BREWSTER COUNTY — The Big Bend region’s dire need for more mental health resources was central to discussion among local political and medical leaders at a hospital district meeting last week.
The Big Bend Regional Hospital District (BBRHD) Board heard a proposal from Dr. Adrian Billings — chief medical officer for Preventative Care Health Services (PCHS) and associate dean of rural and community engagement at the Texas Tech Health Science Center — regarding the creation of a new mental health fellowship, one funded and shaped by the BBRHD.
Thanks to federal grant funding and a partnership with Texas Tech, PCHS clinics are already hosting mental health fellows, licensed professional counselor (LPC) program graduates, called associates, from Sul Ross State University and The University of El Paso for their required 3,000 hours of supervised training.
The hope is that by supporting their continuing education, fellows may opt to stay and practice in the area once fully-licensed. “Many of these students, it’s their only exposure to rural medicine, which is really important because the second biggest predictor of future rural practice is rural medicine exposure,” Billings said.
The potential BBRHD mental health fellow would work anywhere from 18 to 24 months and be offered a $60,000 annual salary, Billings said. In order to make the position more competitive, the hospital district may also consider providing free housing and mileage for travel. Tech would help identify candidates and supervise the fellow, Billings said, but the scope of work would be up to the hospital district — a taxing entity that helps provide health services for low and mid income residents in Brewster and Presidio counties.
BBRHD Executive Director J.D. Newsom said the approximate $120,000 expense for a two-year fellow seemed reasonable, and the district could offer either totally free or sliding scale appointments. “This is an area where [the board] can have a pretty cost effective immediate impact to our communities,” Newsom said.
The BBRHD could embed the fellow into one of their provider offices, like the Alpine, Presidio or Marfa PCHS clinics or the Big Bend Regional Medical Center. There is also the need for a mental health professional to visit local jails, where those experiencing crises may be held. The possibilities are endless, Newsom said. “One day a week they go to Brewster County Jail, the next day they go to Presidio County Jail, they’re doing a rotation in Presidio, a rotation in Terlingua.” Newsom said. “I think there’s a lot of ways we can directly impact these individuals.”
BBRHD Board Member Angela Juett asked if it was appropriate to expect a counselor in training to travel such vast distances every day or every other day. “There is so much need,” Billings said, agreeing it was a big ask.
He said he is in talks to expand Texas Tech’s mental health fellowship to include social work and psychology graduates, who also require 3,000 worth of training hours.
Previous Brewster County Judge Eleazar Cano said he is already stretched as one of two LPCs supervising fellows at PCHS, but “the more resources we have, the better.” He said he particularly supported the focus on recruiting graduates from local colleges, who may be from the area therefore more likely to stick around long term. “Being from Alpine, this is my home,” Cano said. “We have a lot of homegrown folks here, and we want to take care of our own.”
BBRHD Board Chairman Buddy Cavness and Board Member Reagen Reed said they were in support of the initiative. Reed, the board’s treasurer, said they first need to make sure they can afford to support a fellow. Newsom said he will work with Texas Tech Health Science Center to create a proposal for the new mental health fellow, including cost and scope of work, for presentation to the board by the next regular meeting.
Also being pursued is a mental health professional to help serve Big Bend National Park employees and South Brewster County more broadly. Speaking to the “very critical need” at the hospital district meeting was Rick Gupman, Big Bend National Park deputy superintendent.
Gupman explained that just the day before, on March 20, an 80-year-old man from Alpine drove down to the park and committed suicide on Grapevine Hills Road. He expressed sympathy and sadness over the tragic event, which he said also took a toll on first responders’ mental health.
“We literally have someone in crisis here in Alpine that came down to Big Bend National Park, took their life,” Gupman said. “We spent our entire day yesterday dealing with that, and today we’re dealing with the mental health of those officers and individuals who went out on that scene.” He said the park has existing partnerships with organizations that allow them to get emergency assistance for employees, but there are no long-term mental health opportunities.
The remote national park is home to around 250 individuals, around half of which work for concessionaire Aramark. The employees — some of which are international — are picked up at the airport and immediately transported to the national park, meaning most do not have their own vehicles, Gupman said.
The closest mental health resources are located in Alpine, nearly two hours away, or online. But Gupman is pushing for an in-person counselor, which he argued would allow South County residents to develop a more meaningful, lasting relationship with a therapist they can connect with face to face, as opposed to a series of brief online sessions. “We provide six sessions and that’s it, you’re literally done and you’re not passed off to another healthcare professional,” Gupman said. “Your therapy is over.”
Gupman said beyond what is included with employee insurance, the federal park service is not likely to funnel additional resources into mental health services for park employees, and that is why he is seeking outside help. “Officially, the answer for the National Park Service is we provide mental health services through the employee assistance program, so we don’t expend any additional dollars on that,” Gupman said.
BBRHD Board Member Valynda Henington asked whether Aramark had been contacted regarding a potential collaboration, to which Gupman said no. In a follow up with The Big Bend Sentinel, Gupman clarified that Aramark employees are not eligible for the same employee benefits as federal parks staff, and he was not sure what their employee assistance program was like.
Aramark did not respond to a request for comment about mental healthcare coverage for its Big Bend National Park employees.
Gupman said ideally any new mental health services would be offered for free for the greater park community, which includes family members and employees of NPS, Aramark, Border Patrol, San Vicente ISD, Big Bend Natural History Association and the U.S. Postal Service, as well as the surrounding areas of Terlingua, Lajitas, Big Bend Ranch State Park and more.
Dr. Barbara Tucker, dean of college education and professional studies at Sul Ross State University, said the need for mental health resources in the national park is “significant and immediate” and seems like a separate role in addition to a mental health fellow for the BBRHD.
She located an LPC colleague from the Dallas area willing to offer telehealth and some “intermittent, occasional in-person” services for national park employees. The candidate is Donna Wallace, a Sul Ross graduate who used to live in the park and is familiar with the area, traveling back often.
Two potential new mental healthcare providers for the region aside, Brewster County Judge Greg Henington wondered whether leaders “ought to dream a little bigger” pooling together resources and searching for ways to create an endowment for a more robust, permanent mental health entity.
PCHS Chief Executive Officer Linda Molinar said one of the issues she deals with is the fact that insurance companies will not pay for patients to see LPCs in training unless an LPC supervisor is in the room.
Marfa resident David Marwitz recommended local political leaders approach state representatives for support on mental healthcare initiatives, stating any potential new bills could require insurance companies to pay for LPCA visits in counties with populations less than 10,000.
Presidio County Judge Joe Portillo expressed excitement about increasing mental health services, which he noted were particularly needed in Presidio with military and Border Patrol veterans. He said he is hopeful they can win support from state legislators. “For the first time in probably the last two sessions I’ve seen them have more of an appetite for mental health,” Portillo said. “I’ve started to see them make investments.”