On Sept. 11, 2001, May Chen stood outside Confucius Plaza, a 44-story residential tower located on the outskirts of Chinatown.
It was primary day, an important day for Chen, whose husband was running for New York City Council. The streets were buzzing with voters heading to the polls and workers en route to their offices.
But a morning that started full of optimism suddenly became one of the most traumatic in American history.
“We saw this huge fireball hit the World Trade buildings,” Chen, now 73 years old, told NBC News. “And we thought there was a bomb that exploded inside the building. And then there was another big, orange fireball.”
Chen watched as the air filled with thick dust and debris and remembers the smell of burning plastic in the air.
“People were kind of all walking around like zombies,” she said. “It just felt so unbelievable and disorienting.”
Nearby, Peter Lee, whose family has run the Cantonese restaurant Hop Kee in the heart of Chinatown since 1968, was also in shock.
“I lived in that neighborhood all my life,” Lee said. “I saw the empty ground before they built the towers. I used to play in those empty lots. Then, in your preteen days, you know, you watch it build up and you go to visit it. All of a sudden, it's all gone.”
When the twin towers fell on Sept. 11, the more than 80,000 residents of Chinatown were just 10 blocks away from the World Trade Center. But in the months and years that followed 9/11, few outside the area focused on the physical or mental health of this densely populated neighborhood. Chinatown fell just outside the immediate zone of impact around ground zero. As a result, residents and workers there were entitled to fewer resources, further exacerbating the trauma they felt in the wake of the terrorist attacks.
“There was a sense that Chinatown was ignored after 9/11,” said Daniel Huang, clinical director for behavioral health at Hamilton-Madison House, an Asian-focused outpatient mental health clinic in lower Manhattan.
Huang joined Hamilton-Madison House 10 years after the attacks.
“I was still hearing stories about 9/11,” he said. “People who had dreams and nightmares about what happened; people who are still on medications, who are still getting counseling.”
It wasn’t just the image of the towers falling that day that affected the people of Chinatown. In the weeks that followed, their tourist hot spot neighborhood was placed on complete lockdown.
“There were police everywhere, federal officers. They were making sure no residents or people were going in or out of Canal Street,” Lee remembered. “You needed to have proof that you lived in the area before they let you back down, because they didn't want anyone down here.”
Jo-Ann Yoo, who runs the Asian American Federation in New York, said Chinatown never fully recovered after 9/11.
“The fact that so many of the small businesses closed down because all the trucks could not come into Chinatown, because all the arteries were blocked, it took out the whole garment industry happening in Chinatown,” she said. “So I know that there's been an ongoing ripple effect.”
At the time, almost one-third of Chinatown’s residents lived below the poverty level, compared to 21 percent of the general New York population.
In the aftermath of 9/11, many of the mental health resources designated for World Trade Center survivors were either unavailable to, or underutilized by, the people of Chinatown.
In November 2001, a Federal Emergency Management Agency-supported program launched a massive public education campaign for free crisis counseling in New York. But, none of the TV, radio or subway advertisements used targeted the Asian community in Chinatown, according to the Mental Health Association of New York City, now known as Vibrant Emotional Health. And a 2015 report found that the Asian community received only 0.2 percent of contract dollars issued by the New York City Department of Health and Mental Hygiene from 2002 to 2014.
The 9/11 Mental Health and Substance Abuse Program provided financial assistance for mental health treatment costs in people affected by the World Trade Center attacks. But of the more than 9,000 individuals enrolled in the program between 2002-2004, only 4.6 percent identified as Asian, according to Vibrant Emotional Health.
On top of that, the residents of Chinatown were susceptible to a more durable and intense course of post-traumatic stress disorder after 9/11 compared to other New York City residents, experts say.
“We know from so many PTSD studies the closer you were to ground zero, the more at risk you are for developing long-term mental health problems,” said Yuval Neria, the director of trauma and PTSD at the New York State Psychiatric Institute.
In the weeks following 9/11, approximately 8.2 percent of people who lived south of 110th Street in New York City had symptoms consistent with probable PTSD, according to one survey.
Among people living south of Canal Street — the heart of Chinatown — the prevalence of PTSD jumped to almost 20 percent. Another study, conducted several years after 9/11, found the prevalence of PTSD among Asians exposed to the attacks had only slightly decreased to 14.6 percent.
Asian Americans are the racial group least likely to reach out for mental health help, according to the American Psychological Association. Some of the reasons include stigma within the community over mental health, the "model minority" myth, stress of bi-culturalism, PTSD from history that includes fleeing war-torn countries, and more.
“It impacts if you can get a job. It impacts who you marry. It impacts how people are going to start to look at you and your family, thinking there's some flaw,” Yoo said.
Chen, who turned to her family for emotional support after the terrorist attacks, acknowledged the challenges.
Twenty years later, Huang said they’re still struggling with a lack of resources.
“We simply don't have the funding for the staff requirements that we need to keep our programs open for new patients, year-round,” Huang said. Beyond Hamilton-Madison House, “there's probably just like a handful of organizations that are focused on our community,” Huang said.
The result is a severe shortage of mental health providers who speak Chinese fluently.
“You can't go to the phone book and pick out a Mandarin-speaking, Fujianese-speaking counselor,” Yoo said.
The lingering pain of 9/11 has also been made worse by the COVID-19 pandemic and an alarming rise in anti-Asian hate incidents.
“For those who've been traumatized by 9/11, those traumas tend to just resurface,” Huang said.
Huang said it’s never too late to start talking about the pain from 9/11, and he is encouraged by signs that people in the area are now more open to seeking mental health treatment compared to those terrible days in 2001.
“It's something that needs to be worked through,” he said.
Chen, who still lives in Chinatown, said she “feels very sad and frustrated” when she reflects on how 9/11 affected her neighborhood. But she credited her support system for helping her cope.
“My family is all in this area,” she said. “So just being able to talk to each other, comfort each other and just have a normal family life together and appreciate that we came through this has been very helpful.”
And, like Huang, she is hopeful.
“Seeing this next generation and the ability of this community to reinvent itself and to find new ways to survive … is a good thing,” Chen said. “There's progress being made.”
For anyone looking for mental health resources:
Text HOME or NAMI to 741741 for 24/7 support from the Crisis Text line
Text WELL to 65173 or call 888-NYC-WELL to speak with a mental health counselor
Call the NAMI HelpLine at 800-950-NAMI for mental health information, referrals, and support
Call the Suicide Prevention Lifeline at 1-800-273-TALK
This article was originally published on NBCNews.com.