Facing tremendous need after Hurricane Harvey, Texas has made it easier for out-of-state health care providers to come and help.
The Texas Medical Board says health care workers who are licensed and in good standing in other states and who are coming to work at a hospital can practice in Texas while the governor's disaster declaration is in place. Hospitals must provide details for each provider. Physicians who are not affiliated with a hospital can apply for an expedited permit.
But state officials and others are urging practitioners not to self-deploy to the disaster area but to work through relief organizations including the Red Cross, which has issued a call for health and mental health volunteers.
The Texas Department of State Health Services also has its own disaster volunteer registry for medical, public health and lay volunteers. And FEMA is directing people to the group National Voluntary Organizations Active in Disaster.
The extent of the need ahead is already apparent in temporary shelters. Mental health professionals have been on hand, trying to address immediate needs of evacuees, some of whom fled their homes without their regular medications, and many of whom are experiencing elevated levels of distress.
With thousands of people living in tight quarters, tensions can flare suddenly. Michael Berry, who's been at the George R. Brown Convention Center for four days, says a man who appeared delusional tried to swing at an officer. "They had to get rid of him," he says. "I don't know where they took him."
Dr. John Fermo, a psychiatrist with Houston's VA Medical Center, is particularly concerned about patients in recovery from an opioid addiction.
"The flood has got me really concerned about my patients running out of their prescriptions of either methadone or suboxone," Fermo says. "Once they run out of their medications, they may relapse."
As social worker Emma Jones entertains three young siblings with colored paper, she's looking beyond this moment to the coming months.
"They've seen a lot of hard things, but they feel safe right now," Jones says of the children, who were rescued from their trailer by helicopter. "I think that trauma for them will continue to set in as they realize that school looks different this year, or home looks different or family looks different. I think it's more about being able to provide that long-term response."
Antonio Puente, president of the American Psychological Association, says the real impact of Harvey on behavioral and mental health will begin to be felt after the waters recede.
"There is no easy or quick solution to the destruction and subsequent loss associated with something as catastrophic as Harvey," he wrote in a statement. "Healing — both physically and mentally — will take a long time."
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Mental health professionals in Houston are trying to provide emergency services to thousands of people in shelters. The storm has separated people from their medications and exacerbated mental illness symptoms. And NPR's Rebecca Hersher reports the storm's psychological toll is still unfolding.
REBECCA HERSHER, BYLINE: Capriesha Whitley Price's apartment was destroyed by water earlier this week, but one of her main concerns right now is her 60-year-old mother.
CAPRIESHA WHITLEY PRICE: She takes mental health meds. She has really bad anxiety and PTSD.
HERSHER: As the family packs the car to leave for a shelter, Price says she doesn't know what she's going to do to make sure her mom gets her prescriptions filled.
PRICE: She has enough for one week. That's all.
HERSHER: It's something that's on the minds of a lot of people who are spending time at shelters, both volunteers and those who've been displaced. Dr. John Fermo is a physician with the VA. He's been volunteering at the big shelters in Houston, first at the convention center downtown and then at a second 8,000-bed shelter that opened later in the week.
JOHN FERMO: The flood has got me really concerned about my patients running out of their prescriptions of methadone or suboxone. Once they run out of their medications, they may relapse.
HERSHER: Fermo is one of hundreds of medical staff who are volunteering at shelters, writing prescriptions, assessing patients and even giving out some medications. Michael Berry has spent the last four days at the convention center shelter. He's glad that doctors, nurses and social workers are there. He's also happy there's a police presence.
MICHAEL BERRY: It's getting tense right now, people getting agitated.
HERSHER: It's close quarters at the shelter. He and Irving Small saw one man who started having delusions in the middle of the night and started trying to hit people. EMTs were called, and they took the man away on a stretcher.
BERRY: He tried to swing on a officer, and they had to take him down and take him up out of here. I don't know where they took him, but...
IRVING SMALL: That stretcher? Been here all day.
HERSHER: The acute crises are like little fires flaring up. Underneath is a larger wave of psychological problems that mental health experts are concerned about going forward.
EMMA JONES: You guys want some more paper?
UNIDENTIFIED CHILDREN: Yeah.
JONES: Yeah? I got a lot of colors. You can pick what you want.
HERSHER: Emma Jones is a social worker in Houston. She's sitting on the floor playing with three little kids while their mother goes to change a fourth child's diaper. They were rescued by helicopter from their trailer.
JONES: You know, they've seen a lot of hard things, but they feel safe right now. I think that trauma for them will continue to set in as they realize that, you know, school looks different this year. Home looks different. Our family looks different. So I think it's more of being prepared to provide that long-term response.
HERSHER: That response will need to address everything from PTSD in people who were trapped or injured to depression. For now, Jones says she's just trying to be a safe and friendly face for families who are under a lot of stress. Rebecca Hersher, NPR News. Transcript provided by NPR, Copyright NPR.