October 22, 2021

Mental health services rise as county facilities plan for funding cuts

Photo Illustration by Todd R. McAdam

Just as mental health agencies face spikes in need because coronavirus has left people stressed, anxious, depressed and isolated, those agencies must expect cuts in state funding because of the pandemic-inspired recession. The bright spot? Telehealth services has reduced waits.

They’re isolated, alone. They’re anxious and worried. They’re stressed, depressed and at a certain point, need clinical help.

And coronavirus means more of them than ever need that help.

“The needs are real,” said Lisa Hoeschele, executive director and CEO of Family & Children’s Counseling Services.

Their facilities and the Cortland County Mental Health Department have seen an increase in both new clients seeking services and previous clients keeping their appointments, and nearly a third of a nine-fold increase in telehealth services were for mental health assistance — nearly 900,000 calls.

In New York, almost 2.7 million adults have a mental health condition, reports the National Alliance on Mental Illness, according to an alliance fact sheet, “a condition that affects a person’s thinking, feeling, behavior or mood” that affects daily life.

“That’s more than 10 times the population of Buffalo,” the alliance states. In the U.S., one in five people live with mental illness.

Facilities are pushing for continued telehealth services to deal with the increase, while trying to figure out how to provide those services with a potential funding cut looming from the state.

An increase in clients Hoeschele said the Family and Children Counseling Services clinics see about 400 people a day.

“Which is unbelievable,” she said. “We’re seeing very high rates of participation from clients and we’re seeing a lot of new patients who are coming in with anxiety, with concerns about their own mental health issues.

Nearly half of Americans say worry or stress tied to the pandemic has infringed on their mental health, reports a poll by the Kaiser Family Foundation.

“You can’t put people into situations where they’re locked in their homes for weeks on end and not expect that there’s going to a significant number of people that develop mental health problems,” Elinore McCance-Katz, who leads the federal Substance Abuse and Mental Health Services Administration, said in a release.

Cortland County Mental Health Director Sharon MacDougall said her department sees the same increases. In particular, there was an increase between March and April, compared to the same period last year.

“The April rate is much higher than any previous April, so we’re definitely saying that’s the response because of the crisis,” she said. “The anxiety, the depression, the isolation is having people reach out for services on an increasing level. We’re also seeing an increase in people who normally would have skipped a visit or something; instead they really want the visit due to anxiety and depression increasing.”

Breaking barriers

Those increases come as some clients aren’t canceling their appointments because they don’t have the same barriers to stop them.

“We’re having fewer cancellations because transportation is no longer an issue,” MacDougall said.

It’s one of the upsides to the state allowing more telehealth services. In March, the state adopted regulations to allow streamlined approvals and more facilities to provide telehealth services. That included both the Mental Health Department and Family and Children Counseling Services in Cortland.

“So, ‘My car broke down, I can’t get into my session,’ ‘I lost child care for the day, I can’t get into my session,’ ‘I got called into work, I can’t get into my session’ are no longer barriers because they can connect with their counselor on the phone in a way that’s meaningful and in a way that’s timely and really meets the clients where they are at the time that they need the service,” Hoeschele said.

Excellus BlueCross BlueShield estimated New Yorkers used telehealth services 2.6 million times in the first four months compared to 290,000 times for all of 2019.

“The spike we’ve witnessed this year in the use of telehealth is directly related to the COVID-19 pandemic,” said Sudha Bakshi, Excellus BlueCross BlueShield medical director. “We may look back on this crisis as the trigger event that forever changed the way health care services are delivered, and the level of acceptance and treatment of mental health disorders.”

The company said more than a third of the 2.6 million uses were for mental health services.


Help yourself stay mentally healthy

As people continue to cope with stress, anxiety and other mental health issues during the COVID-19 pandemic, mental health officials suggest ways people can stay mentally and emotionally healthy.

“There’s so many amazing options out there,” said Sharon MacDougall, the Cortland County mental health director. “I kind of enjoy these mid-day meditation moments and some of the things the providers are offering.”

MacDougall said the county mental health department’s Facebook page offers a number of recommendations to ease mental and emotional stress. The county’s website, too.

Many providers also offer tips on their websites as well, MacDougall said.

People can slow down their lives while in quarantine, said Dr. Marketa Wills, a psychiatrist and co-founder of Healthy Minds MDs, LLC.

The first thing is to acknowledge you are stressed, she said, then put yourself in an optimistic mindset. You can do that by slowing things down, she said.

“It’s really doing your best to be as present and as mindful on any given day,” she said.

Stick to a daily routine, make sure you get 30 to 60 minutes of exercise every day, connect with nature, including getting fresh air, and keep a gratitude journal where you write down five blessings every day.

She also said people should make sure to take care of things that can cause more stress.

Address finances, which many people may be struggling with now as unemployment spikes. Call companies and people who have sent them bills and let them know what’s going on.

She also said keeping a social connection with people is important. Attend a virtual concert, or virtual church service. Pay video visits to loved ones.

“Make an active plan to reach out and connect with more people,” she said.

However, she said if someone’s mental health is beyond self-care then seek professional help.

“A licensed clinician is who would make a diagnostic determination,” she said.

For community resources, visit:

  • Cortland County mental health website: tinyurl.com/ y8f4tb4p
  • Mental health social media page: tinyurl.com/y98ta53x

Trying to help everyone

There are no wait times, Hoeschele said, noting if people need services, they can talk to someone.

“Everyone knows someone who has needs when it comes to mental health and addiction services,” she said.

MacDougall said she also thinks people see a waitlist at a mental health facility and believe it’s different than a waitlist somewhere else.

“I would emphasize that it’s very similar if I call my primary care provider,” she said. “I’m more likely to be asked, would you see a nurse practitioner because my primary care doctor appointment, they probably don’t have an opening for me for two, three months.”

Hoeschele said the problem in Cortland County isn’t a metric to determine how many people need mental health services and how many slots are available “… it’s these are mental health professionals who are working heroically to provide all the service they can to all the people that need them at a time that there are very few people who are willing to come to this rural community to provide service.”

But it’s not just Cortland County facing this problem, it’s an issue across the state. Hoeschele said there is a 40% vacancy rate for mental health clinicians.

“We can’t afford to pay a master’s degree-level social worker or licensed mental health professional what someone might be paid in Rochester or Syracuse and it’s a challenge for us,” she said. “We have a staff that has worked heroically to see everyone as they present at the door or on the phone immediately in the state of unprecedented staffing shortages and staffing turnovers.”

On top of that, MacDougall and Hoeschele said that there are many layers to mental health to determine what service fits best in an area.

“Unfortunately in mental health and behavioral health, the more deeply you dig, the more problems you find and particularly in a health care environment that requires people to engage in a high deductible plan, it makes it more challenging for individuals to access services,” Hoeschele said.

Mental health services face other challenges, including the ability to keep telehealth services as funding cuts come down from the state.

Sustaining programs “Every part of our planning is to sustain this,” MacDougall said, but worries the flexibility to use telehealth won’t continue when the pandemic is over.

Mental health organizations are advocating with state officials for a permanent change for more telehealth, Hoeschele said.

“Regular telehealth regulations do not include telephone — it has to only be telehealth video visits, so some of that part we’d really like some loosening up at the state level,” MacDougall said.

However, Hoeschele said practices don’t want to use telehealth exclusively.

“We want to be able to have the flexibility to be able to provide this type of service when it’s clinically appropriate for an individual based on their needs,” she said.

But mental health organizations expect large state funding cuts, though they aren’t sure how big those cuts will be or when they’ll find out about them.

“That’s the million dollar question right now,” MacDougall said. “We’re very concerned about what we’re hearing coming out of Albany. That’s (people with mental health needs) our most vulnerable population locally. That’s the population we worry the most about. That’s the population that also kind of gets forgotten about during large budget cuts.”

“I think the governor is depending on the federal government to provide some support,” Hoeschele said. “I’m hoping that the congressional package being considered now will be passed by the Senate.”

MacDougall said mental health facilities are advocating but also looking over past data to determine where services are needed most to protect them from cuts.

“It might mean we need to get a little more creative about those services but we’re really waiting to hear from the state so we can plan moving forward,” she said.

The Associated Press contributed to this report.