WORTHINGTON - The Southwestern Mental Health Center hasn't yet reached its fifth anniversary in its Fifth Avenue facility near downtown Worthington, and interior renovations have already been made to create more work space.

The reason?

The need for mental health services in Nobles County has increased 76 percent since 2012, with a 24 percent increase from 2016 to 2017 alone, according to SWMHC Director Scott Johnson.

"The demand for mental health service and service delivery from SWMHC in Worthington has grown more than twice as fast than in surrounding communities," Johnson shared.

The significant rise in demand in Nobles County hasn't been as pronounced in the other four counties that comprise the agency: Cottonwood, Jackson, Pipestone and Rock. Though it's difficult to say what's happening locally to warrant the increase, Johnson said anxiety and depression account for more than half of the reasons why individuals seek help from the mental health center.

"There's a lot of other things, but those are the most frequent," said Johnson, adding that it's important for people to address those issues because they can be very serious.

Johnson speculates some of the increase in Nobles County could be attributed to added staff in Worthington, which allows the agency to provide more services. There are approximately 50 full- and part-time employees at the local SWMHC facility, with many of the doctors and counselors traveling between the agency's five offices. Johnson said some physicians from Sioux Falls, S.D., meet with patients at the local office.

Steady growth

Johnson said the amount of service hours logged at the Worthington facility has doubled since 2011.

"We've been growing roughly 9 or 10 percent in outpatient service hours every year for 10 or 12 years," he said. "Our Worthington office has grown faster - more like 24 or 25 percent growth per year for several years."

Rising demand for mental health services isn't an anomaly in Nobles County; it can be found across the state and the nation.

"We don't exactly know why," said Johnson, who has served as SWMHC's director for 19 years. He said increased awareness of mental health services and a reduced stigma are factors. Asking for help is more acceptable, insurance coverage now exists for mental health services and treatment is better than it used to be, he added.

"There's a fair amount of speculation that people are just under more stress now," he said.

With divorce rates on the rise for decades, more children are coming from broken families. Additionally, drugs and alcohol are more prevalent, and children are exposed to those behaviors at a young age.

"More people are reporting multiple adverse events in their childhood," Johnson said.

Yet, there isn't one particular age group in more need of services. The Nobles County office has seen a rise in patients across the spectrum, from children to young adults, adults and the elderly.

"There's kind of an uptick in all age groups and all backgrounds," said Johnson. "Poverty and economic problems do drive up our business. That's been documented for hundreds of years. We think that could be a factor."

The addition of a 24-hour mobile crisis response program for the five-county SWMHC in 2009 has helped the agency reach more people, as well. Johnson said usage of the hotline (1-800-642-1525) has increased about 30 percent a year, every year.

Cramped quarters

When construction of the new SWMHC facility was completed in summer 2013, Johnson thought there was adequate space to provide for future growth. The need for mental health services, however, exceeded his expectations.

"I had thought things would level off seven or eight years ago. They have not," Johnson said. "Everything we're seeing is showing the demand will continue to rise in the years to come."

With the agency sharing a city block with its in-patient Unity House, Johnson said there's no space for a building expansion.

The Worthington location isn't the only one cramped for space. SWMHC facilities in Pipestone and Windom are both "maxed out" with adequate space at the Jackson and newly remodeled Luverne facilities, Johnson said.

Avera Behavioral Health in Sioux Falls, S.D., where local individuals often are sent for inpatient treatment, opened its new 110-bed psychiatric facility in 2006. Johnson said the facility was poised to meet the needs of the community to 2025, but was quickly filled. Another 14 units have since been added to try to meet the demand.

In addition to adequate space, Johnson said staffing has been a real challenge - both in Minnesota and nationwide. There aren't enough mental health workers to meet demand.

Although SWMHC's outpatient services staff is adequate, Johnson said there have been challenges in the past to fill positions. Currently, the Unity House has a staffing shortage, which has directly affected the number of patients that can be housed in the facility.

"The demand is there, but we're limiting the amount of people we'll take because we're still looking for some full-time workers," Johnson said, adding that physicians who provide psychiatric services are particularly in demand.

In the schools

For decades, staff from SWMHC have been available to students in area schools, where they have welcomed student referrals from staff. Eight years ago, the agency began providing school-based mental health services.

Clinicians visit Worthington's Prairie Elementary, middle and high schools on a part-time basis, which has proven to be effective, Johnson said. Clinicians also spend time in the Adrian, Round Lake-Brewster, Windom, Heron Lake-Okabena, Luverne and Pipestone schools, and Johnson plans to expand on the program next fall.

"Our staff double as crisis responders when there's urgent issues at the school," he said.

Earlier this month, Gov. Mark Dayton proposed an additional $5 million in state funding to bolster mental health programs in schools. Johnson hopes some of that money will end up in the Worthington schools, where a proposal for increased services has already been created.

Other legislative action Johnson is watching is a change in requirements for mental health workers that would increase the pool of available individuals to do the work.

"We're also advocating for increased rates for mental health services," Johnson said.

Despite some of the challenges in meeting the demand for mental health services that exist today, Johnson appreciates the strong local support from the five-county collaborative, including its schools, law enforcement and family service agencies.

"We have strong partnerships in the area that allow us to do much more than we can do ourselves," he added. "I'm very pleased we're able to do a lot of things we wouldn't be able to do in communities of our size because of the partnerships we have."