It is arguable that mental health is one of the major problems modern society faces. Humans have excelled in technological and social advances, especially over the past 200 or so years. Still, we don’t seem to be able to get a good handle on our own individual thoughts, feelings and impulses. How we each feel about ourselves, others and our circumstances – and how we act on or suppress those feelings – often has serious consequences for ourselves and others.
Even residents of a small rural county like Hendry feel the repercussions of poor mental health.
It’s very difficult for many people to get to the root of their issues - partly because the causes of hurtful thoughts and feelings are often not easy to determine. Other circumstances add to a lack of understanding of our problems - a stigma may be attached to the treatment of mental health issues and people may not even recognize that they have a problem.
In a place like Hendry County, with limited resources for all types of health care, it is difficult – and can be expensive – to find mental health help.
In years past, the county provided matching funds for mental health services, such as when Hendry-Glades Mental Health Department was in operation.
Counties are no longer required to match funding, but Hendry County staff is very aware of the importance of behavioral health to residents. The county indirectly facilitates services through “in kind” services such as providing office space.
We should note that Hendry County is responsible for mental health services in the jail, which are funded directly by the county commission.
Since Hendry-Glades Mental Health Department closed its doors years ago, several entities have tried to provide these services to residents. Most recently Crossroads Behavioral Health was based in space on Cowboy Way, which was provided by the county. County Administrator Jennifer Davis said that staff worked hard, but Crossroads was unable to make it work financially and CBHN was forced to end its funding. It’s an old story for small rural counties like this. Services are needed but the challenges are often overwhelming.
Ms. Davis and other county officials are concerned that this pattern will assert itself again.
About four months ago, a group called IMPOWER contracted with Central Behavioral Health Network (CBHN) (one of seven managing entities that distribute federal and state money allocated for mental health services to the local level) to provide telehealth services for mental health issues.
The modern concept of telehealth, providing health services via internet, can be very helpful but she believes many people, especially in a rural area, are not comfortable with online services only. With over 60 percent of Hendry County still without access to broadband, Ms. Davis is somewhat skeptical that online services alone are enough. She feels both are necessary, at least in the short term.
Working to provide telehealth mental health services to indigent and Medicaid residents in Hendry and Glades counties, IMPOWER staff provide ongoing updates to the county commission.
The hope is that IMPOWER will eventually be able to accept private insurance, Medicare etc., from Hendry and Glades residents but, in the meantime, Ms. Davis fears that a lot of residents are still cut off from the help they need. Telemedicine is a very secure process, Ms. Davis said, but the county eventually wants both internet and private personal service.
Ms. Davis said the county is seeking space to use as an “incubator.”
Laura Higginbotham of IMPOWER described the online outpatient services provides. She said services are accessible most anywhere - at home, office, school - using a smartphone, computer, tablet or other devices that have internet and is available for kids, adults, adolescents and families, focusing on mental health, behavioral health and child wellbeing.
According to Mary Dearth, VP of External Relations for IMPOWER, their telehealth portal was piloted in 2013 in Brevard County, and has expanded ever since then. It provides HIPAA compliant, virtual services allowing clients to see their doctor or therapist from any location.
Anyone can call IMPOWER, she said, you do not need to be a patient. At their website you will find a questionnaire to fill out and your information will be processed. Once the eligibility process is complete, a local resident will be assigned a practitioner and may receive virtual services.
Ms. Dearth said IMPOWER was started because of a shortage of practitioners, especially in small counties like Hendry, where people often have to wait months to be seen by a provider. She said IMPOWER clients can be served in 24-48 hours, non-emergencies in about a week.
IMPOWER CEO Anna Basnik said the company provides substance abuse and psychological counseling, directly to the client in Hendry County by telecommunication using any internet capable device with video and sound capabilities.
At present, in Hendry County IMPOWER services only Medicaid and indigent clients. She said there may be a copay for adults. Ms. Baznik said most private insurances do not cover mental health services by telecommunications.
Anyone needing access to mental or behavioral health services can be referred to IMPOWER services simply going online to www.impowerfl.org or by calling telephone number 407-215-0095.
This ease of access allows people in need to get help while they are at home, school, work, at a store or anywhere they happen to be. You don’t have to miss school or work to talk to a consultant. The session is private and can take place most anywhere.
She said they are negotiating with United Way, local churches and schools to set up convenient internet location for clients at their facilities.
According to Ms. Basnik, IMPOWER’s system is “perfect” because service is always available. There is no need for the patient to be with the provider, so clients in outlying counties can access doctors without having to travel to larger towns. Telehealth services can also aid in circumventing any stigma clients may feel from seeking mental health services.
Naturally, children need consent of a parent or guardian to participate in this program, but the adults need not be present for a session, depending on the individual diagnosis. Sessions can host up to 5-6 people – parents, child, the entire family, if necessary.
Throughout its service area, IMPOWER has provided approximately 3,000 services in six years, monthly. In the roughly four months the program has been available in Hendry the program has provided some 208 services to 16 adults, 6 of whom were Medicaid patients.
Ms. Baznik pointed out that IMPOWER “just wants people to get treatment, so they can live happy, healthy lives.”
From the county’s point of view, IMPOWER is providing good health services but there are still many challenges. Ms. Davis said, “We’re determined to figure it out.”
Other partners involved in local health issues are also taking an active part in the effort to provide local mental health services.
Health Department Director Dr. Joseph Pepe recognizes the importance of behavioral health. Although the health department is not directly responsible for serving those needs, he is working to facilitate good services for county residents.
Dr. Pepe is very concerned about mental health treatment because, he said, there are so many adverse effects from childhood abuse, neglect and household dysfunction. These conditions profoundly impact the life of the community and individuals and are linked to poor health and poverty levels.
Dr. Pepe is trying to recruit assistance for mental health providers and build a sustainable foundation.
Video conferencing is one way to reach clients in rural areas, Dr. Pepe noted, but the traditional lack of transportation and ability to make appointments are big obstacles, especially for lower income patients.
In Dr. Pepe’s view, another challenge in particular in Florida is the ability to keep patients on track with their treatment after big storms like Irma. Telehealth may be helpful in maintaining all types of health care in those situations, he added.
The success of telehealth also depends on each client’s needs and how tech savvy they are, for instance. Also, it may be necessary for a provider to physically see a patient in order to prescribe medications. “We’re working through these issues,” he noted.
There are no “safety zones” from mental health issues. All populations, all socio-economic levels, all races and creeds, all ages are susceptible. These problems wreak havoc with individuals and disrupt communities as well as individual lives. The challenge of making these services available to Hendry County residents has been formidable, and will probably remain so in the foreseeable future. But it is not going unmet.