Nothing about the Flint, Michigan water crisis was discrete or isolated in nature. After city officials changed the city’s water supply from Lake Huron to the Flint River in 2014 without treating it for contaminants, they denied for over a year that there was a problem, despite tests revealing high bacteria and lead levels in residents’ water. By the time they switched back in October 2015, it was far too late; corroded pipes had leached enough lead to cause a bevy of physical-health issues from bacterial infections to infertility and what would turn out to be neurological damage in children. Now, new research shows that the mental-health effects of living through the Flint water crisis have likely been just as debilitating and long-lasting.

A representative survey of nearly 2,000 Flint residents conducted in late 2019 and early 2020, nearly five years after the start of the water crisis, found that one in five people had presumptive major depression in the past year, one in four had presumptive post-traumatic stress disorder (PTSD), and one in 10 had both conditions (“presumptive” only because respondents met the DSM-5 diagnostic criteria for the disorders but weren’t individually diagnosed by a clinician). To be clear, this prevalence of depression is more than twice that of the general U.S. population, while this rate of PTSD is nearly five times as large.

These numbers speak to the major psychological toll of the crisis—in fact, a secondary crisis that is likely still ongoing. “In studying other kinds of environmental and man-made disasters like 9/11, we’ve found that while the majority of people experience distress immediately after, that number will drop in the first couple months before basically leveling off,” says Dean Kilpatrick, PhD, lead author on the study and distinguished university professor of psychiatry and behavioral sciences at The Medical University of South Carolina. “I wouldn’t suspect that if we went back to the same Flint residents now, that we’d see much improvement.”

“They’re dealing with the impact of being potentially exposed to something toxic, where they don’t know how much exposure they got, how deadly it was, how long it’ll take for the effects to show up.” —Dean Kilpatrick, PhD, senior investigator at The Medical University of South Carolina

This slow and terrible burn mirrors the path of the crisis itself—which, like many crises involving exposure to toxic substances, didn’t really end when it ended. Even when officials deemed Flint water safe to drink in January 2017, “residents had a hard time trusting that this was actually the case, and rightfully so, given these same officials had misled them before about the quality of the water,” says Dr. Kilpatrick. “At that point, they’re also still dealing with the psychological impact of being potentially exposed to something toxic, where they don’t know how much exposure they got, how deadly it was, how long it’ll take for the effects to show up.” All this remaining uncertainty, he suspects, is what’s now causing the mental-health crisis in Flint to linger so profoundly.

Why environmental disasters like the Flint water crisis are also mental-health disruptors

Any environmental disaster threatening the safety of a person’s livelihood or minimizing their access to basic resources like food, water, or shelter has the potential to be a traumatic event, in its own right. Consider, for example, the traumatizing effect of being displaced from your home, suffering from environmental health consequences, or struggling to access the very things you need to survive or thrive.

In fact, ample research has shown that environmental disasters ranging from hurricanes and tornadoes to oil spills and wildfires often result in psychological distress that can mount into mental-health consequences like depression, PTSD, anxiety, and substance use.

In the case of the Flint water crisis, the mental-health impact was likely magnified by both the sudden onset of the crisis and its lengthy duration, according to study researchers. “Consider the mechanics of suddenly not being able to drink your water or bathe, and having to switch to bottled water for everything,” says Dr. Kilpatrick. “That is a stressor, in and of itself.” And it was one that went on for years, too, as the contaminant levels in Flint’s water remained elevated long after the water supply was reverted (and even once the water was once again drinkable, residents still, understandably, remained skeptical).

Add in the very real health effects of exposure to toxins—in Flint’s case, primarily lead—and the mental-health implications of this kind of crisis are magnified further. Not only can lead exposure itself trigger certain psychological issues (like changes in mood, energy, and irritability), but also, its physical health detriments can lead a person to a state of distress.

“Imagine learning that you may or may not have consumed something that will kill you, or have these other adverse physical effects, and it may be that these effects will show up right away or in 10 or 20 or 30 years,” says Dr. Kilpatrick. “You’re going to be stressed out.”

How the psychological fallout of environmental crises is unevenly distributed

As with most crises, the people impacted the worst by the mental-health burden of the Flint water crisis were the ones in the most vulnerable position to start—and with the most limited access to recourse. For example, people who believed that their or their family’s health was “moderately or greatly harmed by the water crisis” were 123 percent more likely to have depression, 66 percent more likely to have PTSD, and 106 percent more likely to have both conditions at the time of the survey. Which is to say, people who experienced physical harm from the water crisis were more likely to get the double whammy of mental-health issues, too.

The study also found that people who felt they couldn’t trust information from city officials about water safety were also more likely to develop depression or PTSD. And chances are, many of the people in this group were also people of racial minorities, given the ways in which systemic racism has caused and amplified institutional distrust in these groups.

In fact, Flint is a predominantly Black community, which made it more susceptible to this crisis in the first place. The residual effects of racist redlining practices and residential segregation make it more likely for Black people to live in poorly resourced neighborhoods rife with environmental hazards. Just take Jackson, Mississippi, also a predominantly Black city where, in this case, city officials failed to invest in an effective water treatment center such that it was easily overrun by a rainstorm last month, leaving residents without drinking water for weeks. In much the same way, it was a lack of investment by city officials in Flint (to effectively ensure that the Flint River’s water was safe to drink) that jeopardized the city’s mostly Black residents from the jump.

To take it one step further, the study also showed that those in Flint who reported the lowest income, lack of social support, and previous exposure to traumatic events, particularly physical or sexual assault, were also significantly more likely to experience depression and/or PTSD in the wake of the water crisis. And this just goes to show how quickly and tragically a crisis like Flint can have the largest compounding effects on the people least equipped to handle them.

What can be done to reduce the psychological burden of environmental disasters

This study is evidence that there’s not only a physical-health consequence to environmental disasters; there’s a very real and long-lasting mental-health consequence, too. And while this certainly underscores the need for infrastructure investment—particularly in such life-essential resources as water and in such historically under-resourced areas as Flint—it also demonstrates how important it is for local officials to consider long-term mental-health outcomes in crafting their response to disasters.

Part of that simply means acknowledging that the disaster is, in fact, happening, right from the start. As noted above, Flint residents who didn’t trust government officials during the water crisis experienced worse mental-health consequences than those who did—and much of that distrust sprang from these officials’ initial response to deny, deny, deny. Instead, authorities who run up against a similar environmental issue “ought to think to themselves, ‘What if this is actually a real crisis?’ And they ought to avoid blithely telling people, ‘There’s no issue here, nothing to see here,’” says Dr. Kilpatrick, “because if they blow their credibility in the beginning, it’ll create far more serious issues down the line.”

At the same time, it’s essential for communities to expand access to mental-health resources in the wake of a crisis like Flint’s. Though Flint city officials did launch some new mental-health support services in 2016, with the help of federal funding, these initiatives were likely too little, too late. Only about 34 percent of respondents in the above study said they were offered mental-health services to help with concerns related to the crisis, despite clear survey evidence at the time demonstrating a significant need.

Of the Flint residents who were offered mental-health support, nearly 80 percent used it (and those who did so were significantly less likely to meet the criteria for depression at the time of the study). Even so, that number isn’t 100 percent, which reflects the additional need to reduce the stigma of accessing mental-health care when it’s available, says Dr. Kilpatrick.

City officials can help by normalizing the fact that psychological consequences can and do occur in response to eco disasters (in just the same way that physical ones do), and by promoting psychological care from the outset. This will be especially important for people with preexisting risk factors, like for example, those who’ve experienced traumatic events in the past, adds Dr. Kilpatrick: “It’s essential to understand that these things have an accumulative effect on the likelihood that PTSD will exist—and persist.”