Hawaii fire survivors face huge mental health hurdles

She has a cot and access to food, water, showers, books and even puzzles that bring people together to pass the evening hours.

But all it took was a strong wind gust for her to be immediately transported back to the terrifying moment a deadly fire overtook her senior apartment complex in Lahaina last week.

"It's a trigger," she said.

"The wind was so horrible during that fire."

Mental health experts are working in Maui to help people who survived the deadliest fire in the United States in more than a century make sense of what they endured.

While many are still in a state of shock, others are starting to feel overcome with anxiety and post-traumatic stress that experts say could be long-lasting.

Landon, 70, has twice sought help in recent days to help her cope with anxiety.

One psychologist she spoke with at an evacuation shelter taught her special breathing techniques to bring her heart rate down.

On another occasion, a nurse providing 24/7 crisis support at her current shelter was there to comfort her while she cried.

"I personally could hardly talk to people," she said.

"Even when I got internet connection and people reached out, I had trouble calling them back."

The person sleeping on the cot next to her, 65-year-old Candee Olafson, said a nurse helped her while she was having a nervous breakdown.

Like Landon, Olafson fled for her life from Lahaina as the wind-whipped flames bore down on the historic town and smoke choked the streets.

The trauma of the escape, on top of previous experience with depression, became too much to bear.

"Everything culminated - I finally just lost it," she said.

Olafson said a nurse came over and told her, "just look at me", until she calmed down.

Looking into the nurse's eyes, she came back down to earth.

"These people pulled me out faster than I've ever been pulled out from the abyss," she said.

What they witnessed as they fled will remain with them a long time - trauma that comes with no easy fix, something impossible to simply get over.

"I know some of the people died in the water when I was in the water," said John Vea, who fled into the ocean to avoid the flames.

"I have never seen anything like this before.

"I'm never going to forget it."

Dana Lucio, a mental health counsellor with the Oahu-based group Healthy Mothers, Healthy Babies Coalition of Hawaii, is among the experts working on Maui to help support survivors.

She's been going to different donation hubs around Lahaina on the western side of the island, and sometimes even door-to-door, to be present for people and give them a shoulder to cry on.

Lucio, who used to be in the Marine Corps and was deployed twice to Iraq and once to Afghanistan, said she's able to understand some of their emotions because she has experienced post-traumatic stress herself.

"I can connect with them in a way that most people can't," she said of those affected by the fire.

"The trauma therapy that I do, I've learned within myself."

Global medical aid organisation Direct Relief has been working with groups like Lucio's to distribute medication to people who fled without their antidepressants and antipsychotic prescriptions, said its director of pharmacy and clinical affairs, Alycia Clark.

In a natural disaster, people often leave their medication behind during sudden evacuations.

Downed mobile phone towers and power outages can prevent them from contacting their doctors, and damage to health care clinics and a lack of transportation can all combine to complicate medical access, she said.

It can take weeks to find the right dose for a mental health patient and stopping medication suddenly can cause withdrawal symptoms, Clark said.

For this reason, she said, Direct Relief includes mental health medication in most of its emergency and disaster response kits for those who are missing their prescriptions.

Lucio, the mental health counsellor, said she hopes people think about treatment as something that's long-term, as the initial shock wears off and the awful reality sets in.

"This is not something their brains were prepared to understand," she said.

"There is going to be a need for ongoing therapy."

Australian Associated Press