BEHAVIORAL HEALTH AND RECOVERY SERVICES

In January 2020, the Division of Behavioral Health and Recovery Services (BHRS), their public health partners, and other county medical directors started hearing about the coronavirus and imagining its potential impact on their clients and services. It didn’t take long for that reality to set in.

COVID-19 brought many changes to our daily lives. The uncertainty and worry about the physical effects of the virus equaled the emotional suffering individuals dealt with regarding information overloads, worries and pressures regarding finances, and job insecurity, not to mention the overwhelming effects of social isolation.

Symptoms of stress, anxiety, depression, and insomnia rose in the county. Some increased the use of alcohol and drugs as a coping mechanism. These warning signs signaled the beginning of the challenges BHRS was to face. Things got off to a rocky start.

BHRS staff members were deployed into new roles while continuing to fulfill existing casework and balancing their personal lives. It was stressful, and some considered leaving. Several reported challenging experiences with their new assignments due to the lack of training, and others voiced concerns about being placed in unsafe situations.

Resources were scarce. Occasionally, there were times when gloves, masks, gowns, and other personal protective equipment (PPE) were hard to find. Staff reported the need for interpreter services and cited one instance when a Spanish-speaking COVID-19-positive mom and her newborn showed up for help with isolation and quarantine. There was no one available to assist with their follow-up care effectively. Situations like these forced BHRS to make some changes.

These and other obstacles early in the pandemic led the division to rally around its mission, organize protective gear, and muster the courage to maintain access while other services went virtual. The division had to quickly develop telehealth and virtual clinic capabilities to adjust and provide the full menu of options that were required. There was a renewed commitment to partnerships and a great deal of collaboration and support for others. Telehealth administration was given to front desk staff, while contract administrators worked overtime to support social services programs like the Great Plates Program.

They adapted to a model of constant risk-benefit analysis in deciding when clients needed in-person versus virtual services. They also had to fill in gaps for other types of services. By adapting and being nimble in response to the pandemic, BHRS was constantly evolving and stayed focused on its objective of serving those who were in need. The medical team maintained a physical presence at their sites throughout the pandemic, and the requirements of their clients for crisis services, injectable medications, on-site assessment, and mitigating problems related to the use of virtual tools were constant.

Some positive things did come out of the pandemic. A renewed sense of importance regarding and respect for public health and public mental health missions might have been the most important, followed by the rapid build-up and mobilization of BHRS’ telehealth capacity and the use of new and enhanced communication tools. Many staff members also commented on how rewarding it was to be a part of the vaccination distribution process as a disaster service worker and observe the relief people felt when accessing vaccines.

BHRS services never closed the doors to treatment throughout the pandemic, including in-person work at the Crisis Stabilization Unit, Mobile Crisis Response Team, Jail Mental Health, and virtual and hybrid work throughout our outpatient clinics. Substance Use Services, including Recovery Coaches, provided field-based services and an outstanding level of innovation and creativity to adapt to a continuously changing landscape. BHRS staff were incredibly resilient and coped with the stress and quick changes they encountered daily. They looked after each other and were supportive of one another. They persevered through tough times but acknowledged that they couldn’t have accomplished it without the help of their partners.

MarinHealth and its Emergency Department assumed the COVID-19 testing and clearance for every CSU patient before they came onto the unit. Additional partners included the Multicultural Center of Marin, Ritter Center, Buckelew Programs, BrightHeart Health, and Center Point, to name just a few.

The COVID-19 pandemic significantly changed the lives of the residents of Marin and the staff members of BHRS. The direct and indirect suffering brought on by the pandemic was challenging to witness. Increased isolation from family and support systems were symptoms felt by many. By maintaining a physical presence in the community while other vital services went virtual, BHRS stayed connected with its most vulnerable clients. BHRS continued essential services during the height of the pandemic, and the sacrifices made by so many within their ranks, in so many unspoken ways, will sustain them as they continue to battle COVID-19.

BHRS Staff

More than 40 percent of BHRS staff served as disaster service workers at various points during the pandemic. They were stationed in the Project Roomkey motels, the isolation and quarantine sites, vaccination clinics, and the emergency operations center. BHRS staff actively and intentionally engaged the community regularly in person, using virtual means, through the media and radio, often setting aside their own fears and personal safety to ensure the Marin community received the best care possible.