As scientists monitor what the long-term impact of the BP oil spill will be on the Gulf of Mexico, sociologists and psychologists are working to mitigate the spill's impact on the psyche of Gulf Coast residents.
But they're finding it takes a special effort to reach some communities.
In the fishing village of Bayou La Batre, Ala., crisis counselor Le Huong Carter steps onto a porch and takes her shoes off before she knocks on the front door. She's Vietnamese and works closely with the Southeast Asian refugees who have settled on this working coastline, south of Mobile.
A young woman answers the door and smiles when she sees Carter. Phuong Khuu, also from Vietnam, is a widowed mother of two. She used to work picking crab in the seafood processing plants that line the bayou. But now, she says, her days are filled with cooking, cleaning up the house, and taking care of her kids.
"And waiting on BP," she says. "They pay the money."
Since June, she has been living on payments from the BP claims fund, and staying up nights thinking about the future.
"I can't sleep," Khuu says. "I worry [at] nighttime. I'm scared."
Sleeplessness is just one of the symptoms that researchers say have spiked since the BP oil spill. Several studies have found that more than a third of Gulf Coast residents report higher levels of anxiety, stress, anger and depression.
'A Strong Hand'
The uncertainty in the aftermath of the disaster has taken a toll on people who relied on the Gulf for their livelihood, according to Tonya Fistein, a therapist with AltaPointe Health Systems in Bayou La Batre. She says there are many unanswered questions.
"When they do get back to work, is it going to be safe?" she asks. "Are they going to be able to sell their product? There is all of this if, if, if and what if?"
In seafood, no talk, no read, no write. I just need a strong hand.
Most of the Gulf of Mexico is back open for fishing. But the market hasn't been there for the seafood, so the industry has yet to rebound. For Vietnamese immigrant Phuong Khuu, finding other work is nearly impossible because of her limited English skills.
"In seafood," Khuu says, "no talk, no read, no write. I just need a strong hand."
Counselor Le Huong Carter has enrolled Phuong Khuu in English classes, and is trying to help her in other ways. Carter is part of an oil spill crisis team put in place this summer by AltaPointe Health Systems. They've set up group sessions and other programs to get people talking.
But Khuu resists structured therapy as a way to deal with her anxiety. Carter says there's a real cultural barrier when it comes to mental health in the Amerasian community. "Depress[ion], anger or hurt are suppressed within the culture," Carter says.
There's no middle ground where people can explore why they're struggling emotionally in the aftermath of the oil spill.
"There is no concept," Carter says. "Either people are healthy or they are very, very, very broken down. People would say that person is 'coo-coo' ... or very crazy."
Counselors have also discovered a religious reluctance from those who practice Buddhism to seek help.
"If they are experiencing difficulties, a lot of them feel this is a necessary thing to experience," says AltaPointe therapist Pam Maumenee. "And if they don't walk the path now, the next life won't be better, so they should pay this price."
Figuring out how to break through the cultural barriers has been a real challenge, Maumenee says. One way she tries is to start the conversation about physical, not behavioral, needs. Talking about problems with housing or utilities can lead to other issues going on in the family.
"Maybe anger is increasing," she says. "There may be substance abuse going on. Domestic violence -- we've seen an increase in domestic violence."
'Day By Day'
The crisis team is also trying to connect through trusted community resources. At the end of a dirt road in Irvington, Ala., is a brightly colored gate that leads to a Buddhist temple complex. It's part religious hall, part Cambodian community center. Seafood workers chat on the front porch about happier times when work was more abundant.
Thin Bo is 39 and says he used to work six days a week cleaning crab. Now he says he's lucky to get two days' work.
"When we work, we are kind of happy to live with, you know," Bo says. "But now we just staying home, that's it. Just a lot of depression and worry about what the situation in the future."
The father of four admits it's been a struggle, yet he's reluctant to seek help.
"No, no. We would not go to a counselor," he says, shaking his head emphatically. "We can solve one problem at a time, go day by day," says Bo.
The AltaPointe crisis team has been working with Van Suon, an activist in the Cambodian-American community here. He's been trying to help with claims and set up classes so that more immigrants can learn English and a trade other than the seafood industry.
Right now, he says, people are surviving on payments from the BP compensation fund, which he says will run out.
"It's not going to last forever," Suon says. "They're not going to take care of you forever, so you need to go to plan B."
He worries the depression and anxiety will only escalate.
"I guarantee you for those who say they don't need counseling, when they run out of money, they will need some sort of counseling," Suon says, "whether it's marriage counseling or individual counseling."
The experts agree. They say the mental health fallout from the oil spill has yet to peak.
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