“This whole town is heartbroken,” she said. “Everyone suffers from guilt, anxiety and some kind of post-traumatic stress.”
Soto-Quintanilla believes the cure will take years of sustained attention from professionals like her. But she and other experts have warned that limited mental health resources and access to insurance could keep such care out of reach for much of the city.
“It takes time and we know it will be a long journey,” said Alejandra Castro, rural services manager for the Family Service Association, a San Antonio-based organization that has operated in Uvalde for 22 years. “We know our services will be there for the long haul.”
Since the shooting, therapists have flooded the city, offering counseling to grieving residents. But most of those support 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 fought to fund an inpatient psychiatric 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, advocates and clinicians interviewed by The Washington Post said labor shortages, language barriers and cultural stigma within the predominantly Hispanic community have created other barriers.
“School districts have quite a bit of mental health counseling…but it is woefully underfunded and insufficient in our state to meet the needs of schools,” said Mary Garr, CEO of Family Service, which works closely with school districts. “Much more needs to be done, but we cannot train mental health counselors overnight.”
Governor Abbott’s response to the shooting at a school under review
At news conferences after the shooting, Texas Governor Greg Abbott (right) promised to bolster mental health resources in the region, saying the state needed to “do a better job of mental health “.
Abbott has pledged significant support to the community to deal with the “magnitude” of mental health issues, including a 24/7 advice line and the provision of a temporary family resource center for children. residents of Uvalde seeking mental health and other services.
Increasing these state resources could be a challenge in Texas. A recent report by the nonprofit Mental Health America ranked the Lone Star State 51st in the nation for access to mental health care — a ranking that gauges access to insurance and treatment. , quality and cost of insurance, access to special education and the mental health workforce. availablity.
According to another report by the Hogg Foundation for Mental Health at the University of Texas, 173 counties in Texas did not have a single licensed psychiatrist in 2019, meaning more than 2.7 million Texans lived in a county. without a psychiatrist.
Lack of insurance makes the situation worse. Texas leads the nation in the number and percentage of uninsured residents. Nearly one in four Uvalde County residents lack health insurance, according to the Census Bureau. Latino children have the lowest insurance rates in the state, the Hogg Foundation reported.
And even once 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 and behavioral challenges. But the state-funded program has yet to reach Uvalde because it’s “still ramping up,” said David Lakey, president of the Texas Child Mental Health Care Consortium – which was established in 2019, a year after a shooting. who killed 10 people at Santa Fe High School, to increase access to mental health services for children.
“It takes time to go from zero to statewide, not just financially, but also labor-wise and community-relationally,” he said. said, adding that the Texas Child Health Access Through Telemedicine program provides a network of doctors, counselors and other professionals to more than 300 people. school districts across the state and covers approximately 40 percent of the student body.
In the meantime, the need here is acute.
Nine-year-old Jaydien, who said he survived the attack by hiding under a table so the shooter couldn’t see him, told his grandmother that he wanted to attend his classmates’ funerals. But as he sat in the car on the way to church last week, he had a panic attack and begged his mother to take him home, his grandmother Betty Fraire said.
“It’s slowly starting to hit him,” Fraire said. “It’s so difficult, but he wanted to attend all the funerals because they were all his classmates, so we went to pick him up.”
Immediately after the shooting, Jaydien spoke to a counselor who told his family he appeared to be doing well, Fraire said. But as the days go by, the trauma seems to surface, little by little.
Jaydien – who is only identified by his first name because he is underage – loved math lessons but no longer wants to go to school. When he hears a loud bang, he becomes anxious and scared and has trouble sleeping, his grandmother said.
To help him, his family plans to take him back to therapy. “He will need counseling for a long time,” she said. “And U.S. too.”
And while the bereaved community collectively mourns its dead, the crisis has left few in this small town untouched.
At Uvalde Memorial Hospital, emergency personnel who treated the 15 shooting patients, including seven children, are struggling to deal with the trauma of that turbulent and terrible day, said Tom Nordwick, CEO of the hospital. ‘hospital.
The intensity of the crisis and the close ties with the victims hit the nurses, doctors and technicians hard.
“You have personnel who have friends who were here who may have lost someone, others who had family members in the police department,” he said. “You have a lot of involvement, a lot of close relationships, and so there’s a trauma to going through something like this and knowing that your friends and neighbors are hurting.”
A staff member admitted to not knowing how to talk to his grandson who had lost a dear friend, Nordwick said.
To help those struggling, an in-house counselor and a range of other organizations have stepped in to help and are providing advice to hospital workers, Nordwick said. One of them is the Family Services Association.
But even those not directly affected are dealing with vicarious trauma.
Soto-Quintanilla, who is from northern Mexico and bilingual, admitted the job of helping others comes at a cost, prompting 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 process of healing.
To help children process the flurry of emotions, Soto-Quintanilla used a drawing of a heart with different parts, to illustrate how a human has the ability to feel multiple emotions, sometimes at the same time.
“This side is anxious, this side is sad, it’s space for anger,” she told the children, some of whom had seen their friends and teachers killed. “And then there’s also a little space for the happy ones,” she said.
She also helped them find a “magic” word they can use whenever they feel sad and want a hug from their parents, without explanation or question. One girl chose the word “pigeon”.
After a recent session that left her emotionally drained, Soto-Quintanilla decided to hit the cafe to pull herself together. As she was walking, she saw the same girl peeking out the car window, yelling, “Pigeon!”
She ran up to the counselor and gave him a hug, no questions asked.
“You need one too,” the girl said.
Karin Brulliard contributed to this report.