Jin Lee Palen's member clinics are on the health care front lines, too. It's a pity she has to shout to make that clear. Palen of St. Paul is executive director of the nonprofit Minnesota Association of Community Mental Health Programs. The statewide network of 32 community-based mental and chemical health programs serves approximately 180,000 Minnesotans annually, regardless of ability to pay. In a professional sector already overwhelmed by need and largely underfunded, Palen talks about the additional challenges her agencies face as they address the mental health needs of low-income and culturally diverse clients as the COVID-19 crisis escalates.

Q: You must feel like your hair is on fire. What are you hearing from mental health professionals around the state?

A: Clients are absolutely struggling since we moved to a stay-at-home order. They and their families already had a lot of needs and were using a lot of mental health services. Now they're trying to cope in a new environment when they're feeling isolated. Many of their kids were receiving school-based mental health services. Families are trying to understand how to re-relate to each other with limited outlets. We're also seeing an uptick in demand for chemical health services. With liquor stores deemed an essential service, combined with folks struggling with loss of jobs, anxiety and fear from so much uncertainty and loss of social activities, we're anticipating that there's going to be more need for our services.

Q: How are members responding?

A: Our community mental and chemical health providers are amazing! They've shifted on a dime in terms of how they're delivering services to fulfill all the needs of their clients. They've been doing this all the while not knowing whether they'll be able to recoup the costs. My member organizations have said over and over — supported by their charters and boards of directors — that they will not turn anyone away. They'll get them the help they need and find a way to pay for those services on the back end. Our mental health providers are really the backbone of the mental health safety net.

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Q: Why is the pandemic particularly challenging for mental health advocates?

A: The pandemic shifted all our worlds, including bringing new logistical and technical challenges. But the biggest challenge is not on a logistics or tangible level. The challenge is on a perception level. We are health care providers. We have struggled historically and are still struggling with the fact that society and decisionmakers don't view us as part of the health care system. Especially with COVID, a lot of focus is being laid on primary care clinics and hospitals. What's concerning is that all of our critical services — services that keep people healthy as a whole — have not been part of that conversation. Mental and chemical health are not being brought to the table in talks about health care priorities.

Q: Aside from those already at risk, are you seeing an increase in need from people who were managing their mental health relatively well but are no longer able to do so?

A: We haven't seen the numbers yet but I can say, based on what some of my providers are hearing from their local community partners, that we are anticipating a wave of increased demand for mental and chemical health services in the next month. It's going to come, and come in a pretty big way.

Q: What are your concerns regarding chemical health?

A: We're not out of the woods with the opiate epidemic. A lot of members are saying meth is still on the radar. But alcohol remains one of the key drivers of substance use. Opiates really caught the attention of the nation and it's important, but one of the biggest concerns is the ongoing prevalence of alcohol.

Q: In "normal times," where might people turn for help?

A: They might call 911. Emergency rooms are currently utilized a lot, often overutilized. Statewide crisis lines are available via text, but they're not as well known as 911. With even more police and mental health crisis calls, we're worried that this will overwhelm an already struggling system.

Q: I'm guessing those struggles go beyond mental health services, such as to concerns about food and shelter.

A: They all play off each other. You're already struggling to address your mental illness and then you lose your job. Are you going to lose your home? Will there be food scarcity? They all impact each other.

Q: What gives you hope?

A: I was just on a call with some member CEOs sharing their experiences of the pandemic. One mentioned that they're seeing an increase in access, and a lessening of no-shows, in day treatment programs due to the ability to access them through Telehealth. We're cautiously optimistic that one silver lining of this crisis could be that some of the systematic changes occurring across the state and country will lead to a discussion about how to keep some of these new policy and program efficiencies in place permanently.

Q: What do you hope to be able to say six months from now?

A: In a perfect world, we'd be in a space where, first, mental health is really, truly seen as a critical part of health care and our mental health system in the state is part of the same decisionmaking when leaders talk about funding. How do we address how we're funding our mental and behavioral health to get it to equity with other health care? As a care industry, we have just been slowing starving over the years.