Last year, Joy Moore lived through a nightmare for the third time. After the Baltimore resident and mother of two had her son screened for lead poisoning, she learned that the test came back positive. Much to Moore’s dismay, he had a shockingly high blood lead level of 17 — more than three times the amount that is considered elevated.
Unfortunately, it wasn’t Moore’s first encounter with lead. Indeed, it seemed as though the dangerous neurotoxin was following her around. Not only did Moore and her four siblings test positive for lead paint poisoning as children, but her oldest child also recorded high blood lead levels several years ago. Moore was determined to avoid exposing her youngest child to lead paint, so she moved into a new home when she was several months pregnant. But the landlord there furnished a false lead certificate before she moved in, Moore said, and so her son, too, contracted lead poisoning.
The revelations put Moore in a dark place. “Sometimes I go into states of depression because I’m upset,” she told ThinkProgress. “When I found out that my [oldest] kid had a lead level of 22, I cried. I cried profusely because I felt like my baby was poisoned and he’s a year old and he can’t fend for himself. That’s my job, and I let him down.” She paused: “When situations like this happen, you question yourself as a mother… You know you’re trying your best, but sometimes it feels like your best is not good enough. Maybe your children would be better off with someone else.”
It’s a feeling Moore imagines parents hundreds of miles away, in the embattled city of Flint, Michigan, might share. After news broke that a stunning lead poisoning disaster exposed as many as 8,000 children to unsafe lead levels, and subsequent investigations uncovered a litany of government failures over an extended period of time, the Baltimore mother immediately recalled her lifelong struggle with the toxic metal.
“When I first found out what happened in Flint, I was emotionally disturbed,” Moore said. “Because I imagined someone like me, thousands of me, thousands of my children, going through the same situation. That’s all I could think about. I just feel so sad for these women and these children.”
The scope of Flint’s crisis is dramatic. Residents of the Rust Belt city are reeling from the far-reaching impacts of a public health disaster that has significantly eroded trust in public officials, and shows no sign of letting up. Two years after the city temporarily switched its water supply to the highly corrosive Flint River — which caused lead to leach from aging pipes — experts say the water is still unsafe to drink, and estimate that the road to full recovery could take months. The slow-moving process has compounded residents’ feelings of helplessness and anxiety: Chief among parents’ concerns is the daunting possibility that children exposed to lead may suffer lifelong and irreversible damages.
That unsettling reality is made even more stressful by the ambiguous impacts of lead exposure. Although extensive research has found that lead can affect children’s cognitive development and behavior, the outcomes can take years to show up, making it impossible to predict whether exposed children will have adverse outcomes, and if they do, how severe the damages will be. This leaves worried parents with endless questions, but no satisfying answers.
For some parents, the psychological toll of the crisis is exacerbated by what Dr. Mona Hanna-Attisha, a pediatrician at the Hurley Children’s Hospital who helped expose the crisis by publishing research documenting a spike in Flint children’s blood lead levels, calls “mommy guilt” — the sobering realization that they couldn’t protect their children from lead, and even unintentionally provided them with undrinkable water.
“Even when they were told the water was safe, in their guts these moms knew that it wasn’t,” Hanna-Attisha said. “But they had no financial alternative… So that mommy guilt will always be there. Because they think they poisoned their kids.”
To date, The Substance Abuse and Mental Health Services Administration (SAMHSA) and the local mental health provider, Genesee Health System (GHS), are offering phone hotlines, crisis counseling, and resilience workshops for Flint residents. But concerns about trauma and Flint residents’ mental health still linger. According to Hanna-Attisha, the water crisis has now developed into a “PTSD” situation — the result of debilitating stress, widespread community distrust, and anxiety about lead’s impacts.
“This is a traumatized community,” Hanna-Attisha said. “If anything needs to be done acutely, it’s the mental health first aid.”
Lead Exposure And Mental Health: What Do We Know?
For decades, lead poisoning has been a declining but stubbornly persistent problem. National lead levels have fallen significantly since the 1970s, when the government banned the use of lead in household paint and gasoline. Since then, lead levels in the average American’s bloodstream have dropped by more than 75 percent: 88 percent of children between the ages of one and five were estimated to have at least 10 micrograms of lead per deciliter of blood between 1976 and 1980; between 2007 and 2010, that number dropped to 0.8 percent.
Still, the problem hasn’t been entirely eradicated. In fact, experts say that lead exposure remains a critical public health issue: It’s estimated that nearly half a million children nationally still suffer from lead poisoning, and unsurprisingly, low-income and minority children are disproportionately impacted. As a Baltimore-based attorney who works on lead-poisoning litigation recently told NPR, “there’s no doubt in my mind that if rich white kids were the ones being poisoned by lead, this problem would have been solved 75 years ago.”
Although the primary source of lead exposure for children is actually through paint and lead dust — which is common in aging and deteriorating homes — the revelations in Flint shone a light on the nation’s aging water infrastructure, as well as the millions of lead service lines that remain in cities throughout the country.
Despite the scope of the problem, and the recent public outrage, research tracking the outcomes of exposed children appears to be limited or nonexistent.
In the early 2000s, Washington, D.C., went through a lead contamination crisis that revealed strikingly high levels of lead in the city’s water supply. That scandal eventually led to a congressional investigation, which concluded that the Centers for Disease Control and Prevention (CDC) made “scientifically indefensible” claims in a 2004 report contending that high lead levels in the drinking water did not pose a risk to residents’ health.
Marc Edwards, a Virginia Tech professor who helped uncover Flint’s crisis, co-authored a 2009 study that found a connection between the elevated lead levels in the District’s drinking water and the elevated blood lead levels in the city’s children, estimating that more than 40,000 children who were under two years old or in the womb during the time of the crisis might have been exposed to contaminated water.
Just how bad was this disaster compared to Flint’s? Last month, Edwards told a congressional panel that the District’s lead water crisis was “20 to 30 times worse” than the Rust Belt city’s.
But D.C.’s crisis didn’t lead to reliable data about what happened to those children. George Washington University School of Medicine and Health Services’ Jerome A. Paulson, who worked on environmental health issues in D.C. during the time of the scandal, said he’s unaware of any researchers who compiled a cohort of the city’s exposed children and tried to follow them longitudinally.
“The records here in D.C. at that point in time were pretty abysmal,” Paulson told ThinkProgress. “So putting together that cohort probably would have been quite difficult.”
Still, we do know that children, thanks to their quickly developing brains and nervous systems, are particularly vulnerable to the toxic effects of lead. Exposure to the neurotoxin in children can cause profound health consequences, including stunted growth, intellectual disability, hearing loss, kidney damage, attention deficit disorder, and behavioral issues. It’s even been linked to adult criminal behavior, substance use, and decreased lifetime earnings. Alarmingly, research now suggests that lead exposure in women can cause changes in their grandchildren’s DNA.
Although children are especially susceptible to lead’s impacts, exposure can cause long-term harm in adults, as well, including increased risk of kidney damage, high blood pressure, memory loss, fatigue, and reproductive problems. It has also been linked to adverse mental health outcomes: A large-scale study found that high blood lead levels were associated with higher odds of major depression or panic disorder in young adults. A 2012 study found that men with high blood lead levels were more likely to be pessimistic than those with lower levels, and researchers found that low-level, long-term lead exposure was associated with increased reports of depression and anxiety among older women. Because that study tracked long-term exposure with women who were born in an era when overall lead exposures were higher than they are today, it’s hard to predict whether or not a short-term exposure like Flint’s will be associated with the same outcome.
However, the research is certainly suggestive, according to Susan Korrick, a professor in the environmental health department at the Harvard T.H. Chan School of Public Health who worked on the study. “The bottom line is the study supports the notion that long-term lead exposure in adults may be a risk factor for later depression and anxiety, at least among older women,” she said.
Trauma Of The Unknown
For many people in Flint, the water crisis was one just one more thing to tack onto an already long list of struggles.
Like other Rust Belt cities, Flint was once a thriving hub for auto manufacturing. During its prime in the 1960s and 1970s, nearly 80,000 of the city’s 200,000 residents were by employed General Motors. The famed manufacturing company began shutting down plants and laying off workers in the 1980s, pushing unemployment rates to 25 percent and causing thousands of people to flee the city. In the span of just two decades, the company slashed more than half of its workforce. In 1998, General Motors employed about 33,000 workers in Flint; by 2009, that number was down to about 5,000.
The company’s divestment from Flint dealt a blow to the former auto hub. Today, Flint has a 40 percent poverty rate and one of the highest crime rates in the country. Drive around parts of the city and you’ll find blocks dotted with vacant and crumbling, eroding homes. “We have no full service grocery stores in Flint,” Hanna-Attisha said. “The people of Flint already have a 20 year less life expectancy than a suburb outside of Flint.”
These frequent and continual stressors — poverty, violence, lack of nutrition, or housing instability — are factors that can contribute to what’s known as “toxic stress,” and, as research increasingly shows, childhood exposure to stress and trauma can have lifelong impacts.
“We were already at this PTSD level,” Hanna-Attisha said, adding that many of her patients are now showing additional signs of stress and anxiety.
Indeed, living through a crisis situation can carry long-term psychological and emotional consequences. Research shows that events that cause a tremendous amount of community disruption and stress often yield increased reports of depression and other mental health consequences. A study conducted in the wake of Hurricane Katrina, for instance, found that rates of mental illness in New Orleans doubled after the storm, and that nearly half of participants reported symptoms that were consistent with post-traumatic stress disorder (PTSD). Another report found that mental health issues among Katrina survivors, including PTSD and suicidal ideations, actually worsened over time — bucking usual patterns seen after disaster situations where rates of PTSD eventually decline.
It’s impossible to predict whether or not Flint’s crisis will yield similar psychological consequences. But, as Hanna-Attisha pointed out, many of the patients she’s seen are under a significant amount of stress, and their loss of faith in the infrastructure that was intended to protect them is profound.
“I think a lot of people will never trust this water until the pipes are replaced,” Hanna-Attisha said. “They’re going to need lots and lots of reassurance to trust this water.”
Flint residents’ wariness of government agencies in particular can undermine the work of local mental health providers trying to help.
“One of the biggest things when I think about how folks are responding to this is just the amount of distrust,” Elizabeth Burtch, a social worker at Genesee Health System (GHS) who has been involved in the mental health response to the crisis, told ThinkProgress. “People don’t know what they can believe or who to believe… I think sometimes folks see people with a badge on and assume that they’re in on it. That’s definitely something we struggle with.”
Still, Burtch and her colleagues are trying. GHS, the primary mental health provider in the community, is working with the Michigan Medicaid office on providing any Flint residents who are pregnant or under the age of 21 with services and targeted case management, under a Medicaid waiver, and is also offering crisis counseling and resilience-building workshops.
In addition to the stress stemming from the immediate crisis, the uncertainty surrounding lead’s health impact is a lingering burden that weighs heavily on parents. Burtch told ThinkProgress that many of the people she’s met with have expressed concerns about their children’s long-term health outcomes, and confusion about how to spot the problems if they do emerge.
“There’s a lot of unknowns,” she observed. “One of the things we hear about from parents is: ‘If my kid has problems in middle school, how do I [know if it’s because of the lead]?’ Parents are concerned. ‘Is this normal childhood behavior?’ Is this because of the lead or just a normal developmental stage?’
Not every child exposed to lead will suffer from its most severe consequences. Although the CDC does warn that there is no identified “safe blood lead level” for children, outcomes can be extremely variable. “It’s one of the things that parents in Flint and everywhere else need to understand,” George Washington University’s Paulson pointed out. “There’s nobody who can predict which children will have adverse outcomes.”
But it’s hard to offer that reassurance to parents who are concerned about their children’s health, explained GHS CEO Danis Russell. “It’s difficult because it is a very difficult topic,” he said. “You’re talking about your health or your children’s health, and there’s no right or wrong or definitive answer, which is really very anxiety-producing for everyone.”
For now, anxiety is the only visible effect of Flint’s poisoned water.
“That’s the only thing we’re seeing,” Hanna-Attisha said. “Because we don’t see symptoms of lead poisoning now. So what we are seeing is the stress, and what we are doing as pediatricians is the reassurance. Not every kid is going to have every problem.”
‘You Have To Put Your Best Foot Forward’
Baltimore’s Joy Moore is certain that lead exposure has impacted her oldest child, however. He’s seven years old now, and as he ages, Moore said she increasingly sees the effects of lead poisoning: He has a short temper, is on medication due to severe ADHD, and struggles to pick up subjects in school.
“If he’s putting a toy together and he’s sitting there for two minutes and can’t put it together, he’ll get frustrated,” Moore said. “He’ll go into a room and try to break it.”
Moore estimates that the majority of the people she knows in Baltimore — between 65 and 75 percent — were lead poisoned as children. Many of them struggled; she recalled a friend who, at 32, cannot read or write. Those harsh realities, however, have strengthened Moore’s resolve to provide both of her children with the support they need to thrive.
“You have to put your best foot forward,” she told ThinkProgress. “That’s what I teach my kids every day. It’s gonna be hard, but they have mommy here. They have a great support system… If I could tell these parents [in Flint] anything, it’s don’t give up. Because once you give up, your kids give up. They slowly let go.”
Moore’s instincts are backed by research: According to the Harvard Center on the Developing Child, the most important factor of a child’s ability to develop resilience is having a stable, committed relationship with an adult. Moreover, studies examining the impact of lead on children’s outcomes found that a supportive home environment can positively influence a child’s IQ, a report from the CDC noted.
Hanna-Attisha and other experts are looking at the Flint response as an opportunity to address the full scope of trauma and stress that kids experience, to strengthen their resilience.
“When you look at it from this toxic stress angle, we know what builds resistance, we know what makes kids healthy, and it’s the same things that we need for these exposed children,” Hanna-Attisha said. She is advocating for a range of interventions to help mitigate the impacts of exposure, such as universal preschool, early literacy programs, nutrition services, and mental health care.
But, as she notes, many of the interventions that have been shown to help mitigate the impacts of lead — such as nutritional support and educational and behavioral programs — are services that all vulnerable children could use. These interventions could also help address some of the other impacts of poverty, toxic stress, and trauma that Flint children experience even aside from their lead-lined drinking pipes.
“We are using this as an opportunity to lift up our children,” Hanna-Attisha concluded. “These are the things that our kids needed anyway. Especially kids in poverty, in these toxic environments. These are things that we should be doing for all of our children.”