When people in Haiti pause from helping the hungry, injured and homeless the near impossible task of stopping their own emotional trauma from the last week's earthquake becomes apparent.
"Most people are just in shock and disbelief of what has happened. Most people are still sleeping outside. They are scared to sleep inside the houses," Lisa Betor, who runs a shelter for 70 malnourished children in a village called Cazale outside of Port-au-Prince, wrote in an e-mail to ABCNews.com. "You see a lot of people sleeping during the day as well. Everyone is saying that it's hard to have a peaceful sleep time."
Dr. Richard Besser, ABC News' Senior Health and Medical Editor who is in Haiti, said he has seen varied reactions in Port-au-Prince.
"Many who have lost family members and friends sit passively with vacant stares. Other people pray and sing," said Besser. "There is little time to process what has happened or to properly grieve when there is not adequate food, shelter, and water."
"I've been looking in the tent cities and hospitals for programs or specialists in mental health but haven't found them. If they are here, they are not in abundance," he said.
Months may pass before symptoms of Post Traumatic Stress Disorder (PTSD) or clinical depression emerge, and months before volunteer counselors can reach those in distress.Yet post-disaster mental health experts say the way the international relief workers handle the situation could support or erode the mental resiliency of the earthquake victims in months to come.
Dr. Amir A. Afkhami, of the Global Health Division at George Washington University's School of Public Health, said the prevalence of PTSD after a major disaster historically ranged from 1 percent to 11 percent of the population. But rates of clinical depression, crippling anxiety and other issues after a natural disaster might reach up to 30 percent of the population, according to Laura Murray, a clinical psychologist at the Johns Hopkins Center for Refugee and Disaster Response.
With the type of destruction seen in Port-au-Prince, mental health experts wager a large number of people will suffer from debilitating mental health issues afterwards.
"We are in this phase where obviously the most important things are still meeting very basic needs that people have," said Farris Tuma, of the National Institute of Mental Health Traumatic Stress Disorders Research Program.
But, "there is now a knowledge base that suggests that aid can be done in a way to promote mental resilience instead of erode it," said Tuma.
From subtle communication tactics, to long term strategy for refugee cases, Tuma said the way people deliver help in the next days and weeks could influence how survivors of the Haiti earthquake manage their trauma.
Murray agreed, pointing out that he has found that relief workers can even influence how a person feels about the tragedy in the way they communicate.
"One of the most important things is providing accurate information," said Murray. "Don't say things like 'everything is going to be fine,' or 'I know what you are going through' and it's not a time to ask them what they're feeling."
Murray said many who survived Hurricane Katrina were deeply shaken when promises of aid didn't come, or didn't come soon enough. Rather than build false hopes, Murray said it's best to give the most accurate information possible.