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As suicide, addiction death projections soar amid COVID-19, treatment centers struggle to stay alive too

MANCHESTER, Conn. – In early March, Zoraida Diaz was coming to twice-weekly yoga classes here at Community Health Resources' offices. She's in recovery from colon cancer and alcoholism while in treatment for severe anxiety and depression. 

Carla Mitchell showed up for intensive PTSD therapy, happy to be free from her stressful home life and the racist taunts she hears walking in her neighborhood. 

And Tara Kulikowski, who has schizoaffective and bipolar disorders, lupus and is in recovery from drug addiction, organized craft classes and other activities at CHR's nearby "We Can Clubhouse." 

By mid-March, however, the answer was "we can't" for all in-person encounters at Connecticut's largest mental health and addiction treatment facility and thousands like it across the U.S. 

Amid projections of soaring suicide, drug and alcohol deaths from the pandemic-spawned social and economic collapse, centers like these and their patients are struggling to keep going. They've been largely left out of the murky formula for federal COVID-19 health care funding, which has focused on the immediate financial impact on hospitals caring for patients with the virus and lost revenue from elective procedures.

Tara Kulikowski, 44, of South Windsor, Conn., receives treatment for her PTSD, bipolar and schizoaffective disorders at Community Health Resources in Manchester. She also leads craft activites at the We Can Clubhouse, which is closed due to COVID-19.

Nearly 30 mental health and substance abuse groups representing everyone from addiction psychiatrists to family therapists sent a letter to Health and Human Services Deputy Secretary Eric Hargan on Thursday asking for a separate distribution of money because they've been blocked from getting "desperately needed relief funds."

The lack of government support has come at a deep emotional cost for patients and a steep financial one for centers such as CHR, both groups say. It has also stymied and undermined progress to better integrate mental health care with primary care and into communities and the social services arena to help keep people functioning in society, experts say.   

COVID-19 should be the "door opener" for the health care system to focus on the direct link between physical and mental health, said former Rep. Patrick Kennedy, D-RI, a longtime mental health advocate. Depression, he noted, quadruples the risk of a heart attack, and heart disease is one of the chronic health problems that dramatically increase the risk of serious illness or death from the virus. 

Diaz ended up at CHR after she collapsed on the street with heat stroke following her release from a psychiatric hospital. Caseworkers connected her to a doctor, who diagnosed the colon cancer. Another CHR client relapsed on alcohol when he couldn't attend or connect to 12-step meetings because of shelter-in-place rules and because he had only a flip phone. 

"Our volume of service dropped through the floor," said CHR CEO Heather Gates. "This is not elective."

Loss of funding threatens another public health 'catastrophe'

It took years for Timothy Washington, who has schizophrenia, to leave his apartment to go to the corner store without worrying someone was following and planning to hurt him. 

He credits the therapy and various day programs and services he got through the Washington D.C.-based McClendon Center for his progress. Now patients like Washington struggle to cope with the lack of a routine and face-to-face contact, said Aisha Shabazz, who heads the center's day programs.

By early May, she managed to connect just a third of the 90-day program clients with virtual therapy, including using art and music. But that was too late for another McClendon client CEO Dennis Hobb declined to identify by name, who took particularly hard the loss of activities such as daily meals and Friday karaoke in the center's church basement.

Dennis Hobb is CEO of the McClendon Center in Washingotn, D.C.

The 49-year-old client remained in contact with the "core services" staff who helped her with food, medication management and other basic needs but was "really struggling after we had to close down," said Hobb.

"She really missed (and) needed the social contact," said Hobb. "She was found dead in her apartment about six weeks ago. Hers was a tragic loss for all of us."

Hobb estimates the McClendon Center is losing about $250,000 a month – $95,000 or so from Medicaid due to the cutback in day programs. 

At CHR, Gates said the coronavirus outbreak has cost the center about $500,000 in lost Medicaid revenue. Earlier this month, it received a $36,000 deposit from HHS; Gates said she was expecting $213,000. Since the pandemic hit, the center has spent about $100,000 on technology to interact with clients and $25,000 on personal protective equipment, including masks, that it will continue to buy. 

CHR and other centers learned recently they may now be ineligible for Medicaid reimbursement payments if they applied for and got even a tiny slice of their lost Medicare money. 

Chuck Ingoglia, CEO of the National Council for Behavioral Health, says "HHS keeps changing the rules," and without a fast fix there could be a "secondary and devastating public health catastrophe." He predicts layoffs and program closures at centers. 

In a statement late Friday to USA TODAY, the agency said it "has maintained an open line of communication with health care providers to address urgent concerns and we are answering provider questions on a rolling basis."

Dr. Elinore McCance-Katz, assistant secretary of mental health and substance abuse for HHS, said Friday that there already has been a huge impact on treatment providers. Data on the increases in the percentage of emergency room visits in April and May because of suicide attempts highlight the need, she said.

McCance-Katz supports special funding for these behavioral health providers but also says states should revisit guidance requiring masks and 6-foot distancing at centers, which "tanks our mental health and substance abuse treatment system." The World Health Organization's recommendation for mask use and distancing of 1 meter, or a little over 3 feet, would address the issue, she said.

"We are in a very great state of distress," she said. "People need these services."

'Everybody needs help'

Back in Connecticut, as CHR's government insurance payments were drying up because of COVID-19, caseworker Kevin Rodriguez was canvassing Manchester looking for a homeless man he was told was named David and was living in a box truck. 

Rodriguez found David Lamay in a truck behind a friend's house, where he had been for six years since losing his home to foreclosure.

Kevin David Lamay, 61, who was recently homeless, is now living in this Best Western hotel while he waits for permanent housing through the state. Lamay is receiving assistance from Community Health Resources with food, transitional housing, and with paperwork that will ensure him with Social Security Income, Disability income and permanent housing.

Lamay is blind in one eye and struggles with severe anxiety and depression, which makes it hard to focus on his other health problems including chronic obstructive pulmonary disorder, diabetes and related grand mal seizures. 

Three weeks after finding him, Rodriguez got Lamay a spot at a Hartford Best Western converted into a homeless shelter and hopes to get him in permanent housing soon. That, and all the forms Rodriguez helped him fill out, means Lamay will have a place to get the Social Security Disability benefits for which he has been eligible for years but never received. 

"Everybody needs help," said Lamay, who calls Rodriguez "a blessing."

"He's the most proficient, effective worker I’ve ever seen."

Diaz is among those CHR clients in most contact with caseworkers who, along with psychiatrists, typically go to the client's home. This Assertive Community Treatment Team needs to "see how the client lives," including whether they have enough food, furniture and health services, said nurse and team member Cathy Martel. 

"We assert into their life and manage all of their care as a unit," Martel said.

When Diaz, for example, had her power cut off because she lost a check and didn't have money to pay, her treatment team called the utility. CHR loaned her money that she paid back at a rate of $10 a month, when she had it. 

Zoraida Diaz, 60, stands in her Manchester, Conn., home on Tuesday. Diaz has received treatment for anxiety and depression at Community Health Resources in town. She is also in recovery from colon cancer and addiction.

May, June and July have always been the hardest for Carla Mitchell. Her beloved father died in May 2015 of the lung disease COPD. She would almost be over the anniversary of his death when Father's Day would arrive, followed by his birthday in July. She'd cry for months.

But that has stopped since her latest session of trauma therapy, known as Eye Movement Desensitization Reprocessing, or EMDR. She describes the treatment, seldom available to Medicaid patients, as like hypnosis that helps her emotionally detach from the traumatic event. 

Proof it's working?  She has already made plans to go over a friends' for a Father's Day cookout. 

Carla Mitchell, 53, sits outside her Manchester, Conn., home on June 16, 2020. Mitchell receives treatment for bipolar disorder and PTSD at Community Health Resources.

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Mitchell actually prefers doing her therapy remotely, and CHR's Gates said she's definitely in favor of continuing telemedicine for those who have trouble getting into the clinic. For those and others during the pandemic, "it's been a lifesaver." It's all the others who are drinking, using drugs and experiencing more trauma along with the social isolation Gates worries about. 

Without more funding, new and exacerbated cases will go untreated and people will have "the equivalent of PTSD" from the first round of social isolation that will come back if states close again. Then they'll have "chronic trauma" to go with their other chronic health conditions, Gates said.

"We are working with individuals with serious, persistent mental health issues," she said. "You can’t just shut off face-to-face contact."

Join USA TODAY's I Survived It Facebook group if you are experiencing any of the health problems in this story. Reach O'Donnell on social media as @JayneODonnell or email  jodonnell@usatoday.com. 

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