LA GRANDE — Grande Ronde Hospital’s Behavioral Health Clinic recently received 110 referrals in just one week, a number that suggests both the shortage of mental health resources in the county and an increase in the demand for mental health services since the COVID-19 pandemic.

It’s a number that also reflects a statewide trend. In 2022, a report prepared by Oregon Health & Science University for the Oregon Health Authority found that Oregon ranks fourth in the United States for a lack of accessibility to mental health services and providers.

Stephen McIlmoil, medical director for Grande Ronde Hospital’s Emergency Services, said the emergency department has seen an increase in overdose patients, possibly as a result of the shortage of mental health resources in Union County.

“Mental illness has been a big thing,” he said. “People being stuck inside because of the pandemic, combined with increased availability of the drugs, and few mental health resources.”

Wait times for new patients

Brittany Pryce, a licensed clinical social worker and a certified alcohol and drug counselor with Grande Ronde Hospital’s Behavioral Health Clinic, oversees the care of nearly 90 patients, many of whom need access to her care on a weekly or monthly basis. Pryce, who specializes in trauma, explained that the COVID-19 pandemic brought about new challenges in patient care.

“Virtual calls were markedly different,” she said. “Patients could just stay home in their pajama pants, which they liked, but new patients were an issue because you had no idea what their normal behavioral patterns were like. It was really difficult to get a picture of patient body language, and it was not as focused and meaningful as in-person appointments. People with psychotic disorders were difficult, such as paranoia, because there would sometimes be connection issues, so there were all kinds of noises that were new and different, which caused some issues.”

Pryce also explained that a patient’s wait time to be seen was shorter before the pandemic.

“It became more evident how many more providers we needed but didn’t have,” she said.

At Blue Mountain Associates, where Pryce worked with Dr. Joel Rice before moving to Grande Ronde Hospital, “eight weeks was a long wait. Now, I am looking at August at this point…. Last week there were 110 referrals waiting to be reviewed,” she said.

The pandemic (and the social isolation it required) affected patients in different ways, she said — but those with outgoing personalities likely suffered the most.

“Introverted patients loved it,” Pryce said. “Anxiety patients got better. But for more socially engaged patients, there were a lot of breakdowns of relationships, anxiety and depression. A lot of patients asked themselves, ‘OK, we have been doing this for two years now, when will this end?’ In kids, they totally broke down because of the lack of peer interactions. It was rough.”

Pryce explained that she has a “Christmas wish list” of mental health services and resources that she wishes Union County had. A dual diagnosis and detox center is one thing on that wish list. A dual diagnosis center treats mental illness and addiction at the same time.

“The closest detox facilities are in Pendleton and Baker. These counties serve their patients first. Insurance coverage is sometimes an issue as well,” she said.

Impacts of isolation

Psychiatrist Dr. Tracy Epperson, with Grande Ronde Hospital’s Behavioral Health Clinic, said she sees eight patients per day.

The workload, Epperson said, “is not easy to keep up with at all because a lot of my patients are new. My caseload has dramatically increased, and we are still seeing a steady climb in patient referrals, so the need (for mental health resources) is still increasing. The need and total caseload has exploded.”

Like Pryce, Epperson has a wish list of resources and services that she would like to see available in Union County. Epperson wishes for more therapists, more intensive therapy options for adolescents and a detox center.

Epperson said she saw the isolation during the pandemic triggering new complaints in patients, with social anxiety being the most common concern.

“I was really surprised to see people who considered themselves introverts struggle remarkably with isolation. It was detrimental to their mental health, and a lot developed social anxiety. We are still looking at what happened and how it impacted people. In the elderly population, we saw a significant decline in their cognitive function from lack of social interaction and stimulation. Lots of dementia got worse, and people developed cognitive impairments even though they didn’t have it before,” she said.

Providers at the Grande Ronde Hospital Behavioral Health Clinic sometimes struggle to help their patients find resources. That can have a long-term effect on providers as well, Epperson said.

“The lack of resources is a self-perpetuating cycle,” she said. “Those of us who are in the field are struggling to help our patients find resources, which is called moral injury, and it is leading to burnout, which shrinks the pool of resources even further” when providers leave the field.

Decriminalization of drugs

Union County District Attorney Kelsie McDaniel also has noticed the shortage of mental health resources in Union County and the impact it has had.

“It is difficult to say if COVID-19 was the cause (of more people struggling with mental health), because we also had the decriminalization of drugs, too,” she said. “We are doing what we can with the resources we have. We started scheduling regular meetings with law enforcement and the Center for Human Development, so in terms of workload, it is not an increase in cases, but an increase in the attention and responses required for the individuals we are dealing with.”

But some of the issues McDaniel deals with involve factors that she has no control over, such as laws and policies that are created at the state level, like Measure 110, which decriminalized certain drugs in Oregon.

“The places I find the most frustration with are things beyond our control,” she said. “Things at the state level, for example, are extremely frustrating.”

Like Pryce and Epperson, McDaniel pointed out the need for a detox center in Union County.

“We would really like to see an acute crisis center and detox center,” she said. “We are definitely working on it and trying to figure out how much it would cost. Based on how many fentanyl overdoses we are seeing, it would save lives in Union County.”