Well before the coronavirus pandemic gripped the nation in 2020, Kara Cunningham was on the front line of a deadly crisis in her home state of Utah: the opioid epidemic. Carbon County, where Cunningham lives and works as a clinical director for Four Corners Behavioral Health in Price, Utah, is among the hardest hit nationwide by opioid overdose deaths, as well as emergency room visits due to overdose.
Her clinic, part of the nonprofit community mental health agency serving Carbon, Grant, and Emery Counties, has been pushing through the pandemic to continue serving its clients. Cunningham and her staff of around 25 therapists and social workers have faced increasing amounts of mental health crises, hospital bed shortages, and fractured communication among the organizations and service providers counted as community partners.
Meanwhile, the restrictive conditions caused by COVID-19 are affecting Four Corners’ most vulnerable clients the most. Many of those clients are court-referred – compelled to seek treatment as a result of criminal conviction.
“Mental illness is on the rise and substance abuse is on the rise,” said Cunningham of the area she serves. “People are in situations where they don’t know what to do with themselves. COVID would give anyone anxiety, but our clients don’t know how to compartmentalize everything that’s happening.
“We’ve been trying our best to work together, as a community, to get through this.”
As director for the staff in Price, Cunningham regularly addresses concerns from clients and employees alike and works to develop and maintain relationships across the community. Sheriff’s offices, city halls, hospitals, social services centers, and courts are a handful of the entities Cunningham counts as close partners. She remarked that she spends a lot of time on the phone and in meetings to help those community partners see how Four Corners Behavioral Health works as an agency, and to learn how others function in their services to Utahns. Starting as a therapist, Cunningham has been with Four Corners for 13 years.
“I’m also managing our records, making sure that we’re up to date on treatment plans and assessments, and making sure that clients are seen on a regular basis – so they aren’t falling through the cracks,” Cunningham continued.
The coronavirus pushing day-to-day operations to remote settings has been manageable for Four Corners, given the amount of service they already administered via telehealth, but it has widened the “cracks” for at-risk clients.
“We’re seeing a lot of people who don’t attend treatment, or continue to use, or their mental health condition continues to escalate,” Cunningham said. “And there aren’t repercussions on the legal end to motivate them to do anything. With courts not being held in person, there’s been increasing disconnect between those agencies and our clients.”
The clinic has been able to put at least two initiatives in motion during the pandemic to alleviate stress on not just the legal system, but on an already stressed health care system. Hospital bed scarcity has evolved into a statewide issue, Cunningham said, and the strain has led to “hard times” between community partners. The escalation has led Four Corners to thinking outside of the box to find ways to help people get better.
Through funding from the Substance Abuse and Mental Health Services Administration, Four Corners has been able to develop a Medication-Assisted Treatment clinic, which is able to treat clients suffering from opioid addiction more directly and safely – combining medications with counseling and behavioral therapies. Another effort Cunningham has been able to stand up, to help stem the tide of crisis-related hospitalizations, is a Mobile Crisis Outreach Team.
“It’s a unit where a therapist and case manager go out on calls daily, rapidly responding to mental health crises,” Cunningham said. “It’s something that we’ve recently started in our region, but we’re hoping our ability to quickly reach people in these situations can decrease hospitalizations overall.”
The isolation commonly associated with protecting one’s self from COVID-19 is what Cunningham points to as the compounding factor for all the issues Four Corners and its partners are facing. She would know, as she has been forced to quarantine a number of times due to her proximity to those who may have been exposed to the virus.
Even as an able-bodied, functioning therapist and administrator, Cunningham found the experience to be taxing and difficult, she said. It showed how challenging the situation must be for Four Corners’ clients.
“We’re trying to give people things they can do while still in compliance with COVID rules and laws,” she said. “We’re trying to focus on mindfulness skills for them to practice, but people still really struggle.”
Cunningham has been trying in whatever ways possible to maintain a sense of normalcy for her and her family through the pandemic. A few of her children have been able to continue playing school sports, for instance, and she encourages any chances they might have to resume a “normal” life. In their neck of the woods, mostly everything is functioning but in a modified way.
Her own form of self-care is exercise. It’s a time where she is present and at peace. Exercise is also something that can evade even the tightest of quarantines or gathering restrictions. “I’ll wear a mask, I’ll physically distance, I’ll do it online, I don’t care,” Cunningham remarked.
Not only does the activity keep her physically well, but it’s also her means of recharging her capacity for caring. One of her biggest fears, regardless of COVID-19, is burning out and losing touch with what makes her capable of doing the job she loves.
“It scares me to death to think that I could lose my ability to be empathetic,” she said. “We work with a demanding population of clients. They’re criminals, people suffering from substance abuse disorders, and people who have been through so much. “I don’t ever want to lose my ability to work with them, see what they’re struggling with, and see how we can help them.”
She remains inspired not just by her professional peers who by nature are a support system, but also by the clients who persevere and continue seeking treatment despite everything happening around them. “If you have an addiction or a mental health issue, and you’re able to stay sane and sober, I’d say that’s resilience in and of itself,” Cunningham said.
