Editor’s note: This article is part of a joint editorial initiative between the National Association of Community Health Centers and Direct Relief.
In the first weeks after floods tore through central Texas, killing at least 138 people and damaging thousands of homes, people kept their heads down and pushed through.
Mikki Hand, a family nurse practitioner and executive director of Frontera Healthcare, a community health center serving a number of severely impacted communities, described a provider who came into work despite losing her home to the floods. “I have more than our patients, and I didn’t lose somebody,” the provider told her.
“I can control this, but I can help people. If I go home, I have nothing left, and I’m not ready to deal with that,” Hand recalled a staff member saying.
Hand, a seasoned provider and community health leader, knew the worst need was still ahead.
Frontera staff who had lost their homes or suffered severe damage faced overwhelming financial challenges. Meanwhile, first responders—nearly all of them volunteers—were returning to their own hard-hit neighborhoods after taking on swift water rescues and emergency operations that otherwise might not have happened, Hand explained. “They’re expected to resume their everyday lives,” she said.
The health center’s patients were struggling with damaged houses and property – they had nowhere else to go. A nursing home where Frontera staff provide medical care was heavily damaged by water, Hand told Direct Relief.
Parents began requesting mental health appointments for their kids, who “learned on social media or the news that people they knew were gone,” Hand said.
Frontera and the close-knit rural communities it serves are no strangers to tragedy. The area’s rivers are prone to flooding, and the area has struggled with recent wildfires, although the death toll has never been so high – or the public spotlight so glaring. In March of 2025, the Crabapple Fire destroyed nearly 10,000 acres near Fredericksburg, where one of Frontera’s clinics is located: Krista Bopp, a licensed professional counselor at Frontera, said many of the same first responders who’d worked through the fires had gone back to the field to help with the flood response.
“These men and women in these small towns, they are working full time jobs and volunteering as first responders,” Bopp said.
Hand, a dedicated advocate for her staff and patients, knew the needs in flood-affected communities would be tremendous – and they were only beginning to emerge. She secured a $50,000 emergency grant from Direct Relief for Frontera, one of five grants the organization awarded in the aftermath of the flooding. Part of the funding was used to cover healthcare costs for flood survivors and to give emergency cash assistance to health center staff members who were experiencing severe financial hardship, enabling them to continue working. Funds also covered staff time to help patients clean out their homes, mental health support for staff members, and mental health and wraparound services to first responders and volunteers.
“The funding Direct Relief provided has empowered us to care for these patients,” Hand told the organization. Bopp and Hand both described Frontera’s patients – most of them from small towns in the central Texas counties of Mason, Menard, Kimble, McCulloch, and Gillespie – as deeply committed to their communities and concerned about their neighbors, in part because so few outside resources are available.
“There aren’t enough hands-on deck to assign roles, so people do many roles,” Bopp explained. She offered the example of her own father, a small-town mayor, schoolteacher, and volunteer first responder when she was growing up. “His example has led me to what I do: It’s a part of me to be service-oriented.”
In the aftermath of the flooding, public funding and other support have been slow to come in, Hand said: “Neighbors are helping neighbors.”
She described one patient who was hesitant to apply for aid, even though her family had lost their livestock and they were experiencing financial hardship. They hadn’t lost their house, so felt their need was less. Others had experienced property damage, but didn’t want to take funds or attention from those more heavily impacted.
Frontera’s role in these affected communities is pivotal. “We are the only primary and only behavioral health providers in some of the counties we serve,” Hand said. “These counties don’t have the biggest infrastructure and they’re not the best funded.”
Hand said more than half of Frontera’s staff experienced impacts from the flood, whether property damage or mental health symptoms. Caring for them is essential, even as Frontera “is starting to plan and mount the long-term response” in the larger community.
“We’re so intertwined in these small communities,” Hand explained.
Mental health support will be an urgent priority in the coming months, Bopp said.
“This isn’t even here yet,” she said of the coming need for mental health services. “I can see the wave off in the distance…We’ll start to see our first wave of people who say, ‘I’m not OK.’”
Bopp is already working with search and rescue volunteers and other first responders, and said more are beginning to seek counseling.
The number of children affected by tragedy has made the July flooding especially devastating. “When you have that aspect of children, people just go weak at the knees,” Bopp said. She noted that two children of a first responder had brought up the tragedy during a play-therapy activity. They hadn’t fully understood the danger, but they knew their dad had gone to help people and “all we could do was pray he was going to come back.”
Frontera is developing partnerships with local schools to help them prepare for an influx of children who need mental health care.
Because she works in a small community and is well known, Bopp said she emphasizes the legal confidentiality of therapy, and promises patients she’ll never approach them outside of a session. If they want to say hello, she’ll say it back. Telehealth is also available to first responders in neighboring counties, who often prefer a therapist they’re unlikely to see in the grocery store.
“I have to be a safe place,” Bopp said. As people get through the process of securing material needs – funding assistance, food, medications – they will be able to turn their attention to post-traumatic stress, anxiety, and other mental health issues connected to the floods. “This rolls into something so much bigger as time goes on.”
