Brad LaBass started his job as a clinician on the mobile support team in Santa Rosa a few weeks before the pandemic hit.
"There's so much unknown in general about COVID," LaBass said. "The anxiety for all of us was high too."
The mobile support team shows up when police officers call because someone is experiencing severe mental health issues. The team, made up of licensed therapists, social workers and substance abuse specialists, assess what resources and support is needed. And, in extreme cases, whether or not someone needs to be put on an involuntary psychiatric hold, commonly known as a 5150.
"It was terrifying, just on a personal level," said Jeremy Bailey, a therapist on the mobile team. "Someone might inadvertently cough or I might get too close to someone or forget where I am or what I’m doing in the moment. I get so involved with trying to establish a rapport with someone to deal with their crisis."
Bailey said the ongoing pandemic brought unique challenges. For one, building connections with clients who are dealing with severe mental health crises is harder with a mask on, at a distance. And LaBass said the team saw more severe calls during the pandemic than before, and an increase in involuntary 5150 holds.
"An increase in more of the psychotic type calls," LaBass said. "People are really hearing voices more and having delusions that are much more significant than maybe in the past."
One place that clients go after being placed on a hold is the county’s crisis stabilization unit. Charles Alaire is the clinical specialist at the CSU. The unit is designed to help clients find resources or a hospital bed within 24 hours, but Alaire said stays were generally longer during the pandemic, partially because of the ongoing shortage of hospital beds but also because clients needed negative COVID tests to move to other facilities, like psychiatric hospitals or longer term residential treatment centers.
"I mean, there was a period when the test volume was really high at the public health lab, and it was taking three or four days to get results. So that, of course, it's one more barrier to getting people the help they need," Alaire said.
In addition to losing up to half his staff at various times throughout the pandemic, Alaire also saw an increase in the severity of people’s mental health needs, by roughly forty percent.
"I think it was people being isolated," Alaire said. "A lot of clients weren't getting the care that they got before, because of fears, anxiety, changes with their health care programs, the way that they were delivered services. Substance use has definitely become more prevalent. We've seen an increase in opiate use, for sure."
Sonoma County saw a 78% spike in fatal overdoses last year, which many mental health experts believe was partially caused by the stress of the pandemic and a disruption of in-person mental health programs. Alaire said a lot of people don’t understand the necessity of mental health services, especially in times of emergency, which Sonoma County deals with often.
"I think a lot of people don't understand, don't really recognize the social utility of mental health treatment," Alaire said.
The county’s behavioral health director, Bill Carter, saw the increase in mental health crises reflected in last year’s budget. The department’s budget for psychiatric hospitalization increased by 93% because more people needed more intensive treatment.
"A lot of the services we provide are designed to help people who have serious mental illness, to help them remain in a lower level of care, ideally, living independently in the community with some level of outpatient support," Carter said in an interview in April. "And because we cannot provide as intensive services, we think more people are going into crisis than normally would."
Alaire says resource scarcity in the mental health field isn’t a new problem that came with COVID.
"I think we've been underfunded as a larger mental health treatment system forever," Alaire said.
Despite the financial and resource challenges, people who work in the mental health field have also witnessed resiliency. Bailey from the mobile team said through the emergencies, the wildfires and now the pandemic, he’s seen many communities rise above and make it through.
"There's an aspect of resilience that's also building I think, at the same time," Bailey said. "I think it's a good thing."