NEW HAMPSHIRE — With schools and many businesses closed, regular appointments canceled and basic staples such as toilet paper hard to find, mental health providers say they’re worried about their clients’ well-being.

Some people who struggle with mental illness or substance use are especially reliant on structures and community supports, which are either no longer available or have moved to an online or telephone format during the COVID-19 outbreak and “stay home” orders in both Vermont and New Hampshire.

To prevent clients’ symptoms from progressing so that they need to go to a hospital emergency room, Nancy Nowell, vice president of clinical services for West Central Behavioral Health, said the Lebanon-based community mental health center has turned to telemedicine. But, Nowell said, “Getting there is a process.”

That process has forced the organization and others like it to examine how they can best care for patients while also keeping staff and the larger community safe.

“We are very worried,” Nowell said.

Some clients don’t have access to the necessary technology at their homes, she said. And some of the organization’s work, such as the emergency services it provides, require in-person visits.

On Thursday, the organization issued a call for fabric masks and hand sanitizer through its Facebook page.

West Central isn’t the only organization that has asked for help in recent days. Because some mental health care providers operate on thin margins, they are struggling to manage the costs of the transition to telemedicine.

Lebanon-based Headrest of the Upper Valley, which offers residential and outpatient counseling as well as a crisis hotline, is seeking $20,000 for 25 new laptops and a new server, according to a Facebook post this week.

“Our machines are outdated and unable to support the software that we must use in order to carry out our important work, not to mention the extra strain of conducting virtual meetings,” the post said. “In addition, we are running on Windows 7, which is no longer supported by Microsoft and therefore poses a security risk to our organization.”

Group meetings have now moved to Zoom and outpatient treatment is being done online, said Headrest director Cameron Ford. But the lack of laptops and adjusting to the technology means it will “take a while for that to get smoothed out,” Ford said.

Headrest has seen a slight uptick in the number of people calling its crisis hotline, including teenagers who are feeling frustrated being stuck at home, according to Ford.

“Being cooped up is going to take a toll on people,” he said.

Mental Health Center of Greater Manchester has also put the call out for donations of personal protective equipment and supplies, receiving donations of hand-sewn masks from the community as well as a delivery by the National Guard. The state issued N95 and surgical masks to The Mental Health Center of Greater Manchester, which were delivered March 31 by the NH National Guard.

In an update posted last week on their website, Roland Lamy, Executive Director of New Hampshire Community Behavioral Health Association noted that around the state health professionals are doing all that they can to offer assistance.

“This is a difficult time for all of us and it is particularly hard for adults and children with mental illness. We want all citizens to know that their community mental health centers are ready to help and are working hard to make access to services available via telehealth and by telephone.  If you or a loved one needs support, you can reach out to your local mental health center,” Lamy said. “We are all in this together and we each need to stay well for the sake of everyone in our state, our nation and the world.”

The Mental Health Center of Greater Manchester continues to provide limited but crucial and essential face-to-face services in programs such as Residential, Emergency, Mobile Crisis and our Cypress Center. Anyone in need is encouraged to call (800) 688–3544

Maggie Monroe-Cassel, the executive director at TLC Family Resource Center in Claremont, said that her organization continues to offer support to families and people in recovery via telephone and video chats. Rather than “social distancing,” Monroe-Cassel said she would rather call the COVID-19 mitigation efforts “physical distancing.”

“Still we have ways to have social intimacy even in the face of all of this,” she said.

On the bright side, Monroe-Cassel said her organization and others may ultimately find that they previously had been wasting time driving to in-person meetings when they could be done through video conferencing, and that the time could be put to better use.

And, she said, it’s time they will need to use serving clients in the future as needs for parent education and recovery support are likely to rise.

Monroe-Cassel said she’s worried that reports of child abuse will go up as families are cooped up together for an extended period.

“This is what concerns me the most,” she said. She’s not alone in that worry.

On Wednesday, New Hampshire Gov. Chris Sununu issued an executive order allowing for more than $1.6 million in emergency funding for child protective services.

That same day, the state’s Department of Health and Human Services issued a call for support for children and families.

Referrals to Division for Children, Youth and Families were down last month, compared to the same time period over the past two years, according to a news release. This is due to about half as many referrals coming from groups that usually see children regularly, including school staff, child care workers, mental health professionals, medical providers, social workers and law enforcement.

Referrals from families were up, but not enough to make up for the decreases from other groups.

“It is as important as ever to make sure we check on our families, kids and even older youth to let them know we care,” DCYF Director Joe Ribsam said in the release.

School counselors and nurses at districts across the Upper Valley have offered support to students and families.

Cate Beaton, who manages socio-emotional supports for Orange East Supervisory Union, notified families this week of a shift to a telehealth format to allow counseling to continue with schools closed.

But there are some limitations to telehealth, she said in a note posted to a Listserv. For example, school staff can’t collect as much information as they would in person, technical problems could interfere with a provider’s ability to assess a situation, and maintaining confidentiality could be challenging.

Sharon Elementary School Counselor Maura-Lynne Strance in a recent post on the school’s Facebook page offered to continue to meet with children who had been receiving counseling services via Google chats, text or phone.

“Please remember to take care of yourself,” Strance said in the post. “Get plenty of sleep, try to eat well, meditation, exercise etc. These are difficult times to be sure, but together we will get through it … in spirit if not in person.”

Carol Robidoux contributed information to this story.