The first few months after Hurricane Katrina, most Gulf Coast residents were in shock, say experts. Around the one-year mark, people here started really digesting what happened and what it means to their lives and depression started to sink in, experts say.
As that passes and signs of post-traumatic stress disorder and severe depression appear in the area, average area residents have few places to turn to escape the ever-present hurricane destruction, be it in shattered buildings or lives.
"It means that every single night when people go home they are reminded of the crisis," said Dr. Thomas Yarnell of the Gulf Coast Counseling Center. "Their ability to cope is wearing down little by little. I am seeing that in my private practice: more symptoms are starting to show up. Even some of the stronger people are starting to wear down. Now I'm seeing people who are just worn out."
The relationship between being beyond worn out and being suicidal is closer than it might seem, Yarnell said.
There are 10 major warning signs for people close to killing themselves, according to most experts, and with proper counseling and treatment, suicidal people can be helped.
The warning signs are: talking about dying or disappearing or self-inflicted harm; a devastating recent loss, be it of a loved one, friend, job, home or religious faith; dramatic changes in personality; dramatic changes in behavior; insomnia or oversleeping; changes in eating habits, be it anorexia or overeating; suddenly diminished sexual interest; a strong fear of losing control or one's sanity; very low self-esteem; and extreme pessimism.
Another thing to look out for is if someone who was really depressed and is overnight really happy, because that can mean they have decided to let go, Yarnell said.
While almost no conclusive links between Hurricane Katrina and suicide have been made, there have been more than a few high-profile suicides recently in particularly destroyed communities and family and friends frequently do not talk about them.
It is typical for families not to want to talk about suicide both because of the feeling that there was something that could have been done in addition to a general stigma that makes the word "suicide" seem dirty, Yarnell said.
This is dangerous, because people who feel suicidal are often ashamed to talk with their families and friends about it, experts say.
"A suicidal person has to know it's not going to get better," said Yarnell, who has treated several suicidal patients. "Suicide is an escape. Generally, it's a pessimistic attitude. If the pessimism creeps in that this is not going to be solved, then suicide creeps in as an option to get out of it."
There are always other ways out of it, though, the easiest being trying to talk to family, friends, religious leaders or professional counselors about your problems. There is also a free counseling hot line for people feeling suicidal and free mental health clinics.
The timing of the rise in suicidal tendencies, severe depression and psychological illnesses on the Coast is not a coincidence, experts say.
Besides 18 months being a natural length of time for people to become worn out mentally, there are psychological barriers in post-storm recovery contributing to everyone's stress, said Dr. Darlys Alford, the clinical director of the Community Resilience Center, a free counseling service.
"Eighteen months comes up, because it's a marker of the government's commitment" after major disasters, Alford said. "Whether or not FEMA trailers are going to stay or go, (the threat of them leaving has) already done its damage. People are afraid."
That fear and stress comes from people feeling like they need to be "over" the storm by now, when for tens of thousands of people on the Coast that is an unreasonable expectation, Alford said.
Most alarming about the current situation is that things like high-profile suicides are not only usually a result of that stress, they make it worse, Alford said.
"Hearing of and being exposed to a suicide is very alarming," Alford said. "People find themselves considering that possibility where they might not have thought of it otherwise. For adults, this is deeply disturbing ... which is not what you need when you're feeling depressed. We're worn out with trauma and this is another trauma."
That trauma is really starting to appear physically in local communities, said Toni Kowalski, a Kiln resident and team leader in Hancock County for Project Recovery, which goes door-to-door assessing residents' physical and mental needs and provides assistance.
"There's more divorces going through here right now because of all the pressure," Kowalski said.
Jenni Hillman, director of Project Recovery, said her program is shutting down its operations in the next few months. "Housing is the largest stressor, and you and I both know that's not about to be fixed anytime soon," Hillman said.
Alford said she is going to establish services for the Resilience Center in Bay St. Louis shortly.
That and other programs in schools and hospitals are just beginning to address the wider psychological needs of devastated communities.
In the meantime, experts say that not talking about suicide and depression with a confidante or professional can be harmful, especially with all the stress that is already out there.
Studies by the American Psychological Association on disaster recovery have shown that, in general, people are very resilient in recovery from bad situations.
However, most local mental health professionals say Katrina has been a special situation and people should not be expected to be "over it," especially now.
"One of the lessons that we're all learning from Katrina is to accept loss," said Mike Cuevas, who works in Bay St. Louis' City Hall and recently lost a good friend to heart disease and self-described Katrina-related stress. "The whole community is just falling down around itself. We all lost stuff, and it's a shame that we're losing friends too."