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Hidden Crisis: An occasional series
RISING WORRY:

Experts say mental health crisis imminent

From the Hidden Crisis: Mental Health in Southern Minnesota series

Services strained before and during pandemic

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Imagine you’re having a conversation with someone. Say that person asks you about your weekend plans. While you’re trying to answer, a voice rings through your head.

You may hear: “They don’t really care what you’re doing. They’re laughing at you.

“You can’t trust them. You can’t trust anyone.”

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Registered nurse Mary Beth Trembley conducts a class on mental health first aid at the Mankato Clinic.

That’s one of the exercises people run through in Mary Beth Trembley’s mental health first-aid classes. A psychiatric nurse, Trembley has hosted first-aid courses in mental health for several years in the Mankato area. Thus far, more than 500 people in the community have participated, while some participants come from across Minnesota or from neighboring states.

The classes teach how to help someone in a mental health crisis get connected to area resources, to recognize when someone may need extra help.

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Mary Beth Trembley (right) discusses how people are affected by mental illness at a mental health first-aid course.

For Trembley, who’s spent 30 years helping people in the area with mental health crises, the classes are a crucial step toward spreading more awareness and getting people the support they need.

“It’s my way to be part of the solution,” she said.

Public health professionals have put more emphasis in recent years on addressing mental illness as the stigma of dealing with depression, anxiety and other mental health issues lessens. Yet mental health advocates have long argued local, state and national efforts to treat mental health issues are underfunded, understaffed and in desperate need of more attention.

Now, with an ongoing pandemic compounding mental health needs and amplifying cracks in Minnesota’s mental health system, advocates and experts say a mental health crisis is set to start during the next few months.

“People’s entire framework of what’s going on in the world shifted,” said Jese Rudrogen, head therapist at PrairieCare Medical Group in Mankato. “It turned on a dime and places that they thought were safe and acceptable to be around. Now you’re being told, you know, you can’t go to school, you can’t be around your friends. It just really made the world seem like a pretty kind of scary and unsafe place overnight. And that’s really led to a lot more anxiety, isolation, depression.”

History of struggle

Diane Gerlach knows better than most how complex the mental health system can be. For the past 15 years, she’s coordinated support meetings for parents and loved ones of people with mental health issues through the Mankato branch of the National Alliance on Mental Illness.

Her son was diagnosed with mental health issues at 6 years old. As a nurse with over 40 years of experience, she’s watched mental health services evolve to catch up with people’s needs. That’s why she’s more than familiar with the cracks in Minnesota’s mental health care system.

“Mental health, with services, have really suffered over the years,” she said.

Psychiatric beds are difficult to find. A lack of mental health professionals means long wait times for people in search of therapy or medication. Thousands of dollars in treatment costs. And a general lack of understanding on how to get help.

“A lot of people like to say our mental health system is broken, but when you look at the history, it’s not broken. It’s never been built,” said Sue Abderholden, the executive director of NAMI Minnesota.

Sue Abderholden

Sue Abderholden

Abderholden points to numerous studies done that show state and federal officials know what kind of solutions are needed — more mental health services in emergency rooms and schools, more funding for mental health outreach, more access to services such as mobile crisis units.

Those studies were done in the 1950s, during President Dwight D. Eisenhower’s administration.

While federal officials had planned to fund more mental health programs in those years, funding levels tapered off in the late 1960s and 1970s as the U.S. grappled with what it means to deal with mental health. Though state and federal officials have placed more emphasis on mental health services in recent decades, seeking help for mental illness became more socially acceptable within the past 10 to 20 years.

Younger people are driving that push, experts say, leading to more Minnesotans acknowledging their need to get help for mental health issues. In Minnesota, about 183,000 adults and children have serious or persistent mental illness, according to the Minnesota Department of Human Services.

Locally, the South Central Community Based Initiative reports monthly average contacts with its crisis services have risen from about 200 per month in 2004 to about 566 in 2019, up significantly from 283 monthly average contacts in 2018 and well past the previous high of 472 average monthly contacts in 2012. And those numbers are pre-pandemic.

Gerlach and other advocates have applauded more treatment options in the area over the years, but they’ve found the hardest part for those seeking help is simply starting the process. Gerlach and other local NAMI members are often the first point of contact for people struggling with mental illness or their loved ones.

The weekly support meetings can vary in size from more than 20 people to just one.

“It seems like when it’s only one person, that person really needed to just be one-to-one with somebody and needed to talk,” Gerlach said. “Our meetings would run for an hour and a half, and that person would talk for an hour and a half.”

A lot of those people would come with no knowledge at all, Gerlach said. They haven’t figured out how to talk to their family doctor about treatment options to kickstart referrals to mental health professionals, or they don’t realize Blue Earth County has a hub of social service options for people with more serious needs.

In some cases, people feel stranded without help.

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Participants in a mental health first-aid course at the Mankato Clinic discuss how an exercise affected them.

Gerlach remembers the man from Gaylord who would drive to Mankato for weekly meetings because his wife suffered from mental health issues. Her family, who lived nearby, thought there was nothing wrong with her.

“They have two children,” Gerlach said. “And he just didn’t have a lot of support.”

The man talked about moving the family west to be closer to his relatives, who could help with the kids. But he’s hardly the only one from outside the Mankato area who’s struggling.

“People would drive for miles to come and talk to our groups,” Gerlach said.

New reality

Access is everything for Angela Anderson. The 43-year-old Mankato resident enjoys spending time with others at the Second Step Clubhouse, a community program through Blue Earth County that allows people with serious mental health issues to bond with each other in a friendly setting.

Mental health clubhouse

Angela Anderson enjoys spending time with others at the Second Step Clubhouse, a community program through Blue Earth County that allows people with serious mental health issues to bond with each other in a friendly setting. A pause like what happened during the pandemic can cause even more issues for people like Anderson seeking help and support.

Second Step, like a lot of in-person programs, went through a pause during the COVID-19 pandemic. For people seeking mental health help, a pause like that can cause even more issues.

“I think one of the things that people tend to want to do when they’re not doing well is isolate, and that is the exact opposite of what they need to do,” Anderson said. “I need a lot of down time even when I’m doing really well just because of the way my nervous system is, but not completely isolating is huge.”

That’s one of the many concerns mental health professionals and advocates have about how the pandemic has affected overall mental well-being. COVID-19’s effects on mental health are largely unknown and still under study, in large part because the mental health industry hasn’t tackled a widespread event like this before.

“It was a unique situation where our providers were suffering the same pain as our clients were,” said Neerja Singh, behavioral health clinical director with the Minnesota Department of Human Services. “Our workforce had to acknowledge their own trauma and treat their clients at the same time.”

Singh and Paul Fleissner, director of the state’s Behavioral Health Division, oversee the state’s mental health services. When the pandemic shut down much of the state, they helped implement a switch to telehealth services — video conferencing or phone appointments — between patients and mental health professionals to ensure people could still access treatment.

Though telehealth services grew among medical providers in recent years, mental health professionals rarely offered telehealth services at the same rate as in-person visits and insurance companies didn’t fund those services at the same level as in-office appointments. State officials quickly remedied that in the early days of the pandemic.

“It was simply astonishing the way the state moved to make that happen,” Fleissner said.

State officials have worked to improve mental health access in recent years, in part by integrating mental health and substance use disorder programs together and offering more mental health program options at community clinics. Before the pandemic hit, state officials were gearing up to streamline more of its services to offer more mental health support for communities of color, immigrants and refugees.

COVID-19 put a damper on many of those projects as officials rushed to break down barriers for telehealth access.

Contact information, websites and phone numbers of area mental health crisis services, chemical dependency services, mental health therapy resources.

Despite more access than before, however, worrying trends became clear to many mental health providers. Children’s services were arguably impacted the worst — most children with mental health needs get support at school. When schools switched to distance learning, a lot of school-based mental health support suffered. More people sought treatment for anxiety and isolation. And people who hadn’t had many mental health issues in the past struggled to deal with pandemic regulations and the uncertainty behind the COVID-19 virus.

“I think this has just been the longest, the most consistent busy season we’ve had in gosh, probably five or six years,” Beth Quinby said in June.

Quinby, a licensed clinical counselor and the former chair of the Blue Earth County Mental Health Task Force, said mental health providers across the region have reported more demand for services, driving up wait times for patients. Mental health providers don’t normally see as many patients in the spring and summer — people tend to feel better when it’s nice outdoors — but the pandemic spurred a steady demand for services this year.

And it’s not just adults who need more help. Children and families are seeking more mental health support. School districts are gearing up for more mental health support once the school year starts this fall, and places such as PrairieCare are trying to keep up while following pandemic guidelines and limiting in-person exposure.

“There’s this whole separate group of kids that are coming in, just because of the things that happened in their life because of the pandemic,” Rudrogen said. “If the pandemic didn’t happen, these kids might not have been here to begin with.”

The recent COVID-19 delta variant surge has some mental health advocates concerned the pandemic’s adverse effects will only continue to compound mental health needs. While lawmakers continue to work on mental health policy, advocates say the pandemic only exacerbates the need for more funding and more access to mental health professionals.

“There’s been a lot of death, there’s been a lot of worry. No one’s really sure when this all will end,” Abderholden said. “It doesn’t seem to matter what the age is, what the age is, where they’re located throughout the state. We’re still just seeing a lot of anxiety and depression.”

Still, local advocates say one good thing may come out of ongoing crisis: more sustained attention on the issue.

“It’s always been there, it’s just now being talked about,” Anderson said. “We’ve always needed more help and more support.”

Anderson knew she needed help as a teenager in the 1990s, but she didn’t feel comfortable enough to seek treatment until about 12 years ago, when she felt her life spiraling out of control. She knows it’s much easier to get help now compared to then, but she remembers how difficult it was to take that first step to access services.

“I think the more it’s being talked about, the more people will actually go and seek help. And need the help,” she said. “I don’t think it’s anything new, per se, it’s just that it’s being brought to the forefront.”

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