Trauma is not always quantifiable; it manifests in myriad ways that are uncountable and untracked by official tallies, and unlike the immediate damage, it unfolds over time. (Illustration: Charlotte Fu)
Trauma is not always quantifiable; it manifests in myriad ways that are uncountable and untracked by official tallies, and unlike the immediate damage, it unfolds over time.

The Long-Lasting Mental Health Effects of Wildfires

Across the West, fire season lasts longer and has become more intense than any time in history—tens of thousands of structures burn every year, and dozens of people die. But new research is highlighting a different problem: those who survive are never the same.

When Aimee Gray woke up on a Sunday morning in October 2017, she decided she was finally going to get a new pair of shoes. She’d worn holes in her favorite Skechers, so when she and her husband headed into town for groceries, she stopped in the shoe store and treated herself to two new pairs.

As they drove back to the home they rented on Bennett Ridge Road, in the hills southeast of Santa Rosa, California, her husband remarked on the strange, warm wind that had been blowing through town all weekend. Later that night, as she lay in bed, Gray heard it whipping through the trees until she finally drifted off.

Just before 2 A.M., Gray woke up to her mastiff barking frantically. She thought, It’s a windy night, I know—go back to bed, Brighton. But Brighton wouldn’t stop, so Gray got up. As soon as she opened the bedroom door, smoke hit her in the face. She ran to the other side of the house. Outside the big picture window overlooking the valley, everything was red with fire. “You’re the best damn dog in the world,” she told Brighton, patting her on the head.

It was a mad scramble to evacuate. The couple threw a few pairs of underwear in a bag, then loaded Brighton and their other mastiff, Reese, in the truck. Gray lifted her daughter, just shy of two at the time, from her crib, telling her the family was going on a fun trip with the dogs. Gray changed out of her pajamas into the clothes she’d been wearing the day before and put on her favorite pair of Skechers, the ones with the holes worn through. “I had this moment of, wait, hold the phone—you have brand-new shoes,” she said and put on one of the pairs she’d bought a few hours before.

As Gray slipped out the front door, she was nearly knocked over by a powerful gust of wind. The air was thick with acrid smoke, and she noticed flames creeping toward their front porch; embers fell from the trees, threatening to ignite the house. Flames were already overtaking neighbors’ houses.

Huge swaths of Santa Rosa were ablaze. The wind had blown a tree into a power-line conductor and started the Nuns Fire, torching the hills around Gray’s neighborhood. A little farther north, a faulty electric system near Tubbs Lane ignited a second blaze, the Tubbs Fire. Fifty-mile-an-hour winds quickly stoked both into uncontrollable infernos. Tubbs rapidly became what was at the time one of the most destructive wildfires in state history, killing 22 people and destroying some 5,600 structures. Nuns, and the nearby fires it merged with, went on to burn over 56,000 acres and destroyed more than 1,500 structures.

Driving away from her house, Gray says, the only road out was enveloped in fire. She wondered whether she could make it. Would the heat pop her tires? But there was no other way off the ridge, so she gunned it through the flames. “I will never, until the day I die, forget how hot it felt to have that fire right at the car window,” she says.

The next few days were a blur. As friends shared stories through Facebook posts and text messages, Gray learned which neighbors got out, which ones hid in their swimming pool to avoid the flames, and who died. Residents weren’t allowed to visit their burned homes as the National Guard secured the area and local officials performed safety checks on utilities, but one intrepid neighbor snuck up the ridge to report back about the damage. According to him, nearly all of Gray’s street was gone. Of the roughly 120 houses he checked on, Gray says, some 90 had burned to the ground. But still, the Grays received no calls from the city, no official confirmation. Finally, four days later, a satellite-imaging company released photos of the area. When the family scrolled to their neighborhood, “we saw with our own eyes that there was nothing there,” says Gray.

They moved in with friends nearby, and Gray put on a brave face. “I remember posting all these super positive things on Facebook,” she says. “It’s part of my personality: Hey, I’m OK, don’t worry about me. I’ve always been the worrier, the comforter, taking care of people.”

But one November morning a few weeks later, as she walked outside to grab something from her car, she smelled smoke. “All of a sudden, I started dry heaving and ran back to the house to get fresh air,” she says. The neighbors were burning wood in their fireplace. She went to the bathroom to splash water on her face, and as she closed her eyes, she saw flames, sending her into a fit of sobs. She decided she needed help. A therapist told her that some of her symptoms sounded like post-traumatic stress disorder. “I knew some things about PTSD,” she says, “but I certainly never thought in a million years that I’d be experiencing it.”

(Photo: Jae C. Hong/AP)

In the wake of a fire, governments and newspapers count the damage: lives lost, acres of forest burned, homes and businesses destroyed.

Those are the hard numbers, the data we have to measure the destruction. But trauma is not always quantifiable; it manifests in myriad ways that are uncountable and untracked by official tallies, and unlike the immediate damage, it unfolds over time.

A fire’s effect on a community is like the ripples of a stone dropped in water, says Erika Felix, an associate professor of psychology at the University of California at Santa Barbara (UCSB) and a licensed psychologist who specializes in working with survivors of traumatic events. The most severe disturbances happen at the impact site, but that causes smaller ripples far from the point of impact. “There’s a subset of people who experience the most trauma and loss, then people with moderate and low levels,” she says. But there are exceptions; emotional weight affects everyone differently. “Some people who have lost their homes might seem to be doing better than people who just evacuated, in terms of emotional impact,” says Wendy Wheelwright, a patient-care analyst at Sonoma County Behavioral Health in California and a licensed therapist. “There’s no way to do emotional comparison.”

Each new fire creates a new group of evacuees, survivors, and communities with their lives upended. And with the increasing numbers of fires, there will be more people who need help—not just in Sonoma County, though the area has been struck multiple times in the past few years—but across the western United States, where acres burned by forest fires have increased by 1,200 percent in the past four decades. The year after Tubbs, the Camp, Carr, and Mendocino Complex Fires tore through Northern California, killing nearly 100 more people. This year California has experienced yet another worst-ever fire season. The August Complex Fire earned the distinction of the largest fire recorded in modern history, the first ever to burn more than one million acres, a so-called gigafire. Not only were the fires enormous, but they were also incredibly quick to spread, driving 100,000 people across the state to evacuate, many scrambling to narrowly escape like Gray did in 2017. As of November, 10,488 structures have burned and 31 people have died in California this year. States like Oregon, Washington, and Colorado have also suffered record-setting wildfire seasons. As climate change continues, experts project an even longer fire season with still more intense burns that have the potential to displace millions. What happens to all of those survivors?

In the days following the Tubbs and Nuns Fire, Irva Hertz-Picciotto, an epidemiologist at the University of California at Davis, was glued to the news. As smoke blew through town, she read story after story about the fire’s aftermath: the harrowing evacuations, the missing loved ones and pets, the death toll.

“Once I started looking on the web, I just felt sucked in—I was so hypnotized,” she says. “I was thinking, God, I want to do something, but what can I do?” It dawned on her: she could start a study. So in just two weeks, Hertz-Picciotto cold-called local and state agencies looking for collaborators and wrote a grant proposal seeking expedited funding to study the mental and physical health outcomes associated with the fires. Meanwhile, she read everything she could from the existing body of disaster research. “I was surprised that almost everything about wildfires was about acute physical effects and not much at all about long-term effects,” she says. “And in terms of mental health, I could find almost nothing.”

Hertz-Picciotto secured over $300,000 in grant money, which helped fund several new studies, including one known as WHAT NOW, a bit of a tortured backronym for Wildfires and Health: Assessing the Toll in Northwest California. Hertz-Picciotto and her colleagues released an online survey asking survivors about their needs, worries, physical health, and mental health—a catalog of lived experience the researchers could use to figure out what questions to explore next. As word spread among survivors, over 2,000 households responded within the first year. A third of them reported heightened anxiety or stress, and a quarter said they’d experienced nightmares or trouble sleeping. Around 20 percent of people had trouble concentrating or felt depressed. Like Gray, one respondent had a run-in with smoke that sent him into a panic; another, a young girl, said she was triggered at a traffic intersection, the red traffic light glowing like fire embers.

“People certainly have anxiety, depression, nightmares, and difficulty concentrating,” says Hertz-Picciotto. “But the question is, how long does that last?” 

There are just a handful of finished studies that have tracked wildfire survivors’ mental health symptoms beyond the immediate aftermath, and they suggest the effects can be far-reaching. Like respondents in the initial WHAT NOW survey, children and adults who survived wildfires in Canada, Greece, and Australia reported symptoms like anxiety and trouble sleeping.

Some of the studies tracked survivors for six months to a year after the initial fire. But that’s just the beginning of the recovery period, often on the tail end of an emotional high experts characterize as a “honeymoon” period. In the first few weeks or months, survivors might feel more connected than ever to their community through rebuilding common spaces, helping neighbors, or starting new programs to aid one another. And they’ll hold on to those positive emotions, unable to fully deal with grief and sadness. “People have feelings, but they don’t have time to process them,” says Sonoma County’s Wheelwright.

After a few months, though, unaddressed negative emotions seem to catch up to survivors and leak through in strange ways, “like crying at Kmart commercials,” Wheelwright says. Six months to a year after a disaster, people start to fall apart from trying to sprint through what’s essentially an ultramarathon. “By the time we hit the one-year anniversary, you have the full grief starting to happen,” Wheelwright says. “People were white-knuckling it up to that point, saying things like, ‘In a year, I’m going to have my house back.’ Because a year feels like a lot of time.” But after a year, many fire survivors still hadn’t received permits to rebuild, let alone a new house. The lucky ones were still staying with family or in rented homes—others were forced to move out of the area. And even once that house is built, Wheelwright says, there may be new emotional challenges; many still report PTSD-like symptoms such as nightmares, flashbacks, and intrusive thoughts. If you rebuild a house in the same spot your old one was in, Wheelwright says, “suddenly you can’t sleep at night.”

It can take the land years to recover from a wildfire, and it might take that long for some people to as well. “People attach emotionally to land—what it looks like, their favorite paths to that particular tree or rock. To have a visual scar on it can be a trigger,” says Wheelwright, who has found that it’s common for locals to avoid certain parts of town, not wanting to see the damage. What little longitudinal research exists on fire survivors also suggests that emotional recovery occurs on the scale of years. One study of 185 Texas households who survived a 2011 wildfire found that three and a half years later, some still reported difficulty concentrating and sleeping, as well as depression. Unsurprisingly, those survivors whose homes were damaged were more likely to still be experiencing issues. And a study of over 700 Australian wildfire survivors found that, five years later, rates of PTSD and other mental illnesses in the survey group were still higher than rates found in the general population. Hertz-Picciotto says that research on other types of natural disasters has found that post-traumatic stress symptoms can persist a decade after an event, so she’s hoping to resurvey respondents to her 2017 survey every few years. “There are just so many unanswered questions,” she says.

(Photo: Marcio Jose Sanchez/AP)

People are traumatized by traumatizing things: that should come as no surprise. But what is unprecedented is the scale and frequency at which this trauma now occurs.

When Hertz-Picciotto launched WHAT NOW, the plan had been to track 2017 wildfire survivors, but after the devastating 2018 Camp Fire, she and her colleagues opened their survey to a new cohort of victims. By 2019, they needed to add a drop-down menu to allow users to indicate which recent California fire—or multiple fires—they had endured.

The proliferation of fire survivors has led to a growing mismatch between existing resources and the longevity of trauma. While local government employees like Wheelwright try their best to get crucial help to people who need it as soon as possible after a disaster, funding for such efforts are short-lived compared to the scope of trauma.

After the 2017 Tubbs Fire, Sonoma County launched a program called California HOPE, which provided crisis counseling for survivors, initially using money from FEMA. The program was popular—over 48,000 people used it in the first two months; within a year and a half, that number had grown to around 75,000 people. A year after Tubbs, the Wildfire Mental Health Collaborative, a coalition of Northern California nonprofits, released an app called Sonoma Rises, which allowed users to track their mood over time; educate themselves about PTSD, depression, and anxiety; and connect with resources. Psychologist Adrienne Heinz, who led the app’s development team, calls it a “resilience tool kit.” In its first year, the app received around 1,000 downloads. But now, three years later, funding for all of it has dried up. Emergency grants from FEMA for crisis counseling typically only last a year to 18 months, says Heinz. Private donors, like Kaiser Permanente, chipped in to extend the initial programs, but that, too, has run its course; as a result, the collaborative ended operations in June of this year.

Primarily, this is a result of how disaster-relief funding has always been structured. There is an event, dollars flow in to help deal with it, and then it’s expected that people move on. But that’s clearly not in step with how humans process trauma. While these initial programs can get survivors on the right path toward recovery, continued support and resources are key to maintaining mental health. In a 2015 study of wildfire survivors, UCSB trauma researcher Erika Felix found that those with social support were more likely to have better mental health outcomes. But, she emphasizes, after the initial honeymoon period, ongoing resources and programs serve as an important outlet for survivors and other community members to gather and maintain connections. There’s increasing chatter among mental health experts about looking at the “long game” for survivors, according to Heinz, who believes that programs and research should be ongoing and federally funded.

The lack of long-term funding for mental health support also perpetuates inequity in who can access resources for emotional recovery. Wealthier residents might have resources and insurance that allow them to seek out private therapy—as well as the financial flexibility to more quickly resolve stressors that can harm mental health, like housing issues and insurance woes. Some communities may not be able to access financial resources at all; to qualify for FEMA disaster assistance, for instance, a member of the recipient’s household must be a U.S. citizen, a noncitizen national, or a “qualified alien” (like a green-card holder or refugee), though crisis-counseling hotlines don’t require residency status.

After the Tubbs Fire, Ariel Kelley, cofounder of the California nonprofit Corazón Healdsburg, says that some families with undocumented members lacked access to crucial resources. The fire “really created huge levels of fear and trauma in our community,” she says. “We all really botched a lot of the recovery work. During evacuation we weren’t putting anything out in Spanish, and we weren’t communicating proactively that FEMA was not ICE, so people were not getting resources.” For less affluent families who did know about the resources, some lacked reliable transportation to access them. “There’s a huge combination of things that can really compound someone’s trauma,” says Kelley.

For Gray, the years since her family lost their home have been tough. Brighton, their beloved “hero dog,” passed away. The family moved 15 minutes up Highway 101 to Windsor, and in October 2019, two years after they lost most of their belongings in the Tubbs Fire, the Kincaid Fire prompted another evacuation. This time, Gray had the packing down; the car was ready hours before the evacuation order came through.

Initially, people who have experienced fires and evacuations before might have a leg up. UCSB’s Felix says that some studies of natural disasters show an “inoculation effect”—just like Gray was prepared for her second evacuation, survivors might be quicker to react and better able to handle the initial stressors of a fire, since they’ve been through it before.

But that preparedness might not completely buffer survivors against more emotional distress. It depends a lot on what you went through the first time, says Felix. For people with mild trauma, previous experiences may allow repeat encounters to roll off their backs, but for people with more traumatic memories, it could cause a relapse of symptoms.

Gray held it together through the second evacuation and didn’t fall apart until after they’d safely gotten to a friend’s kitchen. There, in a moment of déjà vu, her husband received word from their security-alarm company that their front door had been breached. Gray was sure they’d lost their home again. “I just collapsed to the ground, sobbing, and I was like, I can’t do this again. I can’t handle it.” A few hours later, the family discovered that their home was intact—the wind had blown open the front door. “I realized I’m still such a wreck from not only my initial fire but also when we went through the second fire and evacuation,” she says.

A fire’s effect on a community is like the ripples of a stone dropped in water, says Erika Felix, an associate professor of psychology at the University of California at Santa Barbara.

At the moment, scientists know woefully little about retraumatization. There are, after all, limited opportunities to study it; few communities are unlucky enough to be struck by multiple disasters in such a short time frame. But that’s quickly changing. As climate change progresses, wildfires around the world are becoming not only more frequent—fire season in California is now at least 75 days longer than it was in the 1970s—but also more devastating.

Data collected by the WHAT NOW team could better illuminate the patterns of retraumatization. Currently, researchers are surveying survivors with follow-ups every few years; Hertz-Picciotto says that about 40 percent of the initial respondents from the 2017 Tubbs Fire have participated in a 2018 follow-up survey. The team is still analyzing results and gearing up to release a follow-up survey for survivors of the 2018 fires. When I caught up with Hertz-Picciotto in August, she logged into Zoom from her home in Berkeley, which was choked with smoke from the Lightning Complex Fires. Her team had already begun discussing study follow-ups; this year, mental health and wildfire response have been even more fraught than usual, as COVID-19 has limited people’s options for evacuation and stifled the typical face-to-face social support important for emotional recovery.

As for Gray, she and her family have built a new life in Windsor, where the Skechers she remembered to take that night are among the few of her old possessions that remain. In the latest round of fires, an area just west of their home had been on evacuation warning, so she’d stacked up plastic bins of belongings, all ready to go in case they were given an order to leave. As she prepared the family for another potential evacuation, she found herself on the verge of panic attacks, the stress triggering her PTSD.

And even when fires aren’t burning within miles of their home, Gray says the memories of 2017 are never far. “It’s the littlest things—you’re in the kitchen, and you’re reaching for a certain baking dish you had, and then you go, ‘Oh yeah,’” she says. “There has not been one single day of my life that I have not thought about the fire.”

Lead Illustration: Charlotte Fu