Facing a mental health crisis head on

Advocates create new programs, services to address gaps for those in need

By Sara Foss

Earlier this year, the Mental Health Association in Essex County ramped up its “sunshine call” program. 

These calls, made by trained staff, go out to people struggling with depression and anxiety. Some might receive a call daily, others weekly. 

“We’ve found that these calls are pretty beneficial,” said Doug Meyer, the association’s director of services. “We work with a lot of people who are very socially isolated. They stay in their apartments, and they’re depressed. If someone from an agency calls and asks how they’re doing, it’s a big deal. It’s a nice part of the day.” 

The isolation and stress of the pandemic, combined with spiking cost-of-living and other pressures, has fueled an alarming rise in mental health issues in the Adirondacks, and providers are working hard to meet the surge in demand. 

They’ve boosted programs for people in need, opened new facilities and launched new initiatives to better connect struggling individuals to resources such as counseling and stable housing. 

Some projects are simple, like MHA’s push to increase sunshine calls, while others are much bigger undertakings, like the organization’s new crisis residence in Ticonderoga. 

Initiatives to make North Country residents healthier and happier are also underway, with Essex and Clinton counties embarking on long-term efforts to build more resilient communities, where people are better positioned to rebound from trauma and overcome adversity. 

“We were all frustrated with the reactive system that’s in place,” said Terri Morse, director of Essex County Mental Health Services. “We want people to have more tools in their toolkit for when the inevitable difficult situation occurs.” 

‘A public mental health crisis’

Still, providers acknowledge the current climate forces them to react to one calamity after another. 

“We cannot keep up with the demand, even though we continue to grow,” said James Button, president and chief executive officer at Citizen Advocates, a Malone-based health and human services organization that provides mental health and addiction recovery services in Franklin, Clinton, Essex, Hamilton and St. Lawrence counties. “We’re continuing to be asked to do more.”

Citizen Advocates runs two crisis phone lines, one serving the Adirondacks and the other the Ogdensburg/Seaway Valley region. Between 2020 and 2021, the number of crisis calls jumped 45%, with 1,100 calls in 2021.

The organization was also inundated with calls from people looking to schedule a first-time appointment, with almost 4,000 new intakes between March 2021 and March 2022, a 50% increase from 2019-2020. 

“We are in a public mental health crisis,” said Amanda Bulris-Allen, executive director of the National Alliance on Mental Illness of Champlain Valley, which provides peer support and educational classes to people with mental health issues. 

Bulris-Allen said she recently spent three days with a client because the hospital refused to admit the person, who wasn’t well enough to return home on their own. “I brought them to primary care, to psychiatry, I was hand-holding them from one system to the next,” she said. 

“We’re really challenged by the very specific definition of imminent danger to self or others for hospital admission,” she continued. “It’s too restrictive. It’s very hard to get somebody that’s very sick into the hospital if you feel like they need a hospital-based setting.” 

As a peer advocate at NAMI Champlain Valley, Carrie Levasseur has seen firsthand how hard it can be to get care when needed, and she draws upon her experiences to help clients. She recalled escorting her husband to the hospital when he was in crisis, being separated from him and not realizing he never checked in. 

“He was treated poorly, ripped off his arm band and left,” she said. 

The nature of NAMI Champlain Valley’s work changed during the pandemic, Bulris-Allen said. 

“Previously we could work with people when they were doing really well and provide ongoing support,” she said. “Now we’re picking up crises day after day. There’s not a lot of opportunity for prevention anymore.”

A provider shortage

The mental health provider shortage is nationwide, but the problem is most acute in rural areas, where agencies often struggle to recruit staff and typically serve large, remote swathes of territory. 

In New York, there are 310 people for every mental health provider, but these providers —a designation that includes psychiatrists, psychologists, licensed clinical social workers and counselors—are not evenly distributed. 

In Essex County, there is just one mental health provider per 600 residents, according to the University of Wisconsin Population Health Institute’s 2022 county health rankings. Other Adirondack counties are even less served: Washington County has one provider per 670 residents; Hamilton County, one per 1,450 residents. Essex, Hamilton and Franklin counties are all federally designated mental health professional shortage areas.

There are different avenues for connecting with mental health services in the Adirondacks. 

Those in crisis can call a hotline—the new, nationwide 988 Suicide & Crisis Lifeline, modeled after the 911 system, launched in July — or go to the emergency room. In some communities, they can seek help at a round-the-clock behavioral urgent care facility run by Citizen Advocates. 

However, people in severe distress often require direct intervention—someone to drive them to the hospital or contact law enforcement if they are at risk of harming themselves or others. 

“It’s rare for someone to call our agency and say they’ll sign up for services,” Meyer said. “Most of the people we see are referrals, from therapists, ERs or police.”

The rise of telehealth has eased some of the strain on providers, enabling people to connect with therapists from a distance. Some patients have even come to prefer it. Getting to in-person appointments has always been difficult for those without cars or reliable transportation, and telehealth has removed a longstanding barrier to care. 

With remote therapy, “I don’t have to cancel people because the roads are bad,” said Valerie Ainsworth, executive director at MHA in Essex County. “If somebody has health issues, it can be a real hardship to get themselves dressed and bundled up and the car started and drive half an hour to go to an appointment. For some people, telehealth can be a real lifesaver.” 

But it’s not a panacea. 

Children and adults with severe mental health issues, such as schizophrenia and bipolar disorder, don’t usually respond well to therapeutic services delivered via computer. Many Adirondack residents still lack broadband internet at their homes. For others, it’s just a bad fit. 

“Some people absolutely hate it,” Ainsworth said.

Expanded services

Some Adirondack organizations have expanded the options for emergency in-person mental health treatment beyond the ER. 

The Department of Veterans Affairs recently announced a grant of $750,000 for Homeward Bound Adirondacks to support suicide prevention services for veterans and their families in Franklin, Clinton, Essex and St. Lawrence counties. The funds support mobile crisis intervention, outreach, case management, workshops and retreats focusing on improving mental health. HBA is developing a retreat center for which there is a separate capital campaign underway.

Citizen Advocates has built several new, 24/7 facilities where those experiencing a mental health or substance abuse crisis can get immediate assistance. 

Modeled after urgent care centers, these clinics take walk-in patients, eliminating some of the hurdles, such as appointment requirements, that make getting treatment a challenge for people in extreme distress. Stays are limited to 23.5 hours, and staff connect patients to services such as therapy, addiction treatment and housing assistance. 

“When someone’s in crisis, you can’t just give them an appointment in six weeks,” Button said. “Behavioral urgent care clinics have an open access model. People can come in and see us.” 

This low-barrier approach has brought people out of the woodwork, he said. 

“We are seeing people from all across upstate New York because there’s nothing like it in their communities,” Button said. 

Citizen Advocates began accepting walk-in patients in 2013 and opened its first 24/7 behavioral urgent care facility in Malone in 2017. A second behavioral urgent care facility opened last April in Ogdensburg, and a third is expected to open in Watertown in 2023. 

This fall the Mental Health Association in Essex County opened a three-bed residence in Ticonderoga with the goal of giving people in crisis a safe place to calm down and stabilize. Stays can last up to 28 days. 

“This is intended to divert people from the ER so they don’t end up in the hospital,” Meyer said. “Some people do need to be in the hospital, but if you’re a paranoid person, the ER is a scary place. … A lot of people need a medicine adjustment, or they need to be out of the stressful environment that they’re in.” 

Keeping people from slipping through the cracks is a priority for Meyer. 

He worked closely with Morse and local law enforcement to create an online form that state troopers and other first responders can use to refer people to MHA or Essex County Mental Health Services. The agencies follow up with those identified by law enforcement, first through the mail, then by phone and then with a knock on the door.

This system, called the Law Enforcement Mental Health Referral System, has steadily grown, becoming a model for other Adirondack communities. In 2019, its second year in operation, LEMHRS received 55 referrals: in 2021, 201—a 265% increase. About one-third of the people referred to Essex County or MHA sign up for mental health services. 

“Before LEMHRS, these people would go to the hospital and get treatment and the county mental health system would never know about them,” Meyer said. “Now they’re on our radar.” 

Sometimes even law enforcement professionals need help for mental illness. 

The June suicide of Capt. Christopher Kostoss, a well-liked forest ranger, prompted state Department of Environmental Conservation Commissioner Basil Seggos to highlight the resources available to those who are struggling, such as the crisis prevention numbers listed on the New York State Office of Mental Health website. 

In a statement, Seggos noted that Kostoss, 49, was a tireless advocate for mental health awareness, particularly among his fellow rangers. 

“His death is a painful reminder of the critical need to promote wellness and destigmatize issues surrounding mental health that prevent individuals from seeking treatment,” Seggos said. 

Breaking the cycles

Some providers, frustrated by the high number of residents in dire mental health straits, believe an even bigger culture shift is necessary. They’re looking to strengthen the social fabric and empower people, with an eye toward preventing crises borne of addiction and family dysfunction. 

In mid-August, Essex County staff, elected officials and service providers gathered at Boquet Valley Central School in Elizabethtown for a day-long conference to educate people about the work of the BRIEF (Building Resilience in Essex Families) coalition, which brings stakeholders together to improve mental health outcomes. 

Attendees received a copy of “The Resiliency Workbook,” which teaches that people are born resilient and thus capable of bouncing back from adversity with the help of friends, loved ones and other caring individuals. 

“This is a way that a community takes care of its own,” said Morse, who spearheaded BRIEF. “It’s not just providers taking care of people —it’s providers and the community, working together.” 

All too often, providers are in short supply. 

There are no psychiatrists in Essex County, which means other types of providers are often tasked with prescribing medication. “We have three psychiatric nurse practitioners and they provide wonderful service,” Morse said. “What we need is more counselors. We need more community-based support resources.” 

At the BRIEF conference, people shared personal stories of overcoming hardship and navigating their own struggles.

Angie Allen, deputy commissioner at Essex County Department of Social Services, described the support she received from her parents when she told them she was pregnant as a teenager. 

“What got me on track to the point where I could help others?” she said. “I couldn’t have done it without my family, without my community, without people like you sitting around this table.” 

Clinton County has also formed a resilience-centered coalition to improve mental health outcomes. Called HEARTT (Healing, Empowerment, Advocacy, Resilience and Trauma Transformation), its focus is at-risk youth. 

Under a new program, children with multiple mental health diagnoses, a history of suicidality and previous admissions to mental health units or emergency rooms will be eligible for a HEARTT referral.

These referrals will be reviewed by a council composed of representatives from agencies such as NAMI Champlain Valley and the Clinton County Department of Social Services. If approved, a team will meet with the child and their family and develop an intensive treatment plan. 

“We have kids going in and out of the ER with repeated crisis issues,” said Richelle Gregory, director of community services for Clinton County. “We want to look at those kids. … The resources to assist them are limited.” 

HEARTT’s collaborative, team-based approach is a good fit for a county hard-hit by a provider shortage and spiking mental health complaints, Gregory said. 

“The only way to get through this is together,” she said.

Call for help:

• If life-threatening, 911. If in crisis, 988 
• Essex County-based HOPELINE, 1-800-440-8074
• Franklin County’s Citizen Advocates, 518-483-3261
• Hamilton County’s crisis line, 1-800-533-8443
• Washington/Warren counties “warmline,” 518-502-1172 
• Clinton County crisis hotline, 1-866-577-3836
• New York anonymous text line, Got5 to 741741