Bringing mental health care to rural places
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More resources are flowing into rural Central Massachusetts communities to improve access to mental health care.
(Updated on Dec. 14) Mental illness has become a national problem of great proportion with potentially serious consequences. The National Alliance on Mental Illness (NAMI) reports that 43.8 million adults experience a mental illness in a given year. Another 20.2 million have substance use disorders; half of them with a co-occurring mental illness.
As the healthcare system strives to treat those with mental illness and addiction, hospitals, clinics and agencies in urban areas might be in a position to cope with a growing need.
The picture is different in rural parts of Worcester County. Thirty miles northwest of Worcester, Heywood Hospital in Gardner feels the strain of reaching those with behavioral health needs.
In spite of a 12-bed adult inpatient program; a 20-bed geriatric unit; and an outpatient partial hospitalization program (which is a step below inpatient hospitalization) that can accommodate 20 patients, all programs have a lengthy wait list. The two inpatient units admit an average of 40 to 50 patients monthly, according to Nora Salovardos, a registered nurse and director of Psychiatric Services for Heywood Hospital.
“There are too many in the community that need to be treated and we just can’t see them all,” Salovardos said.
North Worcester County faces another serious challenge -- suicide related to mental illness -- noted Barbara Nealon, Heywood’s Social Service & Multicultural Service Director. She pointed out that debilitating medical conditions, especially those with opioid-managed pain control, sometimes lead to depression and suicidal ideation.
“[We] have some of the highest suicide rates in the state out here,” Nealon said.
Guy Beales, president of the North Central Worcester County chapter of NAMI, confirmed Nealon’s claim, reporting that the 2014 Massachusetts rate of suicide deaths was 9 per 100,000, while the rate in the Heywood Hospital service area was 20.9 per 100,000.
Barriers to care
Although Heywood offers comprehensive mental health programs, actually getting to them can be a major stumbling block for some patients. The Gardner area does have a transit system, but service can be spotty and schedules don’t always coincide with patient appointment times. So Heywood created a van service that picks up and returns patients home. This service costs the hospital $50,000 annually, but reduces recidivism and boosts patients’ sense of well being, said Nealon.
For Beales, whose wife has bipolar disorder, van service has been a lifesaver. She has been hospitalized 25 times over the years and is fragile upon discharge. “The idea of going out and standing at a bus route and making what for her would be complex decisions to get to a partial (hospitalization) program could be overwhelming,” he said.
Meanwhile, Salovardos said recruiting qualified providers has been daunting; many prefer to remain closer to cities.
State support
State policy makers have recognized these challenges. In October 2013, the Massachusetts Health Policy Commission (HPC) provided $10 million to 28 community hospitals through the Community Hospital Acceleration, Revitalization & Transformation (CHART) Investment Program. Heywood used its $2.9 million CHART grant to place mental health counselors in the emergency room. Known as “navigators,” these counselors are available to answer questions and help calm patients when they come into the emergency room.
“After getting some counseling from the clinicians, some patients actually de-escalate in their acute care needs. We’ve then been able to put them in a partial program or offer other types of community services,” Salovardos said. She added that using navigators in the emergency room has reduced recidivism nearly 20 percent.
HealthAlliance Hospital in Leominster, which is not quite rural, but “on the cusp,” faces similar obstacles, according to Chief Operating Officer Paul MacKinnon. HealthAlliance received a $3.8 million CHART grant, which it used to help patients navigate the system.
“They may not have the skill set to manage complex treatment plans, get to all their appointments and use public transportation,” he said.
Dual diagnosis unit
When he arrived on the job four years ago, Gregory Mirhej, executive director of Behavioral Health at Southbridge-based Harrington HealthCare System, found the problems in South Worcester County to be more profound than in the urban places where he’d previously worked, including Hartford and New Haven, Conn.
A dearth of available services, and lack of access and transportation, hindered the delivery of appropriate treatment. But that may be changing. “In a rural setting, we are developing a comprehensive system that’s integrated and unified,” Mirhej said.
As part of that integration, Harrington used grant funding to build clinics in nearby towns. “We had been Southbridge-centric. Through CHART we developed transportation, levels of care and accessibility, and built outpatient clinics in Charlton, Dudley, East Brookfield ... and Webster,” said Mirhej. A spokesman for Harrington said a Spencer clinic is in the works as well.
Harrington also developed an integrated system in which clinicians work in primary care offices to identify and screen patients at risk for mental illness, thanks to the $3.5 million CHART grant.
But taking it a step further, Harrington completed construction of a new inpatient unit that will offer behavioral health treatment by the end of the year. Harrington Recovery Services at Webster is an 8,222-square-foot dual diagnosis unit that Harrington plans to open in the next couple of months. Harrington Recovery Services contains a 16-bed inpatient unit, and partial hospitalization and outpatient programs. The services will be housed in the former Hubbard Regional Hospital, which Harrington assumed operation of in May 2009. Harrington will continue to operate a psychiatric inpatient unit with 12 beds at the main campus in Southbridge.
The new dual diagnosis unit is one of the only specialty units to be licensed by both the Department of Mental Health and the Bureau of Substance Abuse Services in Central and Western Massachusetts. It is designed to treat patients with multiple disorders, such as mental illness and underlying depression or anxiety, according to Mirhej.
“One condition exacerbates others and treatment has not been successful working on these issues independently. If people continue to use substances while anxious or depressed, treatment won’t work,” he said.
Greg Mirhej, executive director of Behavioral Health Services
at Southbridge-based Harrington HealthCare System, said access to mental health services in South Worcester County is significantly hampered compared to the urban areas where he previously worked.
(Editor's note: An earlier version of this story was updated to clarify the licensing status and planned opening of Harrington Recovery Services at Webster, as well as the status of Harrington's outpatient clinic in Spencer.)
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