YOUNGSTOWN, Ohio – Mental health concerns have been on the rise since the pandemic started, forcing providers to reshape or adjust their services.
“We have seen an increase in people coming in and desiring services due to the challenges this pandemic and life has brought,” says Joseph Caruso, president and CEO of Compass Family and Community Services.
“As people … deal with the stresses and the fears associated with the pandemic and the isolation people experience and not necessarily getting their needs met, things have changed,” Caruso says.
“The new normal is you have to live in the COVID age,” he says. “There still is some reluctance of people [to transition back into normal life].”
Those who do seek help have more significant symptoms because of the isolation they have faced, Caruso says.
“People may not have addressed some of their concerns they were facing during that period of time. Now things have changed and they are seeking help now,” he says.
Although Compass no longer does a lot of work with children and adolescents, Caruso says many of his peers who do are telling him they have been seeing significant challenges with school-age children.
There has also been an uptick in severe mental illness and addiction among people in their early 20s and mid- to late-30s, he says.
“During the pandemic, people were isolated and people may have abused and used substances that they might not have done in the past,” he says. “Unfortunately, when these things become habitual activities, then it becomes an addiction. And somebody who has within their DNA a propensity for addiction, the use and abuse is triggered even more.”
Another issue is that although more people are now coming in for mental health services, fewer providers are available in the area, Caruso says.
“There is a significant workforce shortage,” he says.
Caruso says Compass currently serves more than 7,000 clients.
The agency is a service provider to the Mahoning County Mental Health and Recovery Board and the Trumbull County Mental Health and Recovery Board.
CRISIS INTERVENTION
Carmella Hill, director of behavioral health for Trumbull and Mahoning County at Coleman Health Services, leads a team of counselors, intake workers, case managers and a behavioral health substance use navigator.
“We have noticed the increase in mental health crisis presentations in both of our offices and in the local emergency rooms,” she says. “Particularly, for Trumbull Regional Medical Center, we are embedded in the local emergency room. And, we provide mental health crisis assessments. Our role there is to determine a level of care for potential hospitalization to a psychiatric facility.”
In 2021 and 2022, Coleman completed 1,973 crisis intervention assessments in its ER and local offices. From July 2022 to March 2023, it already has had 1,445 presentations – an average of 160 to 180 per month, Hill says.
Overall, Coleman served 4,216 people from October to December 2022.
Hill says there also has been an increase in counseling, crisis intervention services, psychiatry services and medication.
“The pandemic really seemed to impact the conditions for mental health symptoms to come to the forefront. So it really brought to life what people may have been experiencing for years and maybe did not seek help or treatment,” she says. “The pandemic seemed to trigger that or provide the opportunity to seek help.”
One big change to the mental health profession caused by the pandemic was the switch to telehealth services.
“We had to shift how we provided treatment to individuals,” Hill says. “That, I believe, helped open the door for clients to reach out in a comfortable way that they felt was suitable for them instead of coming to a brick and mortar.”
According to the Center for Improving Value in Healthcare, telehealth service use increased by 2,000% from 2019 to 2020. This number dropped only 11% from 2020 to 2021.
“That really helped shift the behavioral health industry,” she says. “We still are operating in that fashion today.”
Popular treatment options include counseling, psychiatry services for medication, case management and employment services.
CHILDREN, ADOLESCENTS
Hill says adults, children and adolescents alike have been affected, with a particular increase in adolescents.
“Many were at home with virtual learning or the dangers of school shootings and threats, increasing their anxiety or worry about their health concerns – their own physical safety,” she says.
Incidents of child abuse also have risen since the pandemic, Hill says, eliciting a targeted response.
“We have what is called a mobile response stabilization team,” she says. “Those individuals work with families to address issues within that dynamic and if they present in our local ER or if they call our agency. We are like a linkage to those particular clients and connect them with particular services they can obtain for their child or adolescents.”
Many women with children were also impacted, Hill adds, resulting from a loss of support systems and housing issues.
“With the housing crisis in the Mahoning Valley where there are limited options, it has just been a challenge for people,” she says.
In addition to an increase in drug abuse spurred by the pandemic, the recreational use of substances has also risen.
“The increase in ordering food and drinks online and then having it delivered right to your home – that was easy access for alcohol,” she says.
Opioid and stimulant use also increased among both adults and adolescents.
“They’re experimenting more,” Hill says.
Individuals seeking help in a mental health crisis or who are concerned about someone they know can call 988 or text 741741.
Poverty, Drugs, Lack of Support Lead to Mental Health Issues
Poverty and drug abuse are common triggers of mental health problems, according to a recent report from the Brookings Institute.
In addition, lack of access to social support aggravates the problems, the report states.
The Substance Abuse and Mental Health Services Administration reports that 20% to 50% of homeless people have serious mental illness, which is exacerbated by being homeless.
There are differing opinions as to whether housing-first or treatment-first models are better. But according to the Brookings report, several large cities have begun initiatives that first provide shelter to the homeless and then offer other services to assist them with mental health and substance abuse concerns.
U.S. Sen. J.D. Vance, R-Ohio, questioned housing-first policies during a recent Senate hearing, saying they can introduce people with drug problems and mental illness into communities with children, normalizing drug use for them.
The Brookings report suggests a need to improve the coordination among all levels of government and social services to provide those suffering from mental illnesses with both housing and health care services.
But housing is only one piece of the mental health puzzle.
Food insecurity for low-income families is associated with a 257% higher risk of anxiety and a 253% higher risk of depression, according to a study conducted by Di Fang of the Department of Agricultural Economics and Agribusiness at the University of Arkansas in Fayetteville.
This depression can affect both mothers and the development of their children.
The U.S. Department of Agriculture estimated in 2021 more than 34 million people, including nine million children, did not have enough to eat. It noted that many families who qualified for emergency food programs during the pandemic have since lost those benefits.
The Brookings study suggests extending the funding and expanding it to include personal hygiene items.