Officials with the Ulster County Department of Mental Health held a community needs assessment session on March 19, giving county residents and field professionals alike a chance to list perceived shortcomings in programs meant to help folks with mental health issues.

After two hours of fleshing out areas where members felt more work was needed, this event marked one of the first steps centered on outreach and data gathering. The goal is the development of a framework Ulster County officials can use to guide department improvements in the years to come.

These efforts were driven by the Ulster County Legislature, said Department of Mental Health Commissioner Tara McDonald. She said the county had to secure funding and then decide which program enhancement method to pursue. After reviewing submitted requests for proposals, Ulster County went with Human Services Research Institute out of Massachusetts, a data analysis group with a focus on mental health program augmentations. McDonald joined the group discussions after briefing the audience on how this event came to be. “This has been years in the making,” she said.

The needs assessment session was organized by department Special Projects Director Joleen Darby. While the goal was to poll participants for weaknesses, she felt the department is making strides. “There is so much going well here,” she told the audience. “There are some really special things happening in this county.”

That sentiment was echoed by Bevin Croft, the director of behavioral health with the Human Services Research Institute. She told the group that, compared with other groups in different states that she has been involved with over more than a decade, Ulster County is very well positioned to provide services. Both she and Darby agreed that the groups working on these matters locally are very well connected, with Darby specifically noting that most groups in Ulster are “extremely collaborative.”

As no topic appeared off limits, Darby and Croft started by recognizing known weaknesses. According to the two, the county is aware that some groups like minorities and undocumented immigrants were underserviced, more so when language barriers prevented good communication. Affordable housing also came up early and often, noted as being a stressor for folks with mental health issues. Outside of affected county residents, folks gathered for the needs assessment included mental health advocates, peer specialists, support coordinators, government employees, community-based service providers, social works students and hospital employees.

From group session discussions, a wide array of service shortfalls was presented to the audience. Concepts covered included a lack of providers over the lifespan of an individual; a lack of psychiatrists and counselors in general and the impact of long wait lists for help; insufficient pay for professionals in this field which results in high turnover and burnout; the impact of the national drive for deportation of undocumented immigrants and how local enforcement affects students going to school; rural county residents’ lack of access to services and the danger of becoming isolated from social interaction; the impact of insurance on those who would seek services and how low-income residents can be forced to choose between getting help and paying bills; sending patients out of the area to receive services and the disruption that causes within a patient’s support network; and a perceived lack of familiarity with the 988 phone service — which, in addition to suicide prevention, can also point callers to available resources.

This isn’t the first instance McDonald acknowledged work was ongoing. In her previously released 2024 year in review message, she said: “We saw a 33 percent decrease in opioid overdoses and a 45 percent reduction in opioid-related fatalities. Additionally, suicide-related fatalities were reduced 17 percent in 2024. While we recognize there is still much work to be done, these improvements serve as a reminder of the positive impact of our collective efforts.”

After the event, Darby said she was grateful to have so much early participation. “Overall, participant feedback was overwhelmingly positive. Many expressed that they felt comfortable sharing their voices and engaging in meaningful discussions. The forums fostered a strong sense of community and support, underscoring the importance of continued collaboration to address these critical issues,” she told us.

With an online assessment session also under her belt, Darby said concepts from the group are solidifying. “Several key themes emerged from these discussions, including immigration policy reform and its impact on mental health, challenges faced by an underpaid and overburdened behavioral health workforce, housing and transportation barriers across our geographically vast county, and the lack of services and transportation in rural areas, which make long-term engagement in care difficult. Additionally, there was a recurring theme emphasizing the need for increased education for youth and expanded preventative services to better support both school systems and parents of youth in need of care,” she said.

Darby said the department should have useful insights by year’s end, with expected developments throughout 2025.

Discussion Group Focuses on Community Needs

We sat in with one of eight groups to get a sense of how discussions would lead to results. Each group was instructed to review problems they face and propose solutions that could be seen in five years. As group participants could be folks either using services or related to folks using services, event organizers requested a degree of anonymity for participating folks.

Group members included Julie, a parent and family peer advocate; Kristen, a social work student; Alexandra, with affected family and with the Resource Center for Accessible Living, and Ezra, a psychiatric nurse with HealthAlliance.

Ezra started the group off by saying more work was needed to promote available services. He said if those in need could be routed correctly to services they can use right away, it would reduce burdens on other emergency services. He also said the county would benefit from a stabilization service unit, which Julie agreed with. “It provides an opportunity to cool off,” she noted.

As could be the case with pre-hospital diversion services, which Kristen claimed was in development in the county, Ezra noted getting usable options took too long. “All these programs take forever to launch,” he told the group.

Ezra also called for appropriate, stable housing for folks in need. “They’re already living on the street or couch-surfing,” he told the group, also noting that such folks often end up in hotels next to similar people who are dealing with their own complex situations. Julie agreed, stating that in some instances fights can result — and the situation could be dispelled with more appropriate available housing. She said there aren’t enough beds available to take on everyone. “It just seems like they’re always full,” she said, speaking for a service providing house she has experience with.

Ezra said just having any space isn’t enough. “Not just a room with a key, but a house with support … medication supervising.” He would later go on to also call for more post-hospital transitional services, describing the current state of hospital care as “catch and release.”

Mirroring sentiments shared by Ezra, Alexandra called for a clubhouse model for support, a place she and her family could make use of as needed. Clubhouses in this context are defined as locations in a community that can offer people with mental health issues opportunities for friendship, employment, housing, wellness and access to medical and psychiatric services. She said after experiencing such a center in Columbia County she was surprised Ulster didn’t have any.

This group proposed developing these ideas into guidelines for program development before and after hospital treatment. They also suggested the county move forward with creating at least one clubhouse option for residents.

Croft told the assembly that all of their ideas would be pooled with similar respondents in other sessions. She said the plan was to conduct about 100 interviews, then aggregate the data into usable forms and plan around those results.