In this cross-sectional household probability sample survey of 1,970 adults living in Flint, Michigan, during the water crisis, more than one-fifth met criteria for presumptive past-year depression, nearly one-quarter for past-year presumptive posttraumatic stress disorder, and more than one-tenth for both disorders 5 years after the onset of the water crisis. Only 34.8% were ever offered mental health services to assist with water-crisis–related psychiatric symptoms; most (79.3%) who were offered services utilized them. These findings suggest that public-works environmental disasters such as the Flint water crisis have lasting psychological sequelae and may require expanded mental health services to meet long-term psychiatric need. (Publisher abstract provided)