For Mary O’Dell, a counselor at St. Michael’s Medical Clinic in Anniston, Alabama, expanding mental health services is just the start of addressing what patients need.

“So many feel like there are mental health services provided that will fit an issue or provide a solution, but it’s just touching it,” said O’Dell, who works at the free clinic. “We’re just starting to provide a service that has not been there for clients who have just been neglected for a long time.”

The free clinic began offering counseling and therapy sessions to low-income and unhoused people at the start of the year, with funding from the Community Routes: Access to Mental Health Care program, a partnership with Teva Pharmaceuticals, the National Association of Free and Charitable Clinics, and Direct Relief. Eleven free and charitable clinics/pharmacies across Alabama, Mississippi, and Texas received support to expand mental health programming to patients.

In addition to expanded services for patients, St. Michael’s Medical Clinic also expanded counseling services after a partner non-profit opened a homeless shelter in February. The area has limited options for therapeutic support, and the places that are available have waitlists, said Nannette Mudiam, the clinic’s executive director. According to Mudiam, about 12% of the area’s population is uninsured.

Putting patients on a months-long waiting list for therapy is “really not a workable solution for any person struggling with mental illness,” she said.

The clinic, which has existed for nearly 50 years, has built a trusting relationship with the community. O’Dell said that news about the counseling services spread quickly as she sees patients at the clinic and the shelter. They hope to hire another counselor who is bilingual to support the cultural diversity of the area.

A Helping Hand in Dallas

Providing culturally competent care is making a difference in Dallas, too. Accessing care is a challenge in the state, with significant barriers including high numbers of people without insurance and fewer treatment options than other states.

To address the need, Brother Bill’s Helping Hand, a nonprofit in Dallas, Texas, has built a wraparound service program to support the predominantly Latino area of West Dallas over the last 80 years. Brother Bill’s provides food to nearly 200 individuals daily and operates a primary care clinic, among several other community-based resource programs. Three counselors offer bilingual counseling services to increase patient access to care.

Ivan Esquivel, clinic director, said providing culturally competent care also means breaking cultural barriers that prevent patients from seeking care, including generational cycles, taboo, and denial.

“Mental health among the Hispanic community is a very taboo thing, especially among men,” he said. “You grow up learning that if you’re a man, you don’t cry. You’re machismo, a lot of pride, and so being vulnerable and sharing how you feel mentally can be viewed in our community as a sign of weakness.”

Esquivel said that Brother Bill’s is also working to restore dignity to their neighbors and patients enduring mental and emotional stress from hardship, including food insecurity.

The nonprofit sees 150 patients a month, and there’s a waiting list for mental health care. They created a virtual space to help the community overcome cultural stigmas around mental health. Counselors use Facebook Live to discuss taboo topics and answer questions from the community in real-time to make people more comfortable and understand that they have community support.

“Too many times in life, when you have to use these services, you have to jump through so many hoops of application qualifications, and then once you get in the program, you’re treated like you’re taking a handout,” said Esquivel. “You’re almost feeling like less than, and so everything we do here, all the way from calling them neighbor to being seen as a patient, or getting food, is providing dignity to every single aspect.”

Beyond ‘Bootstraps’

Providing care in a way that makes people feel seen, heard, and cared for is a priority in Bryan, Texas, too.

Sherri Clement, a social worker at Health For All, said that the rural areas of Texas have a high demand for mental health services and not enough counselors to cover the need. Additionally, the area’s culture doesn’t have broad support for mental health, which discourages patients from seeking care.

“We tend to have an approach of ‘pull yourself up by your bootstraps’ mentality,” Clement said. “Unfortunately, seeking mental health care services is seen as a negative thing, that it’s some sort of shortfall on a person…We know that’s not the case.”

The free clinic serves a diverse area, by culture, race, sexual orientation, and socioeconomic status. Clinic leadership said they strive to create a welcoming and respectful environment for everyone, especially for those who are marginalized and underserved.

Clement said it’s an unnecessary barrier to care in an area that doesn’t have enough options for health care. She said that cost is the biggest barrier for patients who do want to seek care. According to Census data, nearly 23 percent of the city’s population lives below the poverty line, which is 1.5 times higher than the poverty rate for the state.

The health clinic works with patients who have experienced panic attacks and may experience anxiety and depression. They offer EMDR, one-on-one counseling, and behavioral health management services.

Clement said that patients are referred when they can no longer manage on their own, even with medication assistance. Some, she said, just want to know some coping mechanisms that they can implement into their daily life.

“There are a lot of people who are experiencing this,” she said. “The solution is a light at the end of the tunnel, so it gives them hope.”