NEWTOWN, Conn. - Anxiety, depression, guilt, sleeplessness, marital strife, drug and alcohol abuse - two years after the massacre at Sandy Hook Elementary School, the scope of the psychological damage to children, parents and others is becoming clear, and the need for treatment is likely to persist a long time.
"Here it is two years later, and it's still hard to deal with. But, God, you didn't want to know me two years ago," said Beth Hegarty, a Sandy Hook mother who happened to be inside the school that day with her three daughters, all of whom survived.
Hegarty and her girls are among the thousands of people in this close-knit town of 27,000 who have taken advantage of counseling and other programs made available through millions in grants and donations.
With the second anniversary of the shooting rampage approaching Sunday, agencies have been working to set up a support system for the next 12 to 15 years, as the youngest survivors approach adulthood.
Mental health officials say the demand for treatment is high, with many people reporting substance abuse, relationship troubles, disorganization, depression, overthinking or inability to sleep, all related to the Dec. 14, 2012, attack in which a young man killed 20 children and six educators before committing suicide.
And some of the problems are just now coming to the surface.
"We've found the issues are more complex in the second year," said Joseph Erardi, Newtown's school superintendent. "A lot of people were running on adrenaline the first year."
The Hegarty children have had trouble sleeping and difficulty with loud noises and crowds. Whenever they leave the house, they look for places they can hide in case something bad happens. In February, a school counselor suggested the family seek help because one of the daughters wasn't paying attention in class; she was staring at the doorway.
Hegarty and her children have been receiving support from Newtown's Resiliency Center, an organization formed after the shooting that has seen rising demand for its offerings, which include art, music and play therapy.