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Mental health care providers brace for what could be a ‘pretty difficult’ fall

UPDATED: Wed., Sept. 16, 2020

State and local mental health providers are preparing for a deluge of demand on the state’s mental health care systems this fall, as forecasts predict October and November will mark the lowest points in mental health and behavioral health responses in people in the midst of the COVID-19 pandemic.

Disasters always bring about a heightened behavioral response, but COVID-19 is a bit different than a more typical event like a hurricane or flood, which are usually over in a few hours or days.

“With COVID, the responses people are having are (marked) by the sense of isolation and uncertainty, so that’s not PTSD, it’s depression,” said Dr. Kira Mauseth, the Department of Health’s leader of the state’s behavioral health strike team.

A new spike in COVID-19 infections in the fall could also trigger what Mauseth called a “disaster cascade” pattern, which could restart the current pandemic disaster response curve that we are all living through.

Entering ‘disillusionment’

The pandemic has stretched both people who already receive mental health care or treatment, as well as those who have never sought help for their mental health.

The Department of Health formed a behavioral health group at the outset of the pandemic to offer guidance and predictions on how the mental and behavioral effects of the pandemic will play out in Washington.

Thus far, its predictions are right on target, including a projected dip to the lowest points of what is called the “disillusionment phase” of the pandemic curve in October and November.

“That’s when people are struggling the most with behavioral health symptoms, and they tend to be depression-oriented,” Mauseth said.

People in the “disillusionment phase” struggle with what the new normal looks like, what will change and what will stay the same, which brings about a lot of grief and loss, she added.

“Unfortunately for Washington and the Northern states, it comes at the time of year where we lose daylight and the weather changes, and you have seasonal affective conditions,” she said.

The Department of Health predicted adverse mental health impacts of the pandemic early on, but now that fall is here, those realities are setting in.

“In Washington, the highest risk of suicide is most likely to occur between October and December 2020,” state health department guidance says. “This estimate is based on known cycles of disaster response patterns. Seasonal affective disorder (SAD) exacerbates mental health challenges at that time of year due to increased hours of darkness and inclement weather. Winter holidays can also worsen mental health challenges for many people, as they are often an emotionally and financially difficult time of year.”

In other words, fall is predicted to be a critical time for residents’ mental health, and as Mauseth says, “the ingredients for fall are pretty difficult to say the least.”

Data indicate the pandemic is already taking a toll on both young and old residents.

Adolescents in Washington have not escaped the inevitable impacts of the pandemic. The Washington Poison Center reports a 5% increase in youth intentionally harming themselves or indicating suicidal intent. Abuse has increased 34% compared to 2019 for adolescents.

Statewide domestic violence offense reports were higher every single week from April to July, when comparing 2019 to 2020, according to data from the Washington Association of Sheriffs and Police Chiefs.

Local resources will be stretched

Locally, behavioral and mental health resources already are stretched thin.

Frontier Behavioral Health is operating at about 90% capacity, said Jeff Thomas, CEO of the mental health provider, meaning it is still taking new clients.

The majority of Frontier services are being offered through telehealth, although some outpatient treatment services, including crisis response teams, are working in-person. If statewide projections are correct, Thomas said, the region’s mental health care system will be taxed this fall, including at Frontier, where he anticipates the agency will get to capacity eventually.

“The mental health system is not going to be able to expand to respond adequately to the projected increase in need if that turns out to be an accurate projection,” Thomas said.

Inland Northwest Behavioral Health, the region’s freestanding psychiatric hospital, has seen a shift in the primary diagnosis of patients seeking care since the pandemic hit. Patients also are coming in with more acute and urgent mental health needs.

“The majority of what we’re seeing is an exacerbation of symptoms and more acuity,” said Julie Hall, director of admissions at the hospital.

The number of first-time clients at INBH as well as the number of walk-in clients also has increased.

INBH has seen a 365% increase in patients with schizophrenia; a 140% increase in patients with major depressive orders with psychotic features; and a 198% increase in patients with schizophrenic depressive-type disorders, all compared to client diagnoses pre-COVID.

The length of stay has ebbed and flowed since the pandemic began but is on the uptick. Typically, patients stay on average nine days. In July, the average length of stay was 10.2 days and had been as many as 12 days earlier this year.

The psychiatric hospital has had days during which it is treating as many patients as possible, with its staffing resources, including on its adolescent wing. Other resources, like Providence Sacred Heart Medical Center’s inpatient behavioral health unit, has sent the hospital patients when they run out of space, Hall said.

Thomas believes that Frontier and the region’s mental health resources will be at capacity this fall, although he noted Frontier will never really “cap out” on patients it can take. Instead, it might have to delay a patient’s intake.

Similarly, INHS will assess everyone who walks through its doors. Most local mental health providers will not turn away people seeking services, even if they are at capacity, although increased demand might make wait times longer or delay access to services.

“No state will be able to meet every need, so there will be a resource scarcity in terms of mental and resource availability,” Mauseth said. “But having said that, Washington is more well-equipped than other folks.”

Building up resilience

The glimmer of hope in the near future is that education and access to information can go a long way to building resilience and preventing crises down the road.

Mauseth said there is a lot of research that shows having accurate information and simply knowing that “Oh, hey. I’m normal!” or not alone can go a long way to increasing a person’s resiliency.

“Getting that information out there is a data-driven way to increase resilience in the population in general, and the other thing I would focus on is balance and structure around what they do know. So making structure for your kids to the extent that you can, keeping it simple and efforts focused on yourself and your family,” Mauseth said.

The state established a support line called Washington Listens for residents who need support to manage stress because of the COVID-19 pandemic. The line is anonymous, and listeners can connect callers to community resources as well.

The Washington Listens line has taken nearly 4,400 calls so far. Calls to the line have also led to at least 228 in-person visits at local tribal providers, some of which are participating in the program. About 75% of calls to the line last longer than 15 minutes, data from the Health Care Authority show.

The region’s mental health crisis line, which Frontier Behavioral Health operates, has not seen a big uptick in call volume recently. However, Thomas said Frontier has seen a 30% increase in referrals to its crisis services. While Thomas expects resources to be stretched this fall, he also hopes that community members prepare and support one another with information before a crisis occurs.

“There will be an increased imperative given to using alternative supports,” Thomas said, pointing to resources like the Washington Listens hotline.

“It’s good to encourage individuals to use other resources and supports: family, friends, faith-based agencies, community groups,” he added. “They can go a long way for individuals in need.”

The Washington Listens line is available Monday through Friday from 9 a.m. to 9 p.m. and on the weekends from 9 a.m. to 6 p.m. at (833) 681-0211. The Regional Mental Health crisis line is available 24 hours a day, seven days a week at (877) 266-1818.

The Washington Department of Health has released a behavioral health toolbox for families at

Arielle Dreher's reporting for The Spokesman-Review is funded in part by Report for America and by members of the Spokane community. This story can be republished by other organizations for free under a Creative Commons license. For more information on this, please contact our newspaper’s managing editor.

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