Beyond the Stigma

After 45 years of marriage, Lara’s* husband was diagnosed with Alzheimer’s disease in his 60s. The sudden decline left him extremely agitated and sent her reeling. “I was rapidly becoming hopeless and felt helpless,” she says. He ended up in a specialized facility. 

Lara sought help as she tried to navigate the grief of watching a loved one decline, as well as the guilt of living her own life while he received care. “I’ve been seeing my therapist weekly for nearly 1 ₁/₂ years,” she says. “It’s absolutely been the best thing for me. I’m learning to accept my feelings and how to be the best wife to my husband during this period of our marriage.”

Andi*, an educator and media professional, began going to therapy after having “ongoing panic attacks, overwhelming feelings of dread, and constant anxiety,” she says. The process helped her realize she had never dealt with her father’s death when she was in her early 20s. “Those repressed feelings showed up in a big way, and therapy was the most accessible way to start untangling my anxiety,” she adds. Today she finds herself advocating for it. “The right therapist can truly change your life. There is work involved, but it’s so worth it when you reclaim yourself.”

Cade*, a former high school athlete who now works in marketing, also sought therapy because of a parent’s death. Less than two years ago, he began seeing a counselor following the death of his father. “I’ve been amazed at how well they have helped me work through some deep-seated anger issues that I have harbored for the majority of my life,” he says of his therapist. 

Tanner*, a nonprofit employee, grew up in a home with an abusive father. One evening, at age 9, Tanner fled with his toddler-age brother when their dad knocked their mom unconscious. “I thought she was dead,” he says. “No one told me until a few days later that she was in the hospital and she didn’t die.” His father eventually ended up in prison. 

It wasn’t until adulthood that Tanner began to realize the impact of his upbringing. He was depressed. He had nightmares. The smell of alcohol triggered major emotional responses. “My anxiety and depression could almost all in one way or another be traced back to my father and who he chose to be,” he says. Finally, a local therapist trained in eye movement desensitization and reprocessing therapy and complex trauma helped Tanner lower that trigger response and unwanted recollections of what he thought was his mother’s death. “It gave me back control over little things in my life that I had lost hope over,” he says.

These are anxious times, and not just for the Texas Panhandle residents whose stories are shared above. The closures of schools and workplaces during COVID made some feel like they’d lost their foundations. Loved ones died. Politics turned fraught. Relationships became digital. The numbers of Americans contending with anxiety or depression were rising before the pandemic, but it has accelerated in the years since. 

Pew Research surveys have found that at least 4 in 10 U.S. adults “experienced high levels of psychological distress” since the pandemic began. A third of adults experienced regular sleeplessness and anxiety. Around 40 percent of parents say they worry about their children suffering from anxiety or depression—concerns that rank higher than bullying or violence.

National stats from the National Alliance on Mental Illness find that 1 in 5 adults experience mental illness to some degree, from generalized anxiety disorder or PTSD to more severe conditions like schizophrenia or psychotic disorders.

Residents of Amarillo and Canyon are facing mental health challenges. But at the same time, our culture is more willing than ever to talk about those mental health challenges and seek professional health, and that’s a positive sign.

A Disease, not a Weakness

“It’s an exciting time to be in psychiatry because we are understanding more about the brain, and about the pathology that we take care of, than we ever have before,” says Dr. Amy Stark, a board-certified psychiatrist who has specialty training in addiction psychiatry. Currently an associate professor of psychiatry at the Texas Tech University Health Sciences Center School of Medicine, Stark says new medications and new models of patient care are combining with a growing cultural acceptance of mental health care, for the benefit of Panhandle residents.

That hasn’t always been the case, though, especially given the independent local spirit.

“That spirit of being able to pull yourself up by your bootstraps pervades our community,” Stark says. “And I think in most cases, that resilience and willingness to take care of yourself is a good thing.” But willpower isn’t always enough when it comes to caring for your mental health. It’s becoming increasingly clear that mental health is a medical issue, not a moral one.

Anxiety or depression, in other words, are not character flaws. “It’s not a weakness. It’s not someone being lazy. It’s a brain disease.” The same goes for addiction, bipolar disorder, and extreme depression. Mental health struggles at all levels are not the result of some kind of personal failure, she says. “It’s genetics, its environment, its biology, it’s all of it together. It’s nature and its nurture. It’s not that you’re not enough.” 

Margie Netherton describes it another way. The president of the Texas Panhandle chapter of the nonprofit NAMI, she says there’s no shame in seeking help for a mental health issue. “If you’re lying on the floor with your leg broken and bleeding, you would get help for that,” she says. “We need to encourage everyone to get help. There’s no health without mental health.”

In many respects, the pandemic changed the national attitude toward mental health, as the combination of lockdowns, illness, social withdrawal and other forms of stress saw nationally skyrocketing rates of anxiety and depression. Kirk Daniels says local attitudes have reflected those national trends. “For a long time, people didn’t want to talk about mental health because of the stigma attached to it, [but] it’s becoming more part of the conversation,” says Daniels, executive director of Family Support Services, which offers a number of behavioral health and counseling services. “People are more open to it.”

Still, mental health professionals like Stark, Netherton, Daniels and their peers have to work hard to educate local people about the issue, telling them, in Stark’s words, that “it is OK to not be OK and it is OK to accept help when something isn’t going well.”

Caring in Times of Crisis

Most of that help involves less intensive services like therapy and counseling. These are designed for individuals like those mentioned in this article’s introduction—people who are not yet experiencing a crisis but are working to manage conditions like anxiety or depression or deal with traumatic experiences.

Thankfully, Amarillo and Canyon offer a solid number of professional counselors who provide what might be described as consumer-focused mental health services, and organizations like NAMI, Family Support Services and Texas Panhandle Centers host support groups. Many churches also offer faith-based groups and counseling.

But what about acute or crisis care? That’s a little more complicated locally. 

“Nationally, there is a shortage of mental health providers,” Stark says. “Waitlists for psychiatrists all over the country are long.” It may be even worse in the Texas Panhandle, where the local medical community serves more than 220,000 Amarillo and Canyon residents as well as everyone else in the top 26 counties of the Panhandle, and beyond.

“We are very, very fortunate to have primary care docs and providers in this community who are well­-versed in mental health, because the bulk of psychiatric care in any community is actually done by our primary care physicians—our first­line docs—because there just aren’t enough psychiatrists to do all of it,” she says.

At NAMI, Netherton agrees. “We have a real shortage of psychiatrists and other mental health care workers,” she says, noting that 170 counties in Texas, including much of the Panhandle, don’t have a psychiatrist living in the county. “Some psychiatrists have two-year waiting lists.”

Those are holes in the safety net, and acute care mental health institutions are meant to be the safety nets for individuals who are going through a mental health crisis. These facilities include the Behavioral Health Hospital (Pavilion) at Northwest Texas Healthcare System, BSA Behavioral Health, and Oceans Behavioral Hospital Amarillo.

These offer immediate and intensive care for individuals who are suffering a severe mental health crisis. For instance, Northwest has a 106-bed inpatient unit as well as an outpatient clinic. Sometimes patients are referred by physicians. Some check themselves in voluntarily. Others may be brought in by law enforcement or by court order.

Sometimes these individuals are facing a drug addiction combined with mental health disorders. “It could be their medications are off, and they need a couple of days to get stabilized,” says Christopher Veal, the chief executive officer for the NWTHS Behavioral Health Hospital. “There are different ways to end up here, but they’ll be inpatient if they are a danger to themselves or others.”

Four psychiatrists, including two specializing in child or adolescent care, team up with a half-dozen nurse practitioners to offer 24-hour supervision and intensive therapy at Northwest.

Oceans Behavioral Hospital Amarillo offers similar treatment to address acute symptoms and help patients regain stability. Its patients may be dealing with severe depression, schizophrenia, threats of suicide, behavioral changes related to Alzheimer’s disease and other issues, and often arrive with referrals from the two hospitals or VA Amarillo Healthcare System. While the hospitals provide care for all ages, inpatient care at Oceans serves people 30 and older across 28 beds. Average inpatient stays are around three days, though Executive Director Jim Womack says longer stays tend to be better.

“Some may be here six days to two or three weeks, depending on the severity of their symptoms,” he says. Womack says the need for acute care doesn’t always stem from something as dramatic as a psychotic break, but a compounding of existing crises. “What I’ve seen is someone under an extreme amount of stress already—job, finances, home life. Then another crisis gets added on.” 

Maybe a family member passes away, a car accident adds to a family’s financial struggles, or a business has to file for bankruptcy. “Any catastrophic event can be a real big trigger.”

Inpatient to Outpatient

These inpatient facilities, including Northwest and Oceans, also work to transition patients from inpatient crisis care to less restrictive outpatient care. A patient’s success often depends on how well they manage those next steps. In these cases, a patient might attend daily programming at a behavioral health hospital, then return home. 

For instance, Oceans offers an intensive outpatient program for adolescents age 12 to 17, who might go to school for a full day before arriving at 4 p.m. for three hours of group counseling or individual care. “They’ll work with a licensed professional counselor or mental health technicians,” Womack says. Whether for adults or students, these are considered “step-down programs,” transitional services to help individuals move from residential treatment into a lower level of care with support. “You don’t want someone to get discharged but no one follows up,” Womack says.

A significant part of that monitoring comes from the Texas Panhandle Centers, which provides behavioral health services to more than 10,000 individuals a year across the top 21 counties of the Panhandle. This includes assessment and case management, along with other treatment and support services—cognitive and behavioral therapy, medication monitoring, coordinating inpatient services—for all ages.

“Our agency serves the lifespan,” says Program Administrator Sara Northrup. “We have early childhood intervention that’s [age] 0 to 3, children’s services up to 19, and then our adult services,” which include behavioral health as well as care for individuals with intellectual and developmental disabilities. “For our adult population 18 and older, we serve individuals that have a diagnosis of schizophrenia, bipolar disorder, major depression, and many other diagnoses, in addition to substance-use disorders,” she says. “We want to keep people in the community, having a quality of life that makes sense for them and reducing hospitalizations.”

TPC also activates disaster-response teams to provide care for those facing mental health crises due to events like the early 2024 wildfires. “We just want to keep people from falling through the cracks. There’s someone watching them through the process,” says Northrup.

One of the most significant local steps toward a holistic mental health infrastructure dates back to 2016 and the establishment of the Panhandle Behavioral Health Alliance, a collaborative organization that has 25 organizational members in 27 counties. This regional partnership works to bring a variety of health care providers and organizations to the table to address local mental health needs, attract and retain professionals, and make it easier for people—including people in rural counties—to get the help they need.

Netherton and NAMI were part of the launch of that organization, and she calls the PBHA one of the most significant “positive steps” toward improving mental health in the area. “They created what we’ve needed for a long time, which is a one-stop-shop mental health website,” she says. That site is panhandlementalhealthguide.org, and it connects people needing care with providers and resources.

State Beds & Specialization

A second major step forward is taking shape: the construction of the only state hospital for inpatient mental health care in the Panhandle. Funded by the 88th Texas Legislature, this $159 million, 75-bed hospital will occupy land at 6610 W. Amarillo Blvd., not far from the VA facility and the existing hospital district.

“It’s something we’ve needed for decades, in my opinion,” says Rep. Four Price about the Panhandle State Hospital in Amarillo. Price, the outgoing District 87 member of the Texas House of Representatives, advocated for the hospital’s funding for years. Currently, the closest state psychiatric hospitals are in Wichita Falls or Big Spring, and that has had a profound impact on the local criminal justice system.

One of the main functions of these hospitals is to assess or restore competency for individuals who haven’t been able to stand trial because they’ve been declared incompetent. Without space in a state hospital, an inmate may languish in a county jail. “As I’ve traveled the Panhandle in my legislative career, the No. 1 issue county judges, sheriffs and local police voice to me—their No. 1 concern—is dealing with individuals who don’t need to be in the criminal justice system but are wrapped up in it,” Price says. “They cycle in and out because they’re not getting any treatment.”

Some wait up to a year to get into a state facility. And if Wichita Falls or Big Spring aren’t options, they may end up in El Paso or the Metroplex area.

Beyond those waiting to stand trial, state hospitals provide long-term forensic psychiatric care. Some individuals require hospitalization due to severe mental illness that keeps them from functioning within the prison system. Others may have been found not guilty by reason of insanity. These people will also be served by the state hospital.

Upon completion, it’s expected to bring 300 to 400 mental health jobs to the area. That is, if the workforce exists. Questions remain: When that facility opens, will it be able to hire psychiatrists and mental health professionals to staff it? Those positions are already in high demand at the hospitals, places like Oceans, and at Texas Panhandle Centers.

The Panhandle is stretched thin when it comes to specialized licensure in mental health care. Stacy Sandorskey, LPC, who directs the children’s program at Texas Panhandle Centers, has had a licensed professional counselor position open and unfilled for two years. “Those positions are in such demand,” she says, and many mental health professionals gravitate more toward the financial advantages of private practice rather than state or nonprofit work.

Counselors at Family Support Services maintain a caseload of 25 to 30 appointments per week, with a waiting list. Kirk Daniels says his organization is also trying to hire more therapists. 

Price recognizes that the demand for mental health professionals outweighs the supply, and says the state has prioritized resources toward developing that workforce. “There’s a great need for peer support counselors, licensed social workers and mental health professionals of all varieties,” he says. “We’re looking at creative ways to partner with institutions of higher education to develop curriculum to attract and train those professionals.” He believes mental health carried such a stigma for so many years that decades of funding and policy development, from the legislative side, failed to keep pace with the state’s population growth.

Meanwhile, Texas Tech University Health Sciences Center in Amarillo is hoping to develop a psychiatry residency program to train future psychiatrists. After medical school, most burgeoning psychiatrists endure another four years of additional training. “We would love to develop our own program, because the data suggests that 60 percent of psychiatric trainees stay within an hour of where they train,” Stark says.

All those efforts are trying to turn the tide. “There’s a lot more emphasis today than a decade ago. But it’s a real challenge,” Price says. “We definitely have a lot of ground to make up.”

Talking it Through

Those are the needs. Forensic beds at a state psychiatric hospital. Mental health professionals, from licensed social workers to psychiatrists. Increased funding. Expanded capacity. 

That part of the local mental health conversation covers elements that many residents, thankfully, will never have to deal with. Most won’t find themselves needing treatment in the criminal justice system. Most won’t find themselves enduring a mental health crisis or a situation where they threaten to harm themselves or others.

But these experts all agree that everyone should be talking more about mental health, from conversations with friends and family to conversations with a professional.

“The reality is that there are many more discussions [today], privately and publicly, about mental illness and mental health,” Price says. “I think the stigma that was once associated with mental illness is still present, but to a lesser degree. Folks are more open about the care they need.”

The need for it now is greater than ever, Daniels says, listing some of the mental health issues that he’s seen clients dealing with. “Post-pandemic, people were isolated, they were having a hard time financially, they got sick with COVID, they lost a family member,” he says. “All these different issues bubbled to the surface.”

In fact, suicide rates have been rising nationally since 2020, with increases in particular among younger adults and racial or ethnic minorities. The year 2022 saw the highest-ever recorded number of suicides in the U.S.

“We have to talk about mental health in the same sense as we talk about physical health, and not really separating the two,” says Northrup at Texas Panhandle Centers. “If you break your foot, you don’t feel well all over. It isn’t just your foot. And if you miss work or you’re stressed about money, it just has a snowball effect.”

Dr. Stark says the independence of local people has always been one of those defining Panhandle characteristics that Amarillo and Canyon residents speak of with pride. But it can also keep some people from seeking help. “Having feelings doesn’t mean you’re not tough. It means you’re human,” she adds. Further, mental illness and addiction should be viewed as medical problems rather than moral ones. “It’s of the utmost importance, but it takes a lot of education. [It requires] a little bit of breaking down walls and helping people understand that this is not because of something you did. That’s not why you have depression. That’s not why you have bipolar disorder.”

As our society understands more about mental health, we are making progress. At the same time, this region needs more professionals to walk alongside residents who are struggling. The conversation is expanding. And in a world that keeps getting more complicated, it definitely needs to continue.