Alex and Alyssa Spero embrace outside the Red Cross shelter at Kazen Middle School.
Alex and Alyssa Spero embrace outside the Red Cross shelter at Kazen Middle School. Credit: Roseanna Garza / San Antonio Report

Houston residents Alex and Alyssa Spero have been at the American Red Cross shelter at Abraham Kazen Middle School on San Antonio’s Southside since they were forced to evacuate their apartment during Hurricane Harvey. Regaining their material belongings will consume months, but the process of regaining their emotional footing began at the shelter.

As the water began flooding their apartment, the Speros – along with Alyssa’s brother, his wife, and their 3-month-old baby – went up to the second floor to find shelter in a vacant apartment. A family member called to let them know that the National Guard had been called to their location. The Speros were directed to stand outside and wave something in the air so that rescuers could spot them.

Alex Spero went outside and held a car seat in the air, waving it around like a flag. “They never saw us,” he said. “They left and we were not rescued.”

Spero was reminded that his neighbor had a makeshift wooden boat, and in what he called a “life-or-death decision,” he chose to swim the five blocks toward what he considered his family’s last chance to get out safely.

“I felt like I was getting bit a lot,” he said. “I saw catfish and gators, but my main priority was my family.”

Retrieving the boat, Spero got his family into the craft and began to pull them to safety with a rope attached to his waist. Then the rain started again, which scared Spero and his family the most.

“The adrenaline was pumping so fast that I shoved my emotions to the side,” he said. “I feel like I’m still fighting back all of my emotions. I’ve never been in this situation.”

After his family was safe, Spero and his brother-in-law continued to use the boat to rescue others. He remembers assisting six families “until [his] body started locking up.” At that point he decided to rest, worried that if he pushed himself too hard he would drown.

When the Speros arrived at the Red Cross shelter at Kazen Middle School they felt emotionally drained.

“It’s very devastating to be in a shelter,” Spero said. “It’s kind of hard, but we are getting everything we need. We are treated well. The Red Cross is amazing, and [the San Antonio Police Department] has been excellent and a great informational source for help around San Antonio.”

In their conversation with the Rivard Report, Alex Spero did most of the talking, whereas Alyssa remained quiet throughout. When asked if she wanted to share anything from her point of view, she became tearful.

“I can’t. I’ll cry,” she said as tears began streaming down her face. “This is the worst moment of my life so far.”

For many, the effects of Hurricane Harvey were traumatic. Whether they swam out of the flood waters to safety or evacuated only to return to a home that had been decimated, the toll that these experiences take on a person’s mental health can be tremendous.

Lynn Hottle is a licensed clinical social worker and American Red Cross volunteer from Maryland who was stationed at the Kazen shelter. Hottle said that the emotions displayed by the shelter’s temporary residents range from extreme hopefulness to anger. People are worried about how they will receive their Social Security benefits now that their bank or home has been flooded. Many have been displaced, and some don’t know the condition of their home or if they even have a home to return to. Most struggle with all of the unknowns.

“We provide help and support for clients and staff in the shelter,” Hottle said. “[Our] role is to offer support, advocate for staff and clients, [and] when people ask us questions we help them find the right resource.”

With hundreds of people packed into shelters following a stressful and traumatic situation, tension may rise quickly.

Cots for displaced evacuees line the gymnasium floor at Kazen Middle School in San Antonio.
Cots for evacuees line the gymnasium floor at Kazen Middle School in San Antonio on Aug. 27, 2017. Credit: Scott Ball / San Antonio Report

“[People experience] the entire range of emotions. [We do] a lot of work with grief and loss – this is a loss,” Hottle said. “People could be grieving the loss of their livelihood. They have been separated from their families. It’s confusing, it’s frightening for people, and its frustrating.”

While Hottle and other disaster mental health employees are licensed to provide mental health services in their home state, state-by-state license restrictions do not allow them to provide direct therapy to those staying in Red Cross shelters, she said.

The Red Cross mental health workers are trained to defuse heightened emotions. For those in need of specialized or ongoing therapeutic services, they turn to local organizations.

Hottle, who has deployed as a Red Cross volunteer a number of times, told the Rivard Report that the mental health of those in a helping position during a crisis is of equal importance to that of those who were directly affected by the event.

Red Cross mental health workers also provide supportive services to fellow volunteers. Hottle recalled a time during a volunteer deployment where a staff member had to be sent back home because “they [were not] able to emotionally deal with it.”

“It’s a roller coaster when I listen to the stories,” Hottle said. “I’m a human being. I feel sad.”

The Center for Healthcare Services (CHCS), San Antonio’s local mental health authority, has ensured that licensed mental health workers were stationed at shelters 24/7 to provide any needed therapeutic services to evacuees.

David Pan, director of acute care services at CHCS, told the Rivard Report that the center is prepared to take on the mental health services for those who enter Bexar County at any given moment. He said that the center has been around since 1965, and its employees are well-versed in disaster preparedness and response.

“Any time there is a natural disaster, we provide ongoing [mental health] services to those who need it,” Pan said.

In addition to the stress and trauma victims experienced, Hurricane Harvey’s aftermath includes an additional strain on those already grappling with drug addiction and mental illness, further depleting their emotional resources.

Pan said that CHCS worked diligently to address the needs of people who were in treatment for substance addiction and found themselves in San Antonio after evacuating.

“We tried to coordinate people who had substance use [issues or were] on opioid treatment, identify them, get them in our methadone clinic to get them that or Suboxone,” Pan said. “It was mostly crisis intervention.”

Opioid withdrawal symptoms include muscle aches and pains, agitation, insomnia, abdominal cramping, and diarrhea, and may last for more than a month. Often the debilitating symptoms of withdrawal lead people back to using. Pan told the Rivard Report that getting these people the treatment they need is a form of crisis intervention because they might relapse if they run out of their medication.

Of the evacuees who came to San Antonio, Pan said, only three or four people over the span of the last few weeks were in need of acute care services. “We had several instances where people did need crisis stabilization,” Pan said. “We brought them to our extended observation unit,” where they remained for 48 hours until their symptoms stabilized.

“People were already overwhelmed,” Pan said. “Maybe they had a diagnosed mental health concern [such as] schizophrenia, bipolar [disorder], or depression, who were not safe in the shelter, or maybe they were feeling suicidal.”

These individuals are treated by CHCS, which contracts with the Department of Health and Human Services, to provide services to “whoever comes needing services.”

Pan said that the Red Cross, FEMA, the Salvation Army, and the Bexar County Department of Behavioral and Mental Health are some of the organization that shared the brunt of providing services to those displaced by Harvey; CHCS was the sounding board as members of the various agencies worked to meet evacuees’ needs.

“Most of them just needed someone to talk to,” Pan said.

CHCS employees provided the majority of mental health services to evacuees in San Antonio; they also put out a call for volunteers licensed to provide mental health services to assist with around-the-clock coverage of local shelters. Those volunteers provided brief crisis intervention counseling, helping people to digest, accept, and heal from a traumatic experience, Pan said.

“Generally, people need to process what went on, relieve some emotion, and relieve some worry,” Pan said. “The capacity to deal with what was happening kind of overwhelmed their internal resources and they just needed someone to process things with.”

What helped mental health efforts across the state was the fact that “no one community got the brunt of everyone coming to their city,” Pan said. He recalled that Houston was a primary evacuation location when Hurricane Katrina hit, receiving around 75,000 people from New Orleans.

As people leave Bexar County and begin to return home, CHCS works to connect them to resources in their communities for a continuation of services. For many, processing immediate feelings of fear and despair during the time they were displaced may be the extent of their needs.

Pan said that some people’s traumatic experiences may begin when they return home. Post-traumatic stress disorder (PTSD) may set in as people return to the their communities destroyed by Hurricane Harvey. Stress may increase as people are unable to return to their homes and jobs, with the potential for an onset of major depression.

The experience of New Orleans residents in the aftermath of Katrina provides insight into how a traumatic natural disaster can impact a city.

The New Orleans Health Department issued a 2012 report on the state of mental health in the city. Seven years after Katrina, it concluded that while stress and trauma related to Katrina increased the need for mental health services, the infrastructure needed to service traumatized individuals was also impacted by the storm.

New Orleans has mostly recovered from the physical and psychological devastation of Hurricane Katrina, but for years after the storm survivors struggled with mental health challenges. Depression, anxiety, addiction, and, for those who experienced life-and-death scenarios, PTSD were common. In fact, one study found that rates of mental illness in New Orleans doubled after the storm.

In an attempt to make mental health services more accessible, the State of Texas has made it easier for out-of-state mental health workers, psychologists, and medical professionals to assist disaster victims by issuing temporary licenses for people in good professional standing to practice in the state during the time Gov. Greg Abbott’s disaster declaration is in place.

The Speros are returning to Houston prepared to brave the unknown; what they know for certain is that they will not be able to return to the apartment they once called home.

“Sometimes I feel like if I wake up, that this was just a bad dream and everything will be okay again,” Alex Spero said. “But I know that it won’t.”

Roseanna Garza reports on health and bioscience for the San Antonio Report.