BMH adds mental health specialist

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BRATTLEBORO — When President John F. Kennedy signed into law the Community Mental Health Act of 1963, the hope was that people suffering from mental illness could get better treatment in their community rather than in institutions.

"The Act was the first of several federal policy changes that helped spark a major transformation of the public mental health system by shifting resources away from large institutions towards community-based mental health treatment programs," states the website of Young Minds Advocacy.

Growing awareness of the inhumane conditions in many psychiatric hospitals and a recognition that even those suffering from mental illness should be accorded their civil rights led to the passage of the Mental Health Act.

In 1980, Congress passed and President Jimmy Carter signed into law the Mental Health Systems Act of 1980, which provided grants to community mental health centers.

However, during the Ronald Reagan administration, the Omnibus Budget Reconciliation Act repealed the Mental Health Systems Act, ostensibly, wrote Penn State's Elaine Carmen Guerra, to give mental patients a choice to seek treatment outside of a mental institution, an option to seek treatment at clinics at the state level, and the freedom to administer their own medication.

"The consequences of Reagan's social policy can be measured by the fact that today one-third of the homeless population are suffering from severe mental illness which puts a burden on police departments, hospitals and the penal system which lack the training and resources to deal with psychiatric emergencies," wrote Guerra. "Reagan's unethical choice to end federal funding for mental health programs was driven by the desire to cut the budget. As a result, he did much more harm than good."

Communities around the country have since been struggling with how best to care for their family members and friends who struggle with mental health issues.

"The nature of and demand for mental health services has drastically shifted over the past few decades," said Dr. Kathleen McGraw, chief medical officer at Brattleboro Memorial Hospital. "As a result, the care model has become a more community-based way of providing outpatient services. While this shift improved access to care for patients with minor mental health conditions, the volume of patients requiring acute intervention has grown exponentially as psychiatric hospital bed availability continues to decrease."

Windham County, because it is home to the Brattleboro Retreat, is more well-positioned than other communities in offering services to those in need of mental health treatment. However, the need for services often outstrips the Retreat's ability to provide help at any given time to everyone needing assistance.

"At BMH, those in serious crises seek care in our emergency department, and sometimes have to wait days or even longer to get a bed in an inpatient psychiatric setting," noted McGraw. "In order to better provide appropriate and timely care for this patient population, we decided to hire a clinician who could begin treatment while our patients wait for appropriate beds."

BMH hopes that having access to early care can start psychiatric treatment more rapidly and ultimately speed up the access to treatment for all its patients.

"It is part of our attempt to more effectively meet the evolving needs of our community in a time with great need for mental health services," said McGraw.

Matthew Dove, a nurse practitioner, was hired by BMH as the behavioral health resource coordinator in the hospital's emergency department, where patients are cared for until room can be found in an inpatient program.

When Dove agreed to take the job, he learned that some patients were spending many days in the ED before they could be placed in a program.

"The longest I heard was 35 days," said Dove. "That's something no one should have to experience, especially if you are in an emergency situation."

Since coming to BMH two months ago, Dove has immersed himself in the job.

"I see my role as a consultant and as a resource," he said. "I don't practice in a vacuum. My role is at the intersection of a lot of complex and nuanced issues."

When a person comes to the Emergency Department, or is escorted there by law enforcement, the circumstances for his or her arrival are not always explicit, said Dove, and treatment needs to be tailored for each individual.

"Someone who is acutely psychotic doesn't present in the same way as someone who might be depressed," he said. "And someone who is suicidal would certainly trigger us to work in a different way. Each moment has its own needs."

The way the Emergency Department responds to a patient in need is also dependent on whether that person is seeking help on a voluntary or an involuntary basis.

"Each has its own processes that affects wait times," said Dove, "because there are different levels of beds in the state."

Dove admitted that waiting in the Emergency Department for a spot in an appropriate program is not the most effective method of treatment for those suffering from mental illness, but it's what the community has to work with. "We want to respond to both the medical somatic emergency and the mental health emergency. We are striving to do that and promote the best patient care."

According to the National Alliance of Mental Illness, one in five will seek emergency psychiatric services in the next year. In addition, 30 percent of those struggling with severe mental health needs are homeless and 46 percent also have a co-occurring substance use disorder.

"We need to understand the people who are struggling with mental health needs are not bad people trying to get good — they're sick people trying to get well. We need to focus on their care and we shouldn't think of it as any less emergent or any less problematic as someone struggling with diabetes or a chronic health problem. It's essential as a community to recognize and begin the conversation towards improving mental health needs. Just as we think about interventions like medication or changing diet and exercise for diabetes, there are immediate tools available if you or someone you know is experiencing a mental health crisis, such as are texting 741741."

Dove also sees his role as an advocate for those with mental illness.

"We get wrapped up in debating whether people who are mentally ill are violent and what gets lost is the majority of the people who struggle with their mental health needs are non violent, and either way I am trying to make sure they get the care they need," he said.

According to the U.S. Department of Health & Human Services, "Most people with mental illness are not violent and only 3 to 5 percent of violent acts can be attributed to individuals living with a serious mental illness. In fact, people with severe mental illnesses are over 10 times more likely to be victims of violent crime than the general population."

"We have a lot of work to do," said Dove. "We need to think in a conceptual way. It's not just about mental health and treatment. It's also about disparity and social justice."

Health disparities are defined as health differences that adversely affect socially disadvantaged groups, such as those suffering from mental illness.

"We know that poverty, racism, and violence put people at higher risk of developing mental health problems ," wrote Ailbhe Finn, policy manager for Mental Health Europe, " so that means we need population-level interventions which can focus on fighting the root causes of this public health crisis."

Dove envisions addressing disparities in treatment and social justice as a collaborative model, working both within the hospital itself and with local organizations such as the Retreat, Health Care and Rehabilitation Services, Groundworks Collaborative and the Women's Freedom Center.

He believes state lawmakers, care providers and community members truly care about the most vulnerable Vermonters. He hopes that that concern can be converted into a way to address what he considers "a mental health emergency in Vermont."

"We need longer term solutions and strategies in addition to the immediate care delivery," he said. "That's how I view the role here. Those are the things I am working to accomplish in my role here at BMH."

Bob Audette can be contacted at 802-254-2311, ext. 151, or raudette@reformer.com.

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