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May 2024 was Mental Health Awareness Month. Ephraim McDowell Health and the Rotary Club of Danville partnered to host a Mental Health Symposium on May 29 at the Boyle County Library to encourage discussion about mental health in the community.

At the symposium, Boyle County Emergency Medical Services Outreach Coordinator Terry Dunn and Community Behavioral Specialist Mark Smith presented on the mental health issues EMS sees in the county. 

Boyle County EMS recently hired Mark Smith specifically to help local people struggling with mental health issues, which is a new position. EMS is working to form a crisis response team specialized in responding to mental health crises. 

“We don’t know what we are going to see once we get out there,” Smith said. “We are seeing a lot of substance abuse, mental health cases, anxiety, depression, and suicidal ideation. We are getting everything lined up now and hope to start in July. The purpose of the crisis response team will be to meet individuals in the field, perform an assessment, de-escalate, and offer the resources we can.”

Dunn explained that Boyle County EMS expects to increase their caseload once the crisis response team begins operation. 

“Some of these new drugs coming out we don’t even have tests for,” Dunn said. “Fentanyl is still at the forefront of overdoses. We are seeing it in basically anything, even in vape pens. Teenagers and even adults think they are safe because they are made in a factory, but they don’t know they have been altered.”

He explained that fake pills are particularly dangerous.

“Pill press machines can be bought online very easily,” Dunn said. “They are being manufactured in basements and bedrooms. They look identical to prescription medication, but the ingredients are different.”

2023 was the first year that Boyle County EMS began tracking mental health issues that they respond to.

“In 2023, we had 10 suicide fatalities; eight of those were from gunshot wounds. That is almost one a month. That is too high,” Dunn said. “I do have some good news. Looking at the data for where we are now in 2024 compared to 2023, we have had 36 substance abuse cases compared to 69 last year. They are down significantly. Overdoses, we had 39, and right now, we are at 23. Overdose deaths, we had 12 at this point; today, we have three. That is a dramatic difference.”

He said they have seen 71 mental health cases as of this point in the year compared to 43 in 2023.

“One of the biggest mental health issues we are seeing in the county is anxiety,” Dunn said. “We are seeing that we respond to a case of chest pain, but if you look at their vitals, they are fine. Anxiety can become physical, and it presents physical symptoms.”

Dunn explained that it is vital for EMS to have a trusting relationship with patients when they respond to mental health crisis calls. 

“You need to have the compassion to do this job and build a repertoire with individuals who suffer from mental health conditions,” Dunn said. “They are not easily trusting, especially to those on the outside. Sometimes, it may take a few different visits. You must continue coming back and calling to check in.”

Dunn hopes that Boyle County EMS’s mental health programs can become a model of success for other communities to implement.

“We are hoping to set the trend nationwide,” Dunn said. “We hope to give this program to communities all over the state. We look forward to continuing to do the initiative. We are just getting started.”

Harm Reduction and Syringe Exchange

Boyle County Agency for Substance Abuse Policy Coordinator Kathy Miles spoke about the connection between mental health and substance abuse, along with the importance of harm reduction and the benefits that the needle exchange program provides.

“Think about recovery readiness when it comes to substance abuse and mental health as a puzzle,” Miles said. “A puzzle where you put together what research says and what we know we know in our community. We need to help people be in long-term recovery for mental health and substance use disorders.” 

Miles said that the community realized tackling the problem would require a joint effort between law enforcement, medical professionals, treatment professionals, and the community. 

Miles explained the concept of recovery capital, a relatively new concept in addiction treatment that refers to the resources, support, and opportunities an individual has access to during their recovery journey. Recovery capital encompasses the physical, social, and emotional assets that enable someone to maintain sobriety and overcome addiction.

Recovery capital is crucial for individuals struggling with addiction because it provides a safety net that helps them navigate the challenges of recovery. It includes factors such as access to healthcare, housing, employment, and social connections, which can help reduce stress and increase feelings of well-being. Recovery capital also involves having a supportive network of friends and family members who can offer emotional support and encouragement.

Having adequate recovery capital can significantly improve treatment outcomes and reduce the risk of relapse. Research has shown that individuals with high levels of recovery capital are more likely to remain abstinent and experience improved mental health. On the other hand, individuals with limited recovery capital may be more susceptible to relapse due to a lack of access to resources and support.

“We don’t take anything away from a person’s internal commitment to recovery,” Miles said. “When a community supports their recovery, it makes so much of a difference. Addiction is a treatable disease, but it is a chronic disease; they need help all along the way.”

Harm reduction is a program that utilizes research-based methods of communicating with those struggling with substance use disorders to equip them with life-saving tools and knowledge.

“Everyone has worth,” Miles said, “Even those who are using drugs. They deserve to have help with their life. The phrase used to be, ‘let them hit rock bottom, and they will seek help.’ With the substances out there today, hitting rock bottom means dying.”

In addition to reducing overdose deaths, harm-reduction policies have been proven to reduce the transmission of disease. People can bring used needles to the Syringe Exchange program at the Boyle County Health Department, and get clean needles. This reduces the risk of spreading disease through dirty needles.

“You need to develop relationships that matter,” Miles said. “You would have people coming back to the health department over and over because somebody cared about them and gave them what they needed. Change is a process for everybody.”

Editor’s note: Mental Health Awareness Month was in May, and Ephraim McDowell Health sponsored a symposium on the topic. This is the first of two articles on what was discussed at the symposium.