When Anjie Vickers’ then-17-year-old son started exhibiting signs of psychosis in early 2019, she knew he needed immediate help. As Vickers, a former critical care nurse and current president of the board of directors for the North Carolina chapter of the National Alliance on Mental Illness, began seeking assistance, she heard a familiar refrain: Her son would have to consent to treatment. Vickers knew he wouldn’t agree to it.
Vickers reached out to a fellow nurse who had children with mental health issues and was advised to go to the local magistrate’s office and obtain an involuntary commitment for her son. “Once you go to the magistrate’s office and fill that paperwork out, they send a sheriff’s car out, and the individual oftentimes goes in handcuffs to the emergency department, where they wait for help,” said Vickers, who also serves as president for the Cabarrus County, N.C., chapter of NAMI.
Vickers’ son spent nearly two months in the hospital. Although Vickers said the staff was helpful and pleasant, she could only visit her son once daily, and no one informed her about available community resources. The district attorney mentioned NAMI, a nonprofit organization that offers classes, groups and other means of support, right before her son was discharged.
“There are so many resources available, but what I’ve learned is that so many people don’t know about these resources,” Vickers said. “We could do a much better job of connecting people to the resources in our community.”
Filling gaps and meeting needs
The US is grappling with a mental health crisis, and its effects span generations and populations. Deaths of despair, or those caused by suicide or alcohol or drug use, rose to nearly 210,000 in 2021 across all ages, geographic groups and races. That total stood at 60,000 in 1999. Suicide itself is one of the top causes of death in the country, and rates are at their highest level since 1941. Deaths of despair disproportionately affect historically underrepresented populations.
Youths are being adversely affected, too. A recent report released by The Cigna Group found that the number of young people dealing with a mental health issue has risen nearly 30% since 2018, and the number of youths with at least two mental health issues jumped 48% in the same time period. Further, 1 in 4 parents said they have a child with a diagnosed or undiagnosed mental health issue. Although interventions such as telemental health and digital therapeutics have helped, barriers such as accessibility, which is also an issue in traditional mental health care, and network connectivity still pose challenges.
Community resources can help fill gaps with not only treatment but everyday needs that create roadblocks to caring for patients, said Erica Chetney, a therapist at Professional Counseling Services in Camillus, N.Y. “Community resources that provide things like transportation, medication management, legal services and vocational training are crucial to treating the whole person,” said Chetney, who added that patients are able to go deeper in therapy when they don’t have to worry about these stressors. “People heal more quickly when their basic needs are met.”
Chetney’s practice also hosts community support groups that focus on issues such as depression and grief. “This way, the person in treatment has support outside of the hour or two they spend working with their therapist,” Chetney said. “They are around people who can relate to their experience and have the same goal, and can call upon these people for support and socialization.”
NAMI bases its community outreach efforts on three pillars: advocacy, education and support. Initiatives range from handing out flyers at community events to directly interacting with the community and hosting support groups for peers and families. The Guilford County, N.C., chapter of NAMI holds a weekly peer-to-peer support group for people with a mental health concern and runs an eight-week education program that teaches attendees how to navigate the mental health care system – and how family members can help.
These support groups give family members “the skills to know how to support their loved one on a good day and on a bad day,” said Madonna Campbell-Greer, president of NAMI’s Guilford County chapter. “The thing I love to hear in our support groups is, ‘When I learned how to approach, support, talk to my loved one with a mental health concern, it completely changed the dynamic of our family relationship.’’’
The health plan perspective
Health plans also utilize community involvement and resources to enhance mental health care treatment. Getting involved with the community is a “mission-centric thing” at GuideWell-Florida Blue, said Dr. Nick Dewan, vice president of behavioral health for the health insurance provider. “We have a saying that there’s no health without mental health,” Dewan said. “Community involvement is smack dab in the middle of that mission.”
GuideWell-Florida Blue partners with professional sports teams, including the NBA’s Miami Heat and NHL’s Tampa Bay Lightning, to get its message out to younger people. The insurance provider goes deeper into communities through partnerships with school districts, churches and organizations like the Boys and Girls Clubs of America. GuideWell-Florida Blue also combs through ZIP code data to identify areas that need the most help with mental health resources and social determinants of health. SDOH factors often play a critical role in mental health. “We have a lot of what I would call ‘real people’ who want to do good for society,” Dewan said. “And our role is to connect those dots.”
Outreach to make the community aware of available resources is a constant – and critical – process. GuideWell-Florida Blue piloted a care program that puts “boots on the ground” to inform “key portions of the ecosystem,” Dewan said. Care teams check in regularly with local hospitals, emergency departments, housing shelters and group homes to assess needs and provide resources. “It’s not a one-and-done kind of thing,” Dewan said. “It’s a regular conversation. It’s constantly being connected to people.”
In addition to the pilot program, GuideWell-Florida Blue’s mental health collaborative taps people affected by mental health issues to help inform its strategies. “I think it’s so important to stay in touch with those who have actually gone through it,” Dewan said.
Cigna Healthcare sees community organizations and the resources they provide as “an essential part” of how they support their plan members, said Jason Youngblood, senior director of behavioral health strategy for the health insurance provider. “Some 80% of health outcomes – including mental wellness – are dependent on factors that happen outside the doctor’s office,” Youngblood said. “Community organizations are often able to aid our [members] in addressing these [SDOH] needs, and can improve their health both physically and mentally.”
Cigna partners with accountable care organizations through its Collaborative Care Arrangements to accomplish population health goals, particularly those related to mental and physical health, affordability and patient experience. Providers are rewarded based on outcomes rather than the number of services they provide. Cigna works with various providers across the care delivery system to coordinate care, assess risks and connect them with community mental health and other resources.
The insurance provider also partners with community groups and provides grants to boost mental health screenings and care access. The Cigna Group Foundation, Cigna’s philanthropic arm, recently announced a three-year, $9 million grant program to fund youth mental health initiatives related to distress and post-pandemic stress. One of the first recipients is the Boys & Girls Clubs, which will use the funds to train staff to recognize signs and symptoms of distress in youths and better inform the organization about trauma.
Breaking down stigmas, silos
The lingering stigmas around mental health can create barriers to care. Community resources help raise awareness and reduce stigmas, Vickers said. And, it can have a cascading effect. “I think advocacy can start at your local levels, and then state levels, and then national levels,” Vickers said.
Being honest about mental health also makes a big difference. “The more that we can start having conversations about it and educating – and being educated – about mental illness will definitely reduce the stigma,” Vickers said.
Communication and advocacy can also break down silos in mental health care. “Historically, we have just been in our own little silos, and we’ve created these different apparatuses – very well intended, very well run with the best possible results – but because they’re not interconnected, it’s not working,” Dewan said.
Campbell-Greer agreed that breaking down silos will help further incorporate community resources into mental health care treatment plans. “We have so many silos, and so people don’t talk to people and things get lost in the shuffle.”
For Chetney, it comes down to more robust financial support. “The community resources that care about quality patient care and relationships are poorly funded and just scraping by.”
Ultimately, improving mental health care – and leveraging community resources to help achieve that goal – comes down to empathy and understanding, Campbell-Greer said.
“We always meet people where they’re at, we accept them where they’re at, and they know that from the way we approach them, we’re not coming in there to tell anyone what they need to do or how they need to do it,” Campbell-Greer said. “We’re coming in there to say, ‘We’re here. Let us know what you need. And then we’ll meet you where you’re at and get you the resources that you need.’”
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