April 29, 2020

Behavioral health providers across the community report a 40 percent drop in client visits since COVID-19 struck Multnomah County.

Residential treatment centers have scaled back resident slots 20 percent to 35 percent to meet physical distancing recommendations. The Oregon State Hospital has stopped accepting admissions, blocking access for residents with acute mental illness. State officials expect that ban on admissions to last well into summer.

Meanwhile residents across the County struggle with the new normal of COVID-19. 

Some residents in recovery from alcohol addiction report feeling triggered by the pervasiveness of alcohol-based hand sanitizer. 

Some residents who usually see therapists in person lack phones, computers or data plans that would allow them switch to virtual care. Others don’t have a private place to talk. Even those who can connect virtually still feel the loss of physical proximity.

And County-run health centers report new levels of anxiety and depression in formerly stable primary care clients. 

“We have definitely seen this impact the clients and families we serve,” said Leticia Sainz, interim deputy director of Multnomah County’s Behavioral Health Division. “The general stress and anxiety is making existing challenges more challenging.”

Sainz appeared Tuesday, April 28, alongside the Division’s director, Ebony Clarke, and the Division’s medical director, Dr. Nimisha Gokaldas, to brief the Board of Commissioners on the mental health impact of COVID-19 and how the Division has responded. 

The challenges around accessing care, and a surge in generalized anxiety and depression under COVID-19, are both compounded by a seasonal rise in mental health concerns, said Dr. Gokaldas. Springtime typically brings a rise in suicide attempts and hospitalizations, she said. And the closing of admissions to the state hospital through these months means longer hospital stays locally and higher demand for more acute care. 

“That’s an incredible factor in how our system works,” said Commissioner Jessica Vega Pederson. “That’s a big red flag for me. If we look long-term, how do we address that and what resources do we need to put in place. This gives us a lot to think about.”

The ramifications will extend well beyond the reopening of our economy and a return to “normal” socializing, Gokaldas told commissioners.

“We’re anticipating a wave of individuals who faced isolation, increased depression, anxiety and relapse,” she said. “There has been a lot of discussion about what larger mental health issues come of the stay-home orders.… We’re having a lot of discussion about how we are going to support our community moving forward.”

When COVID-19 struck Multnomah County, the Behavioral Health Division pivoted from offering entirely in-person care to developing telehealth services over the phone and through video conferencing, Clarke told the Board. To bridge the digital divide, staff worked to purchase and distribute phones with data plans to anyone who couldn’t otherwise access the virtual services. And it shifted call center staff to virtual offices with reliable and secure connections. 

Behavioral Health also began weekly calls with partners at Care Oregon, the Oregon Health Authority, neighboring counties, area hospitals and community providers to identify trends and address concerns.

All the while, staff continue to meet a select few clients in person to help address their urgent needs and support individuals transferring among levels of care. And Division leaders have stepped up with mental health support for an extensive network of county employees who are part of the emergency response.

“I’ve been impressed with our team’s ability to adjust,” Clarke said.

Commissioner Sharon Meieran sought out a silver lining.

“Are there things we want to hold onto and leverage, some barriers we have been able to break through?” she asked. “This is really an opportunity, as we’re doing system transformation work. There are some real positives that could come to bear.”

Clarke said the Division is balancing the needs of today with the needs of tomorrow, working to  return to direct care and serve more residents while continuing to offer new ways to connect.

“How are we going to adapt and plan for a future of the unknown,” she said. “How do we continue to create care that is nimble enough to change?”