About four months ago, Casa de Salud expanded into a building next door to its Midtown clinic to offer for the first time onsite mental health services.
It was expected to be a slow rollout for the clinic serving uninsured patients, most of them immigrants and refugees.
“Because of stigma and other challenges, we expected 15 appointments in the first month,” said Jorge Riopedre, president of Casa de Salud. “We had 79.”
The mental health services are part of a collaborative, bringing six agencies under one roof to treat patients referred by the clinic’s primary care physicians. It eliminates the long wait time — the average is 18 months — to see a specialist and alleviates the anxieties that often come with going to a new health care facility.
“There is more fear in reaching out to someplace new,” said Meredith Rataj, site director with St. Francis Community Services, one of the agencies in the new collaborative. At Casa, “there is a trust because they know you and you can walk them (patients) over and say, ‘Hey, we have this facility.’ That’s really important.”
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The partners use the space for free, with the condition that most of the patients they see onsite are Casa referrals.
“This is a gateway to those who might not have been willing to reach out and get mental health service,” said Katrina Orlet, a mental health therapist with Bilingual International Assistant Services, better known as BIAS.
“This is a huge deal,” said Jason Baker, executive director of BIAS. “If Casa was going to bridge that gap from physical to mental health, we wanted to be active partners in that.”
The new mental health center has four consultation rooms used by the Casa partners and three more for professionals starting out and not affiliated with a practice or agency. The rooms are connected by small observation areas to help with training, especially for medical students.
“We want to have as many learning opportunities as possible,” Riopedre said. By doing so, the hope is that the medical professionals will stay in the St. Louis area to expand access to mental health services, he said.
“We need all universities to be thinking about this as a place for graduate students to work and do practicums,” said Cathy Krane, executive director of St. Louis Psychoanalytic Institute. “It’s the only way we’ll fill the need. There are not enough providers in the community.”
Casa’s model was built on the use of volunteers, which include doctors and other medical professionals. They include physicians from area hospitals, federally qualified health care centers and retirees. About 3,000 hours a year are clocked by the 70 volunteers. The clinic also has 16 full-time employees.
Like the clinic, the building housing the mental health care facility is owned by St. Louis University. Casa pays no rent or utilities, and maintenance issues also are taken care of by the landlord. The build-out of the new 3,850-square-foot space, formerly a storage facility, was covered by $500,000 from donors and a $500,000 loan from SLU.
Under one roof
Mental health services vary widely, so having several partners with different specialties working together helps, Krane said.
“This removes one of the challenges, and that is access,” Krane said. “This building really relieved a lot of that pressure and brought referral sources together under one roof, where we can share experiences. Not everyone needs the same kind of care.”
With the new collaborative, a Casa patient is screened and in front of a therapist for mental health treatment within two weeks, Riopedre said. The new center offers services five days a week but hopes to expand to seven before year’s end.
The mental health collaborative is part of Casa’s mission to provide a complete health experience for its patients, he said. The $447,000 grant Casa received this year from the Missouri Foundations for Health will help significantly.
“It will give us the tools to achieve our goal of by 2020 becoming the premier health care location for all immigrants and refugees,” Riopedre said. The funds will help pay for cross-cultural training and more community outreach such as health fairs.
Inside the new mental health center, all of the signs, from conference rooms to bathrooms, are written in English, Spanish and Arabic. It’s a nod to the changing demographics of those the clinic serves. While 84 percent of Casa’s patients are Hispanic, 59 nationalities are represented.
With a population growing well beyond Hispanics, the new grant also will allow Casa to look at rebranding itself, including website changes to more clearly indicate that the clinic serves an international population. Casa’s board will be discussing over the next few years whether the clinic’s name, which is Spanish for “home of health,” best reflects its future to move beyond serving a Latino population.
“We don’t want Casa to be off-putting to other immigrants,” Riopedre said of the eight-year-old clinic.
Another indicator of change can be found in the back of the new mental health center. With the build-out of the new space, Riopedre convinced his board to put in a small dental clinic. It’s not yet operational, but Riopedre said he was confident it would be soon.
“My intention by the end of the year is to have a dentist and a hygienist here,” Riopedre said.
For now, the focus is making sure patients understand that mental health care is easily available and an important piece of the healing process, he said. From Feb. 26, when the clinic doors opened, through May, 416 patients had been seen. More than half of those patients returned for follow-up visits, something the providers say is a promising early sign.
Providers are challenged with reducing the stigma often associated with mental health care, said Orlet, with BIAS. As well, doctors have to explain to patients that the emotional baggage brought with them during the migration process can make them physically sick.
It is common for immigrants to suffer with emotional distress as they leave behind a familiar culture, a job, a home and relatives.
“Imagine you go to a foreign country. How do you deal with stress?” said Rataj, with St. Francis. “I go for a run or eat a bunch of comfort food or call a friend. Those options are not always available to immigrants. They are not living in a safe neighborhood, or they work too much or they don’t have a calling card to call or money for or access to comfort food.”
For refugees, fleeing from their home country, there is trauma in the migration process and adapting to a new land where language and ways of life stand in stark contrast to what they left behind, Rataj said.
The current political climate of the U.S. regarding refugees and immigrants adds anxiety to the mix, she said.
“This is a group that is really suffering, and we can provide them long-term therapy,” Krane said. “If that takes three months, or two years, our goal is to have them be productive, happy members of this society. To be able to get through these issues.”
