The good news is the issue of mental health in the United States is no longer relegated to the shadows. The bad news is the encroaching light of day has illuminated a problem far greater than anyone could have imagined, much less been prepared to address. As a result, government agencies, mental health professionals and private treatment centers alike are struggling under a tidal wave of demand that smashes against the levees of available services and capacity.

 

“I’m speaking generally about what we’re seeing here,” said Megan Miller, CEO of the BridgeWay in North Little Rock. “I would say that what we’re noticing is people are still having a large amount of mental health concerns and that people are often more ill when they come to the hospital than they’ve been in years past. It seems to us over the pandemic, people waited much, much longer before coming in for help and I think that is still true in 2023.”

mental health

Megan Miller

Across America, the story is largely the same. According to the National Alliance on Mental Illness, one in five adults experiences mental illness annually, or 23 percent of the country’s adult population, 58 million people in 2021. NAMI also noted one in 20 adults experience serious mental illness each year, which works out to nearly 6 percent of U.S. adults, or more than 14 million individuals.

 

As staggeringly high as the incidence of mental illness is, treatment is lagging well behind, with less than 48 percent of adults with mental illness receiving treatment in 2021 and only about 65 percent of adults with serious mental illness getting treatment.

 

Young patients did not fare much better; despite 7.7 million people between the ages of 6 and 17 who reported having a mental health disorder in 2016, only about half received treatment.

 

Arkansas’ report card on treatment of individuals with mental illness laid out by Mental Health America is mixed. Overall, the organization ranked the Natural State 32nd, taking into consideration factors such as incidence rate of illness and substance use disorder, suicidal iterations, as well as access to and cost of treatment.

 

While Arkansas was ranked in the top 20 as far as least prevalence of mental illness overall, the state did not fare as well on measurements of how well it took care of the cases it did have. The state’s adult cases score, a composite of the number of adults with mental illness and/or substance use disorder who reported thoughts of suicide and did not receive treatment for reasons of cost, lack of insurance or other unmet need, ranked Arkansas 32nd nationally. Concerning youth patients, the state was 44th, based on a composite score of essentially the same criteria.

 

Most concerning of all, Arkansas ranked 45th nationally in its performance serving those patients’ needs, regardless of age, based on multiple factors. These included adults and youth who did not receive any treatment, adults who experienced 14 or more mentally unhealthy days per month but could not afford care, youth whose private insurance did not cover mental or emotional problems, and mental health workforce availability.

 

Paula Stone, director of the Arkansas Department of Human Services Office of Substance Abuse and Mental Health, said a relatively poor state like Arkansas relies heavily on public funds to help people get the help they need.

Paula Stone

“The bulk of what we do is Medicaid-funded,” she said. “The latest statistics I have were that of all the people who received behavioral health services in Arkansas, 70 percent of those are paid by Medicaid. They are the largest funder and driver of services.

 

“[The state] pays for mental health services and substance use disorder services in a couple of ways. We have federal funding that comes in, state funding that comes in, and with that funding, we do a couple of different things. One, we either pilot programs with some of those funding sources, or we use that funding for people who are not insured in any way or are underinsured. We use it to fill gaps.”

 

Stone said while the funding arrangement is not new, the agency is not content to bow to the status quo. In November, she and other DHS leadership appeared before state appeared before state legislators to walk them through extensive changes that will expand care for thousands of individuals.

 

The new regulations overhaul the state’s Provider-led Arkansas Shared Savings Entity, launched in 2017, which provides government-funded health care to more than 55,000 Arkansans requiring specialized health care. The changes are the result of the work of a 2021 task force convened to study issues surrounding mental health care in Arkansas.

 

“As the payor of services, one of our roles is to make sure services get out there,” Stone said. “We know there’s big challenges out there with the master’s level counselor workforce. Those counselors have moved largely into private practice. There’s a lot of online services being offered, which can be very helpful, and we have changed our regulations to allow a lot of the services to be provided via telehealth platforms.

 

“Another thing we’ve done to address access is working on integration with primary care. There are a couple of really interesting programs where people can identify their needs in a primary care clinic and then also get some services through that clinic, accessing help at the place where you intercept instead of having to call another place.”

 

Recognizing the intense personnel pressure many private mental health providers are under, Stone said DHS is also tweaking regulations that help broaden the scope of available expertise and equip health care outlets to be part of the solution.

 

“We’ve changed some programs allowing primary care physicians to employ master’s-level counselors to submit billing for them and have them be part of the team,” she said. “We’ve also written a grant in working with the University of Arkansas for Medical Sciences in Little Rock on behavioral health integration. It’s about a $9 million grant over the next five years, about $1.8 million a year. That is really working on a model called the collaborative care model where primary care physicians can share a psychiatrist across many different clinics, which is a really great use of psychiatry.

 

“What they can do is while they’re screening for behavioral health needs or conditions, they can have a care coordinator that staffs those clients with a psychiatrist. The psychiatrist can either provide support for a primary care physician to prescribe medication, provide support for a counselor who’s working in that office, or they can say this person really needs more intensive services than we have currently available in our primary care clinic. A lot of those integrations are very helpful.”

 

Stone said the changes identified thus far are only the beginning. The next step lies in maximizing existing resources, strengthening relationships with various entities that connect with the public and strengthening protocols of what to do when coming into contact with a person in need of mental health services.

 

“We have crisis stabilization units across the state that are not being filled,” she said, “so we’re expanding what they are doing. Sometimes people just need to come and talk to somebody, maybe need an assessment, but they don’t want to get admitted and spend the night. We’re looking at running some pilots with them of how many people would just come and either sit in a recliner and be assessed, settle down, get some medication, whatever it is that they need, and then move on.

 

“I know a number of our police departments, including the Little Rock Police Department, have an embedded counselor. Fayetteville is doing some really great stuff in conjunction with the university where they have co-responders who are responding with the police. I think North Little Rock is looking into that. Lots of really great things are coming on how we send people out there who know how to address these situations, and by doing a lot of training with law enforcement, allowing them to help recognize when they’re dealing with someone who has a mental health condition.”

 

Private mental health care providers are also stepping up to reach more people and address more issues within the state. In October, the BridgeWay celebrated the grand opening of its Women’s Center for Health and Wellness. Miller said the facility offers a unique option that focuses on challenges typically faced by women seeking treatment.

 

“What drove it was, during [the COVID-19 pandemic] especially, we were seeking feedback from our consumers, and we heard from quite a few who are women who said they would have had a different experience if they had been on a specific unit only with other women,” she said. “They would come into the hospital needing care, and being isolated or separated from their children was very difficult. They needed some different accommodations to be able to have those connections.

 

“They also felt that they got some unique support from other women on the unit and that could be enhanced in that [same-sex] type of environment. There is some truth in that; when you look at the research, women experience mental health treatment differently than men, so [the new center] is a way that we may be able to really accelerate how women get their mental health treatments.”

 

The new inpatient treatment facility was created within the BridgeWay’s existing acute psychiatric space. It offers 13 beds, which Miller anticipates expanding to 20 in the new year. Individualized treatment plans, which can include assessment, stabilization and focused treatment interventions that utilize a trauma-informed approach, are expected to become more effective thanks to the women-only setting.

 

“I don’t know that I could exclusively say [a single-sex environment] works for everybody, but I do think there is a large number of women who get a benefit out of being in an area where they feel confident and comfortable opening up,” she said. “In speaking about trauma, 51 percent of women report at least one traumatic event in their lifetime, and in many cases, that traumatic event may have had some transference with a male.

 

“Being able to talk about that or other sensitive women-only subjects in a group setting, those could be offered in that unit and may be helpful to them by limiting some of those triggers. It will allow us to have a level of privacy to open up about different issues that a patient may not feel comfortable doing in a mixed group.”

 

Miller said the Women’s Center is also home to a variety of treatment approaches, including art, music, aromatherapy, yoga and nutritional education.

 

“Most of [these services] are provided in a group-based format with a specialist in that area coming in to provide that care,” she said. “We have yoga instructors, for instance, who come in to do some of those classes for us. We have a dietician, and she meets individually with all those ladies in that program but also may choose to do some group-based work if she sees some trends that would be helpful to pull that all together for us.”

 

The nutrition component is particularly innovative, Miller said, and one not many people think of when picturing mental health treatment.

 

“There’s an enormous link between what you put into your body and how it makes you feel,” she said. “We do a larger education about different foods that might help us energize ourselves and that would reduce a lot of other symptoms from depression and anxiety.

 

“A depressed person generally isn’t taking very good care of their body. They often are isolating. They may have an increased appetite or a decrease in appetite. They may be picking poor foods or not eating foods at all. They also may be dehydrated during that time. We’re talking to them, especially within their age grouping, about what foods they need to have the energy to get out of bed so they can do the things that are ultimately going to make them feel better.”

 

Miller said such creative thought is going to be essential in dealing with the surge of demand the BridgeWay and entities like it are experiencing. She said the need for services is likely to increase as people continue to get more comfortable with seeking treatment.

 

“If there was a silver lining to COVID, I would say that some of it is we had a reduction in a lot of the stigma [surrounding mental health],” she said. “With sports stars and entertainers and others in the media being more open about talking about their mental health concerns, it did help people to feel more confident in coming into care. We’re still seeing a little bit of those residual effects.

 

“It’s not over, however. Stigma still exists. It’s here, and many people are still reluctant to talk about it. We sometimes have people who come in, talk with us about the services and not come back until days later. It’s still hard to make that decision to take the time to really care for yourself.”

 

One area of treatment that has been particularly challenging concerns substance abuse disorder. KFF, an independent provider of health policy research and polling, reported in March that excessive drinking and drug use accelerated during the pandemic, causing lethal consequences. During COVID-19, drug overdoses spiked by 50 percent in the U.S., and in 2021, more than 106,000 died due to overdose, the highest total on record.

 

Alcohol-induced deaths were also up substantially, increasing 3 percent during the pandemic, a rate that was even higher among certain demographic groups. African Americans, for example, saw a 45 percent jump, and those in the American Indian Alaskan Native category reported death rates six times that of the next highest group. Rural areas’ death rates due to alcohol grew at a substantially higher rate than metropolitan dwellers, 46 percent compared to 36 percent.

 

Justin Buck, director of the Wolfe Street Foundation in Little Rock, said Arkansas’ resources for people trying to get help vary widely by region of the state, not to mention the thorny issues surrounding reimbursement. These and other serious roadblocks often prevent people from getting the assistance they need.

Justin Buck

“It’s certainly better, especially in central Arkansas and northwest Arkansas, where there are actually quite a lot of treatment resources for people who are seeking help with substance use disorders,” he said. “The family support side is also getting better; we have some family members who have launched nonprofits and who have launched advocacy movements to help parents find a place. A lot of those resources are for family members who have lost loved ones. I think we still have some way to go for resources for family members who have a loved one actively using substances.

 

“I think those two factors, [family support and availability of care], come together when it comes to access. When we’re ready to reach out for help, do we have access to those resources? On the one hand, I mentioned that in central and northwest Arkansas and some other places around the state, there are good treatment resources available, but the access is still constricted based on what kind of insurance that you have. To me, it’s very convicting and shameful that the first question you have to ask someone who’s seeking treatment is, ‘What kind of insurance do you have?’ because that really will determine where you can go.”

 

Buck, who assumed his role in 2021, knows the pain a family suffers under addiction from personal experience. He lost a sister to a drug overdose, and his brother came close to either death or prison before entering recovery. He said a Wolfe Street Foundation program called peer recovery support specialists harnesses the life experience of people like his brother and equips them to reach others dealing with the same issues.

 

“When a family member or a person who’s seeking help for themselves calls or walks in the door, they can sit down and meet with a peer recovery support specialist who has shared that lived experience, who’s been through addiction and recovery,” he said. “That peer specialist can help share what worked for them, and they can help people get into treatment the same day if they’re ready to get help. They also follow up during the treatment process, and after they complete treatment. They connect people to the resources they need to continue a recovery journey.

 

“That’s been very important to have someone to help families and people who are experiencing substance use disorder to navigate what can be a really confusing, intimidating system to work through by themselves.”

 

Another hurdle many face is finding quality sober-living environments, which has led Wolfe Street Foundation to redouble its efforts. The organization launched a recovery housing program last fall and is up to 32 beds.

 

“The reason we did that —  and we launched very urgently and we grew very quickly —  is because it’s not necessarily that there are not enough places out here; many are just not any good,” he said. “I mean, there are no standards. There are very few regulations. It’s almost as easy as putting an ad in the classifieds that says, ‘Room for rent.’ That’s almost exactly what the barrier to entry is like. There are very few things to stop unethical operators from taking advantage of people in early recovery.

 

“We launched as quickly as possible, and we used a national standard to inform our program. We’re working now with some other ethical providers and the state to get certified on that national standard.”

 

Buck echoed Miller’s assessment that shame is still one of the most persistent retardants to recovery for people dealing with substance abuse issues. He said the more community organizations and groups that get involved in the effort, the more options can be afforded to those who need them.

 

“Our motto is, ‘We recover together,’ and we really do,” he said. “We find that isolation is deadly. That means connection is vital. What we’re hoping to continue building is a recovery-oriented system of care, where ethical, mission-minded organizations — faith-based, nonprofit, government agencies — all come together, sit down at the same table and work out solutions in the best interests of people who are seeking help.”

 

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