UVALDE, Texas (AP) — A girl runs and hides when she sees thin people with long hair similar to the gunman who broke into her school in Uvalde, Texas, and killed 21 people. A boy stopped making friends and playing with animals. A third child feels her heart racing as she recalls the May 24 massacre that killed a close friend – once at such a dangerous rate that she had to be rushed to hospital, where she stayed for weeks.

The 11-year-old girl has been diagnosed with anxiety, depression and post-traumatic stress disorder. The Associated Press spoke to her and her family on the condition that her name not be used to protect her identity.

“I’ve never lost anyone before,” she said, adding that her friend who was among 19 students and two teachers killed in America’s deadliest school massacre in a decade would encourage you to get through the difficult times. “He was a very strong person.”

As students prepare to return to Robb Elementary on Tuesday for the first time since the massacre, symptoms of PTSD are beginning to manifest. Parents find themselves unable to help and experts worry because communities of color such as the largely Hispanic town of Uvalde face disparities in access to mental health care. For low-income families, this can be even more difficult, as access to limited resources requires long waits for referrals through medical assistance programs such as Medicaid.

“It’s hard to hear what these kids are going through at such a young age,” said Yuri Castro, a mother of two boys in Uvalde, whose cousin was killed in the shooting and whose sons were tutored by both teachers killed. Castro knows children so traumatized that they have stopped talking.

School shootings dramatically disrupt the lives of survivors. For some, symptoms persist for years and high-quality treatment can be hard to come by.

In recent years, Texas lawmakers have focused on spending on mental health services, spending more than $2.5 billion in the current fiscal year.

But according to the 11-year-old’s family – permanent residents of Uvalde – the area’s only mental health center – a few blocks from Robb Elementary – was rarely used or discussed, raising concerns about the lack of awareness of the signs and symptoms of mental illness and the stigma surrounding seeking help.

The mother of the 11-year-old girl whose pounding heart led to her hospitalization says open conversations about mental health were previously taboo in the heavily Latino community, where culturally mental health is seen as lazy, bored or making a fuss. temper tantrum.

“I remember growing up it was like, ‘Go over there, you’re just a chiflada,'” the mum said, using a Spanish word that means ‘act spoiled’.

Now, she says, the city is waking up to the reality of mental health, even though some people are still asking why survivors like her daughter need help.

Community members support each other by connecting with extended family and friends and taking advantage of community resources that have been put in place, including advice from the Red Cross and emotional support from churches. The parents of one of the children who were killed have started an organization that will organize wilderness retreats for the families of the victims and the survivors. Residents also have social media groups where they can share mental health resources and express their grief.

The Texas Health and Human Services Commission contracted organizations to create a mental health hotline that, within six weeks, answered nearly 400 calls.

Martha Rodriguez, who coordinated efforts to help students recover from the mass shooting at Marjory Stoneman Douglas High School in Parkland, Fla., said officials need to visit the community to ensure the right resources are available. She said it was essential to fight stigma and send providers who understand the language and values ​​of families.

“Some families may not feel comfortable sharing their distress and needs,” she said.

Many of the families affected by the shooting are Roman Catholic. The mother of a girl who survived the attack says her daughter was only able to open up to a priest in Houston – 450 kilometers away – who the family go to when they visit parents.

“It’s going to be a long journey. It will not be something that we can just do a little work and fix,” said Archbishop of San Antonio Gustavo García-Siller.

Julie Kaplow, director of trauma and bereavement centers at Texas Children’s Hospital and Children’s Hospital of New Orleans, said many students who survived the Santa Fe high school shooting in May 2018 who killed 10 people in suburban Houston had no symptoms for six months.

“I anticipate we’ll see some similarities,” said Kaplow, who has trained clinicians and others who treat families at Uvalde. “Part of the reason is that these symptoms haven’t shown up yet and will start to show up when they remember the event itself. Or the caregiver starts to recognize, ‘Wait a minute, my child isn’t eating still not, still not sleeping.’

The duration of treatment varies depending on the severity of symptoms. For some, it can last up to two to three years.

Melissa Brymer, director of terrorism and disaster programs at the UCLA-Duke National Center for Child Traumatic Stress, was the primary counselor for public schools in Newtown, Connecticut, after the Sandy Hook Elementary massacre in 2012.. She said officials need to make sure families can get services at the school. They also need to create more convivial spaces, such as community meals, rather than clinics.

The parents of the new fifth grader who is struggling with symptoms have opted to home school her this year so she can continue to get to her appointments more easily. She also receives a service dog who will alert her if her heart rate increases.

But she worries about her brothers returning to class and worries that others will judge her because of how she was affected by the massacre when she was not shot, said her mother. She is awakened daily by night terrors.

“We are not sleeping. … We don’t even know what it is since it happened,” the mother said. “I’m going to have to deal with this for as long as it takes for him to heal.”

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Read more about the school shooting in Uvalde, Texas: https://apnews.com/hub/uvalde-school-shooting