In 2022, 988 launched as the dialing code for the nation’s suicide-prevention and mental health crisis hotline. That same year saw the creation of the Arkansas Opioid Recovery Partnership to distribute the state’s share of opioid litigation settlement funds. Over the years since, the 988 Lifeline has answered more than 13 million calls, texts and chats from people across the country in need of support. Provisional Centers for Disease Control and Prevention data, meanwhile, has shown three consecutive years of declining overdose deaths in Arkansas. The promising results of stigma reduction, outreach and increased resources are tangible. Still, there is no shortage of work left to be done.
“In recent years, we’ve seen a steady increase in the number of individuals seeking mental health treatment at The BridgeWay,” said Megan Miller, CEO and a licensed clinical social worker. “This rise reflects broader national trends where more people are recognizing the importance of mental health and actively seeking care.”
Megan Miller
The greatest increase in those seeking care has been among children, adolescents and young adults, Miller said, but older adults are also seeking help more often, especially for co-occurring disorders and age-related mental health needs. The 988 line gaining momentum has also increased The BridgeWay’s reach, she said.
The availability of capital through avenues such as ARORP and funding made available during the COVID-19 pandemic has contributed to more organizations entering the recovery space and, crucially, filling gaps in rural and underserved areas. For Justin Buck, executive director of the Wolfe Street Foundation in Little Rock, the positive impact of collaborative efforts between different providers, agencies and resource groups has been “huge.” Progress in preventing overdose deaths highlights the ongoing need for community-based services.
Justin Buck
“We must remember that substance use disorders are chronic health conditions, and community support is vital. … We’re thrilled about the reduction in opioid death rates, but stimulants like methamphetamine, novel drugs like xylazine and nitazenes, and pervasive alcohol-related issues will continue to challenge our communities,” he said.
While Peak State Recovery has not received opioid settlement money, founder and CEO Chris Dickie said the funds are targeted at similar programs — “rural, trauma informed, holistic and built to meet people where they are.”
Chris Dickie
“We opened because Saline County had zero residential treatment options,” Dickie said. “Now we have men and women walking through our doors who never thought recovery could look like this. They’re resting for the first time in years. They’re doing yoga in the morning and journaling at night. They’re talking about goals, real ones, for the first time in a long time.”
Peak State recently opened its residential facility in Paron with an emphasis on wellness treatments such as yoga, aromatherapy, art therapy and nutrition. That focus reflects a larger shift in the way providers are thinking about treatment and is informed by Dickie’s own recovery experience.
“When I got sober, the focus was all on the clinical: detox the body, stabilize the mind and send you on your way, but addiction isn’t just a disease of the brain,” Dickie said. “It lives in the nervous system, in trauma stored in the body, in loneliness, in shame. You can’t heal that with medication alone.”
Holistic treatment has garnered renewed interest in many areas of medicine, but it is not a new concept for the recovery space either, Buck said. Coordination between different providers and resources again proves vital. In addition to incorporating wellness treatments, the health of the “whole person” — mental and physical — can be impacted by a variety of other needs, such as food, housing and employment.
“When we can understand that those outcomes drive health outcomes, then it makes a lot more sense to work in a coordinated way to treat that whole person’s needs,” Buck said.
Those social determinants can pose even steeper barriers in rural areas, where a lack of transportation, limited in-network providers, and limited or infrequent internet access can reduce one’s ability to receive care. The most significant obstacles for mental health care in Arkansas are access, affordability and stigma, Miller said, particularly in rural communities.
“We’re encouraged by the increased integration of mental health into primary care settings, as well as the growing interest in school-based mental health programs,” Miller said. “The rise in telehealth, particularly since the COVID-19 pandemic, has also made services more accessible for many patients, especially in underserved areas.”
When it comes to addressing youth mental health concerns, Miller said, schools are often the first line of defense. School-based resources such as access to counselors, mental health therapists, peer support programs, and other programs aimed at early detection and intervention are critical.
In addition to the need to devote more resources to child and adolescent mental health, Miller added that research is still emerging on the impact of social media, as well as how trauma affects mental health outcomes. New developments and findings are likely to change future treatment recommendations and effective interventions.
“Suicide is the leading cause of violent death in Arkansas,” Miller said. “Young adults are among the highest risk for suicide in Arkansas. Youth face a unique set of challenges. Fear of stigma, lack of trusted adults to confide in and the normalization of distress on social media often prevent them from seeking the help they need.”
Perhaps the biggest specter hanging over the mental health care industry in recent months is the uncertainty that has also affected other areas of medicine, in addition to entire swathes of programs, nonprofits and public services. Federal funding cuts and policy changes pose a significant threat, Miller said, especially in rural areas, where resources are already limited. Reduced support for Medicaid, block grants or workforce development could significantly strain providers.
“We continue to work to create innovative care models that allow us to remain resilient amid financial uncertainty,” Miller said. “Our priority remains clear: providing high-quality, accessible mental health care to those who need it, regardless of geography or income level.”
Public grants that fund organizations such as the Wolfe Street Foundation are becoming less predictable and reliable, Buck said, and uncertainty across the sector is contributing to a scarcity mindset. A lack of clarity at the federal level trickles down to state-level grants and makes grantwriting as a whole more difficult. Even charitable giving changes significantly from year to year.
While the passage of the reconciliation bill alleviates some uncertainty, it also solidifies policy changes with potentially dire consequences. Buck said he expects some of those changes to have a big impact not only on substance use disorder, recovery and treatment but on mental and behavioral health as a whole.
“There are also some really damaging things that are happening, like the Substance Abuse Mental Health Services Administration is going to be shut down,” Buck said. “Many of these offices and agencies are being consolidated. … On top of funding uncertainty and funding reduction, there’s going to be some reduction in technical assistance and some other noncash support.”
Legislative machinations aside, pandemic-era grants and opioid settlement funds were always finite resources. The question facing mental health care providers, recovery organizations and other community resources is turning the progress of the last few years into a sustainable upward trajectory.
“We have to think beyond short-term fixes,” Dickie said. “That means building workforce pipelines, supporting quality staff, expanding access to recovery housing and transitional care, and ensuring Medicaid reimbursement is fair and consistent. Recovery doesn’t end when the grant ends. If we want real change, we need real systems behind it.”
For The BridgeWay, part of sustaining mental health gains is taking full advantage of community education efforts, school partnerships and outreach programs that normalize mental health treatment. The BridgeWay works with schools, primary care providers and local organizations to help shift perceptions and encourage early intervention, Miller said, and staff frequently speak at events, participate in awareness campaigns and help share resources.
“On a more micro level, we work to provide every patient with a discharge continuing care plan that includes a safety plan if they find themselves in crisis again and a connection to other providers in their community to continue their treatment beyond the hospital,” she said.
Ultimately, Buck said, sustainability will require a permanent, reliable source of funding for the most effective programs and interventions — in his view, that would mean opening up the ability for community-based organizations like the Wolfe Street Foundation to bill Medicaid, Medicare and other insurance providers for community-based support. It also, he said, means “recognizing that those public savings merit public investment.”
“We know recovery support means a healthier, more engaged workforce — in fact, unsupported alcohol and substance use challenges cost U.S. businesses an average of $81 billion in lost productivity and profit every year,” he said. “Businesses have to have meaningful ways to invest in recovery, and we know that for every public dollar invested in recovery support, between $4 and $7 in savings show up in public health and law enforcement costs. City, county and state governments need common-sense mechanisms for funding these supportive services.”
The organization’s “big, hairy, audacious goal” is to ensure that every county in Arkansas has access to effective prevention and recovery resources, Buck added. The foundation is currently either partnered with a local organization or directly providing those services in 12 counties.
“I don’t want to have to try and open Wolfe Street Foundations in every county,” he said. “I want to find the right partners to learn and grow with so local solutions are available to meet local needs.”
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