Buffalo Business First Editor-in-Chief Donna Collins tapped into current trends in mental health care during a recent discussion with top service providers from the region.
The dramatic increase in demand for mental health services throughout Western New York has been met with an equal response by organizations that are staffed with professionals poised to assess and address the disorders.
The staff of Buffalo Business First tapped into current trends in mental health care during a recent discussion with top service providers from the region.
Joining the discussion were:
Weinstein may have spoken for all the panelists when she said, “There has to be education in companies to communicate that mental illness is not a fly-by-night disease. It is staying and it is worse than ever.”
Cause of the increase
Mauro believes the increase in mental illness stems from exposure to tragedies covered in the media. There is greater awareness of how people are handling problems, especially at work where work colleagues often see more of each other than they do people in their own families, she said.
The cost of poor mental health to an individual is significant, but so are the costs to the organization, when burnout leads to substandard quality of services or turnover. Poor mental health has an impact on the entire system, everything from family structure to the economy, Mauro said.
Contributing to the increase in mental illness is the isolation and loneliness of remote work, and the worker’s reluctance to reach out for help from afar. It is difficult to solve because of the popularity of remote work, Weinstein said.
Univera Healthcare, recognizing the circumstances, made adjustments meant to encourage access.
“For our non-standard plans, we have tried to eliminate the outpatient mental health and substance use disorder clinic copays in January to help eliminate one of those barriers for people to feel they can access care,” Mikowski said. “It’s new and hopefully it will pay off with people being able to do the outpatient visits and preventative work and lessen the down-the-line hospitalizations for crises.”
Hybrid work arrangements, that bring remote employees into the work place a couple days a week, improve employees’ ability to feel connected with their colleagues, Weinstein said. A hybrid arrangement won’t work, however, if the office time is done when there is no one else around. It also requires greater supervision, particularly of young hires primarily working remotely with no one to guide them along.
“There needs to be a balance,” Weinstein said. “It shouldn’t be all remote. It shouldn’t be face-to-face. It has to be somewhere in the middle.”
Community-based services
How well a person navigates the stresses of life is an indicator of mental health, and the cry of increasing poor mental health has been increasing. Vandermark-Murray believes the over exposure to social media and trauma are causing stress now unheard of in previous generations.
“These things aren’t new to us,” she said, “they’re new to our exposure. That is contributing to the psychological safety of all of us. The population we’re seeing are, unfortunately, young adults. The acuity of what’s happening, the suicidality, the harm, the depression in younger and younger ages is where we are seeing the rapid growth. The good thing is they’re coming in and getting services and learning skills.”
While the youth are accessing services, there will never be enough outreach, particularly as certain populations continue to hold onto the stigma of mental health problems and seeking help.
Harmonia serves a semi-rural region where the stigma is strong, Nowak said. Many are from households where they are expected to, as the saying goes, pull themselves up by the bootstraps and move on, Nowak said.
“Those people are tough and resilient, and that’s a wonderful thing, but sometimes you need extra help and support,” she said.
Harmonia serves clients aged 13 and older, reaching them for the past 12 years in part through its satellite clinic in Lake Shore High School in Angola. The office there is staffed two days a week.
Nowak said it is encouraging how the students embrace the help and services offered, which will continue to break down the stigma.
However, the parents often aren’t supportive of the child getting the help that’s needed. In those cases, when family insurance is unavailable, Harmonia uses grant money to cover services for the young school-based clients.
ECMC’s client base is primarily urban, and the behavioral health professionals there are taking a trauma-informed care approach coupled with understanding the social determinants of mental health to address the needs of that population. Central to their work is to provide programs and services that will keep the clients from going to more restrictive levels of care, Schoelerman said.
ECMC’s Help Center Behavioral Health Walk-In Clinic at its Grider Street campus has positioned itself as a community resource offering services that might prevent a trip to the comprehensive psychiatric area, he said.
Government funding
Gov. Kathy Hochul has made mental health a priority in several areas, including increased funding for housing programs, services targeting youth with mental health symptoms, and expanding peer-to-peer services.
As a result, Spectrum Health has seen greater opportunities to apply for funding for new types of services to go beyond traditional clinic-based services.
Spectrum Health is embedded in pediatric offices and the three Williamsville high schools and is exploring a relationship with Lancaster schools for a presence there.
“We find that when we can embed ourselves in a location where a person is more willing to access those services, we get a better engagement rate,” Farrell said. “There is a wealth of different kinds of funding available through the governor that really has changed the face of mental health services in the community.”
Vandermark-Murray pointed out that mental health services were underfunded for a decade, so the current funding is only serving to patch up the system.
Stanton said another challenge is what seems to be a constant change in funding.
“You have a product that might be working and that grant shifts or adjusts and you have to morph services that you have been providing in such a way that either your service areas or catchment population is lost, or you have to have the staff readjust themselves to fit the new model,” Stanton said. “Funding has been not enough, and they haven’t funded long enough to see true outcomes. It’s been very quick to jump around.”
Staffing issues
It’s a challenging time, all agreed.
Service providers leave, burned out by the trauma, the increase in symptoms and the dysfunction that has been increasing during the past few years. Other providers move from difficult clinic-based care to private practice.
“It’s the climate of change,” Weinstein said. “There’s turnover wherever you go, because they think the grass is greener and the grass is not always greener. The turnover rate is substantial, and it has a negative impact on patient care.”
To combat the problem, BestSelf is using treatment teams that give the client a connection with more than one key individual at the agency so there is continuity in care should one person leave the team, Stanton said.
BestSelf also is improving the technology involved with the work of caring for clients, such as improving the electronic medical record and telehealth platforms and optimizing workflows.
“With less staff, we have to make sure that everyone is doing something that isn’t a repetitive task,” Stanton said. “So, by using that entire treatment team, having different people take components of the service, maximizes the time they are spending with the consumer.”
Contributing to work stresses is that personnel might not be prepared by their education institutions for the reality of the work, Schoelerman said.
“They almost feel like ‘why am I failing?’ And they’re not,” Schoelerman said. “They are actually doing a pretty good job, but in their mind, it is not working like they were told it was going to in coursework or in the textbook. That is a challenge for us clinically.”
Employees and mental health
Given the prevalence of mental health-related absenteeism in workplaces, employers would be wise to first become educated on what mental health is, Weinstein said.
“If someone had chest pain and they were out over and over again, that would be looked at very differently than if they were depressed and out over and over again,” she said. “There is a break down between the system and the people who work there. Communication between the two, that may go a long way.”
Employers overall might well follow the lead of these mental health organizations and how they address mental health in the staff. At Horizon Health Services, Vandermark-Murray said a special focus is mental wellness through the employee assistance program for staff.
“That way it becomes part of the culture,” she said. “I don’t need to know what is going on with our employees. I need to know they are comfortable asking for help, and I can give them their resources. We are in the business of challenging stigma; it has to start with our staff.”
Telehealth continues to offer another access point for services, Mikowski said. No longer do employees need to take a half-day off from work when they can make a telehealth appointment during their lunch break, for example.
To reduce stress and improve the emotional wellness of employees, Endeavor Health has ongoing training and creates space for employees to connect with and support each other, Mauro said. There also is a week-long wellness program with topics that include an array of issues, such as heart health and financial health. An eight-week stress reduction program addresses building resilience and focusing on mindfulness.
“As the employer, we are going to give you opportunity, space and education on all the different aspects of your health including your mental health and your emotional health,” Mauro said.
It is a neglected mental health issue that can turn into a crisis. ECMC last year instituted the Rushton Resilience Scale, which links personality traits with psychological resilience to protect those facing adversity and help them lead to positive adaptive behavior.
The scale has become normalized, where staff use it to assess their state of mind and determine whether they need to seek help.
Schoelerman said the scale is helping to normalize mental health issues and to take some of the stigma away, to the point where staff have felt free to seek help. What that help is, at what level and at what point is evolving, he said.
Harmonia this year added to the benefits package two mental health days to use at any time, even at the last minute, for “whatever it is you feel you need” to have that day for, Nowak said.
“It is two days, and it is great, but the things we need to do need to happen every day, when they walk in the door to work or when they start work from home to the end of the day,” Nowak said.
To that end, Harmonia offers, for example, the guided meditations on the Calm app, which staff can fit in in between clients, and encourages space to connect with co-workers, for those working on site.
Employers need to be more preventive and recognize and identify what constitutes emotional, psychological or physical health, Mauro said.
“They can give that time and space to do different kinds of health screenings and education and then the opportunities to seek help and go use their benefits not waiting for a heart attack or an overdose to happen,” Mauro said. “There should be no questions asked. If you need some of your time, it is yours to take.”
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