Mental health field preparing for a surge in services Pandemic life has taken a toll on many people Karl Etters, Tallahassee Democrat USA TODAY NETWORK – FLORIDA 12/30/2021 Mental health professionals are anticipating a surge in need for services in the spring as the stresses of the past two years slogging through the coronavirus pandemic catch up. Weary from lockdowns and anxiety over a virus that has killed 765,000 Americans, at least 516 of them in Leon County, there is a delayed physiological response in people who experience such acute stress, said Dr. Jay Reeve, president and CEO of the Apalachee Center. It's a response that itself has been delayed through the ups and downs of the pandemic. "What we anticipated was we would get through the initial spikes of COVID and, as the vaccines rolled out, a lot of us predicted that we're going to see the spike in the service demand," Reeve said. He and others in the mental health profession say those under 18 may need the most help in the coming months. When the pandemic began, waned then surged again with continued mutations of the virus, the number of people seeking mental health treatment remained relatively low as people hunkered down, Reeve said. With more than 52% of Leon County fully vaccinated and positivity rate hovering around 2%, once the acute stress has passed is when the real toll becomes more apparent. "No one anticipated the Delta variant," Reeve continued. "One of the things you'll see with this is mental health and anxiety takes a huge toll. It's after prolonged periods of that fight or flight response then it's the aftermath of that. I'm anticipating this spring is when we're going to see the spike." Apalachee Center provided data about the number of people committed through Baker Acts since 2018, roughly 90% of all admittances locally. They represent an anecdotal snapshot of mental health services administered but are not exhaustive. The state law allows doctors, mental health professionals, judges and law enforcement to commit someone for psychiatric evaluation. It can be done either voluntarily or involuntarily. The data shows an increase in Baker Acts, both voluntary and involuntary, from 2018-19 and into 2020 when the pandemic began. After that, from 2020 to 2021, there was a mild decline, but numbers settled back into pre-pandemic ranges. "We did not see a flood of new Baker Acts across the board during COVID," Reeve said. "We certainly didn't see it spike but we didn't see a lot of diminishment." Psychiatric services need is on the rise Heather Lincicome, the administrator of Tallahassee Memorial Health-Care's Behavioral Health Center said the number of people seeking inpatient services has rebounded to pre-COVID levels while at the same time the number of Baker Act hospitalizations decreased. But the need outside the hospital for psychiatric services, primarily psychotherapy, has grown exponentially. "Outpatient care has skyrocketed and the need for that has definitely risen," said Lincicome, who is also the chief liaison between TMH and the Apalachee Center. The need centers around the varying impact COVID has had on everyone. It's fostered an environment where grief, financial, job, health and life stressors have taken a front seat in people's lives. "We've seen people delaying care until a point of crisis to the point where they're needing urgent services," Lincicome said. She agreed with Reeve that a surge in need for mental health services of varying types was on the horizon across all ages. "It's not a one size fits all. We're predicting we'll have a pretty steady population of kids needing both crisis inpatient and outpatient services. I think the same will be true for adults." Two areas showed a marked increase over the past few years: Baker Acts among children and the number of outpatient calls for service that were handled by a mobile unit that travels the eight counties where Apalachee Center operates. It also works alongside a mobile mental health unit supported by the Tallahassee City Commission. Reeve said since 2018 the number of calls the mobile response team has worked has continued to steadily increase, tripling the number of people served over the last three years, while Baker Acts have decreased. That's a good thing, he said. "One of our overarching goals is to provide services to people in the least restrictive environment possible," he said. "If you're solving it in the street or in the home and getting someone hooked up with services ... that's exactly what we want to do." Child Baker Acts have increased Reeve said increases in child Baker Acts were noticed in 2018 when the center admitted 561 children, 413 of them unduplicated clients. In 2019-20 that went up to 549 unduplicated kids. This year already there have been 543 children admitted for Baker Acts. "We didn't see that 10% or 20% decline in Baker Acts that we did among general population," Reeve said. "We saw it hold pretty steady." There's a number of theories as to why. Typically, child Baker Acts come in waves that dip in the summer when stressors are at a minimum. That didn't happen during the pandemic. "That has to be an impact of what's going on, and I don't think it's just COVID as a disease," Reeve said. "The lockdowns, the anxiety, the homeschooling — there was this whole host of things that interrupted that normal rhythm." Lincicome said child psychiatric care is one area where there is work to do, to handle not only what is likely to be an increase in cases but to connect them and their parents with the right kind of services. A silver lining to the pandemic has been the growing popularity of telemedicine. It allows people who may be hesitant to go to the doctor, have transportation or cost issues or live in rural areas to seek help when the need it. Lincicome noted that outpatient resources are stretched thin. That means facilities like TMH and Apalachee Center need to continue to work on expanding alongside community trends that are heading in the direction of more need. "I don't think that is going to go away," she said. "That is something that is here to stay." - - - Contact Karl Etters at ketters@tallahassee. com or @KarlEtters on Twitter.