Transcript Mental Health and Substance Abuse on Martha’s Vineyard

Mental Health and
Substance Abuse on
Martha’s Vineyard
Anecdotal evidence as collected
by UMASS Medical and
Graduate Nursing Students
Introduction
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Island Health Report showed Island has
comparatively higher rate of mental illness
and substance abuse
Depression prevalence is 14% in the year
round population compared to 9.5%
nationwide
Excess alcohol consumption (5 drinks or
more in a single sitting 2-3 times a month)
prevalence is 15% in full time residents
compared to 9.6% nationwide
Introduction
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We are working with Martha’s Vineyard
Health Council to determine how and where
clients present, how they are treated, what
resources are available, and what resources
are needed.
Screening Clients
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Most agencies do not have a formal tool
Use observations and clinical judgment
Make judgments based on history of client
Obtain information from friends and family
Sheriff's Department, VNS, certain physician
practices, and the ER have formal tools with
questions regarding substance abuse and
mental health
What next?
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Refer refer refer
Many agencies refer clients to ICC
Some refer to private practice, but none
accept MassHealth
School counselors attempt to work with
students and parents before seeking outside
help
What next?
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Children and Portuguese population referred
off island for counseling (no specific
resources on island)
Clients referred off island for detoxification
Emergency situations sent to ER
Referrals to specific offices as appropriate
(DSS, elder services, etc.)
An ideal world…
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Additional therapists for counseling
Additional practitioners for medication
management
Everyone would accept MassHealth
Attending psychiatrist at hospital
Specialized practitioners for children,
adolescent and elderly populations, marriage
and family counseling
An ideal world…
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Everyone would be bilingual
Easier access to resources
Resources for acute and emergency
treatment
One agency that can connect all resources
on island and provide information to clients in
order to access services
More activities for year-round population
An ideal world…
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Alternatives for delinquent youths (other than
lockup)
Case management system
Everyone would be comfortable talking about
mental health and substance abuse
Resources for breaking the cycle between
parents and children
Where are clients presenting?
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Primary Care Providers and specialists
ER/EMS
Elder Services
ICC/private therapists
Women Support Services
Criminal Justice system
School
Visiting nurses
Clergy
Why such a high rate?
The Island creates problems and
the Island attracts people who
have them
Island Creates
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Isolation - Water barrier
Lonely, tired, and overworked
Lack of privacy
Seasonal economy – “hostile dependence”
Lack of social activities
Fierce sense of independence
Cost of living
Summer “party” atmosphere
Island Attracts
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People who are “a little whacky”
Population that is creative, talented, nonmainstream
Come here for geographical therapy – safe
place
Presence of culture with permissive attitude
towards substance use that spans
generations
People arrive with baggage
Gaps in the System
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Not all practitioners know how to screen
No detoxification center on island
No step down treatment for clients
No acute care facilities
Poor public transportation
Lack of continuity of care
High uninsured/underinsured population
Brazilian population fearful to seek resources
Lack of privacy
What is done right?
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AA/NA services
Community support of population –
possesses same mind think
Elder outreach programs
Existing counselors provide good services
ICC is good resource
Vineyard House
VHCAP
Where do we go from here?
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Create universal screening tool for healthcare
providers
Create directory of all appropriate resources
Create primary prevention programs in
elementary and high school
Explore possibility of expanding acute care
resources
Explore possibility of establishing step down
care
Where do we go from here?
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Seek additional state and federal resources
where available
Community service requirements for High
School Students
Establish relationships/partnerships with
outside communities and resources
Continue work on Island Health Plan
Recruit providers for specialty populations
Special Thanks…
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to all those who were able to take the time to
discuss these issues with us.
to Olga Church, Cindy Mitchell, Terry
Appenzellar, Tom Bennett, Sarah Kuh, Paddy
Moore, Murray Frank, Suzanne Cashman.
to MVCS, Island Healthcare, MVH for their
hospitality.
The UMASS Clerksters
Jimmy Hart, Stephanie Chen
Brenna Wiberg, Tim Markantes, Kathy Rittner