In the destitute town of Flint, Michigan, the story of one of the worst environmental injustices in modern history unfolded. It began in 2014, when reckless city management switched the water supply to save money at the expense of the population’s health. This new poorly treated water supply contaminated the town’s residents with unsafe levels of bacteria and various industrial toxic byproducts, including lead.

The scars left by this outrageous abuse run deep in the Flint community to this day, with a new study showing that more than 13,600 people, or one in five adults, suffer from clinical depression. Furthermore, 15,000 Flint residents, or one in four, suffer from PTSD as a result of the crisis that befell them.

“The mental health burden of America’s largest public-works environmental disaster clearly continues for many adults in Flint,” said Aaron Reuben, a postdoctoral scholar at Duke University who led the new research.

Flint: from prosperity to calamity

Flint was never blessed with clean water. For more than a century, the Flint river, which cuts the town in half, has served as an unofficial waste dump site for various local industries that made their base on the river’s shores. These include meatpacking plants, lumber and paper mills, and automotive plants, as well as agricultural and urban activities whose runoff was dumped into the river.

Nevertheless, Flint residents enjoyed a relatively safe water supply from Lake Huron and the Detroit River – but that wouldn’t last long.

In the mid-20th century, Flint was home to a booming automobile industry. It was here that General Motors was born more than 100 years ago. Unfortunately, rising oil prices and auto imports put the brakes on Flint’s prosperity in the 1980s, and it’s all been downhill ever since.

From a quaint, working-class American town of 200,000 people at its height, Flint spiraled down into a poor city of fewer than 100,000 residents in the early 2010s when the water crisis broke. Most of Flint’s residents are African-American and nearly half live below the poverty line. One in six of the homes in Flint have been abandoned.

In short, Flint was an economic and social disaster. Something had to be done, and in 2011 Michigan Governor Rick Snyder appointed an emergency manager to put the city back on the floating line. But rather than improving the lives of the city’s people, this intervention only made things worse — much, much worse.

Facing a $25 million deficit, the city’s authorities started looking for ways to cut city costs and singled out the water supply system as a prime target. For more than 50 years, Flint’s water came through piped treated water from Detroit. But this was viewed as too expensive, so the authorities decided to directly pump water from the Flint river — the same river everybody knew was foul — temporarily until a new water pipeline could be built that brought cheaper water from Lake Huron.

The Flint water crisis

Not long after the city started pumping water from the Flint River in April 2014 into people’s homes, residents’ complaints started pouring in. Everything about the water that poured from their tap looked, smelled, and tasted wrong.

After formal complaints and people being admitted to hospital, investigators from Virginia Tech found that lead levels were way past the federal acceptable limits. In some homes, lead had spiked to alarming levels. Children’s blood-lead levels nearly doubled since 2014 and nearly tripled in some neighborhoods. Later, it was reported that the local authorities failed to prevent the neurotoxic metal from leaching out of the city’s old water pipes.

If that wasn’t bad enough, the water was also contaminated with fecal coliform bacteria (like E. coli), a result of the city’s failure to disinfect the water supply with chlorine.

Failed by the state at all levels, Flint’s residents banded together and petitioned the Environmental Protection Agency (EPA), which did little to help. In 2016, a coalition of Flint citizens and civil rights groups sued the city demanding safe drinking water for the city’s residents. Their efforts paid off when, in November 2016, a federal judge sided with the disenfranchised people of Flint and ordered the federal government to replace the city’s thousands of old lead pipes with funding from the state and supply free bottled water until the new clean water supply was installed.

The Flint water crisis finally subdued in late 2018 when the city had access to a new water supply and lead levels were recorded below the federal action levels for the past four six-month monitoring periods, from July 2016 to June 2018.

The Flint trauma

In the wake of the Flint water crisis, residents’ trust in government agencies was shattered. And even if water is safe to drink today, many of the city’s residents are still coping with the deep trauma of this disturbing episode.

“We know that large-scale natural or human-caused disasters can trigger or exacerbate depression and PTSD,” said Dean Kilpatrick, Professor of Psychiatry and Behavioral Sciences at the Medical University of South Carolina and senior author of the new study.

Kilpatrick and colleagues found clear evidence of high rates of mental health problems in Flint residents during the first years of the crisis. “What we did not know until now was the extent to which Flint residents continued to have mental health problems at the clinical diagnosis level five years after the crisis began.”

According to the new study, which appeared today in the journal JAMA Network Open, the rates of depression and PTSD in the community are three to five times higher than the national average. The psychiatrists explain that these conditions were likely exacerbated by higher base rates of mental health problems owing to Flint’s numerous social problems already underway prior to the crisis, including racism, unemployment, and disproportionately high exposure to traumatic events, including prior physical and sexual assault. During both the crisis and its aftermath, virtually no resident was offered mental health services despite evidence that the event was highly psychologically stressful.

“Now that pipes are being replaced, the time is right to begin a second phase of recovery from the water crisis – one that focuses on providing additional resources to heal psychological wounds,” Reuben said.

The authors of the study surveyed nearly 2,000 Flint residents to learn more about how the crisis affected them, and found little was done to address their deteriorating mental health. Many still worry about being exposed to the city water, fearing it might cause health problems to themselves or their family. This uncertainty provokes significant anxiety that builds up with each stressful day. “There is a clear unmet need,” said Reuben.

If this study is any indication, the trauma of the Flint water crisis still reverberates around the community, which is all the more incentive to prevent another episode like it. There are an estimated 6.1 million lead service pipes in the U.S. that ought to be replaced. Michigan, for instance, learned from its mistakes and passed the Lead and Copper rule which requires all lead service lines to be replaced within 20 years. Now, other states need to follow suit before they get their own Flint story.