Kentucky mental health professionals dealing with case overload after multiple disasters

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Corina Hall remembers looking out her window and watching her car be submerged by water shortly before 4 a.m. on March 1, 2021. Minutes later, water soaked her feet in her bathroom.

Hall said that shocked her. She didn’t expect the water to keep rising, and she didn’t know what to do.

“I’m sitting there trying to dip it out with a mop bucket,” Hall said.

Soon the water was waist deep. When rescuers arrived, Hall said they struggled to open the door because they had to work against the force of the water.

“We had to ride on that boat — that was the scariest thing I ever went through I think because I can't swim and muddy water scares me to death,” Hall said.

Hall said she struggles with the memories and the trauma of that night when a historic flood devastated Beattyville, an eastern Kentucky community of a little over 1,000.

In the last year alone, weather disasters have destroyed or damaged hundreds of homes and claimed the lives of dozens across Kentucky.

The mounting trauma from loss of life, homes and memories of the weather events themselves can often lead to survivors struggling for months or even years on end. While relief efforts can aid in rebuilding homes and communities, it's key for all survivors to deal with the lasting mental trauma left in the wake of many disasters.

In Kentucky, community mental health centers are working to that end.

The state has 14 community mental health centers serving as a safety net for behavioral and mental health services in rural areas, sometimes providing specialty services for populations such as children or those with substance use disorders, which may be harder to find in some counties.

Steve Shannon is the executive director of the Kentucky Association of Regional Programs, which represents 11 of the 14 centers. He said [CMHCs] are a result of a federal bill signed by President John F. Kennedy.

“As opposed to having a system of state psychiatric hospitals, three or four hours away from where people live, the premise was let's go back to where people are and treat them there,” Shannon said. “So they don't have to go to Lexington or they could stay wherever they live.”

The responsibilities are large for these centers, many of them covering geographic areas of thousands of square miles. Shannon said it can be challenging to keep up with the demand.

Yet amid a prolonged pandemic and natural disasters that have compounded the stress and trauma faced by some Kentucky communities, those leading this safety net are trying to hold on to the mental health professionals they do have, facing the prospect of burnout and trauma of their own.

Months and years down the line, long after the immediate crisis, survivors will be coping with their experiences of loss from natural disasters, events that are made more likely from a warming climate.

Responding among the rubble

Danelle Sams and her colleagues woke up to a community that was unrecognizable. The historic downtown and county courthouse in Mayfield, Kentucky were shredded by a mile-wide EF4 tornado, red bricks and debris scattered on the streets.

Historic churches lay in pieces on the ground the morning of Dec. 11 as street signs lay bent sideways or missing. Workers were trapped underneath the rubble of a local candle factory, and other loved ones were still missing.

“We've heard that they are trying to save and talking about the restoration of some of the buildings that were hit,” Sams said. “That's great, but there's still so much that was a total loss.”

Yet her facility in Mayfield was still standing outside of the tornado’s path, although without power, running water or gas. Her coworkers at Four Rivers Behavioral Health rallied to get residents receiving substance use disorder treatment to working facilities elsewhere in the region.

Sams has worked for Four Rivers Behavioral Health in Mayfield – a CMHC serving nine far western Kentucky counties – since 2019 as a therapist and administrator for the site.

A little more than a month out from the disaster, Sams and her colleagues have been knocking on doors in devastated neighborhoods, sending case managers and clinicians to motels and state lodges to meet with those who’ve been displaced.

People are having trouble sleeping, she said, and others are on edge whenever a storm brings rain or thunder into the area. She understands that the recovery of Mayfield will take time, long after the visible destruction of the town is repaired.

But with the outpouring of support, both within Kentucky and outside the state, she believes Mayfield and other impacted western Kentucky communities will persevere.

“Seeing that person answer the door, knowing that they've survived. Maybe they've experienced loss in their own families,” Sams said. “Just standing there and listening to them, you know, and just hearing them and taking that moment. That's the rewarding part of my job.”

Helping the helpers

Challenges still lie ahead for community agencies like Four Rivers. Even before the storm, CMHCs across the state were operating understaffed. Four Rivers Behavioral Health has more than 30 job openings, many of them clinical in nature and requiring master’s degrees.

Thelma Hunter, Division Director of Addiction Services at Four Rivers Behavioral Health, said that shortage can mean some clinicians at the CMHC could have up to 250 people on their caseload – double of what is normally expected – and that was before the tornado outbreak.

“There are shortages of clinicians at every mental health agency that we know of, and they are constantly looking for new clinicians,” Hunter said. “This is just going to make the problem tenfold. We're probably having enough problems meeting the needs of the clients we were having already.”

Telehealth visits at the CMHC have skyrocketed with the onset of the pandemic, with the number of clients receiving telehealth appointments multiplying from 807 in 2019 to 6,214 in 2021. The CMHC is also seeing between 3,000 to 4,000 new clients the past three years, a number that’s about 20% higher than past averages, according to a spokesperson.

Hunter’s worried that with the ongoing stressors of the pandemic and now the widespread devastation of the tornado, effective and impactful clinicians could be lost to burnout. It’s something that the CMHC is trying to tackle in part through a collaboration with the University of Kentucky which began last fall.

The collaboration aims to study secondary trauma experienced by their staff through their work, or the emotional duress one feels when hearing first-hand experiences of another. Leah Fondaw, a part of the team at the CMHC leading the effort, said she still has flashbacks from walking around with the Red Cross to tornado-impacted homes.

“You kind of even feel guilty thinking you're affected when your house wasn't affected, or you didn't lose something,” Fondaw said. “Even seeing it on the news every night has an impact.”

For the University of Kentucky researcher who’s working with Four Rivers on secondary trauma, having mental health professionals be on their “A-game” is paramount in the months ahead, especially for the impacted children they serve.

Ginny Sprang, executive director of the University of Kentucky Center on Trauma and Children, said some children facing vulnerability to trauma disorders through food insecurity, foster care or poverty can experience compounded stress when faced with the pandemic and now natural disasters.

Mental health professionals could face more exposure to experiences that create secondary trauma in rural areas because there may be fewer employees to delegate work to, Sprang explained. Some mental health professionals in western Kentucky may be personally impacted by the tornado outbreak, also.

“In addition to trying to help other people overcome and recover from the tornado, they're having to take time during their day to meet with FEMA, the Red Cross, deal with their own crisis,” Sprang said.

The months after the crisis

As those impacted in western Kentucky continue to seek out their immediate needs of housing and food, residents on the other side of the state show a glimpse of struggles ahead.

In addition to losing their home of five years to flooding in eastern Kentucky, Corina Hall and her partner Danny Spencer lost both of their cars. A volunteer found a van, which became the couple's only shelter.

They lived in the van for a few weeks before finding an open spot at a local hotel paid for by the Red Cross. But when hotel stays ran out, Hall and Spencer went back to the van.

The same volunteer eventually arranged three meals a day for Spencer and Hall at a local restaurant. Hall said living in the van was devastating and she lost the ability to concentrate or think about anything else.

“It seemed like it was never ending. Then you’re sitting in this van all day in the heat,” Hall said. “I cried every day and the last three days in the van, I … gave up. I truly had given up.”

Dave Mathews is the regional disaster grant coordinator for Kentucky River Community Care, one of the CMHCs in eastern Kentucky. He said disaster survivors go through the same grieving process that people do after someone dies.

“When there's a disaster, there's usually a lot of heroism involved at the beginning,” Mathews said. “Neighbors helping neighbors and families helping family members just get through the event, whether it's a flood or a windstorm or tornado or whatever.”

But as time goes by, volunteers leave and attention to the disaster fades.

“They may have come from out of state, they may be involved with an organization that's not a local organization, and it begins to sink in – the seriousness of their plight,” Mathews said. “Because at that stage they really start to mourn, they start to grieve. And they may become very depressed at that point.”

Although the grieving process may take a toll on a survivor’s mental health, seeking help for grief, anxiety or depression isn’t always part of disaster recovery. Mathews said people are far more likely to seek economic help. As the disaster grant coordinator, Mathews works to incorporate behavioral health with other disaster services. Usually, disaster recovery focuses on saving lives.

“We've learned over the decades that the trauma of a major disaster endures, and it may not show itself for weeks or months after the disaster, and then it endures for years thereafter,” Mathews said. “So we are trying to integrate behavioral health professionals and behavioral health services within the entire framework of disaster recovery and resilience.”

On KRCC’s website, a disaster survey asks people about the types of disasters they’ve experienced and how the events have affected them. From February through April 2021, 1,509 surveys were completed. Nearly 81% of responses ranked the COVID-19 pandemic as the number one disaster.

The opioid epidemic came in at number two and flooding was ranked third.

Steve Shannon with Kentucky Association of Regional Programs said CMHC workers meet disaster survivors wherever needed. Currently, that might be in state parks serving as shelters for tornado survivors. Eventually, those meetings might transition to an office, but services are available indefinitely.

“We're not going to leave in three weeks or four weeks or a month, we're going to be present as needed,” Shannon said. “Part of what we do is figure out how to manage that, you know, so we have sufficient people who can respond to the ongoing need.”

Holding on to hope

For Barbara Patterson, the road to her own recovery is just beginning. She lost her Mayfield home of more than three decades where she raised her children, and she says she’s never had much money in her life.

Her husband, Billy, and her are staying in a Super 8 hotel near the county fairgrounds, which is serving as one of several emergency shelters for those displaced until travel trailers, RVs and manufactured home units arrive from federal and state officials.

When she lays down at night and shuts her eyes, she sometimes sees visions of her ruined home that first December morning after the storm.

“It gets hard,” she said, her voice choking on the phone. “I get aggravated at myself because I feel like I'm not the only one, so I should be trying to help people instead of being depressed, you know?”

She said some days have been better than others, though she isn’t used to opening up to others. A local organization her family is working with could provide them a new home, but for now they’ll wait.

Ten months after the floods, moments of recovery and hope are beginning to shine through for Hall and Spence in eastern Kentucky.

The couple was able to find and move into a new apartment in July. Sitting at her kitchen table, Hall pointed out things and talked about their apartment that sits on a hill.

“I love it. I love it. It's got the washer and dryer built in. The bathroom is huge. I love that,” Hall said. “It's just a one bedroom, but it's got a big walk-in closet, and I love that.”

For people still cleaning up from the tornadoes in western Kentucky, Spencer said it’s important to hang on to hope.

“As long as I’m breathing, I’ve got hope,” he said. “Patience comes in there too, but don’t give up hope.”

Hall said talking to a counselor and writing about what happened to her have been helpful. And she hopes other disaster victims will do that for themselves.

“Talk to a counselor, you’ll get there,” she said. “Every day, I wrote about that day.

And like he said about holding onto hope.

“Sometimes it is a very hard thing to do, but hope and faith go hand in hand.”