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Mental health care goes remote amid COVID-19 crisis

Therapists who are doing counseling sessions over the phone or via video chat during the COVID-19 crisis say many of their clients are embracing the change.

“Our show-up rate is actually higher than when it was in-person. People don’t have to struggle with child care or transportation. We’re ‘seeing’ more clients than before. I hope it’s something we can continue. For certain populations, it’s a better way to reach them,” said Jackie Lien, executive director and clinical director of Phoenix Counseling Center in Phoenix.

When the pandemic hit, the federal government loosened up restrictions, making it easier for mental health providers to use telehealth.

“We’ve pretty much changed the way we do everything,” Lien said.

Counselors are working from home and doing individual counseling sessions by phone or through video conferencing services such as Zoom. Group sessions are also being held via Zoom, Lien said.

Jackson County Mental Health still has some therapists out in the field, especially to help provide mental health care to homeless people sheltering in place along the Bear Creek Greenway. But most therapists are working remotely from home and contacting clients by phone or video conference, said Rick Rawlins, manager of crisis and outpatient services for Jackson County Mental Health.

“It’s interesting to see the response from families and clients. They love it,” he said. “They enjoy the convenience. They don’t have to come in to the office. Our ‘kept rate’ — the number of appointments that are kept — is increasing.”

Rawlins said some clients are opening up more to therapists over the phone. He compared it to teens being more willing to talk with their parents on a car ride versus when they’re sitting across from each other at home, eye-to-eye.

Lien said the same phenomenon is playing out for therapists with Phoenix Counseling Center, which provides both mental health and substance abuse counseling.

“Clients are feeling more comfortable talking and sharing more over the phone and Zoom,” she said. “It’s harder to talk face-to-face for some folks. On the other hand, some people are really missing that connection piece that happens in person.”

Lien said she hopes flexibility to provide remote counseling will continue after the COVID-19 threat subsides, but she wouldn’t want to see a permanent switch to an all-virtual counseling world.

Most mental health providers in the Rogue Valley have made the switch to telephone or videoconference services for now. Providers are staying in touch with each other via Zoom meetings.

Jackson County Mental Health continues to operate its walk-in crisis center from 8 a.m. to 5 p.m. Monday through Friday in the Jackson County Health and Human Services building, 140 S. Holly St., Medford.

The 24-hour Jackson County Mental Health Crisis Line is available every day at 541-774-8201.

The crisis center has plexiglass at the front desk and a video conferencing room for people to talk to mental health providers, Rawlins said.

“We’re trying to keep clients and staff as safe as possible,” he said.

Jackson County Mental Health workers are calling local homeless shelters to provide mental health care to people there, and also running out to get prescriptions for people in danger of running out of medication, Rawlins said.

Although many clients are embracing remote counseling, mental health providers say the COVID-19 crisis is taking a toll.

“I think the impact is increasing over time. At the beginning, there wasn’t as much impact,” Lien said. “Now people are starting to notice how trapped they are. There’s more depression, suicidal ideation and self harm.”

Substance use and relapse rates are increasing, she said.

Oregon has reported an increase in sales of alcohol and marijuana during the pandemic. Use of illegal drugs such as heroin and methamphetamine is harder to track.

Rawlins said Jackson County Mental Health has seen a decrease in the number of people calling for services or walking in to the crisis center.

But that doesn’t mean people aren’t quietly suffering out in the community.

“The whole world is slowing down. Fewer people are coming in. They’re probably saying, ‘I’ll wait things out.’ As things start going back to a new normal, we may see a tide of people start to come in,” Rawlins said.

That trend is on display whether it’s mental health care or physical health care.

Everything from emergency department visits to childhood vaccinations to 911 calls are down as people hunker down and avoid seeking care.

Mental health providers are urging people not to delay getting help.

Some people are coping with preexisting mental health issues, and everyone is dealing with added anxiety and uncertainty from the COVID-19 crisis.

“People are anxious and concerned. They’re worried about what’s happening financially in the world. They can’t connect with other people in person and use their usual coping strategies. We see an increase in restless anxiety. People are not able to do their daily routines. It’s starting to wear on people. As it goes on week after week, people don’t know when it will end,” Rawlins said.

Restrictions on some activities and businesses could begin to ease as early as Friday if Gov. Kate Brown grants permission to Jackson County to enter phase one of the state’s reopening plan.

Rawlins said the success of remote mental health care might diminish as more clients go back to work and become harder to reach at home.

But many people will remain at home due to high unemployment rates. State officials are also asking people to continue working remotely if they can, and vulnerable populations are urged to stay home as much as possible to reduce their risk of COVID-19 infection.

Rawlins said Jackson County Mental Health will continue its current telehealth services for the foreseeable future.

“Whatever is the new normal, telehealth will be a part of that,” he said.

At Phoenix Counseling, Lien said therapists will continue to meet with clients remotely during phase one of reopening.

“I’m not sure what we’ll do later. It all feels up in the air to me still,” she said.

Phase one will last at least 21 days. Restrictions could ease further if the state doesn’t see a spike in COVID-19 cases.

Lien noted all organizations and businesses are grappling with how to keep workers, clients and customers safe. Phoenix Counseling aims for a cozy, home-like atmosphere, which makes it hard to practice physical distancing in the building.

“Normally we have 250 to 300 people coming in and out each week. That’s a lot of people,” she said. “I don’t feel ready. I’m kind of scared about having to make the decision about opening back up.”

Lien said she hopes the Oregon Health Authority will issue detailed guidance for mental health providers about how and when to resume in-person care.

In the meantime, providers are urging people to call if they’re experiencing mental health issues.

“One thing I would like to say to people is we’re still open, and we’re there to talk to people,” Lien said. “Please feel free to call if you’re struggling in any way.”

For more information about Phoenix Counseling, call 541-535-4133 or visit phoenixcounseling.org.

Call the Jackson County Mental Health Crisis Line at 541-774-8201 for immediate help or to get information about mental health providers in the community.

Reach the Suicide Lifeline at 1-800-273-8255.

Call 911 if someone is in immediate danger of suicide or of harming someone else, or if suicide has been attempted.

The Senior Loneliness Line is 503-200-1633.

The Military Helpline is 1-888-457-4838.

YouthLine is 1-877-968-8491 or text HELLO to 741741.

Call the Disaster Distress Helpline for emotional help to cope with a disaster, including COVID-19, at 1-800-985-5990 or TTY 1-800-846-8517 or text TalkWithUs to 66746.

Reach Mail Tribune reporter Vickie Aldous at 541-776-4486 or valdous@rosebudmedia.com. Follow her on Twitter @VickieAldous.

Mail Tribune / file photoRick Rawlins, manager of crisis and outpatient services for Jackson County Mental Health, said counseling over the phone and via videoconferencing apps has been good for some people.