Bonner County’s mental health problem

It’s nearly invisible if you aren’t looking for it, but Bonner County is in the midst of a health crisis — and it’s not COVID-19.

While stories of struggle in the past year have often centered on the physical impacts of the pandemic, another effect accompanied, and took hold, alongside the virus: A nearly overwhelming need for mental health service providers in North Idaho, and elsewhere, that counselors are working overtime to meet.

A year ago, one or two behavioral health care providers might have had waiting lists, said Eric Ridgway, founder and counselor at The Human Connection Counseling Services. Now, nearly all of them do.

“It was never like that before, where everyone did,” he said. “The level of stress that we came up from the isolation with COVID-19 — marriages were experiencing more stress, children [had more stress], [and] their school was disrupted.”

Mental health during a pandemic

The problems for people’s mental health over the past year are twofold, said Gina Beck, a behavioral health director at Kaniksu Health Services. The first is that added stress, including financial hardship, isolation and fear over the virus itself, led to more anxiety and depression.

The second is that many of the protocols that were necessary to maintain physical safety — social distancing, quarantining and generally avoiding contact with people outside the household — fell in direct opposition to many standard treatment options for those with depression.

“If people maybe have a little bit of depression, it increased their depression significantly,” she said. “We're telling people that they had to stay home and isolate, which is a symptom of depression.”

Suicide rates also went up in 2020, Beck said, after having droppped in 2019.

According to the National Foundation for Suicide Prevention, Idaho as a state ranks ninth in suicide deaths, and suicide is the eighth leading cause of death. The number of deaths per 100,000 is also 20.3, well above the national average of 13.93.

“2019 actually dropped, you know, that was big,” Beck said. “And then COVID happened a year later and it’s back up again.”

Providers have been working harder than ever to meet the increased demand, Beck said. At Kaniksu, counselors will at times fit clients in crisis into their lunch times or periods they would normally do paperwork. That’s something they’ll always prioritize, she said.

Crisis calls are another thing that’s gone up. When those come in, counselors work to see patients right away, Beck said. In extreme situations, a person may be sent to the hospital, and for general referrals, patients are put on a waiting list, and given a list of additional providers in case someone else is able to fit them in sooner.

The pandemic has also increased symptoms for people with trauma and PTSD, Beck said.

“With the people that were saying they were previously traumatized, what can really aggravate some of those symptoms is when they don't feel safe again,” she said. “If they're always worrying that they could get COVID, that can also increase those symptoms.”

People battling substance abuse were also affected, and had a higher rate of relapse due to disruptions to their recovery routines, Ridgway said.

Even for people without many mental health challenges before the pandemic, the past year had a profound impact on many peoples’ emotional well-being, he said.

Children and families were notably impacted by the inconsistency in school, added pressures and the inability to socialize with peers for much of the year.

While adults are capable of understanding the reasons for some of the unpleasant requirements of a pandemic, children can’t always comprehend it, Beck said. Unlike adults, they also don’t have as well established social networks.

“A young child may not understand, you know, the big picture of COVID and not being able to see grandma,” Beck said. “[We focus on] helping them identify what feeling they're actually having, and then and then gaining better coping skills to decrease that if they're having anxiety.”

Among adults, many were impacted by job loss, and business owners struggled wondering if they would be able to keep their business open. Teachers were in a particularly difficult position, Ridgway said.

“It had never been like that in Bonner County. In the 30 years I've been here, it's never been that much stress,” he said.

Poverty and mental health

Although the pandemic alone would have created more demand for mental health care providers, an increase of those able to afford counseling also went up with the expansion of Medicaid in 2018, said Catherine Perusse, a counselor at Seven Peaks Counseling in Sandpoint.

Currently, only some behavioral health providers such as Kaniksu accept Medicaid, in large part because of prohibitively labor-intensive paperwork that’s required to accept it. Still, it’s significant’y expanded the number of people seeking mental health treatment, she said. Other providers accept payments on a sliding scale. Some, like Perusse, offer both.

“I do try to take a couple of pro bono cases [too], but I do have to pay the rent. So I have to limit those,” she said. “But I typically have one or two people on my caseload that are pro bono.”

Continued challenges to Medicaid, Perusse said, make it more difficult for providers to offer affordable care to patients who need it.

“That's so detrimental to the families that live in poverty. They have to worry about, ‘Not only do I have to make dinner, but what the heck am I gonna make? Because I have one box of mac and cheese in the house, and four kids.’ That's stressful,” she said.

While poverty makes it more difficult to access mental health care, it also greatly increases the need for it, Ridgway said.

“[People in poverty] have the least ability to pick themselves up by the bootstraps. As a society, we have to care about each other,” he said.

Ridgway considers it an ethical obligation to make counseling accessible, he said, as do many other counselors.

Although cost is a common factor in why people do not seek counseling, Ridgway said that shouldn’t deter people from seeking help.

“I don't want them holding back with worries that they may not have the money to pay. I don't want people holding themselves back from asking,” he said. “If they're genuinely seeking help, and they speak to a mental health professional who's in this field for the right reason, they should not be turned away.”

Who counseling is for

One silver lining she’s seen in the past year, Beck said, is that the demand for mental health care shows more people are reaching out for help. Although mental health struggles are still stigmatized, people are often more willing to talk about their struggles.

Although clients sometimes feel weak for getting therapy, Beck said she applauds anyone who chooses to seek help.

“I often hear from my clients that they feel like it's a weakness that they have to go to counseling,” she said. “That's a huge strength to recognize that you have something going on. And you need help to change that. That takes a lot of strength and power.”

Another bright side to pandemic-era health care is that insurance companies are covering telehealth, Beck said. That change increased accessibility for many patients, and will continue to do so as restrictions lift, assuming that those online visits remain covered.

Although there is a high demand for counseling, Beck said, that also shouldn’t keep people from seeking help.

“I get people saying, ‘Well, there's so many people that have had bigger things than me.’ I hear that often, and it doesn't matter. What's traumatic to you?” she said.

Counseling can also benefit anyone, Ridgway said, not just “crazy” people or those struggling with acute mental health problems. Counselors are specifically trained to help people improve anxiety, stress, depression and communication.

Not every counselor will be the right fit for an individual, he said, but people looking for help shouldn’t give up if the first person they talk to isn’t the right match for them.

Perusse noted that when she went to counseling, one of the first counselors she worked with was too “warm and fuzzy” to be a good match for her — so she found someone who was a better match.

“It's kind of like shopping for a hairdresser that you like and trust,” she said. “You don't keep going back when it doesn't work for you. And you don't quit getting your hair cut, you look for somebody else.”

While seeking help from a professional is highly beneficial, communities supporting each other as a whole is also important, Beck said.

“[When] geese fly, they fly in that V formation, right? And the strongest one’s up front, and then they take turns when that one gets tired. And then when one isn't doing well, another, another one will stay behind with them. And then when they're better, they fly back together,” she said. “They're working together. And I feel like as a community, we need to do that, too.”

Ridgway said one thing he’s noticed during the pandemic is that many people are more generous and kind toward one another. Some of his clients, for instance,have asked him to prioritize clients in crisis. Ridgway also pointed to generous giving and thoughtfulness in the community at large.

“I have seen people be more sensitive and caring to total strangers,” he said. “People telling strangers at the grocery store the checkout, you know, ‘Be safe, be careful, I hope your family's safe.’ So, I've seen generosity, and kindness and compassion extended. And that heartens me to see a worldwide crisis bringing out the best in some people.”

Small words and actions can make a big difference to people who are struggling, Beck said. Both she and Perusse noted that helping to create hope for their clients is a big part of their job.

As suicide rates increase, having conversations with people who may be at risk is important, she said. Asking honest questions can be difficult, but could help save someone’s life.

“I wish people would talk more about it, instead of suffering in silence,” she said. “Just asking that question is helping that person. Not being afraid to say it. ‘Have you had the thought of killing yourself?’ That's a powerful statement. People are afraid to say that. They're afraid of, ‘Well, maybe by asking them, I'll put that thought in their head.’ If you're asking that, they probably have already had that thought.”