How one provider's approach is helping to break down barriers to mental health services
Nice as they may be, the Fernbrook Family Center offices, 2519 Commerce Dr NW Suite 210, are not usually busy. That isn’t because no one is seeking out mental health services — quite the opposite, in fact — but because of Fernbrook’s commitment to “meet people where they are.”
“A lot of the clients we work with have been through other services, and it hasn't been successful. They're the clients with the highest needs and the lowest access to resources,” says Shannon Brown, MS, LPCC, Chief Executive Officer. “They need us to go to them.”
Fernbrook staff responds to that need by showing up where their clients are: at home, school, and anywhere in between. When Brown was seeing clients, even turned up at pickup basketball games to deliver services.
Poverty, homelessness, addiction, and mental health issues make traditional outpatient therapy less effective, so Fernbrook staff fit their ways to the client, rather than require the client to fit theirs. This approach lessens barriers and increases access.
“Access is a basic right that everyone needs to have,” says David Scales, MS, LPCC, Fernbrook’s Olmsted County Clinical Director. “We work very hard to promote that right.”
Improving access could mean anything from providing transportation to a session to helping get dinner ready in a client home. That approach comes from a commitment to patience, empathy, and perseverance.
“Showing up and persevering even when people want to quit and throw in the towel because it's hard. We don't let them,” says Brown.
In mental health, a network of community agencies, hospital systems, and private practices fill pieces of a community’s overall need. Fernbrook provides services to families and children. For much of the last decade, Fernbrook’s in-school program has provided therapists to roughly half of the schools in the area, thanks to a grant from the Department of Human Services. These therapists are teaching self-regulation skills and helping students learn coping skills for life.
Early intervention is key, says Ashley Kimmell, school-based services specialist, especially in a world still reeling from the Covid-19 pandemic. When students transitioned to remote learning, some kids went to safe homes, and others went into unsafe, unstable living conditions. Returning to the structure of school is a challenge for many, and Fernbrook therapists are seeing plenty of cases of ADHD, depression, and anxiety.
“There's been a big adjustment period over the last two years as well that adults are struggling with, but so are kids,” says Kimmell.
Helping clients navigate the system
Fernbrook’s clients often come to services with years of trauma and attachment issues.
“Sometimes our clients don't have a sense of hope of it getting better, because this is all they've ever known. And so they're doing it because someone told them to or they thought it was a good idea. They recognize they want something different, but there's not a lot of hope for them that it is going to be different,” says Brown.
Fernbrook breaks through that perception with an approach that has therapists sit, empathize, and validate. They don’t ask patients to do things outside their resources. That patience separates Fernbrook from typical outpatient practices, where a client might be seen for an hour once or twice a month.
“That's just not going to cut it with these clients,” says Brown.
Clients are referred to Fernbrook from a multitude of places: Headstart, Olmsted County, Family Services Rochester, Fernbrook’s in-school offices, child protection systems, and probation. Many come on their own, just looking for accessible help. Fernbrook helps them navigate through those systems.
‘We are in the middle of a mental health crisis’
Patient care with clients requires staff, but as the pandemic stretches into its second calendar year, it is harder to find people.
Kimmell says she sees increased strain on supports. School social workers, counselors, teachers, and administrators have all seen increased workloads. It’s not a situation likely to recede quickly.
“Unfortunately, there aren't more teachers coming, and there's not more social workers coming,” says Scales. “To say that this is a temporary thing that's related to the pandemic… I don't think so. I think this is a long term trend. We're in the middle of it. I would implore any legislators, or anyone with any, any real power here to better incentivize those people going into mental health care fields. We need more. We need more of everything.”
Grants help with funding, but finding staff is the real challenge. Fernbrook’s service rates have not gone up since 2009, even as expenses have risen, and finding people to do the work in a field where compensation often doesn’t match expertise (most Fernbrook staff have master’s degrees) is hard in normal times. The pandemic led many people to put school on hold, or to shift careers. Fernbrook recently started an internship program, which will help train and onboard new providers, and Brown says the team is scrappy enough to maintain a high level of service.
In the meantime, though, the need continues to grow.
“We are in the middle of a mental health crisis,” says Kimmell. “There's just not enough providers. But the staff that we have right now are willing to see as many kids as they can, which has been really helpful.”
Even leadership at Fernbrook have caseloads. Scales sees three patients a week — his way of staying committed to providing services for historically underrepresented people.
“I love this work. I love watching individuals really explore themselves. I really enjoy helping people navigate the darkest points in their lives. And I'm not really here for the easy day-to-day. I want to make a long-lasting impact with the people who I work with,” says Scales.
