There have been many days where Susan Adamson, a nurse practitioner and the executive director of the Blue Ridge Free Clinic (BRFC), and her team of volunteers have planned to work for four hours, only to find themselves at the clinic eight hours later.
“We’ve been overloaded with patients at times … The nature of our volunteers is when they see need, they dig their heels in and just stay and we get the job done,” Adamson said. “But that’s not sustainable indefinitely.”
Adamson said the clinic’s services —medical, dental and mental health — have been utilized three times what the clinic expected since they opened in April 2021. Although the BRFC provides services for a variety of health-related issues, Adamson said around 20% of patients have associated mental health conditions.
Adamson said she’s seen more mental health needs and stressors in the last year and a half than she’s seen in the last 30 years.
“Counseling is where there’s such a shortfall right now, and so we’re struggling along with other practitioners trying to find places to get adjunctive counseling,” Adamson said. “We had hoped to have it embedded in our office, but we just can’t find counselors, there aren’t enough out there.”
With the large student population from JMU and other local colleges and universities, students often seek counseling services both on and off campus. When the JMU Counseling Center got overwhelmed in the past, it utilized community resources as a “pressure release valve,” David Onestak, the director of the JMU Counseling Center, said in an Aug. 17 interview.
“The problem is, the mental health crisis is not limited to college campuses, and so these community providers are filled up,” Onestak said. “That is an avenue that we no longer have available to us, so it’s this constant balancing act of trying to make sure that we use the resources that JMU gives us to serve the most students in the best way.”
Private practices, like Friendly City Psychology founded by Jerrod Koon, see large numbers of college students. Koon said college students are a part of the Harrisonburg community, and it’s the job of community resources to serve students as well. JMU students aren’t taking resources away from the community by seeking help, he said.
“I don’t know what the mental health services would look like if they weren’t supported by college students; I don’t know any private practice person that doesn’t see college students,” Koon said. “It’s like a relationship between JMU and Harrisonburg, you know, benefits and challenges, probably, to all of those relationships.”
JMU still refers students to community resources, depending on the students’ wants and ability to access care off campus. However, JMU has recently implemented telehealth options to provide students mental health care to navigate the difficulty of increased demand at JMU and in the surrounding community.
Harrisonburg boasts a wide array of both private practices and community resources for disadvantaged populations. Even so, it may not be enough to keep up with the demand from the community or the barriers to those seeking counseling.
Need for mental health resources and counseling has been increasing across the country for years, and it’s only been exacerbated by the pandemic. According to the National Alliance on Mental Illness (NAMI), annual encounters with specialty mental health treatment centers increased by 50% from 1992 to 2000. From August 2020 to February 2021, the CDC found the number of adults with symptoms of anxiety or depressive disorders increased from 36.4% to 41.5%, and the increase was larger among 18- to 29-year-olds.
One of the biggest issues facing counseling resources across the board is the need for more practitioners in the area while navigating the increased demand. Rebekah Brubaker, the director of behavioral health services at the Harrisonburg-Rockingham Community Services Board (HRCSB), said there’s an opportunity to develop more professionals in the field.
“We had an explosion of need for services, and the workforce just hasn’t been there to offset that need,” Brubaker said.
In Virginia, Community Service Boards (CSB) are “the single point of entry into publicly funded behavioral health and developmental services” and are supported by federal and state funds, according to the HRCSB website.
HRCSB offers mental health support and substance abuse services, 24/7 emergency mental health support and other developmental and wellness services.
Brubaker said patients are experiencing long wait times for resources, and Harrisonburg is particularly struggling to provide psychiatric care to provide medications for those who need it.
“We are a fortunate community that we do have a lot of private providers for outpatient treatment, for therapy services in our community,” Brubaker said. “However, it still doesn’t feel like it’s meeting the demand of our community.”
According to NAMI, more than half of the people in the U.S. with a mental health condition didn’t receive any treatment in the last year.
For April Hepler, the executive director of the Adagio House, the biggest challenge they face in providing mental health care is funding. Adagio House was first founded to care for caregivers in the community, but following COVID-19, expanded to care for everyone in the community, offering both counseling and respite services.
Amid a shortage of mental health support in the state of Virginia, and an increase of demand, she said she has dreams of how to address gaps in access to mental health care, but not the money to address it.
“We have been seeing … a tsunami of mental health issues coming our way,” Hepler said. “I don’t think we’ve even begun to scratch the surface of the long term impact of what has happened in the last several years.”
Community members working with graduate counseling programs like the Counseling and Psychological Services (CAPS) Clinic at JMU and EMU have been helpful to local partners like BRFC, Adamson said, but it still doesn’t meet the long term solutions community providers are looking for.
“The students graduate, they move on and they go to wherever they’re going to set up their practices long term,” Adamson said. “We just need more people in the field who are living and working in our area.”
Private practices, like Friendly City Psychology, have been trying to provide “accessible and inclusive, high quality mental health services,” Koon said. Koon used to work for the JMU Counseling Center and needed a shift professionally.
“Private practice kind of afforded me most of the positive aspects of clinical work … so that felt like a nice transition from what I was doing back then,” Koon said, “and the community desperately needs mental health professionals, so it was really nice to give back and to bring clinicians to the area.”
It doesn’t take long though, Koon said, for a new clinician to get swamped with a full caseload — “a couple weeks and they’re full,” he said. Koon has been full for a long time, he said, and still receives between half a dozen and a dozen requests each week.
Gaps in care
Barriers to care extend beyond lack of providers. Cost, transportation and education can determine whether disadvantaged populations receive care.
Harrisonburg is unique — alongside being a college town, it’s also a refugee resettlement city and has a significant ALICE population, according to the United Way of Southwest Virginia. ALICE stands for Asset Limited, Income Constrained, Employed, and represents those in the community who “earn more than the official Federal Poverty Level, but less than the basic cost of living.” In Harrisonburg, 38% of households fall within the ALICE threshold, and 23% fall below the poverty line, according to United Way. This can impact families’ eligibility for things like Medicaid, increasing the cost of mental health care. Even for those with insurance, Hepler said, high deductibles can force individuals to pay out of pocket for therapy.
Community resources like the BRFC and Adagio House aim to address these gaps by providing free care or care with a sliding pay scale.
While COVID-19 has increased some demand and barriers to mental health care, it’s expanded access through telehealth, especially for those who experience transportation barriers. Both Friendly City Psychology and Adagio House have been able to expand their care using telehealth services.
“I have clients all across Virginia that I never would have had before the pandemic — it wouldn’t have been a viable option,” Koon said.
Much of the work the BRFC does includes patient education, Adamson said, because of patients’ disenfranchisement from medical care or lack of experience.
“Many of the patients that we see are from other countries, or the whole concept of counseling is new to them,” Adamson said, “and explaining what happens in a counseling session, how many sessions are going to happen, explaining the confidentiality behind it and how counseling and medication often go hand in hand.”
In the end, it doesn’t take just counseling to address mental health in the community — it takes a combination of community support and a holistic approach. Brubaker, the director of behavioral health services at HRCSB, said the community can come together to help one another for care outside of counseling.
“I like the idea of not relying solely on the professional world, to fill all of the needs, because I think all of us as humans have the potential to care for one another and to create a system of connectivity and care that allows us to really support each other through this, through these times,” Brubaker said.
Adamson said the BRFC does its best to integrate a holistic approach to the physical and mental care of patients. Moving forward, they’re working to address more gaps in care by writing a grant application to get funding for patients who can’t afford counseling.
For mental health, community providers agreed: It takes an approach of understanding, compassion and destigmatization. Hepler said factors like housing and economic support can impact community mental health and to address all underlying issues that impact mental health.
Brubaker said professionals in the community care deeply and are available to anyone who needs them.
“There is absolutely no shame in asking for help,” Brubaker said. “It’s OK to reach out to somebody and let people know you’re not doing OK.”
McKinley Mihailoff contributed to this report.
Contact Ashlyn Campbell at firstname.lastname@example.org. For more coverage of JMU and Harrisonburg news, follow the news desk on Twitter @BreezeNewsJMU.