Expanded programs support behavioral health issues during pandemic

Long before the COVID-19 pandemic arrived, people with mental health issues often faced difficulties getting the help they needed. But with walk-in clinics and other mental health facilities shuttered to slow the spread of the new coronavirus, many people are reporting higher levels of stress and anxiety.

Federal funding, however, will help two Western North Carolina agencies expand mental health services, some directly related to the pandemic and the rest addressing overall behavioral health issues.

A pending grant from the Federal Emergency Management Agency will support expanding a 24-hour hotline and pandemic-related crisis services. Meanwhile, money from the Substance Abuse and Mental Health Services Administration will enable the Mountain Area Health Education Center to enhance and expand its existing behavioral health services.

“You don’t have to be a psychiatrist to know that when you take away people’s routines and jobs, it’s difficult for them, especially if they have a mental illness,” says Brian Ingraham, CEO of Vaya Health.

The public managed care organization oversees behavioral health services in Buncombe and 21 other WNC counties as part of the state’s Division of Mental Health, Developmental Disabilities and Substance Abuse Services. Vaya already had a more general 24-hour access-to-care line before the pandemic hit, but it was only for people who were Medicaid-eligible or uninsured. Those whose insurance didn’t cover the behavioral health care they needed couldn’t access it.

On April 30, however, FEMA announced that North Carolina could apply for funding through the federal agency’s Crisis Counseling Assistance and Training Program; that same day, the state requested $2 million.

The N.C. Department of Health and Human Services hopes to use some of the anticipated money to support its April 8 decision to expand the Hope4NC Helpline — initially created in 2016 to help those affected by Hurricane Matthew — to a statewide service. The federal funding, though, “is particular to the COVID-19 crisis,” Ingraham explains. In addition, DHHS plans to use some of the expected federal money to support the crisis counseling program the state has created specifically to help address the pandemic. Both programs are available 24/7 to all who need assistance.

In a May 4 statement, Kody H. Kinsley, deputy secretary for behavioral health and intellectual and developmental disabilities, called for quick and collaborative action to address the pandemic’s behavioral health impacts, which he said constitute “the second curve.”

The federal funding, which hasn’t been awarded yet, “will help us quickly stand up a statewide response that helps folks normalize their experience, get access to additional resources and build resiliency,” said Kinsley.

Long-term care

The Mountain Area Health Education Center’s grant is not specific to the COVID-19 pandemic, although the timing of the $4 million, two-year award couldn’t be better, says Shane Lunsford, the administrator for MAHEC’s Center for Psychiatry and Mental Wellness. The money will enable the agency to hire about 45 new people to provide therapy, manage care and create an additional crisis team.

“We hope to have everything in place by September,” notes Lunsford.

The expansion will make the agency only the fifth Certified Community Behavioral Health Clinic in the state and the first in WNC. The federal designation applies to select clinics providing more comprehensive services.

More importantly, says Dr. Stephen Buie, who directs the agency’s psychiatry residency program, it will allow MAHEC to offer care to people who are uninsured, which is common among those with serious behavioral health issues, since insurance tends to be tied to employment.

The Vaya program provides short-term help, says Buie, but MAHEC’s funding will support continuing treatment that will give people a better chance of successfully managing their illnesses.

“This has been a long-term issue, and this will offer a long-term solution,” he says.

The federal money will enable MAHEC to collaborate with Vaya, RHA Health Services and other local providers to build what Lunsford calls “a sustainable infrastructure,” and there’s a good chance that the agency will be able to extend the funding in two years, notes Lunsford.

“The CCBHC program began in 2014, and the government has renewed these grants pretty routinely,” he says.

Hunkered down

For its part, Vaya Health is expected to get up to $225,000 of the FEMA money, which will support the local agency’s decision to open up its access-to-care line to people who were previously ineligible. Callers with pandemic-related issues are then connected to the state’s COVID-19 response program.

So far, Vaya hasn’t seen an increase in the number of calls, member services manager Christine Elliott reports, but callers now tend to be in greater need than they were before the pandemic hit. “Our clinicians are staying on the phone with them longer, making more referrals,” she says. “People are more likely to have lost a job now, to be worried about money and how to put food on the table.”

They’re also more vulnerable to depression.

“People are hunkered down, and for people who live alone, the isolation is more pronounced,” adds Elliott. “There’s a higher level of anxiety, of stress.”

Hope4NC staff, meanwhile, refers callers with COVID-related issues to the state program’s second component: community-based crisis counselors. Hired locally, they provide support services (including both individual and group counseling) to help clients deal with fear, anxiety and trauma, learn effective self-care strategies and navigate community resources.

In more normal times, crisis counselors typically see patients face to face; now, however, many clinicians are working mostly or entirely online. To ensure that everyone can get the help they require, Vaya Health has used other funding to buy 500 smartphones for those who don’t have one. “We definitely want our most vulnerable people to have access to what they need,” says Elliott.

And though most folks won’t face an outright mental health crisis, she continues, they’re still experiencing higher levels of anxiety and stress. Even working from home, notes Elliott, can be stressful, because it blurs the boundaries between work and home.

“Self-care is especially important right now,” she says. “Get enough sleep, develop a routine, eat healthy foods, stay as connected as possible to friends and family by touching base online or on the phone, and exercise. Get out in the sun for a bit.”

The state DHHS also offers advice on self-care during the pandemic.

And if it all starts to feel too overwhelming, seek help.

“We thought this might be a sprint, but it’s beginning to look more like a marathon,” Elliott observes. “Help is here for everyone who needs it: Don’t be afraid to reach out.”