Evan Roberson, the executive director of Tri-County Behavioral Healthcare, spoke with Community Impact Newspaper about the ongoing coronavirus outbreak and how it is affecting mental health services in the Montgomery County area. This interview has been edited for length and clarity.

How has the ongoing pandemic affected your organization?

A lot of our mental health clients are at home, and they're not getting out yet. I think that we would anticipate that we're going to see a pretty good surge of mental health calls at some point in the not-too-distant future.

And that surge is really not yet common. People are still kind of not sure about getting out and not sure about what to do. And so they're kind of staying out. Now, that’s a risk factor as well though because we know isolation is a big risk factor for depression.

And also, we know that all this, the one thing we have seen is a little tick up in substance use, abuse. Folks who are having tried to recover, they may be using more to cope with the current stress and anxiety.

One of the things that has been brought up several times by Montgomery County residents has been this concept that business closures and shutting down local businesses has a detrimental effect on those business owners’ mental health and could lead to suicide or other mental issues. Has Tri-County heard from people whose mental health has been negatively impacted by the business closures specifically?

Not business closures per se but the loss of jobs; we've had some contact with some folks who've lost their job. And we know that's going on a lot more. You know, we're the public mental health system, so sometimes folks who have resources, who have insurance, don't use as the first line of contact but we are starting to see that trickle in of folks who have life disruption at some pretty significant level and consequently have become depressed and or suicidal because of that you know somebody lost their jobs.

Historically in a downturn like this, looking back to the last financial downturn in 2008, the suicide rates went up across the United States because there were a lot of folks who got displaced financially and otherwise, where they couldn’t support themselves like they were used to and got depressed. So, logically it would tie that people who are not able to open their businesses, that are not able to do what they need to do, are becoming more despondent.

How many people have you served compared to this time last year?

We're up a little bit. It's been pretty slow though during this crisis. But annually we've been going up substantially here for 10 years. The numbers have been increasing here at Tri-County year over year 20% or so.

So, for example, in crisis admissions—so those are people that we take to a psychiatric hospital—we’re up 22% over last year, 15% of that 15% in adults, and we're up to 44% of kids over last year. That's through to the end of April.

But during this pandemic, you have seen a slowdown?

Crisis services are kind of a firehouse model. So there's days that are really really busy. And then days that are really slow. And that's what we've experienced in this crisis we haven't had just, you know, constant flow of crisis folks coming in our doors,

Typically, this time of year, we started getting really busy. Summer is always busy for us. And so, when the weather hits about 90 degrees, we usually on a consistent basis, our numbers start to jump substantially from there on to the end of the summer. We haven't seen that come yet.

I don't see any direct correlation with COVID yet. We may see that; we probably will see it, but we haven’t seen anything yet here.

What are been some of the challenges that Tri-County has faced during this outbreak?

We’ve continued to operate through all this; we haven't shut down at all. The biggest challenge we have had in crisis services particularly is that most the people that come in the front door crisis are not people we know, and making sure that those folks are healthy and not going to expose our staff to the coronavirus is a big concern for us.

So we’ve implemented temperature checks and screenings, and that kind of thing. I think that's been our biggest challenge over there is trying to keep staff available to see folks and keep their risk level under control.

We have been able now to get most of the PPE [personal protective equipment] that we need in some supply all of this thing Most of our staff wear cloth masks and we have other PPE available as necessary. In the outpatient services, it's been trying to make sure our folks stay stable. And for the most part, our folks do stay stable in outpatient services. Once they're admitted and fully seeing us here with the caseworker and a doctor and all that, to keep all those folks stable and functioning. A lot of those people are not comfortable coming into the office.

And so we're doing a lot of things telephonically and via video that we normally have to do face to face, but we've had some permissions from the state to to do some things differently. So, any time you change up the whole system on the fly you know it's kind of a complex process we serve.

Are there any specific projects or services that Tri-County as an organization has been working on to continue to serve or to serve in new ways during this pandemic?

We have a crisis counseling grant from the state that is going to start here any day. And that will allow us to hire staff who will be doing phone and video outreach to the general public. It’s not for people who are in the mental health system; we’ll be doing general outreach to the public.

Normally, that looks like door-to-door visitation, but during this crisis obviously that won't work. So we'll be doing video and phone outreach to the community at large, just to check on people, to see how they're functioning during all this. Our goal in that is to give people tips about a function if they need it, but it's also to look for people who are not doing well and try to connect them to the system or through a provider than it is to somebody to serve them.

So we've run these grants after hurricanes and other disasters, but this is the first time we’ve tried to run one like this. We've already got some staff that are making ready to transition into that program. And then eventually we'll be running for 16 counties from Tri-County. Typically it is a three-county area, but we'll pick it up a couple other areas as well.

Everybody has lost something in this, and you know we'll talk about that a lot here because I work with a lot of therapists, but nobody's life is the same as it was March 1. And even if that loss is fairly small and something like loss of routine, it's still a real loss, and anxiety is a real thing that folks are dealing with. They're struggling with the loss. They may not even recognize that they're struggling with this loss; they may not recognize it that's why they're getting irritable or frustrated or having a hard time staying focused.

How has this outbreak affected low-income or uninsured people in Tri-County’s service area?

Texas has one of the lowest insured rates in the United States. Approaching 30% of folks do not have insurance, and our focus population is the low-income, Medicaid uninsured population and that's what we deal with every day. And so we see those folks, they have so many needs and so little resources to meet those needs a lot of them have kind of basic needs—food, shelter, transportation, medication, things that are fairly basic—and they struggle so mightily at a time like this.

Of course, any time there's an insurance disparity, there's an access disparity. Here at Tri-County, we try to make sure that that access is available for most folks with mental health problems, but our ability is to address medical issues and some of these other social determinants of health are limited, so I would say that always disproportionately impacting folks who are on the lower end of the economic spectrum, which unfortunately often includes folks of different ethnicities, differently. People are having a hard time managing basic needs in life right now on the low end of the spectrum.