ENTERPRISE — While Wallowa County has no shortage of mental health providers, there are still areas where mental health workers feel there is room for improvement.

In many places across the state of Oregon, wait times for new patients can range from a few weeks to many months– if providers are accepting new patients at all.

Earlier this year in Union County, the wait time for new patients to be seen was several months, and Grande Ronde Hospital’s Behavioral Health Clinic received 110 new referrals in one week in May, according to an article published by La Grande’s The Observer. 

In Wallowa County, many patients can be seen as soon as the same day they call for an appointment.

With Oregon ranking number two on the list for the worst access to mental health services and providers in the United States in 2022, according to Mental Health America, Wallowa County is a distinguished example of how quick and easy access to mental health providers should be.

“I think that there’s so many more access points now than there used to be. We’re the designated community mental health program for Wallowa County, but Winding Waters Medical Clinic has their own clinicians as well as psychiatric nurse practitioners. Wallowa Memorial has their own clinicians as well, then there are a number of people who are in private practice here in the county,” said Chantay Jett, executive director at Wallowa Valley Center for Wellness.

Caseload and wait times

Geunia Funches, deputy clinical director for Wallowa Valley Center for Wellness, said the Center for Wellness averages 35-40 patients per provider. At other mental health clinics in the state, Funches said, providers might have a caseload of 100-150 patients. Dr. Elizabeth Powers, Winding Waters health services officer and chief medical officer, said Winding Waters Medical Clinic averages about 100 mental health patients per week.

Mollie Cudmore, clinical director and licensed clinical social worker for Wallowa Valley Center for Wellness, recounts why a small caseload is a priority.

“(A manageable caseload) is something we have really hyper-focused on at Center for Wellness, especially in the last couple years, because of (provider) burnout. We want to ensure we provide the support clinicians need so that they can give the best support to their clients, because it is about client care,” Cudmore said.

When a new patient contacts Wallowa Valley Center for Wellness, they receive a call within 24 hours for a screening. Within seven days of the patient first reaching out to Center for Wellness, they will be seen by one of the clinic’s 35 providers.

As of Aug. 1, Wallowa Valley Center for Wellness has one CGAC, one LMSW, two CSWA, four LCSW, five, QMHP, two CADC II, three CADC I, 10 QMHA, two certified recovery mentors, one psychiatric nurse practitioner, five registered nurses, one adult psychiatrist, and one child psychiatrist. Some providers at the Center for Wellness are dual-certified. Winding Waters, as of Sept. 21, has five counselors and two psychiatric nurse practitioners.

Powers said that most patients needing to be seen urgently for a mental health concern can be seen the same day at Winding Waters if they do not have specific requests.

“If a patient calls in and says they need to be seen today for something like stress or anxiety, they will be seen,” Powers said. “If they say they want to see a specific counselor, they may not be available, but we will have an open access provider, including on Saturdays. Any time the clinic is open, we have mental health staff available. If a client has specific demands, such as seeing a specific provider at a specific clinic, they may not get same-day services.”

Creative appointment types

Jett said the clinic had already been offering telehealth appointments even before the COVID pandemic pushed other clinics into moving in the same direction, and Powers said that telehealth appointments were also offered at Winding Waters prior to the pandemic as well.

Power said that now one in five patients still opt for telehealth appointments at Winding Waters.

During the pandemic, Center for Wellness providers didn’t stop seeing patients face-to-face completely, going so far as to visit patients at their home if a patient was afraid to leave due to a fear of getting sick.

“’Hey, I can see my therapist in the comfort of my own home? Like absolutely I want to do that, I can stay home in my pajamas,’” Funches said of patients who loved the convenience of seeing their provider from the comfort of their own home.

Not only do providers at Center for Wellness offer telehealth appointments, but they offer appointments in nontraditional settings.

“We will see people in the community wherever they are. We will see people in their car, in their house, at the park… it doesn’t matter anymore,” Jett said. “It’s kind of gone much more creative than the traditional 50-minute sessions in an office with a couch. We call ourselves the model of being a certified community behavioral health clinic. One of the center’s taglines is “a hospital without walls,” or “non-four-walls” treatment.”

Wallowa County residents who do not want to see a local provider to protect their anonymity can opt for a telehealth appointment with contracted providers who do not live in the county, Jett said.

Powers did not feel that appointments over Zoom made it more challenging for mental health providers at Winding Waters to assess a patient. In fact, in some cases, it allowed for additional insight into a patient and their life.

“The long answer (to whether or not it was difficult to treat patients over Zoom) is that we could still use all the diagnostic tools that are observational, which translated well to telehealth appointments,” Powers said. “You could also see things happening in the background that added additional context. The downside to telehealth was not knowing who else was in the room with the patient and if they were in a safe environment where they felt they could have an open, honest conversation with their provider.”

Isolation and its toll on mental health

Both Wallowa Valley Center for Wellness and Winding Waters said the pandemic exacerbated preexisting mental health conditions.

“My theory is that a lot of these (mental health) conditions were already there and the pandemic sort of magnified them,” Cudmore said. “Those who had a smidge of anxiety might have been faced with pure anxiety and not knowing what to do with it. People might have been like ‘This is the first time in my life I have experienced this… all of these ethical dilemmas and moral compass issues that I have to face,’ and they have to manage that, so realizing, ‘Oh, I do have to reach out and use those tools (mental health care),’ and I think that’s the numbers we are starting to see more of.”

Funches, Cudmore, and Jett all agreed that the pandemic was beneficial in one way.

“I think as far as mental health, the same issues that we are seeing in patients now have always been there, but since the pandemic, people are now talking about it a little bit more and people are wanting to engage in services a bit more,” Funches said.

Similar to Wallowa Valley Center for Wellness staff, Powers felt that isolation added increased stress on patients which led to an increase in anxiety, depression, and substance use disorders.

“As a medical doctor, I have seen a significant increase in mental illnesses since the pandemic. People are stressed in different ways,” Powers said. “There is chaos and uncertainty. Isolation uncovered a lot of underlying depression and anxiety. People couldn’t go out, so they were watching television and watching the news and getting stressed. Some started, or already were, using substances to cope.”

Small wishes and big collaborations

While Wallowa County is not suffering as badly as some counties from a shortage of mental health providers, Jett and Powers wish for a few additional things that could benefit the community.

“I wish everyone would have a mental health check up once a year. Just like a physical well-person check, or a well-child check. There should be a mental health well-person check. That would be really awesome,” Jett said.

Another service that Jett and Powers both wish for is a detox center. Wallowa County has one of the highest prevalences of binge drinking in the state, Jett said.

As things are now, Winding Waters and Wallowa Valley Center for Wellness work together to try to place a patient in need of more extensive treatment into a facility, which Wallowa County doesn’t have.

“So, we have struggled at times with capacity for mental health crisis response, and that is something Center for Wellness has worked really hard on. I think the changes they have made are awesome. My hope is that will continue to grow over time,” Powers said. “But, there are a couple big, glaring gaps in resources. One is transitional housing for people who have been in a residential psychiatric facility or substance use disorder settings and they no longer need that level of care, but they can’t quite fly on their own yet. We need transitional housing where they can have additional support as they gain skills. We also don’t have a robust outpatient substance use disorder program, and also no detox facility. We don’t have some of those intermediate options, but we partner with Center for Wellness and they help coordinate sending them somewhere. But if a patient is not severe enough to qualify for that, there is no intermediate option for them.”

Wallowa Valley Center for Wellness is currently working on the transitional housing need.

“It will be kind of a soft landing spot for anyone who needs it. It is just going to be one room. It’s small, but we are hoping it works really well and it becomes used regularly,” Jett said.

Providing mental health services for Wallowa County residents is a huge, collaborative effort between Wallowa Valley Center for Wellness, Winding Waters Medical Clinic, and Wallowa Memorial Hospital. A level two detox center would take some strain off the hospital, Jett said. 

“I think it is really important for people to understand that you can reach out for help, and that there is hope, and that help is there… it is offered and it is available,” Cudmore said.

If you or someone you know is experiencing a mental health crisis, Wallowa Valley Center for Wellness offers a crisis line that can be reached by calling 541-398-1175.

Winding Waters Medical Clinic can be reached by calling 541-426-4502 

Lines for Life can be reached by calling or texting 988.

“As a medical doctor, I have seen a significant increase in mental illnesses since the pandemic.” – Dr. Elizabeth Powers