With hurricane nearly two months in the past, the island is still in shock. Its residents are haunted by dozens of deaths caused by the storm, and many more life-threatening near misses. The reminders are inescapable. They lie in piles of rotting debris as tall as homes that still line many streets and in cellphones that are useless for checking on family members.

Returning to a routine is the most important step toward overcoming trauma, according to physicians and public health officials. But for most Puerto Ricans, logistical barriers like scarce water and electricity, as well as closed schools and businesses, make that impossible.

Since Sept. 20, when the storm came ashore at 6:15 a.m., more than 2,000 calls have overwhelmed an emergency hotline for psychiatric crises maintained by the Puerto Rican health department — double the normal number for that period, even though most residents still do not have working phones. Puerto Rican officials said that suicides had increased — 32 have been reported since the storm — and many more people than normal have been hospitalized after being deemed dangerous to themselves or others.

At the emergency health clinic in Toa Baja, where Ms. Serrano Ortiz lives, Dr. Toro said that he had been frantically calling for help from colleagues in other cities because the facility was overrun with people in need of mental health care.

Because it is in a flood zone, Toa Baja was one of the worst affected areas in Puerto Rico. At least four people died there and water levels peaked at more than 12 feet. The city of 80,000 west of San Juan flooded multiple times, each time that it rained after Maria passed.