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Mainstreamed depictions of health care often imagine a world wherein people go about their day-to-day lives until they feel sick, at which point they call their doctor’s office and make an appointment for an exam. Somewhere typically in the mix is health insurance, a co-pay, and maybe a scheduled follow-up, or a prescription picked up at the local drug store.
If debates about the Affordable Care Act and proposed universal health care haven’t already made it clear, that idealized version of access isn’t the norm for many Americans, and according to community health care providers, especially not for those who belong to vulnerable population groups who struggle with mental health challenges.
While there are a multitude of factors at play, the burden of ensuring equitable access to mental health treatment has fallen in part on providers and advocates themselves, many of whom devote their careers to identifying who, exactly, needs care – and who isn’t getting it. But since mental health issues are notoriously invisible, operating out of plain sight, often misjudged or carefully hidden, those providers are faced with two difficult questions: How do you determine people in the community who would benefit from treatment, and how do you convince them receiving treatment is a good idea?
Open Sky Community Services, the Worcester-based nonprofit with a location in Northbridge, works to answer and disentangle those questions. Amy Arrell, director of peer, homeless, and drop-in services at Open Sky, said its outreach plan, which tackles these issues, functions in two main ways: establishing trust and maintaining a presence in the community.
“So whenever someone has a need and expresses it to anyone in the community, we like them to then think about us, because they’ve seen us, they’ve met us,” Arrell said.
Open Sky, in particular, helps connect and provide its clients with a number of service options, including its own outpatient group, which provides group therapy and psychiatry, as well as drug and alcohol counseling. The organization keeps licensed mental health clinicians on staff who can provide short-term crisis management and interventions, and provides recovery coaching, as well as a 24-hour crisis support line, said Arrell.
“We try to help someone immediately and provide the services they need so they don’t have to run to this person and that person,” Arrell said.
Clients working with Open Sky often face multiple barriers to receiving care, and affordability is only one piece of the puzzle. Clients are often low-income and belong to an array of other vulnerable population groups, including those who are recently incarcerated, homeless or suffering from substance use disorder. Among other things, the folks Open Sky works with may not have identification, transportation or know how a smartphone works – basic necessities for accessing mental health care independently in 2020. In that vein, one key step to the organization’s outreach plan involves making sure basic housing and safety needs are met first, before encouraging other types of treatment – with no strings attached to that assistance.
“We approach the situation with no expectations,” said Taylor LaCroix, division director of homeless, justice and addiction services. “A lot of folks that are engaged in our services have been told by the system for a while that they must engage with certain treatments to receive a certain outcome. And our approach is very different.”
That housing-first, trust-building template can mean something as basic as helping a client install a lock on a bathroom door, or changing a lightbulb – whatever a person needs in the moment. From there, conversations can unfold naturally, and clients can be connected with mental health care and other services as needs are identified as clients grow more comfortable with the idea of receiving care.
Spectrum Health Systems in Worcester is known for its relatively new care model: integrated addiction and mental health treatment. Lisa Blanchard, vice president of clinical services at Spectrum, said historically the two were treated separately, even though substance use disorder and mental health issues are co-occurring the vast majority of the time.
“Very large percentage of individuals with substance use disorder have a trauma history, and may carry a diagnosis of PTSD or other diagnoses related to their trauma history,” Blanchard said.
Blanchard said the two problems can become muddled and self-perpetuating. A person may use substances to help cope with their mental health issues, and sometimes the symptoms of a mental health issue may look very similar to symptoms of the withdrawal cycle. At Spectrum, she said, the issues almost always overlap.
“That’s what brings them in: Their need to stop that cycle of abuse and withdrawal, and that negative impact of their substance use,” Blanchard said. “Often that is the reason they may come in the door, and then as we meet with them, do clinical assessments, engage and connect with individuals, then we can help uncover underlying mental health conditions and how to enter treatment for that.”
While many of their clients seek out Spectrum’s help of their own volition, Blanchard said trust still often needs to be built. As is the case at Open Sky, that trust is built through engagement and contact.
While it’s become fairly normal to see depictions of therapy in television or movies, or off-handedly referenced on Twitter or TikTok, stigmas around mental health remain a significant barrier for many patients, particularly those outside of higher income brackets.
In that regard, organizations like Spectrum and Open Sky work to not only connect people with mental healthcare providers, but to break down preconceived notions about how clients can benefit from that type of care.
“It can feel more stigmatizing to access that care because they haven’t been in environments… where it’s accepted and normalized, especially if there’s cultural differences, which often will happen,” Blanchard said.
Arrell from Open Sky said accessing therapy can be a privilege of its own, using her own socioeconomic position as a reference point.
“We’re sort of privileged in a way because we can worry about getting the best therapist because we have a home and we have food, and when I’m going to my therapist or you’re going to your therapist, you’re not necessarily worried about someone coming in and taking away your children,” Arrell said, citing a fear clients might have.
Similarly, she said, someone like her doesn’t have to worry about being able to groom herself, or maintaining a certain immigration status, or even finding a therapist coming from the same demographics she does.
“It’s almost like a luxury that we can engage in it without fear,” Arrell said. “It’s not necessarily the same for the folks that we serve.”
Eliminating those fears and helping foster those relationships between clients and mental healthcare providers, she said, is at the crux of the work to connect those vulnerable populations with the mental health treatment they need.
“That’s why we need our staff out there making those connections,” she said, “ to make it safe to go to therapy.”
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