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Kent Andersen saved for seven years to afford to move his family to Hawaii. When he purchased 10 acres of Puna jungle in 2013, he started building a home — “our little slice of heaven” — using the skeletons of six shipping containers.

In May, the retired engineer was nearly ready to slick a coat of paint on the window trim when a river of lava set it all aflame.

Devastated, Andersen and his family have returned to Utah, where they’re living in a travel trailer parked in a family member’s yard while they figure out their next move.

“Every day you sit around and think, ‘What could I have done differently?’ or ‘Gee, I wish I had been a really bad person because maybe I would have deserved something like this.’” said Andersen, who is 50.

“I’ve never been put through a situation like this before,” he said. “I had a house fire once and I lost a lot of stuff, but this here is just off the scale. It’s just unbelievable. Not only is our house gone, our community is gone, too.”

In the eight weeks since red-hot magma started bursting out of new fissures in the earth, residents of Kilauea’s lower East Rift Zone have watched as the slow march of lava destroys their farms, roads and homes. Even before residents start to rebuild, the psychological and emotional recovery efforts are well underway. A less visible but equally vast casualty of the volcanic eruption is the damage to some residents’ mental well-being.

To cope with the anger, sadness and confusion, Andersen said he and his family members are making an effort to talk about their feelings.

“I guess the worst part is just not knowing exactly what direction to go next,” Andersen said. “You don’t know whether to be sad or mad, whether to go back to Hawaii or find a new place to make a life. It’s like being in limbo.”

An important facet of the Hawaii Department of Health’s disaster response is providing population-based mental health outreach. At a shelter, a pair of clinics and community meetings, state mental health workers have reached hundreds of people, many of them showing signs of trauma since the volcano started erupting in neighborhoods on May 3.

The most common psychological and emotional flare-ups treated so far are a sense of confusion, emotional numbing, anger or frustration, difficulty sleeping and anxiety, according to DOH.

“We are very concerned about folks being traumatized but not getting the help that they need,” said Mark Fridovich, the state’s adult mental health administrator. “Needing help at a crisis is not a sign of a serious mental illness. It’s a perfectly natural and normal response to the stress, whether it’s the stress of losing connections with one’s neighbors, losing one’s home, losing access to one’s possessions, needing to live in a shelter, losing one’s business or having increased risk of respiratory ailments.”

A growing body of research indicates that rapid response to trauma can make a big difference in the trajectory of a person’s recovery, Fridovich said.

Although DOH’s and divisions typically service uninsured people who are seriously mentally ill or behaviorally or emotionally disturbed, the department during a natural disaster is charged with making mental health services available to anyone experiencing an unfamiliar response to stress.

“For the most part we’re talking about folks who are understandably anxious or concerned,” said Paul Beighley, DOH’s medical director of the Adult Mental Health Division on the Big Island. “They may want to have a sympathetic ear turned to them, an opportunity to talk story a little bit — sometimes they want to know what are their options. They want to brainstorm with someone who’s outside their circumstances.”

But some residents are displaying more serious signs of trauma.

Earlier this month a man displaced by the lava hanged himself in the woods near the Pahoa shelter.

In May, a Pahoa resident fired a gun at his neighbor who was surveying damage to his home. The 61-year-old shooter now faces a slew of charges, including first-degree terroristic threatening. No one was injured.

In addition to staffing mental health workers at the American Red Cross shelter in Pahoa, DOH workers have opened up a pair of Pahoa clinics to non-emergency walk-ins. Fridovich estimated that the clinics are treating three to five non-emergency walk-in patients per week.

DOH is also coordinating with private mental health providers in the Puna area, as well as federal partners, to support distressed residents with tools including crisis call-in lines and prescription limit waivers for people who might have difficulty traveling to a pharmacy to obtain a refill.

Of course, natural disasters also exacerbate symptoms experienced by people with serious mental illness — DOH’s core focus when it comes to mental health. As such, state workers have been actively reaching out to support established clients who may have heightened symptoms instigated by the continuing eruption.

Lynn Fallin, the behavioral health deputy director, said the ongoing nature of the eruption also has DOH concerned about its own worker fatigue.

“What we have done is deploy staff to help, but they also have the ongoing responsibility of caring for those that are their consumers — they have caseloads,” Fallin said. “So you can do it for a short period of time, but it looks as if the lava on the Big Island is going to go on for a while, so the question is, as a community and as a state, how do we build that part of the system and sustain it in the long run and in anticipation of hurricanes or earthquakes or volcanoes where there is ongoing need?”

Every disaster is different, and the defining characteristic of this volcanic eruption in terms of mental health services is the duration of the event, Fridovich said. It’s a balancing act and a challenge to continue to provide support to new patients while meeting with the needs of existing clients, he said.

“It’s not part of our primary mission to field any request for support around anxiety or worry or anger,” Fridovich said. “On the other hand, this formal response to crisis is an explicit part of our role. This is something we explicitly plan for when there’s an emergency because trauma can be very disruptive and can be impairing through a person’s life. We don’t want that to happen.

“We want to change the trajectory and have the difficulty of the experience be something that the individual recovers from quickly. Maybe the recovery from a trauma can also be identified later as a source of a person’s strength, like: ‘I got through it, I got through it together with other people and it made a difference.’”

Joseph Kekedi, who lost his home and orchid farm to the lava, said he has come to find beauty in the chaos.

“It was quite an experience to see this monstrous, huge, hot lava just systemically taking over my life’s work — all the structures going down like toothpicks, watching my tractor blow up and all the beautiful orchids just consumed by lava and turned to vapor, I guess,” Kekedi said. “But if this would not have happened, perhaps I would never experience the beautifulness that humans displayed toward me — everyone in the community reaching out and helping. It’s almost like I have to say it was worth it.”

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