When tropical storm Nate hit Costa Rica in 2017, it lashed the Central American nation for three days. Nearly a year later, memories of the storm are still fresh for many - including for Marielos Alvarado.

She is one of thousands of residents of Corralillo, a municipality in country's northwestern Guanacaste region, who spent those anxious days in a shelter.

"On an emotional level it was very stressful. It took a lot for me to overcome certain things," she said.

Nate killed 11 people in Costa Rica, causing landslides and some of the most damaging flooding in the country's history. Some communities trapped by the storm ran out of drinking water and food, and electricity failed.

Such disasters - which are becoming more regular as a result of climate change - often cause mental health issues in those affected, said Jose Francisco Aleman, Corralillo's emergency coordinator.

But that aspect is regularly overlooked in disaster response efforts, he said - though tackling it is vital to help communities recover.

"When the emergency happens, people are in despair for help, scared of illness, desperate for food, etcetera. In the end, these issues - such as food and shelter - are taken care of, but the psychological effect is not," he said.

For Alvarado the flooding brought by Nate meant her family and others ran out of drinking water and food while waiting for help.

"I still can't get the elderly or children vomiting from hunger out of my head," she said.

Nate's intensity, she added, was unprecedented.

"Nobody expected the emergency to be of such magnitude," said Alvarado, who also heads the local disaster committee.

More than nine houses out of 10 in Corralillo were damaged, she said, including her own. When she finally arrived home, more than two weeks after the storm, only the walls of her home were left.

"It was shocking," she said.

 Community members in Corralillo, in Guanacaste, Costa Rica, talk about mental health issues and resilience to risks at the town's main shelter, June 30, 2018.
Image: Thomson Reuters Foundation/Sebastian Rodriguez

Types of destruction

Nate brought significant destruction to Costa Rica: more than $385 million in damage as well as the deaths, according to data from the National Emergency Commission (NEC).

But some experts now think damage assessments should go beyond financial losses and include things like impacts on mental health.

A study published last year in the International Journal of Environmental Research and Public Health, for example, said "recovery efforts must consider the long-term effects of hurricane exposure on mental health".

The Ministry of Environment has said Costa Rica is working to measure those effects, and how best to combat the damage to mental health as climate change brings stronger storms and other extreme weather.

Costa Rica's National Adaptation Plan (NAP) - its core plan to deal with climate change pressures - will be published later this year, and will feature mental health prominently, officials said.

But, the ministry said, the NAP would look only to teach municipalities how to spot mental health vulnerabilities; tackling them would remain the responsibility of local governments.

Gabriela Mora, a psychologist at the University of Costa Rica, said the NAP was a good start but more is needed - including clarity on how the government will work with local authorities to cut the risks and implement better mental health programs.

And it's not just the direct psychological impact of a disaster that needs to be considered, with many communities needing a broader level of support, said Mora, who is also the coordinator for the Psychosocial Brigade, a group of psychologists who provide help to those who have experienced a disaster.

That includes finding ways to reduce a community's vulnerability to future events, and encouraging people to meet and talk openly about their experiences, she said.

Corralillo is one example, Alvarado said. The community lies on what used to be a wetland and is surrounded by two rivers, the Las Palmas and the Tempisque. Access is difficult, there are few jobs, and there is a lack of emergency planning, she said.

Even though Corralillo had experienced three significant floods last year prior to Nate, the impact of that storm was far beyond what people were prepared for, Alvarado said.

 Community members in Corralillo, in Guanacaste, Costa Rica, talk about mental health issues and resilience to risks at the town's main shelter, June 30, 2018.
Image: Thomson Reuters Foundation/Sebastian Rodriguez

After the event

As part of its efforts to deal with Nate's aftermath, the community held a series of workshops with Mora's department to discuss what had happened, and to train their neighbours on risk prevention.

Alvarado said the workshops attracted more people than expected, and allowed residents to talk about what had happened and learn lessons.

"That shows that the community is waking up," she said.

One key aspect of the work is helping people not just work through the damage but find ways to try to cut their risks and feel more security in the future, Mora said.

"The idea is not to remember it as 'the event that hurt me' but, rather, to observe how we have to improve from an event that has already happened," Mora said.

The region's vulnerabilities extend beyond physical aspects, such as the adjacent rivers, Mora said. In Corralillo, job insecurity is a key issue.

"Here they only have sugarcane around them, and the period when they grow cane is very short. After that, they are out of work," Mora said.

 The flooded Tiribi river is seen during heavy rains of Tropical Storm Nate that affects the country in San Jose, Costa Rica October 5, 2017.
Image: REUTERS/Juan Carlos Ulate

Lack of knowledge

Marco Carranza, a workshop organizer, said disaster-affected communities need to ask local authorities for help in order to be considered for it.

The local authority then writes a report listing the damage the community suffered: deaths, injuries and material losses, as well as - in theory - the community's assessment of the mental health impact.

That report gets sent to central government, which examines it and allocates funds.

But, Carranza said, communities are often not aware that they can include mental health "losses" - and many do not know recognize them as a problem until much later, when it is too late to request help.

Marianela Rojas, a member of the Psychosocial Support Technical Advisory Committee, the National Emergency Commission's main source of support for community mental health, said communities need to be trained to ask for such assistance.

But even those communities that do request and get help have may struggle, Carranza said - not least because measuring damage to mental health is inherently difficult.

Rojas said the National Emergency Commission was working on ways to calculate the impact of disasters on mental health. The country's climate change plan also will require every municipality to have mental health and risk programs in place by 2030.

Factoring in mental health considerations is essential in helping communities deal with the impacts of climate change, Rojas said.

Failing to do so, she added, could mean its invisible effects will "end up generating a very high cost to the state".