ORANGE BEACH, Ala. — Her income down to virtually nothing because of the BP oil spill, Margaret Carruth put her face in her hands and wept recently at a town hall meeting before walking outside to what passes for home these days, her blue pickup truck.
Xanax helps her rest. Still, it's hard to relax when you've lost your house and are sleeping at friends' places or, sometimes, in the front seat.
The oil gusher is dead, but the mental trauma it caused along the Gulf of Mexico coast is still very much alive.
"I'm a strong person and always have been, but I'm almost to the breaking point," says Carruth, whose hairstyling business dried up after tourists stopped coming to the beach and locals cut back on nonessentials like haircuts. All but broke, Carruth packed her belongings into her truck and a storage shed and now depends on friends for shelter.
Carruth's anguish is part of a common but little talked about consequence of the summer of oil: People overcome by stress and worry, who are having a hard time navigating a world that seems so different from the one they knew before the Deepwater Horizon rig exploded on April 20, sending waves of crude and tar balls toward the coast.
Surveys show that in some areas badly affected by the oil, more than 40 percent of those seeking mental-health help say they are having problems because of the spill.
The oil spill followed waves of hard luck for the region, including hurricanes and recession. Experts say it's impossible to determine how much of the current mental health downturn could have roots in other ordeals.
But a study conducted over the summer in 13 counties and parishes with a total population of 1.9 million found that 13 percent of coastal adults from Louisiana to Florida suffered probable serious mental illnesses after the spill, although it wasn't clear exactly how many problems were directly related to oil.
The level of mental illness was similar to that seen six months after Hurricane Katrina decimated the coast five years ago, and experts aren't yet seeing any improvement in mental health five months after the oil crisis began. Before Katrina, a study by the National Institute of Mental Health found only 6 percent of area residents with likely mental illnesses.
"From the types of patients we are seeing in our emergency departments, clinics and hospitals, the problems are persisting," said William Pinsky of the New Orleans-based Ochsner Health System, which conducted the random telephone survey of 406 people in four states.
Sleeplessness, anxiety, depression, anger, substance abuse and domestic violence are among the most common problems reported by mental health agencies.
BP has provided $52 million for mental health care in the Gulf region, with $15 million going to the Louisiana Department of Health and Hospitals; $12 million each to the states of Alabama and Mississippi; $3 million to Florida; and $10 million to the federal Substance Abuse and Mental Health Services Administration.
Even though the oil stopped flowing in July and the BP well was finally killed this month, some officials say the toll on mental health may get worse as the financial strains of summer persist into the fall.
"It's like a virus that's spreading," said Tonya Fistein, one of four counselors hired by AltaPointe Health Systems specifically to help people deal emotionally with the spill in Bayou La Batre, a tiny Alabama fishing community hard hit by the disaster.
AltaPointe's clinic is seeing twice as many new patients as in 2009, an increase it blames on the spill. In Gulfport, Miss., 42 percent of the patients surveyed at the Gulf Coast Mental Health Center said they were sad or depressed because of the spill.
Steve Barrileaux, a psychologist at the Gulfport center, said some of the problems leading to mental health issues are obvious, like the loss of work by a person who rented chairs on the beach. Others are more subtle, however.
Many people are worried deeply about the environment, for instance, or lament the lost moments they would have spent fishing recreationally with loved ones. Others are still afraid to eat seafood, even on the coast where livelihoods depend on it.
"What's scary is the long-term damage that can be done, and we just don't know about that," Barrileaux said.
Kim Thai, a single mother of four who worked as a sorter on a shrimp boat before oil began pouring into the Gulf, now lives on BP claim money. She said she used to earn about $4,000 a month, but her BP claims payments have totaled only $10,000 for six months, or less than $1,700 monthly.
"I spend a lot of time thinking now when I can go to work, how I can hold this family together," said Thai, of Bayou La Batre. "I worry about my kids seeing me this way and them getting sad or it affecting their school work."
Chanthy Prak also frets constantly about how to make ends meet in the post-spill world.
Prak worked in crab houses around Bayou La Batre before the oil hit. She and her husband, another seafood worker displaced by the spill, have received only $5,000 in claims payments since May to support them and their seven children.
"I worry. There's money going out but no money coming in," said the Cambodia native.
In some areas, higher rates of mental problems appear to have little to do with the oil.
At Lakeview Center, which provides mental health services in Pensacola, Fla., calls have increased to a crisis intervention line compared to 2009, but relatively few people have mentioned the oil spill as the reason they need help, said spokeswoman Karen Smith. Psychologists believe the uptick is most likely linked to the recession, she said.
More oil came ashore just to the west of Pensacola in Baldwin County, Ala., however, and a survey conducted for the state by the Centers for Disease Control and Prevention found significant mental health problems that people blamed on the spill.
Twenty-three percent of households in the area reported having at least one person who blamed sleep troubles on the spill, and 11 percent had at least one person with appetite loss. Perhaps most tellingly, 32 percent reported a decrease in income linked to the oil spill, which could lead to additional strain, said Dr. Charles Woernle, the state epidemiologist with the Alabama Department of Public Health.
Officials along the Gulf coast worry that many of the hardest-hit groups – shrimpers, Asian seafood workers and low-wage tourism employees – won't seek help for mental problems because of cultural taboos.
At AltaPointe, officials hope to use a share of the BP money to pay for additional oil-spill counselors.
Tejuania Nelson, who runs a day-care center in fishing-dependent Grand Bay, Ala., said preschoolers whose parents were left jobless because of the spill are lashing out in unsettling ways.
"They're throwing desks, kicking chairs," she said. "It's sad. With this, people do not have hope. They cannot see a better time."