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Five months after wildfires destroyed homes and lives on the Hawaiian island of Maui, residents are sounding the alarm on an ongoing mental health crisis facing those impacted by the destruction.
The Aug. 8 wildfires left thousands of businesses and residential buildings burned to the ground and killed at least 100 people. Thousands of people are still moving from hotel to hotel, shelter to shelter without a place to officially call home. Many are still without a job, with unemployment claims increasing by almost 400% since the tragedy, according to data from the Hawaii Department of Labor and Industrial Relations.
"The people of Maui are incredibly resilient, but there's only so much you can take," said Noelani Ahia, founder of grassroots organization Maui Medic Healers Hui.
"The juxtaposition of people on golf courses right next to people who don't know where they're going to sleep tomorrow is painful," Ahia went on. "It's really painful and hurtful."
MORE: Native Hawaiians fighting to take control of Maui's water rights amid wildfire cleanupAhia said she and roughly 600 volunteers -- from doctors to counselors -- traveled to the impacted communities within days of the wildfires to support residents' physical and mental health needs. Months later, the work continues.
"The constant shuffling of people from one hotel to another, getting a notice under your door saying that you have to be out in 24 hours -- all of these kinds of things keep people in that fight-or-flight [response]," she said.
The pain in the community is palpable, as residents cope with the compounding grief, loss and uncertainty, she said.
Concerns have spread among residents about a spike in suicides after the tragedy, prompting calls for action from officials to tackle what they say is a mental health crisis.
The Maui Police Department told ABC News that at least 10 people have died by suicide since the fires. Last year, there were eight deaths by suicide in the same period, according to Hawaii News Now.
It is unclear if the deaths are related in some way to the Aug. 8 wildfires. Concerns, however, remain high as the Maui Department of Health reports ongoing instances of suicide attempts and suicidal ideations among those recovering from the tragedy.
"It is on people's minds," said John Oliver, public health program manager of the state's adult mental health division. "It's a lot of stress and a lot of anxiety and a lot of depression."
Mental health professionals urge people to be vigilant of their loved ones' mental health in the aftermath of a tragedy.
"I'm always happy if we have somebody who's referred to us who's having suicidal thoughts because if they're caught at that time, that's important. It's important to catch this early," said Oliver. "Intervention earlier has much better outcomes than later so it's important to start getting help as soon as you start feeling like you need it so that you don't develop, say, Post-Traumatic Stress Disorder and some other conditions."
PTSD could be loss of appetite, difficulty sleeping, wanting to socially withdraw or become short-tempered in a way that's out of character, health experts said.
When new brush fires start to burn on the island, it reminds some residents of the wildfire scenes, according to Lauren Ampolos, a clinical director and psychologist based on Maui.
"We have to work on allowing people to understand that they're still safe," said Ampolos. "There were some fires that came up over the last few months, little brush fires, and those definitely put people on edge. I think that the community is still just a little bit sensitive."
Ahia said the tragedy has likely exacerbated preexisting traumas, particularly within the native and immigrant communities that are facing longer-term fights for water rights, decolonization and housing.
Hawaii health officials have also noted a rise in calls and visits for mental health care, which they see as a positive sign. This means people are reaching out for help instead of potentially harmful alternatives, they say.
MORE: Hawaii's 'overtourism' becomes growing debate as West Maui reopens for visitorsPost-tragedy access to mental health care services has increasingly become a priority in disaster response, service providers say. Past U.S. disasters, such as Hurricanes Katrina and Maria, appeared to spark a spike in suicides and other mental health complications in their wake, research has found.
Federal, state and local agencies have been on the ground in Maui to offer mental health resources and have invested millions of dollars in long-term mental health programs. Officials have said it could take years to rebuild the infrastructure in the hardest-hit areas of Lahaina.
The Substance Abuse and Mental Health Services Administration (SAMHSA) has given the Hawai'i State Department of Health a $17.3 million grant to provide emergency behavioral support, spotlighting the importance of such care in the aftermath of a tragedy.
"When there is a disaster, nearly every disaster survivor is affected in some way," said SAMSHA Division Director Maryann Robinson in an interview.
Mental health professionals already in the Upcountry and Lahaina areas find themselves at the forefront of the need for mental health care following the wildfires.
"If you talk to individuals with trauma, oftentimes it's very personal and they want to have that connection of being there physically," said Oliver. His team at Lahaina Comprehensive Health Center is one of the few behavioral health centers in Lahaina that wasn't impacted by the blaze. His clinic treats people of all ages and doesn't turn people away based on their ability to pay. The clinic also works as a facilitative resource for other needs clients may have.
Other local programs for those in need can be found on the county's Maui Nui Strong website of mental health resources.
Oliver said the number of calls and referrals is likely to keep climbing as people find space to prioritize mental health.
But if residents' basic needs -- like stable housing and financial security -- aren't met soon, Ampolos said these issues will continue to hinder the community's recovery.
"It's difficult to actually work through the trauma of a situation without addressing those things first, so I think that for some people, that's very much still where they're at -- how do we get our basic needs met?" said Ampolos.