Walla Walla County has already taken a giant step in following the recommendations recently made by staff at the Human Services Research Institute.
Earlier this month, county commissioners voted unanimously to fund the position of a designated leader to oversee the area’s behavioral-health picture, although who can fill that position and when remains unknown.
HRSI was contracted by Walla Walla County officials in 2021 to study and analyze how the area’s behavioral health needs can best be addressed and served.
Their methodology for the results 112-page report included in-person and virtual interviews, community listening sessions and analyzes of prevalent health conditions here, how funding has been spent and local services.
Bevin Croft, director of HRSI’s behavioral health research arm, presented her team’s findings and suggestions for change in a virtual listening session on Aug. 17, attended by more than two dozen people.
The advent of COVID-19 in 2020 had an obvious impact on the health of the community, but many issues were long standing before the pandemic and clearly apart from that event, Croft said.
A need for more crisis support was one such concern. This community uses crisis services more than the state average, and those users reported uncertainty, delays and complications in getting crisis intervention.
That support can come in a number of forms, including peer-to-peer help, in-school systems of care and prevention, and on-the-ground assistance such as transportation to appointments.
Problem: Crisis response, other deficits
One woman in last week’s session spoke of recently trying to get a young person, unrelated to her, into detox here, waiting with him in the hospital emergency department for hours as he came down from using fentanyl.
The woman, who identified herself as Colleen, told Croft and others that she, as a voluntary advocate, had to be the one to call around on his behalf to find a residential facility that takes state medical insurance.
“We need a list of how to get help… I think our advocates and crisis responders need to be better equipped when they come into the emergency room.
“I want to see more people seeking recovery able to have more resources. I want to know people can get the help they need.”
Colleen noted a need for more community advocates.
“Sometimes when they come to the ER, that’s the only help they will get. That’s the only time they will be clean. Kids are dying from drug use… If we are really about recovery, Walla Walla needs to level up on this,” she said, adding that crisis responders are not equipped for the situations they encounter.
Croft said her research team heard the same from a number of people.
“There is a small window when people are willing to think about recovery, and that’s the moment to get them into treatment,” she said.
A listener named Elizabeth explained the situations she witnessed as a family member of someone battling mental illness.
She knows the frustrations of trying to get people served, of patients in psychosis sitting in isolation rooms in an emergency department for six or more hours, only to return to the street again.
“My family member would not be around if I didn’t work so hard making calls around the state trying to find beds. I agree with the need for coordination; it needs to be done yesterday. The level of frustration is just extreme,” she said.
HRSI’s work in Walla Walla found that the situation is exacerbated by a series of things, including lack of a health care workforce, which translates into fewer services, language barriers and reduced access to transportation and stable housing.
The research team recommends that the public health department convene an advisory group, populated with people who use the system and other historically underrepresented groups.
Croft also advised an assessment of how the county, providers and schools work together to support student behavioral health, also that the community develop a behavioral-health prevention strategy.
And, as in the examples given by Colleen and Elizabeth, the report lays out a need for comprehensive, updated and accessible service information for the public. Including, Croft said, a community conversation followed by informational materials about the role of Comprehensive Healthcare’s crisis response team.
Comprehensive is contracted by Walla Walla County to provide mental health care to residents using government health insurance.
The rising use of substances in the area’s teens is another concerning finding, particularly high rates of depression and suicidal thoughts, judging from Washington state’s Healthy Youth survey self-reported results from eighth-, 10th- and 12th-graders in 2021.
Data also showed high rates of alcohol and marijuana use, while the opioid epidemic has continued through the pandemic, Croft told the group.
“It’s not a stretch to say we’re facing a crisis,” she said, mentioning that a number of community partners talked about the danger of fentanyl use in this area.
The gaps in Walla Walla County’s workforce are mirrored nationally, although that data is not crystal clear, researchers found. What can’t be argued, however, is that no psychiatrist practices here, and while there are a few providers who can prescribe medications for mental health, there are not enough, Croft said.
Staffing issues, she added, make it very difficult to provide the services “we know are clearly needed.”
In one instance a health care worker laid it out this way:
“You have McDonald’s hiring and increasing their wages, and you have a really difficult, emotionally exhausting job that pays similar. During COVID-19, when people are overwhelmed and stressed… it makes it difficult for people to stay and do this job.”
Another worker told Croft’s team that people burn out and quit when they feel unable to do something for somebody: “As long as you have hope that you can help people in some way, medical people will stay. Nurses are crying because they can’t help somebody. That causes a personal crisis. I want to go somewhere where I can do some good.”
Others said they just don’t know where to go with concerns, that they don’t know who is in charge of the community’s overall behavioral health care.
Prescription: Talk and listen
Much conversation and much listening is needed to weave a solid safety net for Walla Walla County residents. Engagement among stakeholders can result in collaboration, not duplication of services. Knowing what each is providing means more gaps can be filled, more connections can be welded.
All of that circles back to having a key leader in place who is aware of which agency is doing what, how government funding can be used most productively and what current best practices look like. Someone to track policies and the politics of behavioral health care, Croft summarized.
She’s optimistic, given what she and her team saw in Walla Walla County — leaders willing to say yes to quick action and to put the needed funding in place.
“It’s been a pleasure to get to know this community… I hope the report is used. We did it with a lot of care, and it is evident a lot of you care.”
Nancy Wenzel, the county’s public health administrative director, said this week her department is working with the county to craft the description of the leadership job recommended by HRSI and now approved by county commissioners.
Details regarding salary and qualifications are being worked out, Wenzel said.
That board has also given a green light to ensure every school district in the county has suicide prevention programming in place, Wenzel said.
She has every expectation the new behavioral health leader, whoever it is, will play a vital and dynamic role in shaping mental health care in this county, she said.
“You get the right person with the right mindset, it could be an amazing position.”