By Kennya Alvarado, MSN, BSN, RN
Director of Clinical Services
For over 30 years, Arlington Free Clinic (AFC) has been a cornerstone of our community, providing comprehensive primary care, dental care, behavioral health and specialty healthcare services for our neighbors who would otherwise lack access. All AFC patients are adults living in Arlington County and have incomes at or below 200% of the federal poverty level, which is $64,000 for a family of four, with a large proportion of patients’ households earning less than $35,000 annually. These individuals are not eligible for Medicaid and don’t earn enough income to purchase insurance through the ACA exchange.
This economic reality has a direct impact on healthcare access, as uninsured individuals are often forced to delay seeking care, forego preventive services altogether or end up in the emergency room where care is costly and focused on immediate symptoms, not long-term health. It also has a direct impact on mental health, as people living in poverty face additional stresses that impact their health and overall well-being.
AFC first launched its behavioral health program in 2001 with an emphasis on psychiatric, medical-based services. Over time, the scope expanded as it became clear that many patients needed counseling to manage symptoms of depression, anxiety or trauma. Today, more than half of AFC’s patients screen positive for an unaddressed behavioral health condition. Many of these patients present with symptoms of depression and/or anxiety, which interferes with their ability to manage their overall health and care for themselves and their families.
Reducing Barriers to Timely, Accessible Behavioral Health Care
AFC screens patients for social determinants of health (SDOH) needs and behavioral health needs at every appointment to ensure holistic, patient-centered care. Screening includes assessing access to food, housing stability, transportation, financial strain, safety and social support. For behavioral health, patients are evaluated for depression, anxiety, substance use and other mental health concerns. When screenings identify unmet needs, patients are connected to community resources, referred to the behavioral health team or scheduled for follow-up visits. This proactive approach helps address barriers to care, improves health outcomes and strengthens the clinic’s ability to support patients beyond their immediate medical conditions.
Since many AFC patients do not speak English as a first language, culturally competent communication is a priority in our healthcare delivery model. We actively seek out volunteer behavioral health providers and counselors who share language and/or cultural backgrounds with our patient population. Additionally, we have a team of volunteer interpreters who are carefully trained to support both medical and behavioral health encounters. In recent years, AFC has strengthened interpreter training materials to better prepare these volunteers for the sensitive and emotionally complex nature of behavioral health interpretation. Training emphasizes patient autonomy, inclusivity and awareness of cultural contexts. This investment helps ensure that all patients receive equitable care and that language is never a barrier to addressing mental health concerns.
Challenges
As the need for behavioral health services has grown, so has the challenge of providing them at scale. While our patients’ need for behavioral health services was great before the COVID-19 pandemic, the economic devastation, social isolation and unprecedented uncertainty that continues has resulted in sharp increases in mental health and substance use concerns and stretched our program’s capacity thin.
Physical space within the clinic presents another limitation. Prior to the pandemic, AFC’s waiting room was often filled during evening medical clinics. With a shift to smaller, staggered clinics throughout the mornings, afternoons and evenings, there is now an opportunity to reconfigure this space. Plans to condense the waiting area and create private consultation rooms will not only improve patient privacy but also expand our ability to deliver integrated, one-on-one behavioral health care.
Looking Ahead
The Behavioral Health program at AFC is entering an exciting stage of growth and refinement. Building on strong foundations, our goal is to continue to expand access to counseling, psychiatric care and care coordination for patients who face significant barriers to mental health services. Key priorities for the future include integration with primary care, culturally responsive care, sustainable community partnerships and outcome and impact tracking.
By embedding behavioral health into our whole-person care model, AFC ensures that mental health is addressed as a core component of overall health. Our approach demonstrates the power of integrated care and its role in reducing crises and improving long-term outcomes. For the patients who walk through AFC’s doors, behavioral health care can mean stability, resilience and the ability to thrive. For the community, it represents an investment in a healthier, stronger future.
With October’s National Depression and Mental Health Screening Month on the horizon, AFC is proud to join a broader movement emphasizing the value of mental health screenings. We invite our community to stand with us in ensuring that mental health remains a priority for all. If you are interested in ways to help, visit www.arlingtonfreeclinic.org for additional information, including current volunteer opportunities, ways to donate and more.
About AFC:
Established in 1994, Arlington Free Clinic (AFC) continues to be Arlington’s only provider of comprehensive healthcare services for adults living with a low income and without health insurance. Last fiscal year, AFC provided 9,829 total clinical visits, including primary care, dental, behavioral health and other specialty services, and it dispensed over 27,000 prescriptions to over 1,600 individuals.