“We must work quickly, collaboratively, and boldly to flatten the second curve of COVID-19 — the behavioral health effects of the disease,” said Kody H. Kinsley, Secretary for Behavioral Health and Intellectual and Developmental Disabilities for the N.C. Department of Health and Human Services.
As social distancing and stay at home orders drag on in North Carolina, more people are struggling with isolation and loneliness. For the one in five people in the U.S. already struggling with mental illness, COVID-19 stresses could be exacerbating their symptoms. For others, this might be the first time they’ve experienced symptoms due to the stress and anxiety brought on by such an uncertain time.
“Many people — including all of us, not just the people we serve — are experiencing anxiety and stress or loneliness right now,” said Tabatha Brafford, regional director of community relations for Appalachian Community Services. “And the people we were already serving before the pandemic that have a mental illness, they’ve seen more symptoms recently.”
During a time when more people may be in need of more behavioral health support, they may not know where to turn or who to call or they may not think help is available during the pandemic. However, local behavioral health agencies like ACS and Meridian Behavioral Health Services want to make it clear that they are open and available in a number of capacities to help people through the pandemic even though they’ve had to change how some services are rendered. Some programs have had to be suspended while other services have expanded or moved online. Becca Swanger, Meridian Director for Jackson County, said her staff started to see the impact of COVID-19 in the weeks leading up to the state-issued restrictions to flatten the curve.
“We started seeing less people coming in around mid-March — some of that was because it was right before the school system’s spring break and some was because people felt uncomfortable coming to our offices,” she said. “And things started moving quickly as the CDC changed recommendations on gathering and distancing between people.”
For the following few weeks, protocols and CDC recommendations were changing quickly as Meridian and ACS tried to keep up.
“So much happened so quickly — it was a month of change after change after change, but I think now we’re in a place where we know what we need to know right now,” Brafford said. “And now we’re looking at when will we start opening back up and what will that look like and can we continue to do things the way we are doing?”
So much of what Meridian and ACS has done in the past has included face-to-face contact with clients — adults and children alike — but the pandemic forced them to be creative and innovative to be able to still meet clients where they are. These agencies provide a host of group therapy and support group classes, intensive in-home family services, school programs and other walk-in emergency services.
Swanger said Meridian had to think quickly about how to continue meeting its mission while also adhering to the changing guidelines to keep people safe. Meridian closed down its five resource education centers located in Transylvania, Jackson, Haywood, Macon and Cherokee and stopped holding group classes March 23. Staff was also waiting on some direction from the state about how to proceed going forward.
“It took us a little while to figure out how we were going to provide services,” she said. “We had to close the walk-in centers because we were having too many people and we couldn’t keep people far enough apart.”
Meridian continued with its community based teams — intensive in-home therapy, ACT (Assertive Community Treatment) and PACE (Peers Assisting in Community Engagement) — to do face-to-face services because at the time, the CDC recommendations only restricted gathering, but then social distancing protocols came into play and some more risk assessments had to be done.
In the meantime, agencies worked closely with the state to hopefully loosen some restrictions that would allow behavioral health agencies to receive funding reimbursements when using over-the-phone or certain tele-medicine services.
Meridian is a nonprofit organization that relies on reimbursement from the state for clients covered by Medicaid — for child services, about 80 percent of funding comes from Medicaid, but a large majority of adult clients are uninsured and not covered by Medicaid. There’s a separate pot of state funding to cover uninsured patients, but those funds have been severely cut over the last several years.
Meridian had to make sure the services they provide are reimbursable by the state, and before COVID-19, agencies weren’t allowed to bill for over-the-phone services. As soon as the state gave the go ahead, Meridian began doing telephone sessions with clients.
“This allowed us to check in with our clients to make sure they were doing OK and had the things they needed without having to meet face to face,” Swanger said.
Brafford said utilizing tele-medicine more has been a learning experience for many clients, but many are finding that they prefer having their medical appointment over the computer.
“We’re using tele-counseling quite a bit now and I think we’re doing well with this type of delivery. A lot of people like that they don’t have to leave their home — they don’t have to look for a ride or buy gas to get there,” she said.
While tele-medicine has been a great tool, the fact is there are still many people in Western North Carolina who don’t have internet or even a cell phone with service to be able to access a tele-health call or video. To help overcome that hurdle, Vaya Health, the organization responsible for overseeing public funding for mental health in WNC, started a new initiative to get Smartphones into the hands of people in need.
Vaya purchased 500 smartphones with data in April from Verizon Wireless to distribute to network providers like Meridian and ACS that successfully applied to participate in the initiative. Local providers can then give those phones out to clients in need of services.
“We’ve been working with our providers to offer maximum flexibility while maintaining quality standards in delivering services to members,” said Allison Inman, Vaya director of communications.
However, some services still need to be done in person and sometimes a client’s immediate mental health needs can be more important than the risk of contracting coronavirus.
“We evaluate cases daily trying to decide where the higher risk is and assessing the hierarchy of needs — do they have food, can they get their medication, do they need to go to their doctor’s appointment,” Swanger said. “Sometimes the risk of not doing those things is greater than potential exposure to the coronavirus. When we do have to interact with clients, we’re doing our best with wearing masks, gloves and using hand sanitizer.”
While schools are still out and many staff members aren’t working in their normal roles, Swanger said they’re taking the extra time to make sure they’re giving back to the community. Some employees have been helping deliver meals to students, making masks or making window visits to nursing homes. Peer support specialists connected with local inmates by sending them letters that included their own mugshot from the past and their most recent picture in an effort to give inmates hope that they can turn their lives around too.
“We’re trying to do innovative things now while we have the time to do it — donating blood, volunteering on Earth Day to pick up trash or plant trees — and making sure we take care of our employees’ wellness is super important at this time as well,” Swanger said. “They’re experiencing the pandemic as well and it’s tough to show up for people you’re trying to help when you’re also going through these things.”
Help is still available for people who are struggling through the COVID-19 Pandemic. If you’re interested in video/phone services through Meridian, call 828.631.3973 or visit meridianbhs.org for a complete list of online support groups to join.
To access services through ACS, call 828.837.0071 to speak to someone. ACS’s walk-in centers are still open as well and are following strict screening guidelines. ACS’s crisis line is 888.315.2880.
“The crisis number is available 24/7 or just walk in to one of our centers. Don’t get caught up in a diagnosis right now. It’s just important to know it’s a stressful time for everyone and you can just call and talk to someone without having it turn into long-term treatment,” Brafford said. “Sometimes you just need to talk to someone, and support is there.”
May is Mental Health Awareness Month
• 1 in 5 U.S. adults experience mental illness each year
• 1 in 25 U.S. adults experience serious mental illness each year
• 1 in 6 U.S. youth aged 6-17 experience a mental health disorder each year
• 50% of all lifetime mental illness begins by age 14, and 75% by age 24