NEWTOWN, Conn. (AP) -- 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.

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."

Newtown has received about $15 million in grants from the U.S. Education Department and the U.S. Justice Department to support its recovery.

The Newtown-Sandy Hook Community Foundation, which oversees the biggest pot of private donations made to Newtown, has about $4 million left after paying out more than $7 million to the families of the 26 victims and other children who were in the same classrooms but survived.

Newtown Youth and Family Services, the main mental health agency, has quadrupled its counseling staff, adding 29 positions in the months following the shootings, Executive Director Candice Bohr said. She said the federal grant money that recently came through will help cover its costs.

Jennifer Barahona, director of the foundation overseeing the private dollars, said the group has been spending about $60,000 a month on one-on-one counseling for people who have no insurance or whose insurers won't cover such treatment. She said more people are reaching out for help every day.

The Newtown school system is starting a long-term program to teach young people from kindergarten through high school how to handle their feelings. It is also setting up a mental health center at the middle school in January to help those who were affected by the tragedy while in elementary school. Teachers have been trained to identify students who might have mental health problems.