The existing infrastructure for mental health services is straining under growing demand.

ALL TYPES OF MENTAL HEALTH PROVIDERS ARE LOOKING FOR EMPLOYEES. That’s a fact for the Monterey County’s Behavioral Health Department, and its contractors and partners: places like nonprofits, schools and hospitals, as well as their competitors – growing online powerhouses specializing in telemedicine. They all compete for mental health specialists, while a lot of them, such as local psychiatrists, have “aged out” and they are not being replaced by new workforce, says Barbara Mitchell, who runs Interim, Inc., an agency that provides services to patients with serious mental illness, and who has been in the industry for 40 years.

“It’s really hard to find someone,” she says. Interim has 27 open job positions currently posted. Even though Interim doesn’t help just anyone seeking mental self-help or counseling – clients must qualify for services based on need – they get phone calls asking where to go all the time. “I recently had someone with private insurance who needed immediate help,” Mitchell says. “Waiting for an evaluation would take three weeks, and this person was advised to go to the emergency room.”

Enter telemedicine, which soared in popularity early in the pandemic, with providers looking to minimize Covid exposure but continue delivering certain medical services that could be done without seeing a patient.

Telemedicine isn’t a solution for every person seeking mental health treatment, but it can work for people who need just a few counseling sessions, says Monterey-based private provider Erika Cadenas. It is often the fastest option for getting help with depression, anxiety, marriage counseling, PTSD, etc.

“Yes, they are effective,” marriage and family therapist Noralyn Jackson says of online therapy sessions that currently make up 90 percent of her practice. Jackson works through a platform called BetterHelp that offers various packages and forms of communication. The therapy itself, offered in 45-minute-long sessions, can take the form of a video call, phone call or a live chat, and is priced accordingly. “Some people subscribe for a session once a month and then they can buy an extra session if they need to,” Jackson says. Some packages have unlimited messaging with the therapist.

Jackson has a private office in Salinas and has been practicing for the last six years. Thanks to BetterHelp, she can see patients from across the state. The company needed and hired a lot of people around the past holiday season, Jackson says, and she was offered bonuses from BetterHelp to work more. “People come with a lot of relational problems that could no longer be avoided,” she says. “Or people discover they are not able to cope. There are out-of-job issues, or people discover working from home and they want a different life.”

DATA NATIONWIDE SHOWS RELENTLESS DEMAND FOR MENTAL HEALTH SERVICES. While the mental health system has been struggling to catch up, many people, including children, are seeking help for the first time amid pandemic stressors. In December 2021, The New York Times and Psychology Today surveyed 1,320 mental health professionals. Nine out of 10 therapists said the number of clients seeking care is on the rise; 75 percent of respondents reported an increase in wait times. Nearly 1 in 3 clinicians said it could take at least three months to get an appointment or that they didn’t have room for new patients at all.

Cadenas lists some of the common issues her patients are struggling with these days: “Impacted routines, restlessness, panic attacks and social stressor such as housing instability.”

Cadenas has a private practice and also offers online sessions – her services are linked to Psychology Today, an online platform built around the popular psychology magazine, which she recommends as a good way to locate a specialist near you. Like her colleagues, she also reports an increased demand for her services, and says she had to send people away, especially at the beginning of the pandemic. At some point, she just stopped adding people to her waitlist.

Her experience with telemedicine has been positive; but she recognizes the challenges. Cadenas prefers to work with suicidal patients in person. Some therapists are concerned about missing important body language while working online, while others are happy to look for clues in the patient’s environment, observing their surroundings, their level of privacy and interruptions they experience.

“It takes time to get used to us,” Cadenas says. “Not all people are comfortable with online sessions, and not all clinical issues can be addressed this way.”

NOT ALL MENTAL HEALTH WORK CAN MIGRATE ONLINE. Monterey County Behavioral Health Director Katy Eckert works with social workers, clinicians and nurses who generally do not work from home – they work closely with law enforcement, and experience the pandemic through the lens of a growing substance abuse and overdose crisis, especially opioids.

“People are seeking help, and we don’t have a workforce for existing needs that are increasing,” Eckert says.

“Fentanyl is more prevalent, pills are circulating. Our youth and adults are under similar pressures: isolation, anxiety related to returning to school, bullying, domestic violence and housing and income instability.”

Despite difficulties, wait time on the phone and long waiting lines, it’s essential to not give up on trying to reach help.

“Be persistent,” Cadenas advises to individuals who need help and have health insurance. “Keep calling, and get your insurance provider to help you find a specialist.”

For those without insurance, the county has some options, starting with a crisis line. One of the places they can direct a low-income patient is The Village Project, Inc., a Seaside-based nonprofit founded 13 years ago to help historically underserved people, with the focus on Black, Latino and LBGTQ+ communities. “The pandemic is wreaking havoc in those communities,” says the Village Project Executive Director Mel Mason.

At the moment, The Village Project has only one therapist (who works with 70 patients) and Mason himself started to provide therapy again. They have a waitlist of 80 people who need their help.

“Those needs are not going away, and we are not going away,” Mason says, hoping for more resources in the future. “People tell us that our warmline saved their lives. We just wish we could help more people, not only in Seaside but in the whole Monterey County. I hate sending people away.”

Help Is There

Even with waitlists at many mental health service providers, the advice from professionals is: be persistent, and get the care you need. Some free services are listed below.

• Monterey County Behavioral Health: 1-888-258-6029 (8am-5pm)
• Suicide Prevention Lifeline: 877-663-5433, available 24/7
• National Suicide Prevention Hotline: 877-663-5433
• Crisis support: Text HOME to 741-741, available 24/7
• National Domestic Violence Hotline: 1-800-779-7233, available 24/7
• Local Domestic Violence Crisis Line: 831-372-6300 for bilingual services (Spanish and English)
• Monterey County Rape Crisis Center: 831-424-4357 or 831-375-4357 for counseling and supportive services; visit mtryrapecrisis.org
• The Trevor Project Lifeline: (866) 488-7386 or text START to 678-678, with help for LGBTQ+ youth, available 24/7
• Veterans Crisis Line: call 800-273-8255 (TALK), press “1” for veterans
• Boys Town National Hotline: call (800) 448-3000 or text VOICE to 20121 for teen outreach services