Vt. Mental Health Experts See Gaps in System

Valley News Staff Writer
Tuesday, June 12, 2018

Montpelier — Mental health providers in Vermont say they continue to be concerned that the state still has gaps in the services available to people struggling with mental illness.

“Every time we think we’re making progress, we get a reality check,” Peter Albert, senior vice president of government relations at the Brattleboro Retreat, said in introductory remarks at a meeting — “Improving the Continuity of Mental Health Care: Innovative Ideas” — hosted by the nonprofit Vermont Program for Quality in Health Care in Montpelier on Friday.

In particular, Albert said readmission rates for patients with psychiatric disorders is higher among those covered by Medicaid than those covered by commercial insurers. He also pointed to a report issued last week by the Centers for Disease Control and Prevention that showed that suicide rates in the U.S. have risen 25 percent between 1999 and 2016.

During that time, Vermont saw a suicide rate increase of 49 percent and New Hampshire’s rate increased by 48 percent, according to the report. Both states lost about 17 people per 100,000 to suicide in 2016, which puts them above the national average of 13.5 people per 100,000, according to CDC data.

“It’s just a never-ending battle,” Albert said.

But the roughly 50 people gathered seemed committed to fighting that battle. Presenters outlined three strategies for improving patients’ access to mental health services, including improving coordination between mental health providers and medical care providers, connecting patients with resources they need to stay healthy and using technology to regularly monitor patients’ mental health.

In an effort to meet the needs of people who are frequent visitors to the emergency department, Southwestern Vermont Health Care & Medical Center in Bennington has created a transitional care program, which brings together staff from the hospital and from community agencies to help people struggling with addiction and mental illnesses.

“One of the most exciting pieces of this is watching the transformation of people’s lives,” said Billie Lynn Allard, administrative director of Nursing for Community Health at Southwestern Vermont Health Care and the Putnam Medical Group, a physician group based at Southwestern Vermont Medical Center that is part of Dartmouth-Hitchcock.

Through the program, a 24-year-old woman who had been living on the streets and addicted to multiple substances connected with a “health promotion advocate,” who is responsible for helping the program’s participants access the services they need, Allard said.

Within nine months, the woman had a part-time job, a place to live and had gotten treatment for her addiction, Allard said.

She had “totally turned her life around,” Allard said.

These successes haven’t been without challenges, Allard said. It was difficult, at first, to get emergency department staff interested in participating in this form of care, she said. She also has had to walk a fine line with the hospital’s chief financial officer because when the program is successful, it reduces hospital revenues by keeping patients out of the emergency department and inpatient beds.

However, she said, as the state moves toward a system of payment in which providers’ revenues are tied to patients’ health outcomes, programs like this will be helpful.

“This is going to be the right thing to do,” she said.

A similar effort is under development in Washington County. There, staff from Washington County Mental Health Services — the designated mental health agency for Washington County and the adjacent towns of Orange, Washington and Williamstown — and staff from Central Vermont Medical Center have teamed up to reduce emergency department visits, readmissions and premature deaths by suicide or accidental overdoses, said Mary Moulton, CEO of Washington County Mental Health Services.

The approximately $250,000 proposal they came up with, which has not yet been funded, includes having a mental health clinician on hand in the emergency department to screen patients for mental illness and addiction, said Moulton. Other new positions would include two linkage navigators who would do assessments, case coordination and treatment, and could help link patients to community resources, and a data and service catalog specialist who would manage information about outcomes and track appointments available with private clinicians in the community.

“We haven’t done it yet,” Moulton said.

But, she said, she hopes funding will come through to support it as a pilot project.

Also aiming to reduce readmissions and identify gaps in care, the Brattleboro Retreat is planning to pilot the use of TeleFriend, a tablet-based program which helps people with serious mental illness to monitor their illness and improve self-management of their symptoms.

Researchers from Dartmouth-Hitchcock and Geisel School of Medicine at Dartmouth have been studying the program, which uses a digital format to ask patients a series of questions and offers them tips for managing their symptoms. On the other end, the patients’ responses are reviewed by a clinician. The clinician often follows up with a phone call and can then provide information to the patient’s care team.

The researchers — Sarah Pratt, a clinical psychologist on Geisel’s faculty, and Meghan Santos, a licensed independent clinical social worker employed by D-H — have found that the program reduces emergency room admissions and hospitalizations, they said.

The Brattleboro Retreat pilot, which aims to recruit 20 patients over six months, will provide these tablets to people returning to the Retreat after they were unable to find the support they need to live in the community, said Dr. Simha Ravven, senior medical director of the Retreat and clinical assistant professor of psychiatry at the Yale University School of Medicine.

Through the pilot, Ravven said she hopes to learn why people are coming back for readmissions and whether the TeleFriend program will help to support them in the community for 30 days after discharge.

“Will this work with essentially some of our most vulnerable patients?” Ravven said.

Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.