SCOTT SIMON, HOST:
First responders on Maui continue to work long hours trying to recover and identify remains of more than a hundred people killed in the wildfire that incinerated much of the historic resort town of Lahaina. Survivors are still dealing with physical challenges like where to live in the coming weeks and months. But the size of the emotional and psychological toll is coming into sharp review, and the need for mental health support grows, as NPR's Eric Westervelt reports from Maui.
ERIC WESTERVELT, BYLINE: The scale of the physical damage in the historic center of Lahaina is clear in its apocalyptic landscape of rubble, ash and debris. But the scale of the inner damage can be seen in a 5-year-old girl that Maui's chief mental health administrator, John Oliver, saw the other day. The girl came in with her mother into this Lahaina health clinic clutching a green-and-purple plushy stuffed animal. She seemed withdrawn and afraid.
JOHN OLIVER: I got down to her level, and, you know, I asked her her name and how she was doing and, you know, asked about her stuffed animal. And then she just offered up, and she said, I'm very sad. And I said, I'm so sorry. I said, why are you sad? And she said, I'm sad because I saw a lot of dead bodies.
WESTERVELT: Oliver told the girl how sorry he was and tried to reassure her, saying, I want you to know that you're safe now.
OLIVER: She smiled. We continued to play for a little bit, and she said, you know, I really miss my friend. And I said, I'm sorry to hear that, also. At that point, the psychiatrist came in. And, you know, I talked briefly with the mom, and she shared that when she says she misses her friend, it's her best friend.
WESTERVELT: That friend died in the fire. Counselors here describe these early days of disaster mental health treatment as a kind of triage - psychological first aid for anguish that runs the spectrum of symptoms from sadness and sleeplessness to exhaustion, depression and breakdowns.
DEBBIE SCOTT: They've lost family. They've lost their pets. They've lost everything.
WESTERVELT: South Maui clinical social worker Debbie Scott says for some who had to flee the flames, the initial shock is now giving way to wrenching anxiety and anger as the depth of the trauma settles in.
SCOTT: There is a heaviness in the air that is - we're destroyed.
WESTERVELT: Scott paused her private practice to help counsel the displaced at a community center in South Maui that's been turned into a temporary shelter. Evacuees here late this week were offered the chance to move from shelter cots to much nicer accommodations in hotel rooms or apartments. But several didn't want to go, Scott says, including an older man. He felt safe in the shelter. Both of his hands were fully bandaged from serious burns. Scott went over to him.
SCOTT: I called him by his name, and I said, listen. Let's see about what we need to do to make sure that you feel safe enough to get on that bus.
WESTERVELT: Sometimes it's the little things. He wanted his flip-flops. Scott found them near the bathrooms, and it helped.
SCOTT: It took some work, but I did get him on that bus, and he was thankful to have his bags, and he sure was thankful to have his flip-flops. He needed his slippers.
WESTERVELT: Compounding the grief here, hundreds are still listed as unaccounted for, and people can't identify their lost loved ones. Only a few remains have been ID'd so far, and some may never be found. Officials are trying to mobilize a fresh influx of mental health clinicians to help. To make that easier, the governor issued an emergency order temporarily waiving the state licensing requirement for counseling. But the need and the hurt are enormous. And getting care - and in some cases, medication - to the displaced scattered across the island is a mammoth task. Scott says, in these early days of acute stress, it's really not about intensive therapy. It's more about listening and offering tools for comfort and care.
SCOTT: And whether that's breathing, whether that is progressive muscle relaxation, whether that is mindfulness and meditative practices - just sitting, stretching - whether that is just talking story, making jokes.
WESTERVELT: Another tool to help people cope - therapy animals.
ANNIE VANCE: And this is my handsome boy, and his name is Rio (ph). And I say he's smart, smart and stubborn. He's my best friend.
WESTERVELT: Psychotherapist Annie Vance lost her home in Lahaina. She's now volunteering at shelters and counseling hotel employees affected by the fire with the help of her 9-year-old black lab therapy dog, Rio.
VANCE: I've taken him to my sessions, and people just love him. We get talking about the dog, and then we get talking about how are you and what happened to you. And it gives a nice entrance into the conversations that need to be had.
WESTERVELT: But who counsels the counselors who've had to flee a deadly wildfire and lost their home? Vance admits both she and Rio are pretty tired, and she and these other mental health professionals say survivors will be reckoning with their wounds for a long time. After Vance recently went to buy some much-needed clothes, Rio gave her a forlorn look.
VANCE: I ran out of the house with the dress I had on and one other, and Rio got back into the car, and he gave me this look like, Mom, I just want to go home. Are we going to go home now? And I just looked at him and cried, and I said, Rio, honey, I want to go home, too, but we don't have a home anymore. But we'll make the best of what we've got.
WESTERVELT: And she told Rio, we'll help each other get through this.
Eric Westervelt, NPR News, Maui.
(SOUNDBITE OF LITTLE PEOPLE'S "MOON") Transcript provided by NPR, Copyright NPR.
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