As Cantabrians reflect on the fifth anniversary of the earthquake that rumbled their sleep, others will still be counting the cost in very tangible ways.

The region was rattled by its first big quake in September 2010 just after 4am, and for many, the effects of the shakes have never stopped.

Between September 2010 and the deadly quake that struck in February 2011, residents are so stretched and exhausted, mental health providers are being stretched to capacity.

Canterbury DHB mental heath general manager Toni Gutschlag said the numbers especially in the past three years are phenomenal, including a 60 percent increase in presentations for child and youth, a 37 percent increase for adult services and a hundred percent increase in presentations to the emergency department for mental health reasons.

For children like Annabell Scott, who was three years old at the time, she was too scared to be alone afterwards.

But she, like many others her age, says isn't so nervous anymore after seeing a councillor, even spending time away from mum and dad and be alone without being worried.

Prime Minister John Key wants residents to know the government is behind them, but understands their frustration.

"A lot of Cantabrians I meet to the feel the momentum that's happening, do feel more confident. Yes, there are some unresolved issues but as they, as every day goes past, reduce," he said.

Mayor Lianne Dalziel said that day will stay vividly in her mind forever.

"That really did shake me to my core and I want a moment of time to reflect on what that shake-up has meant for me personally and for the city as a whole and also the future as well," she said.

For the Earthquake Commission, it was the start of the biggest situation in the company's history.

Chief executive Ian Simpson says the company's still facing some enormous claim numbers, including 167,000 building claims, 187,000 contents claims, and 150,000 land claims.