As quickly as COVID-19 began to disrupt the lives of Kansans, the state’s mental health providers pivoted, transforming their service delivery methods to ensure the continuation of behavioral services.
The Central Kansas Mental Health Center in Salina reported no-shows and cancellations for half its scheduled appointments in the days following Gov. Laura Kelly’s emergency declaration on March 12. At the same time, inquiries for services spiked.
“Within 48 hours they started pivoting and scheduling people to telephonic appointments, and they climbed back up from those 50% cancellations,” says Kyle Kessler, executive director of the Association of Community Mental Health Centers of Kansas. “Whether it’s therapy, case management or medical appointments with psychiatrists, you figure out how you can adjust to meet the patient where they are.”
That can mean a therapy session through a video call rather than in person, or for those on a medication that requires an injection, a drive-through clinic staffed by medical personnel wearing gloves and masks.
For 25-year-old Kayla, who has multiple psychiatric diagnoses including PTSD, it’s not fear of the virus that’s increasing her anxiety and depression to near crisis levels; it’s the disruption to her routine.
“I was used to going to school four times a week face to face,” she said of the online pharmacy technician program she’s now finishing. “The social distancing is an issue. I’m cooped up inside when I’m used to being social with everyone. It’s making my anxiety high and my depression is high, too.”
New activities such as writing and painting aren’t compensating for a regular schedule that includes behavioral health services that she’s received in Kansas since the age of 8. The one-on-one therapy sessions, peer support meetings, medication management therapy and case management provided by the Mental Health Association of South Central Kansas are being handled through phone or Zoom video conferencing to minimize risks to all.
Before the pandemic, Kayla would spend about two hours a week with her case manager, who would take her into the community while practicing using coping skills. Often, that was also a time when Kayla would get groceries. Without that in-person time, Kayla ran out of food, so her case manager got an exception at the end of March to meet her immediate need. The following week, her case manager intervened again to engage in crisis prevention.
By acting experimentally even amid daunting adaptive challenges, Kansas’ 26 community mental health centers have continued to provide 24/7 behavioral health services in all 105 counties. They coordinate the delivery of publicly funded, community-based mental health services and are required to provide services to all, regardless of their ability to pay.
Kessler says that means there are no mental health deserts in the state, though some areas of the state have more options than others. In Wichita, for example, the largest community mental health center in the state – Comcare of Sedgwick County – works alongside private providers and nonprofit agencies. In Kansas City, licensed providers have created a teletherapy network to support first responders, medical personnel, military and veterans with free services.
Back in Sedgwick County, the Mental Health Association of South Central Kansas is one of the agencies working alongside Comcare, and it saw more new patients in the last two weeks of March than it had ever seen in an entire month.
Mary Jones, president and CEO of the Mental Health Association of South Central Kansas , attributes that to the increasing rates of anxiety, depression and social isolation associated with the pandemic, as well as people having more time to seek treatment they had been putting off.
“We’ve converted to a telehealth platform entirely on the outpatient side, and that’s made it so easy for more people to access care,” she says.
While a few lessons can be learned from past traumatic events, experts say COVID-19 has created a demand not experienced before.
After a 2016 workplace shooting in Hesston, just north of Wichita, mental health providers from surrounding areas were able to help the local mental health center meet a sudden increase in need. The pandemic leaves no extra resources to assist.
The 9/11 terrorist attacks were traumatic and had reverberations for many people, but the events had a distinct end, and recovery started quickly.
“Dealing with this pandemic is different,” Jones says. “There are so many unknowns. How long will we have to stay in our homes? How long will I not be able to see my friends and family? How long will I be financially impacted? We’re uncertain about so many things, and all you hear is lack of supplies, lack of testing, lack of cure.”
The unknowns create increased anxiety, and the isolation that occurs as people follow local, state and federal public health officials’ guidance also can cause anxiety, along with depression and general worry. Mental health providers are seeing this in new patients as well as caregivers. They also are seeing symptom exacerbation in people already diagnosed with a severe mental illness.
Advice that’s typically given to deal with anxiety and depression often isn’t useful during the pandemic.
For example, maintaining a routine is impossible with schools closed, shelter-in-place orders, mass furloughs and many employees being asked to work from home. Another example: With gyms closed, some people cannot turn to their regular outlets for physical exercise.
Jones said structure-in-place is the revised advice. In other words, create new routines in an attempt to maintain some structure within one’s new circumstances.
Other advice includes practicing self-care, reaching out when assistance is needed, finding new ways to connect with friends and family, and limiting exposure to the bad news surrounding the pandemic.
“The 24/7 onslaught of disturbing stories and images can really take a toll on people’s mental health, and it can create a very similar aspect just like PTSD (post-traumatic stress disorder),” Jones says.
She said mental health providers are benefiting from excellent national guidance from agencies such as the World Health Organization; Mental Health America; and the Substance Abuse and Mental Health Services Administration, a branch of the U.S. Department of Health and Human Services; as well as statewide guidance from the Kansas Department of Health and Environment.
Forcing new systems
The Mental Health Association of South Central Kansas’ main office in east Wichita typically is home to 110 employees; now just 10 are in the building. Jones said their approach has been to be mindful of social distancing and, whenever possible, have employees provide telehealth. Still, there are times when case managers must make an in-person visit, and residential case managers continue to work at the organization’s housing facilities as well as out in the community delivering services to the homeless.
“This shift toward telehealth was almost an overnight response so that we could continue to see people,” she says, giving credit to her IT team for working all weekend to make sure the agency’s staff could work remotely.
She suspects most providers were in the same situation, and Kessler confirms that the 26 community mental health centers had to be quick and agile to get systems in place to handle as much as 90% of their work through telehealth.
“Part of having stagnant funding sources for 10 years is that you don’t invest in technology the way that you could or you should,” he says. “We don’t get a lot of federal funding, so the funding sources for community mental health come from state and county sources, as well as billing private insurance and public insurance like Medicaid.”
In 2016, the state cut nearly 10% – more than $30 million – from the community mental health center system, whose budget had not increased significantly since 2006. The work that groups like the Association of Community Mental Health Centers of Kansas have accomplished in recent years to restore some of the state’s commitment to community-based behavioral health services paid off, Kessler said.
“The centers have been able to invest more in phone systems, computer systems and other technology systems that helped them to be able to adapt to a crisis like this a little bit more quickly,” he says. “To pivot like that when you see the patients need it is extraordinary, and it’s an extraordinary reflection on the system we have built and the support we’ve received from the current Cabinet and local leaders as well.”
Serving as a lighthouse
Kessler equates the Association of Community Mental Health Centers of Kansas to a lighthouse for the big passenger ships that are the community mental health centers. While the centers provide services, his group’s work centers on coordinating service ideas and concepts and making those easier to put in place through state and federal policy.
In a typical year, that happens through about half a dozen meetings. Right now, the centers are gathering by video for meetings twice a week and communicating throughout the week in other ways. Kessler provides updates at the association level, including interpreting what the latest stimulus package means for the centers and changes to state regulatory and funding sections. The centers give reports on what they are seeing, and there’s also time for questions and answers.
While the current crisis has put some of the association’s advocacy efforts on the back burner, COVID-19 has helped highlight the need for behavioral health services, which Kessler said have taken an even bigger backseat at the federal level than at the state level. Until now, that is; he has seen more movement in the last three weeks than in the past three years combined.
“It feels too soon to talk about silver linings, but I think we’ll learn some things about ourselves and our system through this crisis,” he says. “What we know is that when we come out the other side of this virus crisis, people will need us as much or even more than they had. This is a significant trauma for a lot of people.”
If you or someone you know is in need of services or treatment, consider these resources.
National suicide prevention lifeline: 1-800-273-8255
To find behavioral treatment services in Kansas: http://www.acmhck.org/about-us/cmhc-directory/
To find behavioral treatment services nationally: https://findtreatment.samhsa.gov
The Journal, the print and digital magazine of the Kansas Leadership Center, is publishing a digital newsletter that explores what is working, what isn’t working and what’s being learned during the response to COVID-19. To receive twice-a-week updates, subscribe here: https://kansasleadershipcenter.org/contact-us/join-our-email-list/