Uvalde is worn down by loss and grief

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UVALDE, Texas — In the days since a gunman killed 19 students and two teachers at an elementary school here, Enedelia Soto-Quintanilla has struggled to keep up with the influx of residents wanting to speak.

Soto-Quintanilla, a Licensed Counselor Associate, is one of the few professional therapists in this rural area. Since the attack, she has spoken to the victims’ parents, family members and friends.

“This whole town is heartbroken,” she said. “Everyone suffers from survivor guilt, anxiety, and some type of post-traumatic stress.”

Soto-Quintanilla believes the cure will require years of continued attention from professionals like her. But she and other experts warned that limited mental health resources and access to insurance could make such care unattainable for much of the city.

“It takes time and we know this will be a long journey,” said Alejandra Castro, director of rural services for the Family Service Association, a San Antonio-based organization that has served in Uvalde for 22 years. “We know that our services will be here for the long term.”

Since the shooting, therapists have flooded the city offering counseling to grieving residents. But most of those aid organizations will leave in the next few weeks or months, Castro said. And while several public and private practices in the city offer behavioral and mental health services, experts say Uvalde lacks inpatient treatment options and enough psychiatrists who specialize in children and adolescents.

For years, local officials have struggled to fund an inpatient mental health facility in the area, City Manager Vince DiPiazza said. Currently, patients requiring hospitalization or long-term care must travel hundreds of miles across the state to find an available bed, he added.

Mental health experts, attorneys and clinicians interviewed by The Washington Post said labor shortages, language barriers and cultural stigma created other obstacles in the predominantly Hispanic community.

“School districts have some mental health counseling…but it’s woefully underfunded and not available in sufficient numbers in our state to meet school needs,” said Mary Garr, CEO of Family Service, which works closely with school districts. “Much more needs to be done, but we cannot build mental health counselors overnight.”

Gov. Abbott’s response to the school shooting comes under scrutiny

In news conferences following the shooting, Texas Gov. Greg Abbott (R) pledged to boost mental health resources in the region, saying the state “needs to do a better job with mental health.”

Abbott has pledged significant support to the community to address the “scale” of the mental health issues, including a 24/7 counseling line and the provision of a temporary family resource center for Uvalde residents seeking mental health and other services.

Increasing these state resources could pose a challenge in Texas. A recent report by the nonprofit organization Mental Health America ranked the Lone Star State 51st in the nation on access to mental health care – a ranking that weighs access to insurance and treatment, quality and cost of insurance, access to special education and the availability of a mental health workforce.

Corresponding another report According to the Hogg Foundation for Mental Health at the University of Texas, 173 Texan counties did not have a single licensed psychiatrist in 2019, meaning more than 2.7 million Texans lived in a county without one.

Lack of insurance makes it worse. Texas leads the country in both number and percentage of uninsured residents. According to the , almost 1 in 4 residents in Uvalde County does not have health insurance Statistics Office. Latino children have the lowest insurance rates in the state, the Hogg Foundation reported.

And even if the state creates a new program, it can take time to develop.

In 2019, Texas launched a youth mental health program for students with mental health and behavioral issues. But the state-funded program hasn’t reached Uvalde yet because it’s still “getting started,” said David Lakey, chair of the Texas Child Mental Health Care Consortium — which was formed in 2019, a year after a shooting that killed 10 people Santa Fe High School to improve access to mental health services for children.

“It takes time to go from zero to statewide, not just financially, but also in terms of workforce development and community relations,” he said, adding that the Texas Child Health Access Through Telemedicine Program provides a network of physicians, counselors and other professionals for more than 300 school districts statewide and covers approximately 40 percent of the student body.

Now the need is acute here.

Nine-year-old Jaydien, who said he survived the attack by hiding under a table so the gunman couldn’t see him, told his grandmother that he wanted to attend his classmates’ funerals. But as he sat in the car on his way to church last week, he suffered an anxiety attack and begged his mother to take him home, his grandmother Betty Fraire said.

“It’s starting to hit him,” Fraire said. “It’s so hard, but he wanted to attend all the funerals because they were all his classmates, so we chose him instead.”

Right after the shooting, Jaydien spoke to a counselor, who told his family he appeared to be fine, Fraire said. But as the days go by, the trauma seems to gradually surface.

Jaydien – who is only identified by his first name because he is underage – used to love math classes but no longer wants to go to school. When he hears a loud bang, he gets scared and scared and fights to sleep, his grandmother said.

To help him, his family plans to get him back into therapy. “He’s going to need counseling for a long time,” she said. “And so do we.”

And while the grieving community mourns their dead together, few in this small town have been untouched by the crisis.

At Uvalde Memorial Hospital, the emergency workers who treated the 15 patients in the shooting, including seven children, are struggling to process the trauma of that hectic, horrific day, said Tom Nordwick, the hospital’s CEO.

The intensity of the crisis and the close ties to the victims hit the nurses, doctors and technicians hard.

“You have staff with friends who have been here and may have lost someone, others who had family members in the police department,” he said. “You have a lot of commitments, a lot of close relationships, so it’s traumatic to go through something like that and know that your friends and neighbors are hurt.”

A staff member admitted not knowing how to speak to his grandson who had lost a dear friend, Nordwick said.

To help those struggling, an in-house consultant and a number of other organizations have stepped in to help and advise hospital staff, Nordwick said. One of them is the family service association.

But even those not directly affected struggle with second-hand trauma.

Soto-Quintanilla, who is originally from northern Mexico and is bilingual, admitted that the task of helping others came with a toll, leading her managers to consider hiring outside PTSD services for the counselors themselves , she said.

For now, she is determined to continue supporting the community through the arduous healing process.

To help children process the surge of emotions, Soto-Quintanilla used a drawing of a heart with different parts to illustrate how one human being has the ability to feel many emotions, sometimes simultaneously.

“This side is concerned, this side is sad, this is room for anger,” she told the children, some of whom had seen their friends and teachers killed. “And then there’s a little space for happiness, too,” she said.

She also helped them find a “magic” word to use when they’re sad and want a hug from their parents, with no explanations or questions asked. A girl chose the word “dove”.

After a recent session that left her emotionally drained, Soto-Quintanilla decided to go on a coffee run to gather herself. As she left, she saw the same girl peeking out the car window and yelled at her, “Deaf!”

She sprinted towards the counselor and hugged her without asking any questions.

“You need one too,” said the girl.

Karin Brulliard contributed to this report.

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