A Mental Health Crisis Is Brewing Among These Flood Victims. The Worst Looks Yet to Come.

This story contains descriptions of depression, suicide and human remains.

WOODBURN, AUSTRALIA—Weeks later, Freddy Fiori was still haunted by the sight of the body. 

The first time, when it was real, she was trekking through the rubble of a fresh disaster zone, searching for survivors among the flood-ravaged hillsides between Uki and Mount Warning, some 100 kilometres south of Brisbane in Australia.

The 31-year-old cook was never meant to be a first responder. But with the emergency services missing in action for the first several days of the disaster, and as the rains continued to beat down, she, like hundreds of other local community members, had taken it upon herself to help lead the rescue effort.

“It's not the first time I saw a dead body—but this situation is different, so it will obviously affect you way more,” she told VICE World News. “It was like something that you see in the movies; not something you're expecting while you're trying to go and bring food to people that don't have access. You turn around, and you see that in front of your eyes.”

It was a man, caught in a fast-flowing creek, with his arm snagged in the crook of a fallen tree. The rush of the water meant his body was moving, and when Fiori and her companions first saw him flailing they assumed he was alive and trying to stay afloat. So they ran to help.

“As soon as we realised we stopped and were like, ‘Wait a second,’” Fiori recalled. “The people that were with us recognised him; they were looking for him.”

“It's still there [in my mind],” she added, later. “Like I'm focused and everything, but I can still see that. I see it every single day.”

Fiori is running a volunteer-led relief centre in the town of Woodburn, 50 kilometres south of Byron Bay. In the three-and-a-half weeks since some of the worst floods in Australia’s history swept through the area in late February, decimating whole communities and rendering thousands of people destitute, she has spent almost every waking hour at the centre. 

She coordinates relief efforts, takes donations and makes sure that the scores of newly homeless locals who wander in, shell-shocked, are fitted out with everything they need to survive. In so doing, she has beheld a seemingly endless flow of people in varying stages of trauma, grief, anxiety and despair.

The physical impacts of the floods are all too easy to see: the devastated landscape, the rubbish heaps piled outside every home, the crooked holes in the gables of houses where residents had to kick their way out. But now that the waters have receded and the full cost is being counted, there is another dark cloud hanging over these communities. As the dust settles and reality sets in, there are fears among locals and frontline workers that disaster victims may be staring down the barrel of a mental health catastrophe.

“It will hit,” Fiori says. “We haven't realised yet because we're just too into this; the adrenaline is still up and we actually don't have the time even to stop and realise what happened. But this is going to hit us, and we know that. It's going to hit us [all] in different respects.”

In flood-affected communities across northern New South Wales, many people VICE World News spoke to said more or less the same thing: amid the chaos, there hasn’t been enough time to feel depressed—but there will be. People are living in tents and cars indefinitely after losing homes that weren’t insured against floodwaters. The fallout from this disaster could impact generations of families, and the recovery is expected to take years. For many, the worst may be yet to come.

Authorities are bracing for the plunge. In mid March, NSW state premier Dominic Perrottet announced AUD$25 million ($18.75 million USD) in funding, to be used over three years, for trauma and recovery services in the most severely flood-affected communities—a support package that includes $7 million for increased access to psychological and clinical support, $5 million in grants for non-government organisations to fund trauma-based programs, and $3.5 million for mental health services like Headspace and Lifeline.

One million dollars has also been set aside to erect four pop-up “safe havens” in flood-affected areas, where people who are in distress or having suicidal thoughts can seek refuge and support.

On the ground, the cracks are already starting to show. Within half an hour of visiting the Woodburn relief centre for the first time, a VICE World News reporter saw one woman break down in front of a table stacked high with canned food. Her young daughter hugged her, sober and uncertain. Fiori has seen this, too: the moment when people’s resilience gives out, if only briefly, and they falter under the crushing weight of despair. She experiences similar moments herself.

“There's a lot of people that don't have a house; they sleep in a fucking tent—and that is something that affects me every day,” she said. “I'm crying about that.”

Gil Wilson, branch secretary of the NSW Nurses and Midwives Association at Lismore Base Hospital—the region’s primary hospital, located in the heart of its most flood-affected city—told VICE World News that many of the wards there were already running at capacity when the levees burst. In the wake of the floods, a perfect storm of factors has triggered an influx of patients seeking mental health assistance.

On the one hand, Wilson said, there are those with pre-existing conditions who have lost medications or access to treatments in the midst of the disaster, only for their symptoms to be exacerbated by the stress of the incident and its aftermath.

“The long-term effects for those with mental illness already is enormous,” Wilson explained. “Once they're in an evacuation centre, it's a very bad environment—not conducive to mental health… So basically their underlying conditions have gotten worse and then they've ended up in a mental health facility.”

On the other hand are those without pre-existing medical conditions, who have come to Lismore Base seeking help for various symptoms of depression, anxiety and post-traumatic stress.

“These are people who have lost everything. They've walked into their house and just looked at what their life was and they've dumped it on the side of the street,” said Wilson. “[Other] people were on their roof thinking they were going to die.”

In the aftermath of such trauma, Wilson said that he and other health care professionals he’s spoken to all share a common fear.

“People are concerned that there will be a lot of PTSD from this,” he said. “We're waiting to see, and this is a long-term effect, but particularly up in this area where it rains a lot—every time we get a heavy shower of rain now, I can imagine these people are going to build up a sweat.”

Dr Grant Blashki, a general practitioner and lead clinical advisor at mental health support service Beyond Blue, echoed this prediction. He explained to VICE World News that while many people’s initial reaction to a disaster like these floods is to “switch off the grief and the loss” as a defence mechanism, there will likely be some who develop the symptoms of PTSD.

According to Blashki, these can range from intrusive memories or dreams; a tendency to replay a traumatic event over and over in one’s mind; or obsessive rumination—that is, “constantly questioning ‘What if I'd done this?’; ‘What if we left earlier?’; ‘What if?’” Others, he said, may become detached or go completely numb.

“From what we know from the past, it doesn't surprise me that there are increased rates of post-traumatic stress, depression, anxiety, alcohol use and families under pressure,” he explained. “It's not linear causation, but [certain] mental health issues get exacerbated when we have extreme weather events.”

A study of the 2009 Black Saturday fires found that 22 percent of people in high impact communities were still reporting symptoms of mental health disorders at approximately twice the rate evident in low impact communities five years on. A study into the long-term consequences of Queensland’s 2011 floods, meanwhile, found that 26 percent of victims reported some health effects from the floods—including depression and insomnia—eight years later.

The accumulation of recent catastrophes is also having an effect, and as Blashki pointed out, “we're [currently] seeing the impact of a cascade of disaster events.”

“You had the fires in 2019, and the floods, and the pandemic. And there is research that this sort of layering of disaster events creates a lot of stress on communities and leads to increased rates of anxiety and depression,” he said. “So I think there really is a connection between how people cope with extreme weather events and their mental health.”

Worldwide, there are case studies drawing similar links between natural disasters and deteriorating mental health in impacted communities. Research from the University of York and the Centre for Mental Health, which examined studies on flooding events in the UK from 1968 to 2016, found flood victims were nine times more likely to experience long-term mental health problems like PTSD and depression than the general population, and that heavy rain triggered anxiety in some individuals several years down the track. 

After Hurricane Katrina, the prevalence of PTSD in affected regions rose from 15 percent a few months after the storm to 21 percent one year later as its impact bedded in, and the proportion of people experiencing suicidal thoughts more than doubled. 

A study into the impacts of the 2019 South Asia floods in Bangladesh meanwhile found that 57.5 percent of survivors reported having suicidal ideation four to five months later. More than five percent made a suicide plan, and two percent attempted it.

Blashki noted that suicide is a complicated issue, and it’s difficult to draw a line of causation between disaster-related trauma and an individual’s decision to take their own life. But in Australia’s flood-affected communities, stories are already circulating. 

A health worker from the area, who asked to remain anonymous for professional reasons, told VICE World News that one individual had found a dead body in the floods, called emergency services and been flown out alongside the corpse in a helicopter. They would soon after die by suicide from the trauma.

The issue of natural disasters and their psychological aftershocks only looks set to grow, too. The same day that Lismore and surrounds were first devastated by flash floods on Feb. 28, the Intergovernmental Panel on Climate Change (IPCC) released a report that not only forecasted an increased likelihood of extreme weather events like floods and fires, but also noted that repeated exposure to such events is associated with decreased mental wellbeing. 

As the Climate Council points out, “These mental health impacts include loss of sense of identity and place, heightened anxiety, risk of depression and suicide along with post-traumatic stress disorder and other adverse outcomes.”

“In the coming weeks and months,” Blashki suggested, “as the floods recede and individuals are actually left with the aftermath of it—the loss of property, or terrible situations where people have lost loved ones, or the financial devastation for a lot of these businesses—that's when it can really hit home for people.”

A short while later she was sitting in an aluminum fishing boat, ducking power lines with her baby swaddled in plastic bags against the rain as screaming animals floated down the river alongside them.

“We all had this collective feeling of absolute dread,” she told VICE World News. “It's so traumatic… There's a lot of trauma and people are just trying to recover from their evacuation stories.”

It was several days before she and her husband could return home. When they did, they discovered that they’d lost everything. But it wasn’t until more than a week had gone by that the full impact of that started to hit home.

“Everything is sort of a blur because there are thousands of people walking around, everyone helping, and you sort of feel really thankful and grateful that everyone's there. It's like, you're not processing your trauma or your grief because it's just such an amazing community spirit,” Adams explained. “But then as the days go on, there's no one here, and we're sort of just left with this empty shell of the house.”

“It just started in the last few days. My partner and I have been super depressed and we have a little cry every day.”

Adams is homeless, destitute and five months pregnant. Her husband, a builder, can’t work as he repairs his own damaged home. Their future is desperately uncertain. Yet further muddying her complicated grief and trauma is the same inescapable feeling that multiple other locals in flood-affected areas expressed to VICE World News: survivor’s guilt. 

There is always a worse story, it seems, and many victims were quick to deflect attention away from themselves by insisting that there were others, everywhere, more deserving of sympathy than them. Adams described it as a “collective grief.”

“You just feel like someone always needs more help than you,” she said. “It's like everyone's struggling, so it's this weird sort of feeling like you don't want to feel too ‘woe is me.’”

One point all agree on is that without the volunteers leading the rescue effort and the resilience of the community at large, circumstances during and after the flood would have been far more dire. 

But even those at the frontline of the disaster believe such resilience can only hold for so long. Adams gives it a few months, while Wilson and other health workers are waiting to see how deep the tremors go. Fiori, for her part, is not sure when the mental health crash will happen—but she’s certain it’s coming.

“Everyone that saw what happened in this area—they're never going to forget it,” she said. “You can’t.”

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For anyone experiencing depression or suicidal thoughts, help in Australia can be found by calling Lifeline on 13 11 14 or Beyond Blue on 1300 22 4636.