In the latest installment of our occasional conversations with Fort Worth leaders, Virginia Hoft, executive director of Mental Health Connection of Tarrant County, discusses the organization’s recent report about the state of mental health in Tarrant County. 

This conversation has been edited for length and clarity.

Alexis Allison: Can you start by just telling us a little bit about what Mental Health Connection is?

Virginia Hoft: Mental Health Connection is a 20-year-old organization that was established in 1999 after the Wedgewood Baptist Church shooting. Some people remember that really well. It was back in the day when those were very rare occurrences. There was a man with untreated mental illness that went into a church where a youth group was meeting. He shot and killed a number of people there and then turned the gun on himself. The mayor at that time, Kenneth Barr, pulled together some key mental health providers in the area, and said, ‘We really need to come together, leverage our resources and our expertise to ensure that this doesn’t happen again.’ And of course, that’s a big, tall order. 

That’s where we began 20 years ago. Now, we are a collaboration of over 40 dues-paying organizations and individual practitioners, as well as community folks that have a stake in mental health and substance use. With Mental Health Connection, it’s a very small staff — I’m the executive director and I have an assistant — so the work is really done by the members. What we do here is guarantee a framework and opportunities for collaboration, and we have a shared vision. All the members have a shared vision of really addressing the gaps in services, siloed funding, what we need to do to come together in order to address the gaps, emerging needs. We recognize that we are stronger together than we are as individual organizations. So that’s the role of Mental Health Connection.

Allison: Thank you for sharing. In terms of addressing gaps in addressing needs, I noticed that Mental Health Connection put together a report about how the pandemic has affected the mental health of people living in Tarrant County. Can you tell us a little bit about how the report came together?

Hoft: When the house is on fire, you’ve got to address the fire before you can sift through the damage that was done. During COVID-19, when people were sick, that was the main focus. But as that was going on, people’s mental health was deteriorating. And as it deteriorated, it was compounded by the fact that people couldn’t get to services because everything was closed, people were sick. As a result of that, waitlists got longer. And as waitlists get longer, then people’s distress gets bigger. And so it was just kind of feeding on each other until (what) we have nationally, as well as locally, is a mental health crisis. It’s kind of been the underlier of the pandemic, and all the other things that are going on in this changing world we live in right now. 

So we decided that, if we came together as members, stakeholders, users and providers of mental health services, we could really think through and identify what are the big, big chunks of what’s going on here. And we identified the crisis. I think it’s eye-opening. Prior to the pandemic, Texas ranked in the bottom quarter, which is 38 out of (50 states and D.C.), regarding the number of residents experiencing mental illness and access to care. So Texas is already in this vulnerable state, then this pandemic comes — we weren’t ready to start with, and now what happened is increases in mental health conditions, increased demands for mental health care, and then at the same time we’re experiencing these workforce shortages. 

When you have less staff, you put more responsibility on the staff that you have. And during the pandemic, with people having all of their personal issues and challenges going on, on top of seeing more challenging mental health distress and bigger caseloads, it increased burnout. So we’ve had a lot of people exiting the field of mental health, especially in nonprofit(s). This is a national issue. It’s not Tarrant County or even Texas-specific. This was kind of the obvious issue that got our attention: That we had a waiting list going from seven weeks, depending on the care, to six months or longer. 

So for example, if you’ve got domestic violence issues going on at home, because we saw those go up, because now you’ve got people locked in their houses, and if you’ve got a family that doesn’t know how to kind of resolve conflict anyway, you add pressure, you put them all in one house, no one’s leaving, no one’s able to make outcries. Cases of domestic violence and child abuse exploded. Suicide went up. We needed to unpack that. So overall ranking for access to care, like I said, in Texas fell from 38 to 44 when you looked at state rankings. So we are struggling gravely. With COVID, it just took everything and kind of pushed it over the edge. 

The other related event was the American Rescue Plan Act, which is federal dollars coming in to address COVID-19. We have a lot of dollars coming into Tarrant County and the county is looking at priorities and looking at what they want to invest in. So we wanted to be sure that the county had a really good picture of what’s going on, as well as a collaborative voice to say, ‘This is what we’re dealing with. We need to see some relief here.’

Allison: Thank you for that overview. You touched on the workforce shortages. That’s a big problem. I’m wondering how we address those shortages?

Hoft: Well, it’s really complicated. For example, salary rates are lower in nonprofit than they are in for-profit. And the other thing is that you rely a lot in nonprofit on people’s compassion and being mission-driven. But to those who care, burnout is even graver. 

So a lot of our service providers are moving into for-profit. 

We’re seeing if universities and schools can look at reducing debt: If you’ve come to work in a nonprofit, that some of your school could be relieved. We’re looking at universities to partner with us to help get new graduates on board to be part of mental health, for-profit and not-for-profit, and especially public health care. 

Those are the big issues. What we have to do in a more micro space is look at how we can reduce the stress and burnout on our staff with leadership styles and skills that help respond to the needs of our staff and address those by providing interventions for debriefing and burnout. We can’t continue to expect staff to have larger workloads because we don’t have enough staff. At the same time, we have these folks that are suffering. Virtual care is something that really is helpful. We’re hoping that insurance companies and Medicaid and Medicare will continue paying for those services, even as we move out of the pandemic and become freer to move around. 

Allison: Mental health touches so many different realms of life. You’ve mentioned student debt and domestic abuse — it’s so big. If someone is overwhelmed by these issues, what would you say to them?

Hoft: Some of the simple things are very powerful. We have a Recognize and Rise initiative through Mental Health Connection. The point of that is to help build resiliency in folks and help people see that mental wellness is as important as physical wellness.  

The first thing is we need to get our foot off our throat. You look on Facebook, or you look on Instagram, and you see your neighbors and they look like they have no problems at all. Be it if you’re 40 or if you’re 14, we tend to still look at those pictures and compare our insides to their outsides and think, ‘They look like they have it all together. I can’t tell anyone that I just yelled at my kid at the top of my voice or spanked him harder than I usually would, because I’m so stressed.’ 

What it takes is one person (telling) another person, ‘Man, let me tell you what’s going on.’ Most of the time, the other person goes, ‘Oh my gosh, that’s exactly how I feel. I didn’t know anybody else felt that way.’ So one simple thing that we can do is to understand that when we share what’s going on with us, in a very honest and vulnerable way, it really is an invitation for others to open up at the same time. 

The other thing is, knowing that asking for help — be it at your church, or be it at your workout class, or wherever it is — it is okay to need help. It doesn’t say that you’re crazy, or that something’s wrong with you, or that you’re weak. Best practices show that sometimes just telling your story and having someone listen can create healing. And then sometimes we need antidepressants and sometimes we need medicine and there’s no shame in that. It’s about getting the help you need so that we can build resiliency in ourselves and in our families and in our neighborhood. That’s what we’ve got to do: Look at how we can eat this elephant one bite at a time.

Allison: Is there anything else that you’d like to add right now?

Hoft: Research shows that when you live through adversity or trauma or stress like we’re facing right now, if we can make it through to the other side, we are more resilient, we have more insight, we have better connections. It’s post-traumatic outcomes. When we can weather the storm, we come out of this better than we were when we went in. We just can’t just stay in the muck. We’ve got to know that this, too, is going to end one day. We’ve got to move in that direction together, instead of by ourselves with the blankets pulled over our head, thinking, ‘When is this ever going to end?’

Alexis Allison is the health reporter at the Fort Worth Report. Her position is supported by a grant from Texas Health Resources. Contact her by email or via Twitter. At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here.

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Alexis AllisonHealth Reporter

Alexis Allison covers health for the Fort Worth Report. When she can, she'll slip in an illustration or two. Allison is a former high school English teacher and hopes her journalism is likewise educational....

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