicate symptoms of depression, although some were still likely to exhibit PTSD.

Researchers from the Medical University of South Carolina, Boston University, Dartmouth University and Duke University participated in the study.