Rural North Carolina mental health awareness gets creative -NC Health News
By Liora Engel-Smith
When the coronavirus transformed North Carolina telehealth billing in early spring, Kevin Mahoney began recording with most of his 200 clients by video and phone. But the Asheville-based peer support specialist soon discovered that telehealth was leaving some of its clients behind.
Mahoney, who works at the Mountain Area Health Education Center, supports people seeking to recover from drug and alcohol use. But it can be a challenge. Often his homeless clients do not have working phones and some of his rural clients live in areas with spotty cell reception and little or no internet access.
In the five months since the first known case of the coronavirus in North Carolina, efforts to curb the spread of the new disease have also fostered conditions that can exacerbate mental illness. Anxiety and depression are on the climb amid the uncertainties of the epidemic. Overdoses have also increased, according to Victor Armstrong, who heads the Division of Mental Health, Developmental Disorders and Addiction Services.
And in a survey conducted by the North Carolina Academy of Family Physicians and the North Carolina Pediatric Society in early May, nearly half of physicians said the demand for mental health services is significantly higher now than it is. was not in March.
Social connections can be an important coping tool for people with mental health needs, but how exactly to provide that support without spreading the virus has been a challenge in rural areas, where broadband infrastructure is scarce. limited.
“With the pandemic, the emphasis was so much on social distancing and closure that people were really more focused on the medical aspects of the virus,” said Stephen Buie, who heads MAHEC’s psychiatry department. “Now that this is becoming a longer term problem, people are starting to think about how it affects people who are isolated, people who have to live alone, and people who don’t have a lot of social support.”
In western North Carolina, mental health service providers have explored creative ways to connect vulnerable people without access to technology to services, give them free smartphones and data plans. holding outside support group meetings.
A virtual lifeline
When the lockdown went into effect in early spring, two mental health agencies in the western part of the state began experimenting with ways to connect patients to services. Their experience was similar to Mahoney’s: most, but not all, patients had access to a computer or phone for telehealth visits.
- Hope4NC Hotline connects people with mental health supports, available at 1-855-587-3463
- The national lifeline for suicide prevention operates a 24/7 hotline at 1-800-273-8255 and live chat available at https://suicidepreventionlifeline.org/chat/
- NAMI North Carolina chapters across the state are functioning virtual support groups which are open to all North Carolinians who need support.
- The Promise Resource Network operates a 24/7 hotline that is open to all residents of North Carolina and is available at 1-833-390-7728. The Charlotte agency also has a variety of virtual groups, including support groups and arts groups.
The two agencies – Vaya Health and Partners Behavioral Health Management – identified patients who could not go online virtually and gave them free smartphones with data plans. Vaya and Partners has connected a collective of 1,000 patients to the Internet through these independent programs. The goal is to prevent people with complex mental health needs from being discharged from the hospital.
“The barrier was the technology and the data plan,” said Lynne Gray, clinical director of mental health and substance use at Partners, an organization that serves an area of nine counties. “Because it takes a lot of data on a cell phone.”
Both agencies got free phones from Verizon but had to buy data. The partners opted to provide unlimited data to patients and the company gave a discount, but the cost was a limitation. Vaya ended up budgeting 2 gigabytes per phone per month.
Free cell phones don’t completely erase connectivity issues. Gray said some rural patients have to use public Wi-Fi because they don’t have a reception at home. In addition, the agency cannot replace a lost or stolen smartphone.
Distributing smartphones and teaching customers how to use them can also be logistically complicated, she said.
Neither agency has data on cost savings or outcomes for participating members, but representatives from both organizations said patients are using more resources, including virtual groups and therapy. They bet that connecting people with complex mental health needs to their provider will result in fewer hospitalizations and emergency room visits in the long run.
The savings from this approach could be significant. The average Verizon plan costs around $ 420 to $ 660 per year without corporate discount. But a single visit to the mental health emergency costs anywhere from $ 570 to $ 640 per visit. This cost can skyrocket beyond this figure if patients are admitted to hospital.
Gray said patients report that phones help them reduce the loneliness associated with being at home for extended periods of time, thereby improving their overall well-being.
“We have found that people are just overjoyed and that the phone has changed their lives,” said Allison Crotty, director of member engagement at Partners. “Not only does this help them engage in services, but they are also able to listen to soothing music and they are able to maintain social networks.”
Mahoney, the peer support specialist, has managed to foster closeness even when clients are not physically in the room with him. But when screens aren’t an option, Mahoney meets people face to face. Twice a week he visits the Haywood Street Congregation, a church in Asheville that serves take out food for the homeless.
Mahoney said he wears two masks and frequently sanitizes his hands when seeing customers in person. He sits across from people at a picnic table, offering support and sometimes nudging. And he reminds clients to wear masks during these interactions to minimize the risk of transmission.
Occasionally, Mahoney also drives out of Asheville and into the surrounding mountains to visit rural clients who can’t connect any other way.
“I’m going to sit on their porch or sit on their six foot steps and check it out that way,” he says.
Elsewhere in the mountains, Mary Ann Widenhouse, chair of the Haywood County Chapter of the National Alliance on Mental Illness, attempted to organize an outside support group. Many members, she said, prefer face-to-face interactions over phone conversations and the section has yet to venture into virtual support.
The idea of an outdoor group seemed simple at first – pick a public park and time and invite masked members. Everyone sat six feet apart to minimize exposure. But the first outdoor group, held last month at a park in the city of Waynesville, encountered challenges.
On the night of the reunion, the kids played soccer nearby and their mothers were chatting in the shady shelter Widenhouse intended to use, so there wasn’t much privacy. Other questions quickly arose: How many people should be allowed to participate in the group at a time? Should Widenhouse screen attendees for symptoms before the meeting? And what outdoor locations might guarantee privacy in the future?
Widenhouse’s experience appears to be almost unique among NAMI Chapters, said Mikayla Cardona, affiliate and outreach specialist at NAMI North Carolina. The sweltering summer in North Carolina has limited the usefulness of this approach, but the organization may revisit the idea when the weather cools, but another group in Macon has been meeting outside regularly since June, according to the NAMI leader there. In the meantime, several other chapters hold online support groups, Added Cardona.
Widenhouse said the idea for the outdoor group needed to be refined before the next meeting. Lately, she’s been thinking that maybe a hiking support group could provide the privacy protection members need. But what works in Haywood County may not work for another community, she said.
Whatever type of support a community chooses, Mahoney said, whether face-to-face or virtual, it would be important to maintain it in the months to come.
“We have the opioid epidemic and it hasn’t gone away and the other things haven’t gone away, but we’re in the middle of a pandemic,” he said. “It’s like a tornado in the middle of a hurricane.”
This story has been updated to include information about another NAMI group that met outside.