In Minnesota, communities of color have been hit particularly hard by the global pandemic. Mental health experts around the state are concerned about the toll this added stress could take.
This fall, in response to what they identified as a lack of mental health resources targeted for the Twin Cities’ BIPOC community, Headway Emotional Health, a 50-year-old nonprofit provider of mental health services, significantly expanded service offerings at its location in Brooklyn Center, a Twin Cities community where the majority of residents are nonwhite.
I had a few questions about Headway’s recent expansion, and about COVID’s impact on the clinic’s diverse client base, so I posed them to Teri Clayton, Headway’s managing supervisor of outpatient and psychological services.
Why did Headway expand their service offerings in Brooklyn Center?
Clayton explained that for some time, Headway “had it on the radar” to expand care offerings at their Brooklyn Center location, but COVID accelerated the plans.
“We recognized that mental health needs in the area were growing but aren’t covered that much by the services already available there,” she said. “We felt like the time was right to build on our service offerings so we could better serve the community.”
Expanding the Brooklyn Center office also felt appealing because the community is well connected to public transportation, Clayton explained, making the location accessible for clients who face transportation barriers.
Services offered at Headway’s Brooklyn Center location now include outpatient therapy for children, adults and families; case management for children with mental health needs and their families; a mental health day treatment program for middle and high school students; and psychological assessment and testing for clients of all ages.
Even with Headway’s expansion, Clayton said, Brooklyn Center remains “an underserved area,” with fewer mental health care options available than in other, whiter, communities. She said that by promoting its expanded service offerings, Headway hopes to spread the message to residents that seeing a professional for mental health concerns is as normal and important as visiting a physician for a regular checkup.
“I think that BIPOC are historically less likely to seek mental health services,” Clayton said. “We’re trying to provide services that are open and nondiscriminatory, of course, and to promote that for people. We want to normalize this experience and make it as available as possible.”
Has COVID had a significant impact on the mental health of communities of color?
The global pandemic has had a negative impact on the mental health of all Minnesotans, Clayton said.
“I think COVID has significantly impacted the levels of depression and anxiety in the general population. For a lot of people, depression is related to social isolation as well as the external stressors that people are facing in relation to COVID.”
But because members Minnesota’s communities of color face higher COVID-19 infection and death rates, Clayton added that she believes the mental health of the state’s communities of color has really taken a beating.
“I think that is related to a lot of the systemic inequities that are out there,” she said, explaining that grief and loss can spur depression. “A lot of people have lost loved ones to this disease. They haven’t been able to have the closure or work through their grief because they can’t see their loved ones or have a funeral or similar things that are typical ways we get closure.”
Anxiety can stem from facing the unknown, including “worries about what is going to happen and things that can’t be controlled,” Clayton said. And when an individual’s job carries a greater risk of infection, say in the health care or service industries, that can also be a cause of anxiety and stress, she said, adding that many of the state’s service and health care workers are from minority groups.
In an attempt to serve even more clients of color, Headway offers culturally specific programming, including Family Spirit, a program originally designed for Native American families where specially trained mental health professionals offer mental health care for children and adults in their homes. Thanks to a grant from the Otto Bremer Trust, Family Spirit expanded in 2018 to offer culturally specific home care to East African families.
The idea behind the program is to increase families’ sense of comfort around therapy and to develop treatment strategies focused on their specific cultural needs, Clayton explained. She said that Headway leadership is working to develop more programming designed to reach other cultural groups.
“We want to develop more culturally specific programs to be able to go into the homes of people and provide services that they have limited access to otherwise.”
Does increased need for services translate to long waiting lists to see a therapist?
Clayton said that she and her colleagues are focused on getting clients in as quickly as possible. Because they think that this fast-response approach has a positive impact on treatment outcomes, Headway has minimized the amount of paperwork clients are required to fill out before an appointment: “This way people don’t feel like they end up writing a whole novel about themselves before they come in,” Clayton said.
At all three of Headway’s sites, in Hopkins, Richfield and Brooklyn Center, Cayton said, “We try to do a very quick turnaround. When clients call for a referral, we will get them in within two days of that call if we can. A week out is the farthest we would go.” And at the Brooklyn Center location, which Clayton refers to as a “ramping-up site,” wait times are even shorter.
“We could do same-day appointments. Currently we don’t have a wait at all.”
Has the pandemic changed the way Headway operates its day-treatment program for youth?
In 1970, Headway began in the western Twin Cities suburbs as Storefront Youth Action. Its founders were a group of parents who were focused on finding mental health care in the community for children and teens. Over the years, Clayton explained, the nonprofit expanded services to families, couples and individuals, and, in recognition of that expansion, changed its name to Headway.
But youth services remain at the center of Headway’s offerings, Clayton said. One of the nonprofit’s largest programs is the day-treatment program, an intensive outpatient program for young people between the ages of 12-17 offering a full day of programming divided between for-credit classes and psychological therapy. The day-treatment program was launched at Headway’s Hopkins location in 2015.
The day-treatment program, Clayton explained, “It is for young people who struggle with mental health issues like depression, anxiety, suicidal ideation, self-harm. These are kids that often struggle to attend school.”
In April, when Governor Tim Walz ordered Minnesota schools to close their doors and move all classes online, Headway’s day-treatment program went remote, but this summer’s relaxed regulations made it possible for Headway to bring their young clients back for socially distanced in-person learning. This felt like an important step for Clayton and her colleagues, who believe that young people do better with in-person therapy.
“We’ve found that our young clients have a hard time focusing and paying attention,” she said. “A therapist does a lot of engaging things with youth when they do therapy. You don’t just sit across from each other and chat. If you’re not in person, it can be really hard to get them talking.”
The most recent dial back meant a renewed tightening of restrictions for in-person educational programs. To address concerns about virus transmission between staff and students, the program shifted to a two-part “pod” plan that includes time spent in person and at home, Clayton explained.
“Now we have our clients being bused to day treatment for the therapy component in one block, then they are bused home to do distance learning for the academic component for the rest of the day.”
The in-person therapy is done with the young people in assigned pods, with the therapist moving alone from one pod to the next.
So far, that careful approach appears to be working to keep infection rates down, Clayton said. “We’ve really been following all the social-distancing guidelines. We have sanitizing services coming into the building. We have a cleaning routine. We have hand-sanitizer everywhere. Everyone needs to wear their masks. We do health screening when kids come in. We haven’t had any outbreaks within the program as far as I’m aware.”
If one of your clients would rather stay at home than risk in-person therapy, is telehealth a viable option?
Clayton said that since the start of the pandemic, Headway has offered clients the option to visit with therapists in person or online. Some people report that they have a hard time making progress with a therapist via Zoom, so they’ve kept the in-person option open.
“We allow clients to decide from the start if they want to see a therapist in person,” she explained. “If they do, we try to make it happen.”
Therapists also acknowledge the very real health risks of face-to-face interactions, Clayton said, and have gone to great lengths to minimize those risks, including meeting with clients outside, or in an open garage warmed by a space heater.
The health of all people involved in therapy sessions, from client to provider, is taken into account, Clayton said: “If here are huge risk factors to be discussed we help them come to a mutual decision about what is healthiest for the client and for everyone involved.”
Clayton said that one positive that has come out of changes forced by the state’s response to COVID is a realization that many Headway clients and staff have found telehealth to be a good option for therapy that often minimizes traditional barriers to care.
“We now recognize that telehealth can be effective with a lot of clients,” she said. “It really helps people to manage barriers such as limited access to a vehicle. Telehealth has opened up a door that we didn’t have before. It has increased access to mental health services to people who otherwise may have a hard time making an in-person appointment, which is something we’ve been wanting to do since the very beginning.”