"Folks are starting to realize that they may be in this for the long haul," said Eric Hierholzer, a commander in the U.S. Public Health Service. "And things aren't necessarily going to get better tomorrow or next week." Some local hospitals, meanwhile, are still working to reopen.
At St. John's Episcopal Hospital in Far Rockaway, the psychiatry department has recorded a 20% increase in walk-in patients since the storm hit, with residents reporting the whole gamut of stress-related symptoms. Anxiety. Insomnia. Panic attacks.
Local schools have referred 25% more children than usual to the hospital's outpatient mental health programs.
"The children are very, very traumatized," said Fern Zagor, who runs the Staten Island Mental Health Society. "They have a hard time making sense of this sudden change in their world. It's frightening to them."
A 5-year-old girl who was pulled from floodwaters clinging to her father hasn't been able to attend kindergarten since the storm, Zagor said, because she's too traumatized to be parted from him now. An 11-year-old boy is working with counselors after floating in water up to his neck on the second floor of his home for several hours before being rescued.
"This child has said he worries about rain," Zagor said. "He worries about whether he'll ever want to swim in a swimming pool again."
The society is among many mental health providers who are working with Project Hope, a New York crisis counseling program funded by an $8.2 million Federal Emergency Management Agency grant that has just begun sending counselors to local communities. New York Gov. Andrew Cuomo's office estimates the program will help more than 200,000 people.
Project Hope Counselor Yomira Natera has been seeking out storm victims who don't speak English as their first language.
"We've seen an increase in substance with folks who may have language barriers," she said. "Who may be frustrated with the system, who find it difficult to communicate."
At least 20,000 people have so far made contact with counselors from the New Jersey Hope and Healing Program, which has dispatched hundreds of state-trained disaster crisis response counselors into the storm zone. The state also launched a hotline for people to call and talk to a counselor.
In Union Beach, N.J., a working-class enclave on Raritan Bay, Kathy Parsells helped coordinate deliveries volunteered at a FEMA recovery center on a recent afternoon, helping to coordinate deliveries. Her daughter and grandchildren had to be rescued during the storm.
"I'm OK," she said, stifling tears. "My grandsons have nightmares. My grandson, the first night, was screaming: 'It's coming up the stairs.'"
Jeannette Van Houten, who lost her home in Union Beach, said in a telephone interview that she feels like she's going through the same stages of grief that she endured when her niece was murdered in 2008.
"I have days that I can't put a thought together. Like you start talking and you forget what you're saying," said Van Houten, who sleeps just two or three hours on a good night nowadays. "And the numbness, like you look at things that are happening around you, but you're not part of it."
The Rev. Matthew Dowling, a pastor at the Monmouth Church of Christ in Tinton Falls, N.J., volunteered as a crisis counselor in the days after the storm and heard a lot of survivor's remorse from people who were more fortunate than their neighbors. But there was also a great deal of frustration.
"When FEMA arrives, they think everything is going to be fixed," Dowling said. "The reality is it's going to take months and months to get back to normal. Just like the steps of grief there's anger at the new normal."
Distress calls to LifeNet, New York City's local crisis hotline, doubled during the first few weeks after the storm hit, averaging more than 2,000 calls per week from people who were angry and worried that basic needs — food, clothing, shelter — had not been met.
Officials are now preparing for a new wave of calls from people struggling with depression and other mental health issues, said Christian Burgess, director of the Disaster Distress Helpline, a national crisis hotline run by the federal government that provides a network of trained counselors in the aftermath of a major disaster.