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Mental Health Update

May 4, 2021
Mental Health Update

MH Update – 5/4/21 – Impact of COVID to Mental Health and Innovative Mobile Crisis Team Services

his recent article in the Schenectady Gazette highlights the impact of COVID to the mental health of individuals as well as identifying the innovative practices of the Northern River Mobile Crisis Team especially in regard to adolescent services.  As we continue to advocate for 988 and funding for Crisis Stabilization Centers and Enhanced Mobil Crisis Teams, models like this will be of great significance to communities across the State.

Mental health a greater challenge during COVID; crisis doesn’t get attention it deserves, doctor says By Brian LeeMental health was already in crisis mode across the U.S., advocates say, but since the onset of the COVID-19 pandemic, it’s worsened.

Police and mental health professionals have been busy throughout the pandemic.

Police in Schenectady continue to meet with mental health professionals from Northern Rivers Family of Services when certain emergency calls warrant that type of response.

And at Capital Region TMS, a depression treatment facility on Union Street in Schenectady, director of clinical services Mary Ruhle said she’s out straight with patient appointments, and Ruhle is logging 60-plus hour work weeks.

Her colleague, Dr. Thomas Qualtere, said the pandemic has broadened feelings of isolation, stress and even the mourning of loved ones who died of the coronavirus.

Qualtere said the mental health crisis doesn’t get the attention it deserves. He suggested it should be approached with the same urgency as the nation’s response to the opioid crisis.

“It’s unfortunate. It’s not spoken about enough. You have to deal with the negative stigma of mental health, and people are reluctant to come and get treatment in the first place,” he said.

“And now, with COVID, they’re isolated, secondly. Third, the idea of having to be on medication or be in treatment and having to acknowledge it – it can put you behind the eight-ball. Between the economy, the lethality of COVID, people having all these losses and being isolated… it takes a toll,” Qualtere said.

Before the pandemic, it was widely believed one in five U.S. adults struggled with mental health issues, according to Glen Liebman, chief executive officer of the Mental Health Association of New York State.

In the state in May 2020, more than a third of adult New Yorkers reported symptoms of anxiety and/or depression in the prior week, according to the New York State Health Foundation.

The New York study indicates three times more people reported anxiety and depression after the pandemic.

The proportion of state residents reporting poor mental health remained high throughout the pandemic, reaching 37% of adult New Yorkers in October 2020, the foundation said.

In the meantime, Kaiser Permanente released a national study 12 months into the pandemic that found a 7% increase in visits for mental health treatments during the initial shelter-in-place period in 2020, compared with the same three-month period in 2019.

In Schenectady, police are busy with mental health calls. They responded to 18,832 calls in 2020, up from 17,329 the prior year.

Police Sgt. Nick Mannix stopped short of saying the increase in the city is related to the pandemic. He said police have been responding to mental health calls at a steady rate the last five years, including in 2017, when it went out to 19,239 calls.

Leibman, of the state association, said the general population in New York has been impacted by mental-health-related issues during the pandemic. He cites increased calls to an emotional support line Gov. Andrew Cuomo established last year, and more calls to the national Suicide Prevention Lifeline.

There are really two pandemics taking place, Liebman suggests.

“It’s the pandemic that we all know about – the impact of the almost 600,000 people who have died and the impact of their loved ones,” he said.

The other relates to mental health, he said.

“That’s the pain that people feel – the isolation that they’re feeling, being at home for 13, 14 months. The frustration, isolation, and kids in school remotely,” Leibman said, while adding hope that it will subside as more people are getting vaccinated.

Leibman said he’s also concerned about how people will process the impact of long-term trauma from COVID, which he suggested won’t be known for years to come.

“Younger people have processed what’s going on for the last 14 months,” he said. “How that will impact them in terms of their depression or anxiety? It could be years before we find out the impact of that.”

People are talking more openly about mental health than they did before the pandemic, Leibman said, perhaps the only good that has surfaced during the pandemic.

“I don’t think this would have happened if the pandemic was 10 years ago, that people were openly talking about their feelings and the feelings of the people around them,” he said.

Thankfully, the once anticipated 20% statewide cut to mental health services earlier this year has been restored, now that the state has a surplus, Leibman said.

“We as a mental health system have always been traditionally underfunded,” he said, “so even getting back to what was the norm is still way below where we should be.”

Police and mental health

In Schenectady, Northern Rivers Family of Services is rolled into the 911 system, meaning, if somebody calls dispatch for a disturbance in which a mental health concern is in question, but there’s no imminent risk, the dispatcher transfers the call to Northern Rivers for management.

The police said it can be used for nonviolent “behavioral type calls” such as an adolescent who’s acting out. Police don’t want to be involved in adolescent disciplinary matters, Mannix said.

For calls where there might be an imminent danger, police and Northern Rivers’ Mobile Crisis team meet at the incident site.

Northern Rivers has also been joining Schenectady police on police ride-alongs, Mannix said.

The goal is to divert some of the lower-level offenses with an underlying mental health concern, he said.

“It’s just better to have a counselor that is trained and all that, plus it ties up officers for an amount of time,” the sergeant said.

Another option is for concerned citizens to call Northern Rivers’ crisis line directly at 518-292-5499. This would be in cases the public is unsure an officer is needed, said Jennifer Eslick, executive program director of crisis services for Northern Rivers.

“We encourage individuals to call us and let us help decide whether police need to be involved or not, or if we can just come out safely and provide them what they’re actually looking for, which is help with their mental health,” Eslick said.

The mobile response teams act almost as mental health EMTs and attend to crises in Albany, Rensselaer, Saratoga, Schenectady, Warren and Washington counties.

It responds to adults, adolescents and children in all counties except for Albany, where it does not respond to adult crises.

Northern Rivers either manages the situation over the phone or meets the person in crisis at their home, school, mental health facility, a Stewart’s parking lot or anywhere the person might want, Eslick said.

Nearly 11,000 people in the six counties have called the crisis line since it opened in June 2018 through March 31, 2021, Eslick said. Of those calls, 7,100 warranted an in-person response from a counselor.

People often call the crisis line for teens who are depressed or expressed suicidal thoughts after being upset with a parent about boundary setting. Or it could be a suicidal adult, or someone acting bizarrely as they walk down the street, she said.

“Many times, when we get there, the individuals are just looking for somebody to talk to, or to talk to them about what’s going on, and so many times we are actually able to release the police from the situation and we just stay and provide that support,” Eslick said.

Depending on the particular case, the organization can conduct follow-up with young people for up to 14 days to keep them out of crisis, and manage what other supports they have, Eslick said.

The process helps avoid the cost of an ambulance response, or for the person to sit and wait for hours at maxed-out emergency rooms, she said.

The Northern Rivers service is state and county-funded and free to anyone having an emotional or mental health crisis. The insurance provider is not billed, although in some cases Medicaid may be billed. However, service recipients never receive a bill.

The line is answered 7 a.m. to 11 p.m. Monday through Friday and 11 a.m. to 7 p.m. weekends. It is working toward becoming a 24-7 operation.

Capital Region TMS moving to Albany; expanding brain stimulation treatment

Capital Region TMS, the Schenectady mental health associate on Union Street, is moving to Albany in June where it aims to continue to expand its use of NeuroStar “TMS” therapy, or transcranial magnetic stimulation.

It is a noninvasive procedure using magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression.

Qualtere said his organization has the only NeuroStar machine in the Capital District. He said it got theirs in May and has since bought a second machine because of high demand. It is looking into purchasing a third one soon.

The Federal Drug Administration approved the use of TMS therapy for major depressive disorder in 2008. Insurance companies started covering it in 2013.

Insurance companies generally cover treatments for those that have had an unsatisfactory response to antidepressants or cannot tolerate side effects of antidepressants, Qualtere said.

As of Thursday, Capital Region TMS had performed 2,267 treatments on more than 100 patients. So far this year it has had a 75% response rate, meaning the patient’s depression got better, while 37% are symptom free, Qualtere said.

If three distinct antidepressant meds have not worked, then the chances of a fourth getting him or her into remission is less than 7%. The remission rate with the NeuroStar machine is 40 to 45%, he said.

Within a 30-mile radius of Schenectady, there are more than 75,000 patients with four or more antidepressants in their history, of which 60% have never seen a psychiatrist, he said.

The TMS renders treatment for five days a week for about seven weeks, without the possible side effects of dry mouth and eyes, constipation and weight gain of antidepressants, the doctor said.

A patient, Laci Matthews of Ballston Spa, said Friday she’s about three weeks past her TMS treatments, and after 25 years suffering from severe anxiety, she doesn’t remember ever feeling so good.

“I’m still taking medication, but I’m coping with change 110% better than I would have last year, without the treatment,” Matthews said. “I’m able to manage and cope with my anxiety. I can either just let it stay there and not bother with it and I’m not obsessing over it. I seem happier. I feel happier.

“I’m going to start seeing a therapist, just to keep things going. But as I told Mary [the clinician], it saved my life because my anxiety was eventually probably going to give me a heart attack,” Matthews said. “I’m a total advocate for this. I can’t believe how well it worked.”

Glenn Liebman
194 Washington Avenue, Suite 415
Albany, N.Y. 12210