(inspirational music) - Depression, anxiety, trauma, all growing issues for people across the nation.

Finding care for mental health issues like these is a challenge and we'll talk about how we can meet it next on "Health Matters."

(inspirational music) Good evening, I'm Aaron Luna.

Welcome to "Health Matters."

In Washington, 32% of adults have reported feeling depression and anxiety in the last year.

- Our agencies are really full, there's more need than there are providers - And the need for mental health professionals is growing.

Washington has been named a health professional shortage area by KFF, an independent organization that tracks health issues in the United States.

- But I think what I'm really noticing the last couple of years, especially since the pandemic, that regardless of the diagnosis, the level of anxiety is higher than we were experiencing prior.

And it's moved to more kind of an existential peace for them.

- With us tonight, local mental health experts covering private practice, clinical care, and Spokane public Schools.

Dr. Billie Tyler, private practice therapist and president elect for the Washington Association for Marriage and Family Therapy.

Sean Wright, clinical program director for Lutheran Community Services.

Dr. David Crump, director of Student services for Spokane Public Schools.

We start with Dr. Tyler and when we talk about mental health, how would we define what mental health is?

What are some of the baselines that we can look at to determine someone else's sense of being?

- Yeah, I think there's a lot of different ways depending on the lens you're looking through.

For me as a systemic therapist, I'm really looking at mental health through the lens of the impacts it's having on the individual, but also the impacts it's having on the way that it's impacting the systems around the individual.

So the impacts that their mental health is impacting the systems around them, including like the interactions they're having with their communities, their families, the relationships they're forming and vice versa.

And how those relationships maybe with friends and family are impacting how they're feeling on the inside.

So those depression, anxiety symptoms are impacting them and those things interact and play off together and that impacts their mental health greatly.

- So it's kind of an overall encompassing, there's not one sort of factor that plays into that.

- Exactly, it all works together.

- And how, what do you see happening in your practice obviously?

Are people able to get care when they need it or are they hitting barriers trying to get that help?

- Yeah, definitely in the last few years I've definitely noticed there's a greater increase, especially from the lens of a private practitioner of a lot more calls coming in and a lot more even, I have a pretty long wait list and I'm hearing from many that they're running into that in everywhere they're calling is that there's just longer wait lists right now.

So there's a lot of barriers that people are facing and just getting an appointment, getting that call.

So I do think it's getting harder and I think the need's getting greater.

- Are one of the barriers is just the increased need?

Is there anything else that you're seeing as far as people being able to access that care?

- I think the world, right?

There's a lot of stressors happening right now in just communities in general.

And again, thinking that systemic lens, there's just a lot of stresses financially on a lot of people.

The pandemic I think we're still like, is playing a role on so many families right now and the reverberations that are playing out for them.

And like on relationships, I do a lot of couples therapy so I'm seeing couples still coming in and they're still trying to navigate through the transitions of the financial impacts that played out from the pandemic and inflation and social justice and all those things are coming out and playing out in homes.

And so I think that's also playing on why there's more need as well.

- Sean, you work in a clinical setting, does that differ from private practice as far as what you see the need being in the barriers?

- Yeah, so in community mental health we see the need for a lot of people and we think about the whole system.

So we are trying to serve mainly the Medicaid population.

Also maybe a little bit of private practice and other things.

And so the biggest thing we see is just capacity, enough workforce, enough therapists, enough time.

We're fortunate enough to have rarely closed our doors for new clients, always serving sexual assault survivors.

But we are hearing that people are struggling to get appointments when they need it.

Sometimes people are not getting called back.

So we really encourage people to call.

I know many agencies like ours are committed to calling people back.

And even if we're not the ultimate place that is the best fit, we want to talk to people and steer them where they want to go.

But part of the challenge is there's a lot of different things in the community and it's hard to know exactly where to go, what's open, to keep tabs with that and to make sure that we really have good information for people.

And I think we've heard from a lot of folks that they feel a little bit of a despair that when they don't get called back, when they're waiting, when they have to be delayed to get going, it really makes them maybe even drop out of services.

- So there's a barrier of education so to speak, as far as people not understanding where the resources are or not being made aware of where those resources are.

And Dr. Tyler was talking about some of the driving factors for this, the pandemic, social stresses, financial stresses, do you see the same thing on your end?

- Yeah, absolutely, in community mental health we have a lot of folks that are impacted by those social determinants of health.

All of those factors I would say are amplified.

I think the other piece too is we have what looks like an increased kind of acuity of, in youth mental health, we have a lot of youth that are struggling.

There's also kind of a paradoxical thing.

I think we're seeing some de-stigmatization.

I think we have, we see a lot of youth that are open and willing to talk about mental health and to raise their hand and ask for help, which is amazing.

And we have the challenge then of making sure that we have a spot for them.

- So it's kind of a balancing act of you're encouraging people to seek out these resources.

At the same time you have to make sure that those resources are fully staffed.

- Yeah, and I would acknowledge that I think it's hard even for us as providers to know all the routes and all the new sort of programs and how to navigate that.

And I can imagine anybody seeking services is gonna struggle with that.

And so really would encourage them to talk to anyone that will talk back to them, right?

Like I think many people are trying to solve this issue and are trying to direct them.

So I would say I understand the frustration that folks have and we're working hard on the inside to make sure that those pipelines do exist.

- So it sounds like there's a deficit of providers.

What are the factors contributing to that deficit?

Is it just that now there's more need and the pipeline for providers has not caught up?

- Well we know some people are leaving the profession.

Some clinicians are burned out.

There's also barriers to getting into the profession.

So to become like a master's level clinician, you have to go to grad school, you have to pay for that.

Reimbursement rates are not always very high.

So the prospect of work afterwards is not always that lucrative.

So people struggle with that.

Also, there are some challenges where we have really wonderful people who have the skills to do good clinical work, but they may not be in a spot financially or otherwise to sort of pursue graduate level opportunities.

So one of the things that the state and many people are looking at is using other kinds of providers or allowing people to do some work without necessarily having to go to the master's or PhD level.

And those things are moving, but they haven't really paid off yet.

And I think one thing that to think about is a lot of what we see now is a reflection of basically where things were three, four, five years ago.

So you make the initiatives and they will pay off, but they don't know that they've fully paid off yet.

- Gotcha, Dr. Tyler, you're, you're versed on this as far as the legislature trying to move forward, breaking down some of those barriers as far as the education level that you need to be a certified clinician or licensed therapist.

- Yeah, the work I've done with WAMFT the Washington Association for Marriage and Family Therapy has worked on many bills over the last eight to 10 years trying to increase that access for and decrease barriers for clinicians beyond just marriage and family therapists.

Two bills in particular are 1724 and 2274 in particular, both tried to address just what you're talking about there, trying to minimize the barriers for licensing and broader access for supervision.

And so those are both bills 1724 actually passed through both the House and the Senate last year.

And 2274 just went through the House and is in Senate right now.

So it's to your point, it's moving, it's slow and even once they get past it, then it goes and needs to go get to the DOH to get put into place the policies and procedures.

So I think there is a lot of work to still be done and it's paying attention to, we need to increase that access but also make sure that the general public also understand what resources they actually need and that they're getting directed to the right kind of care for the needs that they have.

Because making sure that they know who they're seeing and the credentials that they have and the training that the person that they're seeing.

And I think all of that is a barrier in some ways of just that trying to make sure that the general public's educated to that because it can be really challenging to just, hey, I'm calling, I need to get in to see someone and you don't know what those letters on the back of someone's name actually means.

And so I think that's something that's really important for us to address for people too, is knowing if I need a certain level of care that they're going and seeing someone that has the right education level for that or that if I don't need that and I need access quicker, that I can see someone with maybe that doesn't have the higher access of care or level of education that I can maybe reach out to other resources.

So I think that's something that is really important that gets looked into as well.

- Almost an entryway into- - Just understanding.

- The process and the system.

- Yeah.

Exactly.

- Real quick, I wanna touch base.

Sean, you were talking about burnout as being a huge thing.

Is kind of that the same, are we using the same word- - Private practice.

- In private practice and how prevalent is that?

When we say burnout, what, are we talking about a small flame or are we talking about a large fire?

- No, I think burnout is pretty big across, I mean I can speak for myself even, there's these ups and downs of burnout.

I think, I mean being a mental health professional in general, it takes a lot out of you.

You put a lot of yourself into doing good work and if you are doing really good work, you are really, you really have to take good care of yourself and to do that, it's hard.

You have to do a lot of continuing education.

You're needing to pay attention to your schedule, right?

Which then means that you can't open up and see 40 clients a week and think.

So it's like finding this balance and then if you are trying to increase access and maybe open up your schedule in private practice in that way, then you're more likely to get burnt out fast.

So it's like this tension you're always trying to hold and be accessible and inclusive and bring everyone in, but also to be a really good clinician, you also don't wanna lose yourself in that.

So it's a dance you're kind of always trying to play.

And then to your point with the financial burdens of reimbursement rates and it's really hard to, I know a lot of clinicians would love to be on paneled on more insurance and be able to be accessible, but if you don't have the ability to have the administrative staff to be able to support that or you don't have a group practice, it starts becoming really difficult to even financially sustain that.

- One of the things that I wanted to kind of bounce off this was, burnout is kind of the umbrella term and oftentimes what we see is we see compassion fatigue.

- Yeah.

- Or we see secondary trauma and so when you look at that and it's a profession, that's a beautiful profession of giving and working with others but that compassion fatigue does pay and then when you're listening to and hearing and trying to deal with trauma, which the vast majority of the individuals that we have the privilege to see are dealing with trauma, it does come off on you.

Another part that I found really fascinating is not much good came outta COVID.

But one of the things it did was that it made the terms of mental health acceptable.

I can talk in a boardroom, I can talk in a classroom and as that happens, people, it becomes more acceptable to talk about that.

We broaden that out.

There's mental health but then there's mental wellness and mental, there's other terms, mental wellbeing, and people are accepting those terms and are willing to have that conversation.

The throughout history, we've had shaman, we've had pastors, we've had neighbors over the fence, and people seek that out.

But it seems to me over the last few years that the intensity has increased in kind of what we as a society are dealing with.

- And you work for Spokane Public Schools, which is a behavioral health agency?

- Yeah, we're one, really one in the nation that is a licensed behavioral health agency.

- Nice.

- And so we have 50 masters level clinicians that are out in the schools.

And I agree with Sean, it has really reduced the stigma of reaching out and getting help.

- And we sat down with some of the therapists working directly to meet the mental health needs of students and they say heightened anxiety is often taking a toll on success in school.

(screen whooshing) (gentle music) Sometimes being a kid can be tough, simple things like saying hello or finding a playmate during recess can be daunting.

- A lot of what I'm noticing with the students I serve is a great amount of uncertainty.

- [Aaron] Stephanie Silva is a mental health therapist for Spokane Public Schools in a program created nearly 20 years ago, specifically for students with mental health needs.

And the need has only grown.

- Almost like an inability for them to invest in the school process.

They're waiting for the shoe to drop somehow.

And some of my students get concerned about threats in the school.

High level of concern with safety.

- [Aaron] Spokane Public Schools is a licensed behavioral health agency with therapists throughout the district, with others working in Central Valley, West Valley, Cheney, and meet schools.

In cases where a student has lost the ability to cope in the classroom, they will be referred to the MAP school in North Spokane.

- It's always a privilege to have someone being willing to share with you things that are difficult for them, things that maybe they haven't shared with other people.

- [Aaron] Therapists like Michelle Owen work specifically at MAP, a therapeutic school where mental healthcare is part of the regular school day.

Two therapists work with the 30 high school and middle school students in group sessions as well as private therapy sessions throughout the week.

It's a year-round program to keep its middle and high school students in touch with their services.

Something a lot of families couldn't find on their own.

- And for a lot of our families, they would like that for their child.

But their life does not allow space or time.

- [Aaron] Having mental health services directly in school helps families eliminate barriers and creates consistency that's vital for success.

- Without question, the barriers that it eliminates really helps our families, especially when they may not have access to services otherwise.

Be it transportation, be it not knowing what their Medicaid benefit is eligible for.

- [Aaron] Mallory Hinchee is a behavioral health supervisor for Spokane Public Schools.

She says breaking down barriers is beneficial for both students and teachers.

- I think for the school staff, it's just somebody else to support them too, of understanding what they're dealing with in a classroom and helping giving them strategies right then and there.

- [Aaron] Hinchee says the program's success isn't always measured with a, B and C grades, but the small things for students, coming to school more frequently or saying hello to someone.

- But we also always hope we're just planting that seed that they will either have a good experience and we'll continue on with therapy maybe later on.

- [Aaron] With a growing need for mental health healthcare these providers hope the program will continue to grow and reach a point where there are multiple therapists in every school reaching any student that may need it.

- We love having the opportunity to serve in the schools and I think we're all very passionate about the work we do and we just, we want to continue to grow that.

(gentle music) (screen whooshing) - So Dr. Crump, what is on the horizon for that program?

- What we're trying to do is we're trying to take and make services available to the students in their environment.

They're going to work, which is their school.

We're going into their work and trying to make it more acceptable, more accessible and to be able to decrease the time away.

And also to be able to help them be able to generalize right there at the moment.

The skills you can learn, the self-regulation, the coping, whatever it might be that they can implement it right there.

We are always looking for grants.

We look for partnerships.

We just got a beautiful partnership with INNOVIA or Launch Northwest and we are funded by Medicaid and Launch Northwest gave us $200,000 to try to say, hey, let's meet the students that are not Medicaid and we can, that are either underinsured or have nothing and we can meet with them and at maybe at that time we can then help them qualify more for Medicaid.

So trying to broaden the scope of the who we can see.

We're working with SAMHSA Grant, which is a federal grant to try to do universal screening, which is not only just mental health but it's food scarcity, it's eating habits, it's sleep patterns.

Trying to do that mental wellbeing, mental wellness approach in Cheney and in West Valley.

And looking at trying to take that we know that our students are struggling and we know that that's a good indication that the families are struggling and trying to get that service and the allied services because when one element is deficit, there's probably others that can be supported.

- And you are in a sense creating a model for other districts across the country.

'cause there's not a lot of school districts that are doing that is my understanding.

You're sort of unique in that aspect.

- Yeah, when we became licensed about 20 years ago, we were the only one in the nation that we could find.

A nice thing is recently the state of Washington has really stepped up and several of the education service districts, or ESDs as they're called in the state of Washington, have become also licensed in the last two years.

State of Washington is really trying to find ways to reach out and to take services and we have a beautiful state, but it goes from real urban to very rural and how do we get providers to be able to reach that?

And so the model is it's a beautiful model and it helps families and I have to say, I've really learned to broaden out the definition of family, what the student sees as their family, as their support system and systems are critical to kids and to helping them.

- Great, Spokane Public School is not the only ones working to address the need in a creative way.

Sean, Lutheran Community Services working alongside the Vanessa Behan Crisis nursery to bring services directly to parents.

- Yeah, Vanessa Behan is a wonderful community resource.

One of the barriers that some families experience is access to childcare.

So it's hard to bring your young person to therapy and participate with them if you've got other children that you've gotta take care of.

And so one way we've met this need is co-locating a therapist at Vanessa Behan one day a week.

And that therapist is providing a specialized treatment called Parent-Child Interaction Therapy largely.

And so families can go, they can get childcare at Vanessa Behan, they can do therapy, they can get other supports and it's a much more convenient way to meet the need for them and they might not be able to participate in services otherwise.

Similarly, another program we have is also a SAMHSA funded program in partnership with WSU, where we have a therapist who is serving rural schools through telehealth.

So the schools do a universal trauma intervention and then for the students with the highest need where they don't have a mental health therapist in the the local school, they're meeting with our therapist via telehealth and receiving high quality care.

- And just to clarify, Vanessa Behan is a crisis nursery for parents?

- Yeah, so they serve youth up to age 12, but really I think they would say any parents that are struggling or just need some extra support, I would start with them, they have so many resources.

- You brought up a good point when you mentioned telehealth.

Is there a difference when you're sitting directly in front of someone as opposed to seeing someone on a screen?

Are there benefits, are there drawbacks to that?

And we can have this discussion with the whole panel as well.

- Yeah, I think in general, the research suggests that telehealth does just as well for people.

That being said, that is usually when people are choosing to have telehealth.

So during the pandemic everyone is sort of forced into telehealth and that worked for some, didn't work for others.

I think now we are in a place where we can really get the best benefit when it makes sense, when the client likes it, when it feels like it's working therapeutically, telehealth is there and if that's not feeling like a good fit and for many of the young people that we serve, it's gonna be hard to keep their attention of a 6-year-old on telehealth.

We still have those in-person options available.

- I can tell you what we found aligns really well.

When we were doing an offer in telehealth to our students and families, the elementary age liked it better than secondary age, which was really interesting.

And we got to a point of what we called screen fatigued.

They got tired of doing a two dimensional.

The adolescents really wanted to be in CE, in person and that, except for one thing, group, they were happy on group for doing telehealth.

But individual we found a much greater impact with that being able to be recognized and be able to be validated and to have that interaction face-to-face.

But in the times when families can't make it, lack transportation or illness or whatever it might be, telehealth is a great option, but what we're finding is they would prefer in person.

- Yeah.

- So Dr. Tyler, it seems like it's kind of a balance of both.

There's not a one versus the other, it's a combination.

- Definitely, to be completely honest, during COVID I had to shift my entire private practice almost overnight to completely telehealth.

And for someone who does almost 80% of my practice is couples therapy.

I was terrified of what that was going to transfer to, but surprisingly there were some unexpected benefits.

These are anecdotal, not necessarily research based.

- Sure, sure.

- But in my own experience with my private practice, there were some unexpected outcomes that I wasn't expecting like couples doing it in their living room with me.

Like some of their changes were translating even quicker because they were sitting in their own spaces, having these discussions and then getting off and like moving on with their life.

So there wasn't this like, we only do this in the office with Billie and then having to go home and try and translate that, that was very surprising for me.

It didn't mean that when we could open up the doors that they didn't prefer to come in and have that space just to themselves.

But it was really surprising to me that there actually were some outcomes that were actually better.

And even the access for some families, it was a lot easier to not have to find the childcare that they could have their kids playing in the background and we could have our sessions and that made it more accessible.

And some people have chosen that they could actually take their lunch break in their office and shut the door and we can do telehealth.

And so there were actually some positives that I was not expecting that have been nice to see.

- Great.

Well thank you so much.

We wanna thank all of our panelists for joining us today.

If you wanna reference any of the portion of this show, you can find the full program on ksps.org.

We will be back in April taking a look at fitness as we age.

I'm Aaron Luna.

Have a good night.

(inspirational music) (inspirational music continues)