EVERETT — Local mental health care clinics are preparing for an increase in demand for services this summer as people slowly come to the uncomfortable conclusion that things won’t be returning to the way they once were in the wake of COVID-19.
This phase, termed “disillusionment” by researchers, will likely usher a sense of hopelessness that’s expected to come with a surge in substance use, aggression and illegal activity, experts say.
The pandemic has already heightened stress and anxiety for many people in Snohomish County and beyond. But the worst is yet to come, officials have warned. The state Department of Public Health expects 2 million to 3 million Washingtonians will experience behavioral health problems in the next three to six months.
The wave of mental health issues is predicted to peak sometime in the fall, leading to more suicides and spurring problematic coping strategies, such as drug and alcohol use. Depression symptoms will become common, as will anxiety and acute stress, according to an analysis published by the department in June.
The gloomy outlook raises questions about whether the county’s behavioral health providers — now cash-strapped and understaffed because of the coronavirus crisis — will be ready for an influx of new patients.
“We’re all trying to prepare as best we can for when we hit the peak in October (and) November,” said Jace Angelly, executive director of behavioral health at Everett-based Sunrise Services, which offers mental health care. “I’m very worried about it. And not just me — my staff is worried about whether we can provide enough services.”
Providers on shaky financial ground
Across the state, COVID-19 has caused revenues to tumble for many behavioral health agencies as social distancing restrictions have limited operations.
In Snohomish County, Compass Health shuttered several of its sites due to financial troubles. Other clinics, too, have had to cut staff.
About 40% of the Washington Council for Behavioral Health’s member agencies reported that they had to furlough and lay off employees due to the pandemic, said Joe Roszak, the council’s board president, at a recent meeting of a state Senate’s Behavioral Health Subcommittee. The roughly 40 providers that the council represents have also seen monthly revenues fall by an average of 18%, he said.
Community mental health organizations, particularly those that serve the poor, already operate on shoestring budgets, said Roszak, who’s also the CEO of Kitsap Mental Health Services. The vast majority are dependent on the low-rate reimbursements they receive for serving patients on Medicaid, he said.
“Behavioral health has always been operated on extremely slim margins,” he said. “We worry that our already under-resourced and stressed behavioral health system cannot meet the forecasted expanded need due to the COVID crisis over the coming year.”
The oncoming wave
The return of cold, gloomy weather could exacerbate mental health problems, experts say. So could the emotional and financial strain of the winter holidays.
The behavioral health crisis is expected to hit poor people, people of color and those with limited access to health care the hardest, according to the Department of Health analysis. Health care workers, law enforcement officials, educators and people recovering from severe coronavirus infections might also experience heightened impacts.
The economic downturn and resulting high unemployment rate could lead to an additional 217 deaths by suicide and 280 deaths by drug overdose annually in the state, according to the analysis.
A second wave of coronavirus infections, though, would change all those predictions, health officials have said.
Demand is mounting as people who have never before sought behavioral health services are beginning to reach out to clinics and providers for help. Front-line crisis workers, social workers and even staff at mental health clinics are grappling with the emotional impacts of the pandemic, too, said Angelly.
“It’s really starting to take a toll on everybody,” he said. “We are starting to see people who have never utilized mental health services and behavioral health services … They don’t know what to do. They don’t know how to handle their emotions.”
Sunrise Services usually fields 10 to 20 requests for mental health care from newcomers each week. But lately, it’s seen 25 to 30, Angelly said.
The company has had to lay off about 20 people, said Lee Phillips, administrative projects specialist for Sunrise Services. Whether the layoffs will be temporary or permanent is still a question.
COVID-19’s lasting effects
Even before the pandemic, a dearth of psychiatric treatment beds, the opioid epidemic and a growing population was fueling a rising need for behavioral health services, said Joe Valentine, executive director of the North Sound Behavioral Health Administrative Services Organization, which funds crisis services in a five-county region that includes Snohomish County.
Now, lower staffing levels could ultimately lead to longer wait times for appointments with therapists and psychiatrists.
In the long term, providers could struggle to restore services to normal levels on the heels of the pandemic, Valentine worries.
Meanwhile, with unemployment rates soaring, more people are becoming reliant on the behavioral health organizations that serve low-income folks.
Between April 1 and June 29, more than 75,000 people who were newly eligible for Medicaid enrolled in the program, said Amy Blondin, a spokeswoman for the Washington State Health Care Authority.
The federal government has offered some funding for behavioral health programs during the pandemic. And many local governments are using money they received from the federal CARES Act to expand access to mental health care.
Snohomish County has allotted $25 million in CARES funding to human and social services and housing; about $3 million of the sum is expected to support behavioral health services.
“We’re trying to piece together all these different pieces of funding so we can support some increased capacity based on what the need is,” Valentine said. “And of course, we really don’t know long term what the impact will be.”
Budget cuts at the state level could also affect providers. Organizations such as Sunrise Services rely on revenue from contracts that they hold with the state to provide social services, from behavioral health programs to services for disabled adults.
“It is a big concern as to how are we going to weather this storm that’s coming,” Phillips said. “This is only going to get worse with these budget cuts.”
State Sen. Keith Wagoner, a Republican whose sprawling district includes east Snohomish County, said lawmakers have worked hard in recent years to overhaul the state’s behavioral health system to make resources available in local communities. When budget talks begin, he wants to see those gains protected.
“We’re going to have to pull back on spending,” said Wagoner, who serves on the Behavioral Health Subcommittee. “I don’t want to see that happen in our vulnerable populations — and that’s behavioral health and people with disabilities.”
Compass Health, which operates more than a dozen locations in Snohomish County, recently said it will shutter outpatient sites in Marysville, Monroe and Snohomish. Despite the closures and staffing cuts, patients of those locations can stay on with Compass Health. But it would either mean traveling to Everett for essential services that can only be provided in person or using Compass Health’s recently expanded telehealth network.
“We care about our clients and they need services and that doesn’t change with a pandemic,” Compass Health’s director of Snohomish County outpatient services Frances Wilder previously told The Daily Herald. “We want to encourage people for their own health, as well as the staff, to use the telehealth solutions.”
The vast majority of clients have stayed with Compass Health despite the closures, President and CEO Tom Sebastian said in a statement. About 825 clients were affected by the transition, and about 645 of them still receive care from Compass Health. Of the roughly 175 who were discharged, many of them were already slated to be discharged under their plan of care, Sebastian said. Four people transferred to another provider, he said.
“Our plans include continuing to scale our sophisticated telehealth capabilities to ensure we can meet clients when and where they need us, designing responsive treatment strategies specifically to address the shared trauma of 2020, and driving forward with construction of our Compass Health Broadway Campus Redevelopment, which is on-schedule to open 82 new units of permanent supportive housing next year,” Sebastian said.
Some of the former Compass Health clients are now patients of Sea Mar Community Health Centers, which has several behavioral health clinics in the county, said Sea Mar Behavioral Health Program Manager Hannah Hamilton. The organization’s Everett behavioral health clinic has seen an uptick in family conflict, hopelessness, depression and suicidal thoughts, she said.
More and more people are dialing into the Volunteers of America crisis line, too.
On a typical day, about 250 to 300 calls come in. Now that number has risen to about 400, said Pat Morris, senior director of behavioral health for Volunteers of America Western Washington.
Many of those callers are new to the system, she noted. Usually June is not a busy time of the year, either.
“People who are calling are not suicidal, but are becoming a lot more irritable, intolerant,” she said. “Because of how long it has drawn out, I think people are becoming weary — people who generally have really good coping skills are starting to get more panicked about all this.”
She believes that may be because no one knows how this is going to turn out. For example, another big increase in cases could shut everything down again.
Money has been a common worry as well. Workers have lost their jobs but at the same time haven’t yet received any unemployment benefits. While Washington residents are protected from eviction through Aug. 1, many have not been able to pay rent.
“There is a clear realization that whenever the eviction moratorium is lifted, landlords will be able to ask for rent in arrears,” Morris said. “These individuals will not be able to pay their monthly expenses.”
Callers are also people who have never needed help from social services before and don’t know how to navigate the different systems to find assistance. At the same time, there’s a certain level of embarrassment and disappointment because they can’t pay the bills, Morris said.
Those who need help can call the crisis line 24 hours a day at 800-584-3578 or visit imhurting.org for counseling options. Dial 211 for information on social services, open 8 a.m. to 5 p.m. Monday through Friday.
More people also have come into the walk-in Behavioral Health Urgent Care clinic at Providence Regional Medical Center Everett, but there’s still room for additional patients.
While the clinic is operating normally with in-person visits, it also offers virtual sessions. For more information call 425-261-4210.
“To everyone who is struggling now, please seek help sooner, rather than later,” clinic director Laura Knapp said in an email. “If you are experiencing anxiety, depression or other mental health and substance use concerns due to COVID-19, know your symptoms are treatable, and we’re here to help.”