Rich in resources, but challenges remain

Editor’s note: Jennifer Donovan is a member of the Mental Health Support Group-Keweenaw Area.

The room was filled, and emotions ran high.

“My son committed suicide four years ago,” one woman said. “Since then, I have made a wish list.”

She was holding back tears. You could hear it in her voice.

“We need our own psych ward here, not hours away or downstate. We need a separate, safer wing in psych wards for people who are suicidal. We need safe housing and support for people after a suicide attempt, a halfway house with trained staff on hand.”

Dr. Michelle Morgan replied, “These needs have been here for a long time. People have been working on them for a long time. We don’t have time to wait. We need to reach out and help each other.”

Photo by Natasha Connell on Unsplash

Dr. Morgan is a psychiatrist and retired director of Copper Country Community Mental Health. She now heads a new organization, Keweenaw Support 4 Healthy Minds, that is working to increase awareness of mental health issues, empower people who have a mental illness, and build a resilient, knowledgeable community trained to help each other and support those at risk.

She was one of the speakers at a Mental Health Awareness Month program sponsored by the Mental Health Support Group-Keweenaw Area on Wednesday, May 11 at the Portage Lake District Library. 

Speakers from five community organizations talked about their work and answered questions. Virginia Lambert and Paige Setter-Hallwachs outlined the many services that Dial Help provides. Beth Shannon and Angela Price described the efforts of Unite Mental Health and Wellness. Mike Bach, incoming director of Copper Country Mental Health, discussed the work of his state and federally-funded agency. Cindy Harrison and Catherine Paavola explained the history of Mental Health Awareness Month and their Mental Health Support Group-Keweenaw Area. And Dr. Morgan described the vision and goals of Keweenaw Support 4 Healthy Minds.

Unite Mental Health and Wellness

Recently established and based in the former College Avenue Vision Clinic near downtown Houghton, Unite Mental Health and Wellness helps people connect with mental health services. They hope to help people who are feeling overwhelmed navigate the mental health system. The organization is a nonprofit offering both telehealth services and in-person therapy. Medicare, Medicaid, and most private insurance cover their services.

Dial Help 

Dial Help is best known for its crisis hotline, but they actually run four different programs for Houghton, Keweenaw, Baraga, and Ontonagon Counties: 

• Crisis services, including the 24/7 crisis line; Safety Net, which is a follow-up program for people at risk of suicide, suicide survivors, families of suicide victims, and those seeking help for substance abuse; suicide assessment at UP Health System-Portage’s emergency room; and Youth One-Stop, a counseling program for youth in crisis.

• Victim services, which include 24/7 emergency advocates, ongoing advocate support, child advocacy, counseling for crime victims, accompaniment to court proceedings, and sexual assault nurse examiners.

• Mental/behavioral health, including alcohol or drug assessments, peer recovery groups, substance abuse counseling, suicide prevention training, and Crisis Support 101, based on Dial Help’s crisis line.

• Prevention programs, which include Communities that Care—a federal substance abuse and violence prevention program, family support services, in-school prevention programs, and violence prevention education.

Dial Help also answers the national Suicide Prevention Hotline for callers from our area.

The Dial Help crisis line is 906-482-HELP (4357).

Copper Country Community Mental Health

This agency is primarily federally and state-funded, with philanthropic support from the Rice Foundation and grants. It provides a variety of mental health services to people receiving Medicare and Medicaid, including emergency services, outpatient therapy, peer support, intensive crisis stabilization, home-based services, nursing home services, and residential services in group homes. It also sponsors the Northern Lights Clubhouse in Hancock where adults with mental illness work together to build on their strengths, talents, and abilities to increase their independence in the community. 

CCCMH’s emergency number is 800-526-5059. The new request for services number is 888-906-9060.

Keweenaw Support 4 Healthy Minds

The group was formed after Keweenaw County Sheriff Curt Pennala organized a public meeting to discuss increasing teen suicide. Its vision statement is: “We support healthy minds through connection and community.”

Goals include raising awareness and getting people to talk more openly about mental health issues, teaching healthy ways to cope with stress, supporting those at risk, and decreasing access to means of doing harm to oneself or others.

“You lock up your toxic chemicals to keep them out of children’s hands,” said Dr. Morgan. “You also need to lock up your guns.”

This summer, the group is focusing on helping people learn to talk comfortably with someone in crisis. They are offering free training in QPR, which stands for question, persuade, refer. The Keweenaw County Sheriff is planning to become a QPR trainer, Dr. Morgan said. 

She hopes to build Circles of Support, volunteers who can help a person just released from a psychiatric hospital. The highest risk for suicide occurs during the first 30 days after hospitalization, she said.

Keweenaw Support 4 Healthy Minds meets at 6:30 p.m. on the last Tuesday of the month at the Portage Lake District Library.

Mental Health Support Group-Keweenaw Area

A peer support group for people with mental illness and their families, the Mental Health Support Group-Keweenaw Area was founded in 1989 by Larry and Carol Evers, with the help of Copper Country Community Mental Health.  It then became a chapter of the National Alliance on Mental Illness (NAMI). The group decided to drop its affiliation with NAMI in 2018, due to national NAMI’s financial and organizational requirements becoming increasingly difficult, if not impossible, for small, rural groups like this one to meet. 

But the need for support remained, so the group reorganized as a purely local nonprofit called Mental Health Support Group-Keweenaw Area, partnering with Dial Help. They meet at The Institute, 900 W. Sharon Avenue in Houghton, at 6 p.m. on the second Wednesday of the month. They also sponsor public programs like the one recognizing Mental Health Awareness Month. This year’s Mental Health Awareness Month theme is Back to Basic, a renewed focus on mental health awareness and combating stigma. 

The Mental Health Support Group-Keweenaw Area has no website or phone number but can be reached by email at mhsgka@aol.com.

During the question and answer session at the Mental Health Awareness Month program, Catherine Paavola, a Mental Health Support Group-Keweenaw Area member, said that it would help eliminate stigma if people called mental illness “brain illness.” 

She explained: “The brain is the organ of the body that is affected. Brain illness is organic, centered in the brain. It is not a moral failing or a choice.”

Cindy Harrison, also active in the Mental Health Support Group-Keweenaw Area, gave a shout-out to law enforcement.

“The police and sheriff’s departments in our area have been outstanding in their concern about mental health issues,” she said. “They are getting Crisis Intervention Training, learning how to defuse a person in crisis and get them to the proper services.” 

Mary Peed, a Keweenaw Support 4 Healthy Minds member, pointed out that there are other mental health resources here too, the VA for example.

“You just have to keep looking and knocking on doors,” she said.

Relying on One Another

If you’re struggling with your own mental health or a family member’s illness, you have to deal with extra appointments and supervision, finances and expenses, maybe even jail visits and court appearances, and more.

Most people have a personal support network, but for the unique problems a mental illness can present, a more educated, experienced, and patient ear is helpful but can be hard to find. Ones that understand the sensitivity and stigma associated with the illness and experiences can be even rarer.

One place those are freely available is at the Mental Health Support Group - Keweenaw Area, or “not-NAMI”, as the members sometimes call it. The group used to be a part of NAMI, the National Alliance on Mental Illness, and many of its members still are individual members under the Alger/Marquette NAMI group, but heightened requirements and lowered membership caused the Houghton group to give up its national affiliation in 2018. Determined to continue supporting each other, they reorganized as an independent support group.

Several regular group attendees agreed to interview with me, and I was able to attend part of one of their confidential meetings.

“NAMI is a wonderful organization,” Catherine Paavola said.

Paavola is a regular attendee at the MHSG-KA meetings, has a degree in school psychology, and is also a board member with Copper Country Community Mental Health. Her adult son was diagnosed with schizoaffective disorder with bipolar disorder in his mid-twenties and has struggled with the illness for more than a decade.

She said she prefers the term “brain illness” to mental illness.

“Nobody can tell me where their mental organ is,” Paavola said.

She said what the MHSG-KA offers is a place you can “actually pour your heart out…” without judgment, and without people tiring of hearing about the same recurring problem. Paavola said other maladies people usually either recover from or die from.

“Brain illnesses aren’t like that, they’re forever,” she said.

She said the support group can’t always offer help, but they can offer suggestions and encouragement.

“We pray for one another, you know,” she said. “But the most important thing is, we listen.”

One group participant agreed to speak with me but wished to remain anonymous to protect future employment opportunities in the face of stigma against their schizophrenia and obsessive-compulsive disorder diagnoses.

“I’m very fortunate, actually, to be fairly high-functional,” they said. “I hold down jobs, I manage my finances and other responsibilities, I engage in social situations.”

Other than the MHSG-KA, they also maintain a good support system of friends and, using coping techniques and medications, have learned to mostly manage as an individual.

Nonetheless, they see the value of support groups like MHSG-KA and even host other small, virtual groups in conjunction with the Schizophrenia Alliance.

One shortcoming of support groups in the pandemic was their reliance on streaming technology to overcome physical distancing requirements. Rural participants on unstable connections didn’t feel fully included.

“The video is in and out and the words are garbled…” Matt Olson said. “It’s better than nothing, but it’s not much better than nothing.”

Matt and Nola Olson have guardianship of their 20-year-old daughter, who’s been diagnosed with schizophrenia, anxiety, depression, obsessive-compulsive disorder as well as some other general health issues. She sat nearby listening as I spoke with her parents.

“I’m not going to say our daughter has the worst case, but it’s pretty severe,” Matt said.

They’re happy to have her at home and that she’s being cared for by people who love her, but they don’t feel they get the support they need to make it truly work well. One thing they find is particularly lacking is the availability of respite care for Nola, who cares for their daughter almost all day, every day while Matt works as a well digger to support the family.

“She’s still our daughter, we love her very much, but there’s a point where most people, their children are having lives of their own,” Matt said. “And we’re not there yet, and it creates a lot of stress.”

To care for someone with their daughter’s needs requires someone with considerable knowledge and training, and while members of MHSG-KA are supportive, most of them don’t have that experience, and not all of the Olsons’ extended family is understanding or supportive.

“My mom came around, and she does help us,” Matt said.

However, his mother is getting elderly and can’t help out for very long, or for overnight periods. Nola has recently been diagnosed with fibromyalgia, which her doctor believes is stress-induced.

The Olsons do like attending in-person MHSG-KA meetings when they’re available, saying it’s an “awesome time for sharing, for support.”

Another problem with the groups is trying to get the word out. Paavola said they’ve received little response, let alone support, from local healthcare offices, and the Olsons, who are interested in a schizophrenia-focused respite care group, don’t have a way of contacting other families who might want to join them.

CCCMH and other health organizations and state agencies might have that information but HIPAA law prevents them from being able to share it with group organizers without gathering permissions from each individual.

The “not-NAMI” group has recently resumed meeting monthly, in person, where they share round table discussions about themselves and their loved ones. You can contact the Mental Health Support Group - Keweenaw Area by emailing MHSGKA@aol.com.

New programs rising to meet young people’s mental health needs

Tiers of mental and emotional support for students from kindergarten up

A survey of parents conducted by the University of Michigan found that 16.5% of youth between the ages of 6 and 17 experienced a mental health disorder in 2016, but about half of those estimated 7.7 million children went untreated.

In much of Houghton County, there is an overlapping and growing network of programs designed to address the mental health issues of youth as early as possible. They don’t meet every need, but several are newly implemented and seeing positive results even during a tumultuous time.

Many schools are also focusing on mental health supports for students without impairments, or any illness or acute needs at all, too. The idea behind these new programs is to support a student’s mental health needs, starting from basic social support and potentially scaled up to 1-on-1 therapies, as necessary.

Multi-tiered Systems of Support

This is based on Positive Behavioral Interventions and Supports and is being rolled out through the Michigan Department of Education and locally through the intermediate school district. MTSS was launched to take a more proactive approach to identify students with greater needs by first taking a schoolwide approach to basic mental health supports. The program is optional.

“School districts can choose whether or not they have tiered levels of support for students in the schools,” Natalie Morgan said.

Morgan is the mental health services coordinator with the Copper Country Intermediate School District.

Not every school district is involved with MTSS. If districts choose to participate, they create a local team that works with Morgan or another CCISD “coach” to develop and execute the details of their MTSS program.

All students in participating districts are screened and school data is assessed three times throughout the school year. Tiers of support can be escalated to meet an individual or group of student’s needs. Parental involvement is also emphasized.

“We try to have as much communication with parents as we can,” Morgan said.

Sometimes the school can call meetings between a student’s parents, teachers, mental health provider, and even an administrator if necessary, but there are other, positive steps taken first.

“Every student throughout the school gets the tier one supports,” Morgan said.

Tier one - School-wide, foundational work to create a generally structured and supportive atmosphere for students. 

This can look different in different schools and classrooms. The structure element comes from the expectations of behavior and conduct.

“So the things that are in, like the student handbook,” Morgan said.

Rather than simply having these posted or distributed, the teacher takes time to teach what the expectations of behavior are.

“Then tier two supports are for those students who just need a little extra boost of those tier one expectations,” Morgan said.

Tier two - Group-level interventions that might include a special reading group or study hall. 

These groups can offer some students some extra assistance toward catching up with peers on schoolwork or offer social-emotional learning lessons.

“So that could be friendships, it could be talking about empathy,” Morgan said.

After seeing a lot of missing homework in their data, Baraga High School recently had a homework catch-up day that allowed students to catch up on homework.

“They didn’t tell the students about it at first…” Morgan said. “The percentage of homework completion that was done was like, through the roof.”

Tier two might also include regular 1-on-1 check-ins with teachers throughout the day.

“And it’s not, you know, a 10-minute conversation,” Morgan said. “It’s ‘thanks for sitting down and getting your pencil out right away’ kind of thing.”

Tier three - Individual interventions for students who might need support like 1-on-1 counseling.

“We have a whole range of students who are referred for services,” Morgan said.

Sometimes a student can be referred because of truancy or problem behavior in class, other times it can be because of something that happened at home.

“So it kind of depends on what the school is seeing and how they assess that situation,” Morgan said. “And then a lot of times it’s a referral to services here. To the ISD.”

The CCISD has two full-time and two part-time clinicians to meet referred students with mild to moderate needs. Students with extremely high needs can be referred to Copper Country Mental Health or served by CCISD staff under Project AWARE.

Sessions are usually once a week for 30 to 45 minutes.

Project AWARE

A new program to the area, this program is launched with federal grant dollars from the Substance Abuse and Mental Health Services Administration.

“We technically started it in like January, maybe February of this year,” Morgan said.

Along with some money toward supporting youth mental health treatment, it also funds money toward public education and fighting the stigma surrounding mental health treatment.

One program under this umbrella is Youth Mental Health First Aid. The training is for people like youth pastors, team coaches, and other people who regularly interact with youth.

“It can be employers if they’re an employer that employs youth,” Morgan said.

The training helps someone recognize if a youth is struggling with something and get them any needed support.

DEFINING TRAUMA - A quick sidebar

Trauma is often thought of as something that occurs after a violent or sudden event, like a fire, car crash, or physical abuse.

“It can be that car accident or that one event that happened that’s traumatic,” Morgan said.

But it could also be a divorce or death of a close family member or mentor. There are also complex traumas like generational drug and alcohol abuse or poverty.

“When a traumatic experience happens it can shift how your brain absorbs information,” Morgan said.

The traumatic experience becomes a lens through which the entire world is filtered.

“We see that in soldiers who come back from war,” Morgan said. “If they hear a door slam it can trigger their brain into thinking that is, you know, a gunshot or an explosion of some sort.”

For children, different things can be experienced as traumatic.

“We’ll work with students who have adults in their life who have identified a traumatic experience that the student went through,” Morgan said. “We’ll start working with them and they don’t see it as traumatic.”

When that’s the case, Morgan said they don’t pressure the person to see it as a traumatic event. She said it all depends on how the individual is internalizing an experience. If a person feels it is traumatic, and that memory is impacting how they perceive and react to the world, then therapists work to help them.

Therapy under Project AWARE is with Morgan as a therapist and Andy Kalcich or Allie Richmond, CCISD mental health services specialists, for skill-building. Therapy is where a student might work through trauma or practice mindfulness techniques. In the skill-building portion of their work, they talk about things like what coping skills they use, and each’s respective effectiveness for that individual.

Capturing Kids’ Hearts

Capturing Kids’ Hearts is a program launched by the Flippen Group that also relies on some of the same PBIS science in MTSS, but involves more intensive, direct training for the adults in a school than the state has dedicated for MTSS. CKH particularly focuses on building strong relationships between the students and adults within a school.

Calumet, Laurium and Keweenaw Elementary School recently launched their program locally with grant assistance from the Portage Health Foundation, and this year they were recognized nationally as a model school. It’s only the second year they’ve participated in the program. The selection process includes a direct evaluation as well as surveys from students, parents and staff.

“But the biggest thing to hang our hat on,” Julie Giachino said, “is just the culture we’ve created for these children and staff.”

Giachino is the assistant principal at CLK Elementary School, and one of the school’s first participants in the Flippen Group’s 2-day training. She described the culture transformation as “magical.”

Students are individually greeted as they enter the school building and classrooms.

“You’re engaging that student and finding out--What are their needs, right now?” Darren Kinnunen said.

Kinnunen is the social worker at CLK Elementary. He said a student isn’t going to learn well if they have distractions like needing breakfast or having lost something important to them, or other personal issues. These initial, immediate check-ins are a way to discover those needs and address them before they lead to bigger issues during instruction.

Photo provided by Julie Giachino

One of the first things a class does together at the beginning of the year is create their shared social contract.

“It could be viewed as your set of rules,” Giachino said.

The group develops the classroom rules for the year together, with the teacher leading a discussion about how the students want to be treated, and how the teacher should be treated. Involvement in the process empowers kids to check in on each other, as the rules are shared, rather than just the teacher’s own.

“So anytime there’s conflict or anything in the room… we always go back to that social contract,” Giachino said. 

The school staff also develops one for themselves at the beginning of the year. In kindergarten classrooms, they call it the ‘classroom promise’ to keep the vocabulary understandable to the young students.

Two examples of social contracts developed at CLK Elementary this year. The one on the left is from a kindergarten classroom, the one on the right is the staff social contract. Photos provided by Julie Giachino.

Kinnunen said that some instruction time is lost to these extra interactions, but by eliminating distractions and stress students can focus more on academics. He said that Horizons Alternative High School has found more classes are being completed since they’ve started spending time implementing Capturing Kids’ Hearts.

“Once you have their heart, their minds are open,” Giachino said.

The concepts of CKH are along the same guidelines at Tier one MTSS supports. The program also dovetails with other programs CLK Elementary has enacted in the last couple of years.

KINGS Time

Through each week, the CLK Elementary School’s social worker, Kinnunen, spends 40 minutes with each class talking about things like problem-solving, developing empathy, understanding your own emotions, and social interaction.

“Some kids are maybe getting it at home, right?” Kinnunen said. “Just because of the household that they have. Some kids aren’t getting it.”

It also helps Kinnunen build a rapport with the kids so that if they come in to see him about an individual problem, they already have the basis of a mentor-mentee relationship.

“For me, it’s just a great opportunity to connect with kids,” Kinnunen said.

These social classes are also very similar to some Tier two MTSS supports, but enacted across the entire elementary school rather than targeted.

Therapy Dogs

Benny the therapy dog and Matt Hampton, CLK Elementary principal. Photo by Joshua Vissers

The CLK district currently has five hypoallergenic therapy dogs that spend their days at the schools. Two are in the elementary school. Sometimes they’re scheduled to be in classrooms, other times they’re in one-on-one meetings.

“He even comes in here once in a while for some of our parent meetings and he’ll jump over there on the chair,” Matt Hampton, CLK Elementary School principal, said. “It really not only puts students at ease but also puts parents at ease.”

Right now the new dogs are training with Hampton and waiting for programs to restart after the pandemic. The dogs that have been in the building longer went through Pet Partners training.

“It’s been a great success for us,” Kinnunen said.

Handle With Care

CLK Schools have coordinated with local police in this state program to increase their awareness of what students are experiencing outside of school. 

“We recognized that there are some students in our district that may have been affected by just, trauma, in their life,” Kinnunen said, “and that maybe we weren’t picking up on some of that.”

Kinnunen would sometimes find that students in his office had major events happen in their lives that the school staff was completely in the dark about.

In the Handle With Care program, if police encounter schoolkids when on a call, they inform the school; not of all the details, but simply that the student may be tired from lack of sleep, distracted in class by something that happened, or need extra support temporarily.

“Depending on the circumstance, it might just be a check-in and not really talk about what happened last night,” Kinnunen said. “But just to say ‘Hey, how are you doing?’”

It’s a simple program, conducted via email, and Kinnunen highly recommends it to other districts.

Copper Country Mental Health

In addition to assisting schools with many of the above programs and being directly involved with Project AWARE, Copper Country Mental Health also provides several independent programs. 

“We provide a whole array of services, as required by the Michigan Department of Health and Human Services,” said CCMH Executive Director Cari Raboin.

Much of their programs are paid for through Medicaid, which sets a severity condition on the treatment they can offer and requires them to follow other MDHHS rules, too. 

Independent referrals go through NorthCare Network. Most children need a parent or legal guardian involved, but there are some limited services available without parental consent to those over the age of 14.

Leslie Griffith is the outpatient program director at Copper Country Mental Health, but spent 17 years of her career focused on early childhood and youth treatment, a segment of the population she says are particularly underserved.

CCMH considers youth to be prenatal to age 21.

Griffith wrote in an email that the goal of youth intervention programs is to reduce problematic behaviors and symptoms to ultimately have “a decrease in functional impairment”. Functional impairment is simply the barriers or limitations an illness places on carrying out a person’s daily life.

Services can be paid for through some private insurance, Medicaid, or MiChild insurance, according to Griffith. Charges are also income-adjusted.

“I’m concerned that people aren’t calling us who are eligible for our services,” Raboin said.

She said anyone in doubt of their need or financial assistance eligibility should call 1-888-906-9060 for a screening.

Parent Support Partner

PSP is a program to help parents with training and support to be caretakers of children with serious emotional disturbances. The goal is to move families to independence from counselors and other interventions through training in how to directly participate in the treatment process.

Youth Peer Support Services

This program pairs youth with a young adult to offer advice and support.

Wraparound

This program helps coordinate the supportive adults in the orbit of a child who has serious emotional disturbance to have a team approach in managing the necessary support. The program is especially effective for those involved with multiple institutions.

The Institute

A variety of education and training programs.

Dial Help

A local organization originally established to address addiction, Dial Help now offers a variety of support services.

Crisis Line

To talk to someone about available help and resources in the community, Dial Help keeps someone available around the clock. They offer specialized youth services and can make referrals to other experts.

Call: 1-800-562-7622

Text: 906-356-3337

Communities That Care

Dial Help supports the local Communities That Care initiative, which uses an evidence-based prevention model to address youth substance abuse, delinquency, and mental health. The organization relies heavily on volunteers.

Pandemic’s impact on youth mental health

“There’s definitely been some ups and downs,” Morgan said.

One of the positives, according to her, is that insurance companies and other institutions have come to recognize the value and effectiveness of teletherapy, which is conducting therapy sessions via video conferencing.

“Some of those students who have been virtual, we’ve done virtual sessions with them,” Morgan said.

She said more people have been able to participate in meetings virtually, too.

On the other hand, the distance has created some problems, too.

“If a student doesn’t want to meet, they just don’t log on,” Morgan said.

Morgan said the pandemic exacerbated the anxiety and depression some students they see were already feeling.

“So it’s just being able to recognize that and really working with students on different coping skills and things that they can use to kind of help get through this,” Morgan said.

The CCISD staff has been approved to keep meeting with students into the summer.

At CLK Elementary, the challenge was how to continue connecting with students when schools went virtual. CLK Elementary was only closed twice in the last school year, both in the fall, but the staff said switching back and forth was difficult.

Social contracts and regular greetings continued, but the venue changed.

Kinnunen said that they tried to maintain what schedule consistency they could so that students could develop new habits.

“We’re all creatures of habit, right?” he said. “Anytime there’s a shift, it just throws your system.”

Kids that didn’t show up for classes got calls from paraprofessionals and other staff from the school to check in on why.

The change to virtual learning also presented some students with issues finding both devices and internet access to participate. Different solutions were found for each, with the Portage Health Foundation assisting with establishing wifi hotspots, too.

Struggling to meet community staffing needs

“It’s mostly just qualified therapists to provide the services,” Morgan said.

Morgan said the CCISD has been fortunate in their hiring, but other ISDs in the UP have struggled just to find qualified people to fill those positions, and keep them there.

Currently, the CCISD has a small staff serving several school districts, with more joining the MTSS program. Morgan said more support from within the individual school districts would be very helpful. Social workers in schools, like Kinnunen, are beginning to be more common.

“If we could have, you know, be able to provide a social worker in every school, that would be phenomenal,” Morgan said.

Griffith wrote that there are “certainly” unaddressed needs in the community, but that families with higher income have access to private practitioners.

Raboin also said staffing is an issue. CCMH covers a four-county area with a small staff that has to be able to do many different things. 

“Our staff really have to be jacks of all trades,” Griffith said.

Frequent turnover makes keeping well-trained people on the job difficult. The geographic differences across the state aren’t always accounted for in the requirements they’re placed under, and encouraging needed people to move to the area isn’t always easy, either.

Social workers and therapists have specific educational requirements that have to be met as well. Raboin said CCMH has found success using remote teletherapy for their patients, as then therapists can be non-local.