Bandera County’s limited mental health resources struggle to keep up with demand

From economic turmoil to political and social divisiveness, the past several years have been some of the most challenging the United States has faced. Not surprisingly, a growing number of people have reported increased feelings of depression, anxiety and stress. Yet during these times, when mental health support services are so critical, many say there’s not nearly enough resources to meet demand, including in Bandera County.

“It’s a problem happening in Bandera and nationwide. There's just not enough providers, there's not enough groups, and there's not enough organizations that work with mental health. It’s a big need that’s not being met,” said Donna Carrasco, an integrated behavioral health counselor with the Arthur Nagel Community Clinic in Bandera.

In Bandera County, which is home to about 21,000 people, the Arthur Nagel Community Clinic is one of just a handful of local resources that help people with mental health problems. Founded in 2008, the nonprofit clinic provides low-cost primary and preventive healthcare for low-income residents.

The clinic also provides behavioral health services, prescription assistance, and healthy lifestyle classes. The organization anticipates providing nearly $1.2 million in services and medications with a budget of $637,000 this year, according to its website.

Susan Broa, the clinical director at the Arthur Nagel Community Clinic, said the nonprofit has seen a 113 percent increase in referrals and treatment of stress- and anxiety- related issues compared to last year.

The clinic treats patients with a “wrap-around approach,” she said, with a medical provider who provides and monitors medication, and a therapist who helps teach patients coping skills.

As demand for mental health resources increased, Carrasco in October hosted for the first time a support group for people dealing with grief and loss. She said she hopes to launch another support group early next year for caregivers and families dealing with drug addiction.

“We’ve seen a dramatic increase in patients coming in with anxiety, depression, stress-related issues and panic attacks,” said Carrasco, who started working at the Arthur Nagel Community Clinic in 2018. “I think mental health issues in some ways kind of snuck up on people. Before, it was something people didn't really talk about. But in recent years it’s really come to the forefront. And I think nationwide we’re behind the curve when it comes to providing resources.”

There’s no shortage of data documenting the country’s struggles with mental health disorders over the last few years. Depression among adults in the U.S. tripled in 2020 after the onset of the pandemic, jumping from 8.5 percent to 27.8 percent, according to a new study from the Boston University School of Public Health. The study indicates the depression rate continued to increase in 2021, climbing to 32.8 percent.

In another study, MyBio-Source.com, a biotechnical products distribution company, ranked Texas as the 18th most stressed state in the country.

MyBioSource examined physical and mental distress data from county health rankings from 2017 to 2021 to see what areas experienced the biggest increase in stress levels.

This data revealed that as a state, the rate of mental and physical stress in Texas increased three percent. By comparison, Maine was ranked No. 1, with a 6 percent increase in total stress, while New York was the least-stressed state in the country, with a stress deflation rate of two percent.

Within Texas, out of 254 counties, Bandera ranked as the 95th most stressed, based on factors like quality of life, health behaviors (smoking, drinking, physical activity, etc.) and social and economic factors.

And looking forward, with inflation, a contentious presidential election coming up in 2024 and ongoing military conflicts around the world, it’s likely that more people will continue to wrestle with mental health issues—and the lack of resources available to help them.

That’s especially true in areas like the Hill Country, parts of which are sparsely populated with few, if any, resources for behavioral health and disability services. And the services that are available often have certain requirements or conditions that limit the number and kind of people they treat.

Additional Bandera County resources include Hill Country Mental Health and Developmental Disabilities Centers. With 22 locations throughout 19 regional counties, the organization formed in 1997 and serves a population of over 630,000 with services for adult and child behavioral health, intellectual developmental disability, substance abuse and crisis care.

In its 2023-2025 strategic plan released in August, the organization acknowledged recruitment remains a challenge and it hasn’t been able to fill all vacancies due to COVID and the current workforce market. The report indicates Hill Country has prioritized recruitment and implemented three incentives for staff, including hiring bonuses, referral incentive and Covid retention payments.

The strategic plan also lays out the organization’s objectives, which include coordinating with partners to improve services and supports. Other objectives include collaborating with government agencies, criminal justice stakeholders, and advocacy organizations to divert people away from public safety and criminal justice settings.

Finally, the organization hopes to expand mental health and crisis intervention services by training law enforcement and community service officers to assist people during a behavioral health crisis.

Another local resource is K‘star Youth & Family Services, a nonprofit, community-based organization in Kerrville that offers counseling and shelter services in 14 Texas counties.

K‘star has an emergency shelter that can house up to 20 children, who are placed with the organization through the Texas Department of Family Protective Service and other local agencies. K’star also offers counseling services free of charge to eligible families and aim to prevent runaways, truancy, abuse, and neglect.

Finally, the organization has parenting classes and family counseling. And the Hill Country Crisis Council is a nonprofit that serves counties throughout the region, including Bandera.

Located in Kerrville, the organization was incorporated in 1984 to serve victims of domestic violence and sexual assault, offenses that typically increase during times of stress and anxiety, said Kim Olden, director of trauma informed services at the council. In addition to therapy, the organization offers emergency shelter for men, women and children, and helps coordinate with local legal, medical and community services to get victims the help they need.

Olden, who’s been in her role for five years, said she’s seen a steady increase in people dealing with trauma and stress.

“It’s just been across the board,” she said. “A lot of people were already operating within fragile systems, and that weighs on people's minds and mental health can decline because of it.”

Similar to Arthur Nagel Community Clinic, the council recently placed a full-time therapist in Bandera to provide individual counseling as well as hold support groups, which are already at capacity, said Anna Reid, who has been a counselor with Hill Country Crisis Council for about a year.

“I started out part-time, but it became obvious pretty soon that there was a need for a full-time counselor, and now I’ve got a full caseload and a waitlist,” said Reid.

She added half of her caseload is children dealing with abuse, violence and neglect, all problems that were exacerbated by the pandemic.

“There were a lot of stressors and people were stuck in their homes and stuck in this environment of abuse. Violence increased significantly,” Reid said.

Looking forward, Reid said she hopes to expand her counseling services and offer additional support groups, especially for adolescents.

“I'm still getting the hang of this area, but the clients keep coming in, so we’re going to do as much as we can to help.”