High demand, limited supply

Mental health resources in Tompkins County are at capacity, barriers to care remain

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In honor of May being Mental Health Awareness Month, this week’s Tompkins Weekly is dedicated to covering mental health issues in Tompkins County. Our cover story this week explores the barriers to care that still exist for members of our community, and the service providers that are trying their best to bring Tompkins County residents the help they need.

The increase in awareness for mental health and mental illness is, most people would agree, a good thing. But it doesn’t come without challenges. Demand for mental health resources locally is extremely high but supply for those resources is limited. Local organizations are doing their best, but barriers persist that keep people from accessing the services they need, and resources for kids and teens are even more limited.


“While there is a lot of great help out there, it’s not unusual for people of any age to wait until crisis happens before seeking help,” said Melanie Little, Director of Youth Services with the Mental Health Association of Tompkins County (MHATC). “We frequently run into families that are in crisis and now are seeking more help, and now are seeking more support, and they’re told ‘Well, you have to wait.’”


Here in Tompkins County, there are two mental health clinics that have specially trained therapists to work with children: Family and Children’s Services, and Tompkins County Mental Health. Both take Medicaid, but both have long waitlists for people looking for individual counseling.


Family and Children’s Service (F&CS) of Ithaca, a private nonprofit mental health agency in Ithaca, has about 35 therapists and around half of them take teenage clients. One of the barriers to access for teens looking for help at F&CS is timing. Diana Levy, Associate Clinic Director at F&CS, said that parents often want to schedule appointments after school, filling up the organization’s 5 to 7 p.m. clinic hours quickly.


To try and expand its reach beyond Ithaca, F&CS also operates limited clinic hours in Dryden and Groton. For residents of the more rural parts of the county, Levy said transportation can become a barrier to receiving care.
“There is a very high demand in the community in general right now, and I think that everyone, all the therapists that are in the community, are trying to serve the population,” Levy said.


Both the Mental Health Association and F&CS agreed that the area could use more trained therapists, especially therapists that are trained to work with kids and teens. But hiring people with those skills isn’t easy. Despite being a college town, there is no school in the county that trains people to be child therapists.


“It is not easy to find a therapist,” said David Bulkley, Director of Adult Services at the MHATC. “It can take a person – even if you can get an appointment – it might take a couple of therapists until you connect with one that actually might help you. Because we’re all unique and one persons’ therapist isn’t necessarily another ones’.”


Consistency and structure is a key aspect of mental health services, and if someone can’t find a therapist that they can create a rapport with, the search can be enough to get someone to quit. The high turnover rate within direct care services doesn’t help either. Workers in the mental health care industry, like many social service areas, often work long hours for not very competitive wages. When therapists leave because they can’t pay their bills, their patients have to start the entire process over again.


Locally, the problem of accessing mental health services is closely tied to another public issue that gets a lot more press: housing. The lack of safe, consistent housing makes getting mental health care and sticking to it difficult.


“Not having a place of residence is very destabilizing,” Bulkley said. “Then you have the combination of the mental health problem which then has generated a substance use issues, which can then go to contribute to a more elaborate or difficult mental health issue. This is a reality. Housing is a very dramatic need for people.”


Accessing care, and maintaining care, are constant hoops that residents in need of care must jump through. Getting the appointment, getting to the appointment, connecting with the therapist, paying for the appointment, keep paying for the appointments and attending consistently. It’s a delicate cycle that could be broken easily with a missed bus, loss of insurance, loss of stable housing, or dozens of other reasons.


“Even when people are ready for treatment and ready to get stabilized and ready to get housing, you have to wait however long, you have to have $1,500, at least, to be ready to sign a lease,” Little said.


Some demographics, like teens, need specialized care. Beyond age, there are more demographics who could benefit from any specialized care at all. LGBTQ teens locally are one such group. Outside of the peer support group at Planned Parenthood of the Southern Finger Lakes (PPSFL), there are no well-publicized and public groups for LGBTQ youth in the county to come together, connect, and share their experiences.


Each case is different, said Devon Ritz, LGBTQ Patient Navigator & Outreach Educator for PPSFL, but what these teens are mostly looking for when they come to the group is a place to feel safe sharing their experiences. If teens are looking for other services outside of the group, Ritz said PPSFL will help connect them to the places they need to be.


“Just being a space they don’t have to explain themselves,” Ritz said. “They can feel safe and welcomed and then they can focus on so many other different things. What we see what happens with our group is that we are able to get folks connected to other kinds of services that they may need, especially in terms of mental health, because we have seen in the past three years an increase of youth struggling with mental health.”


While there are therapists in the area who are open and affirming of LGBTQ individuals, they face the same issue as all other therapists in the area; the demand for their services is extremely high and they are unable to accommodate everyone who wants to make an appointment with them.
More specialized mental health services for LGBTQ youth and a variety of options for services, as well as more spaces dedicated to specific identities are some of the things Ritz thinks would help meet the needs locally. LGBTQ groups in schools, she said, have shown to decrease bullying for all students. When staff is supportive, GPAs go up and students are more likely to start planning for the future. Being able to openly talk about their struggles as LGBTQ youth help them feel more a part of the community, Ritz said.
While there are few specialized resources for LGBTQ youth in the county, the places that provide mental health care are not ignorant to their needs. At F&CS, Levy said they often see LGBTQ and non-binary youth looking for services, and all of their care is specialized to their needs.


The same care is taken at the MHATC and Cayuga Medical Center (CMC), where there are six beds for youth, 13 to 17 years old, in an acute mental health crisis. There are also 20 beds for adults who are 18 years old and older. The facility is set up to help people in crisis then connect them to resources that will help them maintain their health with outpatient services.


“People don’t want to be locked up,” said Eric Jansen, Director of Behavioral Services at CMC. “Because, really, acute psychiatry is made and designed to get through that acute crisis. The curative work is really done in an outpatient setting and developing a longer term relationship with a therapist, with a physician or provider that’s going to manage their symptoms and keep them out of acute situations.”


Both sides, the adult and the youth, are often full. The youth beds are often between 70 and 90 percent capacity. Part of this is because CMC is the only facility with acute care for youth in the area. Sometimes, Jansen said, youth are sent all the way to Rochester if CMC can’t take them.


“There are insufficient numbers of child and adolescent beds state-wide,” Jensen said. “Because, what happens is where you get somebody and we don’t have a bed or they don’t qualify – they’re too young for us, for example – that somebody ends up, in many cases, staying in an emergency room [for] days.”


To help address this, Jensen said CMC is sending their mental health team into the emergency room more to bring the services there and start care in the ER.
As the state put more emphasis on proactive care, Jensen said the focus, and funding, for acute care has gone down. While proactive care is an important aspect of mental health advocacy, fewer beds for acute care means it’s an even more difficult process to get people in crisis into a bed.


Coordination of care, Jensen said, is what needs to happen to help get people to the services they need that are already available. He envisions all of the entities from across the county working in mental health sitting down to work together to get people to the services they need. Compared to cities of a similar size to Ithaca, Jensen doesn’t think there are as many services available as most would believe.

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