It doesn’t seem all that long ago that people bottled up their mental health struggles or got real about them only with a therapist, if at all. Today, much of the stigma is lifted but, for many, access to quality mental health care remains elusive.
My guests today are Meredith Switzer, the executive director; and Brendan Hughes, the development director, for the nonprofit All Souls Counseling Center. We talk about how the demand for counseling has climbed with and since the pandemic, how the circumstances and needs of All Souls' clientele have evolved and how All Souls is addressing the racial and cultural barriers that can challenge access to quality mental healthcare.
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Matt Peiken: Meredith, you were telling me just before we started that you've been part of this nonprofit community here for two decades and with about five previous nonprofit organizations. Tell me about The work you generally did, the overarching work, and what led you, how that blazed a trail for you into All Souls?
Meredith Switzer: I've always been very... Passionate about working in community with others and affecting change in the community. And I really think it started early on I grew up in a household that really valued volunteerism and stewardship. And it started that way, but specifically here in Asheville, I had the opportunity to work for a large corporation when I first moved here in 98.
And that corporation also valued community partnerships. And because of my work there, was able to volunteer for some local nonprofits. And that really is what got me engaged. Started off with junior achievement and then it's progressed over the years. And I started working more along the lines of human services and started doing work at Homeward Bound I guess about four or five years ago.
And that was probably the most intense work I'd done related to human services, recognizing the significant needs of. Those experiencing homelessness in our community and so it really started there in terms of this type of work I was there for a little over two and a half years and now have been with All Souls Counseling Center for a little over a year and a half.
Matt Peiken: So explain All Souls mission and how that overlaps with what you had previously Witnessed or been part of with the constituencies of the other nonprofits specifically homeward bound.
Meredith Switzer: Sure the work of All Souls Counseling Center is to provide affordable, accessible mental health counseling to individuals, couples, and groups on a sliding scale.
And specifically, providing those services for individuals who may not be able to access them any other way. For example, if they are uninsured or underinsured, it is an opportunity to make those services available. And quality services. So that they can have that counseling and access to mental health services that they deserve.
Matt Peiken: So you're dealing largely with a population that is uninsured?
Meredith Switzer: Yes, we are.
Matt Peiken: So is that something generally, is mental health services, is that something that is lacking? In our insurance industry, in a sense, that's one of the things I thought about that I know with some employers I've had, they would cover a certain number of counseling sessions in total, but talk about the relationship of the insurance industry with the mental health needs
Meredith Switzer: wow, how much time do we have? I can tell you First of all, there's a scarcity of mental health providers. That's something that we, I think we could all agree on as those who are working in this arena.
In terms of the connection and the support from insurance companies, I think the needs are so great. And insurance companies have pretty strict guardrails or guidelines around what access there can be for those services. And oftentimes there are very strict timelines.
So for example, they may say you can have 12 sessions or you can have 24 sessions and then that. that comes to an end. The way that we work at All Souls Counseling Center is we work on a sliding scale. And so thankfully we are not bound by guidelines from insurance companies because we don't accept insurance because we're sliding scale.
If someone comes to us and they, for socioeconomic reasons can't afford to pay anything, we are going to still serve them. It may be that their sliding scale is zero. And so if they, if they're able to pay, then that they may pay a range from, zero to 25. However. Another nice benefit of the services that we're able to provide is that we don't say you only get this number of sessions.
In general, our model is three to six months of care. So we're still considered short term counseling. But if someone needs longer than six months because of Specific issues that they need to work on then we're going to still provide that it's going to be therapeutically appropriate for that
Matt Peiken: client
You just brought up something that I think is interesting that you focus on short term care And how does somebody know they need?
Only short term care. You have this arc of three to six months to me. You go in to any sort of counseling service thinking I'm dealing with something. It might be issues going back decades. It might be a very specific relationship issue or a work issue or just not being able to get your head on straight.
How do you time box counseling services?
Meredith Switzer: I will say that it can be very challenging, and so that's why we try to be flexible. What I will say in terms of the model that we provide, because the needs are so great in our community, and we do have a wait list, we try to be very intentional in the services that we provide, and really establish goals or have the therapist establish goals with the clients upon the start of therapy.
And ideally, or hopefully, you can work through issues within that time frame, recognizing that's not the case for everyone. If the needs are significant and they need more intensive therapy, it may be that they need another model. That's not always the case, but if it's a, if it's a chronic illness, mental illness that requires very intensive counseling, maybe inpatient treatment medication management, there may be times that we would refer someone on.
Or, we would decide that they need more, longer than the six months and respond accordingly.
Matt Peiken: Now, are these counselors working for you pro bono in a sense? Do they all have their own private practices and they just step forward to volunteer time to All Souls? Talk about the relationships or how you bring your counselors into the All Souls
Brendan Hughes: fold.
Yeah, so all of the therapists that work for us are contracted and licensed therapists. So they're all working for us part time at this point. Our model is essentially to bring in therapists that are able to give back. back to us and they do not work pro bono. So we do pay our therapists per for every session.
We recognize obviously that therapists could be making more money in private practice. And so a lot of therapists that are working for us are Also working in private practice or at another clinic or facility, not all of them. We actually have several therapists that are close to retirement or actually have retired from their own private practice and they're giving back a lot more time to All Souls.
There's a big component of working at All Souls as a therapist, which is recognizing the community need and really trying to Give back their skills and their time. So as a result, we have a lot of therapists who have tons of years of experience, some with 30 plus years of experience. I think the majority have over 15 years.
So these are also not just therapists, like straight out of getting their licensure to, these are a lot of people that are really invested in this community and have been for a long time.
Matt Peiken: You're a nonprofit model. Your therapists are earning money through this counseling service.
Your clients can be paying anywhere from probably normal rates to zero. How do you supplement your funding for All Souls to make this work?
Brendan Hughes: Sure, yeah, that's a big component of it. We really rely on the community support to make this model work because the funding that we're getting from our sliding scale is very minimal.
There are clients paying on our sliding scale. And actually, I can just quote a few statistics. I don't know the exact percentage, but I know that about 50 percent of all our sessions that we offer are free of charge. It's a little over 50%. And I think it's about 85 percent of the sessions we offer are 25 or less.
That's what our clients are paying. So that doesn't. Subsidize a huge amount of our budget and what it costs to do our work. We do rely on a lot of support, and majority of it comes from grants, but it's actually kind of half half. We do, we get both grants from, Like public funders, a lot of local governments support us, including Buncombe County and the state.
We get grants from foundations. But we also get a lot of donations and support from individual donors and local businesses. Yeah, we're very fortunate to have a Diverse set of supporters that have believed in our mission many of them since the very inception of all
Matt Peiken: souls
You mentioned the county and state you get support from them.
Can you give us a comparison of how North Carolina on a state level, how Buncombe County on a county level, how does that stack up compared to what other counties and states give to mental health providers?
Brendan Hughes: I know that North Carolina as a state has invested a significant amount in mental health support.
We can speak to, specifically we've gotten a lot of grant funding over the last five or six years through a program called the Governor's Crime Commission, which actually is directly designed to serve victims of crime, and that's recognizing that many of the clients that come to us have experienced traumatic experiences and crime in their lives that have made them victims.
So through that kind of work, we've gotten grant from. from the state to support that work with our clients, which subsidizes a large amount of it. Buncombe County in particular has been very supportive of our work over the years, and we have a great relationship with them. We've also been fortunate through Cove.
It there was designated funding that came through the American Rescue Plan Act, actually federal dollars. that were dispersed at a county level, and we were fortunate to be among those that were funded through that grant. And so we really do recognize that local leaders see mental health as a big need and something that they really have to address at a fundamental level if they're going to increase the overall wellness of our county and our population.
Matt Peiken: Yeah, Meredith Brendan just mentioned that at least one constituency are crime victims and the trauma that stems from that. Are there other?
Constituencies that you see a lot of are there certain backgrounds, certain populations that you can point to that commonly come through your door?
Meredith Switzer: Absolutely. What we have seen, especially as of late in the wake of COVID or because of COVID is the rise in depression, anxiety. We've also seen a significant rise in suicides in the state of North Carolina.
The second leading cause of death between ages of 10 and 18 is suicide. And that is incredibly concerning. And so while we don't serve young people within that age range, we are certainly seeing the same types of statistics across other age groups. And so when we see people in here of people reaching out to us because of.
Anxiety depression some of the trauma that you just mentioned. We know that we have to be responsive to that I did want to mention that Governor Cooper just agreed along with the General Assembly to an investment of 835 million dollars in the state of North Carolina, which we are hoping and believe will be a game changer for Mental health as we see
Matt Peiken: it 835 million dollars specifically for mental health treatment.
Meredith Switzer: Yes for mental health services funding for mental health. It could look like a crisis team going out literally into the streets to partner and provide support for people who are experiencing a mental health crisis. It could be for substance use disorders and the providers who are working with those individuals.
It could be for groups like ours who are nonprofits who are receiving support from municipalities. A large portion of that is going to go to Medicaid expansion to really expand the type of services that are going to be covered through Medicaid. So this really is a game changer.
Matt Peiken: Is this a one time allocation that will be grant competitive in that way?
Or is it a biennium funding? What is this?
Meredith Switzer: I'm not exactly sure how it's going to look yet. They're still rolling all of this out. I do know that it's going to look a lot of different ways. I think it is going to come in the form of grants that are coming, for example, as pass through funding. But I don't know.
Probably similar to the way that we received our ARPA grants, the American Rescue Plan funding that came through Buncombe County. That was a pass through funding that came from actually that came through the federal government. However, the Governor's Crime Commission grant that we get from the state is pass through funding as well.
So I think that it's going to look a lot of different ways and hopefully there will be RFPs to be able to apply for that funding.
Matt Peiken: Requests for proposals. Yes. So the 835 million dollars is this All new funding or is it in an increase that the state previously gave X dollars? Now, do you have any sense of that?
Meredith Switzer: My understanding is that is it is a significant increase and I also think that a lot of that funding we'll see coming through the department of health and human services so we'll you know, we'll see how that goes I know that the biggest challenge at least the biggest challenge that i've heard expressed from staff from Buncombe county and asheville city and those who are providing Services at the state level or the county level is staffing So I mentioned earlier that we need mental more mental health providers We know that we're in a crisis, but we need more people to go to school to become mental health providers We need more people staying in this field And we need agencies, to continue hiring and for those people to continue being available to be hired to provide
Matt Peiken: services I would think that's a key challenge and that I'm wondering, is this a new challenge?
Was the mental health field, in general, experiencing a relative scarcity of professionals a decade ago, 20 years ago? What, what's happened to now cause this need for, even though there's a huge need from the public, that you're saying, You don't have enough people to serve the public. Since when?
Meredith Switzer: I can tell you the way we originated is because in 2000, two large mental health hospitals closed. And so that's how we became a part of the mental health scene because there was a scarcity in the type of services and the way that we were able to deliver services for those who were uninsured and underinsured.
So in that way, there was a scarcity. Back in the day in terms of what's happened over the last 20 years I just think that the biggest impact it has been The limited funding to support mental health services for those who can't afford it and for those who are living in the margins Who desperately need mental health care who have no resources because they don't have insurance.
They don't have housing They don't have access to so many of the other supportive services that will affect Mental health as well is
Matt Peiken: some of this to when you're talking about that there wasn't the support. Are we just recently seeing people in positions of authority people in elected office who are now getting it.
In a way, and to a degree that they just didn't before.
Brendan Hughes: Yeah, to me, what it comes down to is lessening the stigma and opening up the conversation. I mean, We've seen that. I think all of us probably in the last 10 to 15 years, there's been a transformation in the way people talk about mental health openly.
I can speak to my own story. I've had Big struggles with mental health, with depression, anxiety in my life. And like even as soon as like 10 years ago, it was really hard to be open with people about that and share that story. But I've had access to amazing therapists over my life and they've helped me incredibly.
What's happened is I've seen that my friends and my network and my community, even co workers are able to open up around their mental health, and it's opened up the conversation to a much broader audience. I think the pandemic was So incredibly tough for many people in many ways, obviously.
But one thing we do talk about at All Souls is it opened up the conversation around mental health on a national level and in our community, because so many people were struggling during COVID 19.
Matt Peiken: Yeah. Do you think it normalized mental health struggles in a way like, Oh, we are all experiencing this. Do you think that's what happened during the pandemic?
Brendan Hughes: In a way, yeah. It like it was a common conversation. Some people talk about the pandemic as like a collective complex trauma that we all went through. And we just we needed to talk to other people about what was happening and all these challenges. So in a way, I do think it really normalized it and we saw Starting from 2020 onwards that when we were engaging with business leaders with government leaders locally that they were all so much more willing to talk about mental health, and I do think that's a good thing.
Obviously, there's still a lot of stigma, and it depends on what culture you're coming from, what community you're coming from, that the ability to talk about that and seek help is still a really difficult thing. So that is one of the things that we try to focus on it at All Souls is not just The therapeutic aspect, which we are providing, but we have our own whole outreach and community engagement program.
And we go out in the community and we talk, try to talk about lessening the stigma and it's okay to talk about your story.
Matt Peiken: At the same time, Meredith, that during the pandemic, it normalized the. Element that we are a lot of us are dealing with mental health issues. I imagine it also changed the mental health landscape.
You're probably seeing certain conditions certain Amplifications of mental health in a way that maybe we weren't seeing a decade ago Can you explain what your intake? Specialists are seeing now on the ground or to a degree now that maybe they weren't before the pandemic
Meredith Switzer: what we hear a lot from our clinical team from the intake process is that the acuity is much greater. So we're seeing clients who are coming to us with maybe still depression and anxiety, but it's at a higher level. And some of the issues are just much greater than some that we've heard of before.
They're just more exacerbated. And I, I do think that it is in large part due to the pandemic and people waiting for a long time, feeling so distraught and affected by what was going on, but waiting to actually come in and see someone or feeling like, what do I do? I can't go see someone because I'm stuck at home.
I'm sheltering in place. There was a time I still remember very vividly in early COVID, how unnerving it was to not know if I was going to be able to go back to work the next week or if I could get my team back together and just, there was so much uncertainty in our world. And so I think you, you have that type of pervasive issue over time continuing and certainly for people who had maybe some.
Pre existing mental health, they saw it exacerbated through COVID. And so what we're seeing now is people who are finally at the end of their ropes and saying, we can't, we can no longer struggle with this. We need to seek help. And to Brendan's point, he mentioned the fact that. For in, in so many ways, the stigmas have been lifted, and I think that's a great thing for our country and our world because that's what we need to see in order for people to get healthy again.
Matt Peiken: Has the stigma lifted even in terms of Employment and being able to maintain your employment. I know when you're sick, you get a certain number of sick days are we seeing the same latitude for just mental health days? Or is that something we still are behind on?
Meredith Switzer: I think we're seeing it.
I know that For example, our organization offers sick time, but also we have two mental health days or self care days
Matt Peiken: I would hope that All Souls would yes
Meredith Switzer: What I want to also share is that is pretty much across the board I'm seeing it with at least peers of mine and non profit work, even if they're not working in mental health But I also see it as an initiative that corporations are really getting behind.
I think corporations the larger Businesses have recognized they can't afford Ford to not support mental health. It's part of the conversations. It's part of the expectations in our world. And quite frankly, if you want to be one of the companies to work for in this day and age, you have to be an advocate for mental health and supporting your employees in that way.
Like you support their other health care is critical to that. You
Matt Peiken: mentioned that you have a waiting list. There probably isn't a social service nonprofit in Asheville that doesn't have a waiting list. There's such. Heavy needs and limited resources Talk about what you're dealing with in terms of the numbers of people you serve At any given time and how many people are waiting to be served
Meredith Switzer: That's a great question and it depends on the day that you ask me.
I can tell you that Currently, we average 35 to 45 people on our waitlist. I can tell you at the end of the summer in June, we were down in the teens on our waitlist. It depends on the number of calls we receive each month, how many people are eligible for services after there is a screening. We had record numbers of calls in July and August of this year.
Historically record, meaning that we'd never seen this number. This type of response to our
Matt Peiken: services.
How many are you serving at any given time?
Meredith Switzer: Currently we're serving over, I would say over a hundred and maybe 120 per month. However, for the year last year, we served a total of. 430 individuals.
Matt Peiken: Oh, so actually when you think about it, if you're serving for an average of 400 a year Not that anybody's mental health can wait but a waiting list of 15 to 40 doesn't seem like they're waiting forever
Meredith Switzer: They're not waiting forever But they're waiting longer than we would like them to because the truth is when you finally get the courage to reach out and ask for help.
It's because you need it now. And when you reach out and the answer is yes, we want to help you, but can you hang on for a little while? Can you hang on for a month? Can you hang on for two months? There are certainly providers who have wait lists because of the nature of the work that they do have people waiting six to nine months for psychiatric care.
Repeat that. Go ahead.
Brendan Hughes: Yeah, we've seen higher wait lists in, in a lot of the organizations that are serving the mental health needs of this community. But I just want to echo Meredith's point is that I've been in that position myself. When you finally make the effort to reach out and try and get help through therapy, like you, you want it now.
And so to have to wait, it can be an incredibly difficult thing. And just accessing, like getting, sometimes getting out of your house if you're dealing with severe depression, like getting in your car, getting on the bus, making it to a place can be an incredible amount of mental effort.
So we try to do everything we can to reduce those barriers and Make it as easy as possible for folks to access us. Sometimes we actually place therapists in a different community partner locations as well to make our services more accessible. Explain that a little bit. What do you mean? Sure. So that's actually a new initiative or an expansion of some work that we've done previously.
And so we've really recognized within the last year and since the pandemic that to make our model. effective. We can't just be serving folks out of our center, which is close to downtown Nashville. Very cute, cozy house. By the way, we also have virtual therapy available, which was a good thing that came out of the pandemic.
But there are a lot of folks that are in really tough situations. That might not just be able to make it to our center, or they don't know about us. For whatever reason, they're struggling with a lot of different challenges in their lives. So we've started partnering with different community organizations to place a therapist on site sometimes to meet people where they're at, just to eliminate one more step, they might not even know about our services. We're trying to get the word out, but if we go there, then we can make that happen more easily.
Matt Peiken: Just give me an example of a place where you have an outreach center or that you are. Doing that kind of external work.
Brendan Hughes: Sure. So one of our most important partners and valued partners right now is Haywood Street Congregation. They're here in Asheville. They serve a population Many of which are experiencing homelessness and many other challenges in their lives So they do a lot of great wraparound services at their site including meals twice a week.
So we actually have a therapist that goes out there for a couple hours once a week and is on site, has his own office at their location, and is basically available for, we call them mental health check ins, so it might not always look like a typical 50 minute therapy session. but they can do short check ins with clients.
And for us, for him, it's all about relationship building. So he's there, he's seeing people on a weekly basis. He's getting that rapport and trust with them so that they're willing to come talk to him. And sometimes that does lead to weekly therapeutic sessions. So Haywood street is a great example.
We've also partnered with ABCCM the Asheville Buncombe community Christian ministry. And they have a temporary housing set up called Transformation Village for women and we've also partnered with them to place a therapist on site and have those services available at the place where they're living as well.
Those are just two examples, but we've had other partners in the past and we're continuously looking for partners that might be a good fit to place a therapist on site.
Matt Peiken: How else has All Souls had to evolve over the last few years, the way you do business that you might not have thought about or had a need to a while ago.
Meredith Switzer: I think that COVID taught us a lot of things, but it also taught all of us that there's some of our work that we can do virtually, right? Because prior to COVID, everyone was seen in person at our center, and now we have a hybrid model. And I will say that clients, still prefer to see a therapist in person.
I would say roughly 70%. But for those who for a variety of reasons may need to see a therapist virtually say that, for example, they wake up and they're sick one day and they don't, they can't come in, but they need to transition to a virtual platform. They can do that if they have transportation barriers.
If they have child care challenges that day, we can still offer a virtual option for them. And so I think that is one change that we learned through the pandemic that has actually worked really well for us. And it also allows us because we technically have a western North Carolina footprint.
We can meet people online in virtual sessions if they're living in a county that's too far for them to come into where we are housed.
Matt Peiken: What are some other challenges of doing your work right now? Whether it's external, internal, with the kinds of problems that people are bringing to the table? What are some other challenges of fulfilling your mission in this community?
Meredith Switzer: I will say that we are a community that has A lot of opportunities for growth and I mean around learning and educating and talking about mental health And so I see that as an opportunity To really get into some of our communities like the faith communities specifically the bipoc community where there may be some hesitation, to access services and i've been speaking with a lot of our partners who work with the bipoc community and they say that But there sometimes can be some trust concerns around accessing mental health.
Matt Peiken: There's a lot of cultural concerns around that, Brandon, you were talking about a lifting of a stigma from what I understand, at least in some communities of color, that the idea, the very notion of seeing a therapist is it's anathema, that that is a cultural hurdle, are you bringing more people of color onto staff and among your counselors to help break through those barriers?
Meredith Switzer: We are certainly trying to do that. I can tell you we are actively working towards that. We are certainly partnering with community Organizations who can help us achieve those goals. We've certainly worked on that in terms of the composition of our board of directors we do have a person of color on our board and We certainly have that representation in our network of therapists, but we certainly want more We're actually going through an equity audit right now With a consultant to help us identify some strategies to really increase that because it's so important to us as an organization not just for The optics of it because certainly it could be seen that way But we also recognize it is important because of the work that we do And in order to have the community impact and meet the needs that exist.
We need to go in that direction
Matt Peiken: And lastly, you know a lot of people in our community see Mental health issues right there in public on our streets. We're seeing that more and more in terms of our unhoused community Vagrancy, we're seeing this epidemic on our streets. Some of it is drug informed, drug fueled mental health issues. How are you and your counselors adjusting to that and trying to cut into that on the ground?
Brendan Hughes: I will say, while we do serve a lot of folks that are very adjacent to those challenges, like the folks that are unhoused, we're not always the first provider to go out and be a case manager, be a social worker.
Connecting to folks that don't have a roof over their heads. We recognize that there's other community partners that do that better. We're really trying to establish what we're good at and what we can support. But we do provide a lot of supportive services when folks are in a stable enough place or they don't have extremely acute symptoms.
that might require a more specialized form of care. So when they do come to us and they are in a stable enough place to, to access our services, then we recognize that's our niche. That's where we can do really good work and support the other great organizations that are on the front lines of working with the unhoused, for example, except for specific examples where we're in like Haywood street congregation.
But I do think those issues come to us through the history of the clients that are accessing our services, they're coming to us and they, many of them have had extremely traumatic circumstances in their lives that they're dealing with, or they have been unhoused, or they're, just dealing with domestic violence, you name it, the kind of extreme, difficult situations that they face in their lives, so yeah our goal with all of this has been to be a great partner and recognize when there are other organizations that can do it better sometimes.
Matt Peiken: Is there anything about your work that we haven't talked about that you think is important for the community to understand?
Brendan Hughes: The one thing is just, we've been trying to be really intentional, especially in the last year of engaging with lots of different groups in our community.
And what I've just about maybe a year and a half ago, we came together as a staff and we're like, what do we need to improve? the most about how we're approaching partnerships and approaching outreach. And we realized that we needed to amp up our outreach efforts, our community engagement efforts.
And as part of that process, we brought on a full time staff member who's doing outreach and community engagement. And her role is specifically that, to go out, connect to community groups that already have the connections and the knowledge. to some of the communities that we haven't been able to form trust with or connect to.
So that's been a huge part of our strategy is just realizing that we can't just rely on folks coming to us. We need to go out into the community. Our connection with Haywood Street, I think, came out of those outreach efforts. Also, ABCCM. A lot of it is focusing on communities where in the past we haven't had as much connection.
We have really. Had great strives to connect to the LGBTQ community, communities of color and so it's also means like having an outreach table at some key events in our community and showing that we are an ally and we're here to provide support to everyone no matter what their barriers to access.