Advocating for high-quality and accessible mental health services in Fauquier and Rappahannock Counties.
Sallie Morgan, Executive Director of Fauquier County Mental Health Association, thinks of her organization as a catalyst for positive change. And what has happened since its inception has been an explosion of good for our community. While the MHA doesn’t provide mental health care to patients directly, its influence can be felt strongly throughout our community in youth programs, substance abuse programs, and overall in helping Fauquier County and Rappahannock County residents lead fulfilling lives with access to mental health care. If it has something to do with increasing people’s quality of life through mental health care or substance abuse prevention and treatment, you can bet that the MHA has had a hand in it somewhere, working hand-in-hand with health professionals, the schools, and other community organizations.
In a nutshell, the MHA is a problem solver. “Our role is to study the community and identify problems, and then ask ourselves, what can we do to solve that problem. Then we say, let’s pull people together, let’s look at models, let’s figure out the concept, let’s go after funding and start the project toward implementation,” said Morgan.
MHA started in 1964 as a grassroots organization, formed by residents of Fauquier County who were concerned because there were no mental health services in the county, or anywhere in the region. They started the first mental health clinic in the community via a state grant. When the Rappahannock Rapidan Community Services Board was formed, they took over the clinic and the MHA transitioned into what is now an advocacy, planning, and education organization that connects people to local resources. Morgan said, “We decided it would be really great to take a different look at things instead of being on the front lines of delivering services, to be able to step back and look at how our community could improve the whole system, take a look at big picture. We have the time and staffing and interest to look at where education could make a difference, where new services coming in could make a difference.” Three of MHA’s current projects are the Collaborative Care Project, the Mental Health First Aid Classes, and their Youth and Family Initiative.
Youth and Family Services
A main emphasis of the MHA is caring for the mental health of Fauquier County’s young people. Morgan explained, “We know that half of mental health issues show up by age 14, and 75 percent become apparent by age 24, so if you can intervene early with a child, you can not only take away some of the barriers to their development but you can even change the course of a serious lifelong condition. So, we have put a lot of stock in working with children.”
The MHA was instrumental in administering the PRIDE survey a couple of years ago to 4450 seventh through twelfth graders in Fauquier County, which yielded a plethora of helpful data. The survey revealed that 30 percent of students have had symptoms of severe anxiety or depression, and that the average age of first experimentation with drugs or alcohol in Fauquier County occurs at age 13, lower than the last time the survey was given. “That’s significant because youth who start using at 13 or younger have a 70 percent risk of becoming addicted.” That information gave rise to the Youth and Family Initiative through which public and private schools, law enforcement and other community partners to address mental health and substance use concerns among local youth. MHA is working together with these groups to increase awareness, offer prevention programs, support parents, and increase treatment options. Recent efforts have included workshops for students and educators on the risks involved with vaping, the impact of screen time and social media on mental health, and forums on treating opioid addiction. MHA is also working with the Fauquier and Rappahannock schools to conduct the PRIDE Survey again later in 2019 to give the community up-to-date feedback from students.
Collaborative Care Project
Collaborative Care refers to the integration of mental health care and substance abuse treatment with the primary care physician’s office. The MHA was a catalyst and partner for accomplishing this at the Fauquier Free Clinic, leading a planning effort with clinic staff and local physicians, and then applying to the PATH Foundation for a grant for the Collaborative Care Model which enabled the clinic to hire a full time mental health coordinator to serve the approximately 40 percent of their patients who are in need of mental health services. The Free Clinic has recruited clinicians from the community to provide services on a pro-bono basis, and also offers tele-psychiatry and tele-mental health counseling to meet the growing demand for services. Currently, the Free Clinic is seeing 135 people per month solely for mental health treatment.
The program at the Free Clinic has gone a long way to increasing the availability of mental health services for financially vulnerable patients in our community, but access to mental health care is a problem for many others in our community who do not meet the criteria for the Free Clinic.
Most mental health care in the U.S. is actually provided by primary care physicians, and most of the time that works just fine. But primary care physicians don’t always have the time that’s necessary for mental health treatment, or the expertise for the more severe forms of psychiatric illness.
“That is our next step,” said Morgan. “We started to ask ourselves, how can we take this collaborative care that has worked so well at the free clinic to the broader community? We call it Phase Two of our Collaborative Care Project, looking at how we can help local physicians, particularly primary care physicians, meet the mental health needs of our community, so we are looking at solutions.”
“As many mental health issues are first expressed as physical symptoms, eventually we’d like to see all primary care physicians screen all patients for possible mental health problems, and then we want to help them know where and how to connect those patients with treatment.”
“Another option to supplement the currently available services is tele-mental health,” said Morgan. “There’s a lot of evidence that it works as well as seeing a provider in person, and many of its advantages are obvious: availability in areas where there are no providers, convenience, access to remote specialists such as child psychiatrists that are hard to find, and receiving treatment right in your own home without traveling. “The Free Clinic has had great success with tele-mental health services at the clinic, and there are also provider options for direct connection to patients in their homes,” said Morgan.
Mental Health First Aid
MHFA is an evidence-based education program that teaches people ages 18 and over without a mental health background about mental health and substance abuse issues, how to recognize them, and where to turn for help. Morgan said, “I am a firm believer that the mental health first aid is one of the things that could really change a community because the more people talk about these issues, the more we are combating the stigma still attached to mental health.”
There are two MHFA programs, one concentrating on youth and one on adults. A typical class focuses on depression, anxiety, psychosis, substance abuse signs and symptoms, suicide prevention, and how to respond to these situations. The Youth Mental Health First aid is primarily for youth-serving adults: teachers, coaches, boy scout leaders, and others who work with young people. “More than 1600 people in Fauquier and Rappahannock have taken the mental health first aid class, of whom more than 500 were school employees, and the rest, residents of the community. Others who have taken the classes include church congregations, fire and rescue personnel, law enforcement, social services, and even the local library staff,” said Morgan. The classes are open to everybody. “It’s a pretty intensive eight-hour course, so it’s a commitment, it’s a lot of information. We try to schedule them about once a month,” said Morgan. “In addition to the eight-hour course, we also offer one- to two-hour programs on specific topics (e.g. coping with anxiety, what parents need to know about substance use, dealing with trauma) which we’re pleased to present to church groups, civic groups, etc.”
Mental Health First Aid is all about empowering people to recognize problems and ask for help, and in that vein, one direct service MHA does offer is information referral services for local residents who are seeking treatment. “It is often very difficult for people to ask for help, and if they can’t find a counselor when they reach that point, many will give up,” says Morgan. “In fact, the average length of time between the onset of symptoms and receiving treatment is 10 years.” To help people connect with treatment, MHA launched a new website in late 2018 (www.fauquier-mha.org) that includes a comprehensive database of local providers. “We also talk with many individuals by phone to help them sort out what kind of care they need and where they can get it.”
The MHA’s goals are big, but their significant accomplishments are made with a tiny staff and a dedicated board of directors. Today, the MHA consists of two salaried staff, Morgan and Community Outreach Coordinator Brittany Dwyer. Their work is supplemented by John Waldeck, who does some contractual work as special projects coordinator. “We have a really great 14-person board, a very active board. They help us raise funds but they are also very active in being mental health ambassadors in the community and developing our programs. We’ve also had wonderful support from the PATH Foundation, the Northern Piedmont Community Foundation, NOVANT/UVA Health, and many generous donors. Together we really can change the conversation about mental health and improve access,” concluded Morgan.