Health

18 HEALTH • Winter 2016 Bringing mental health care to rural places \\ By Phyllis Hanlon M ental 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. ON THE OUTSKIRTS NO LONGER? As the health care 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 hos- pitalization program (which is a step below inpa- tient 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 creat- ed a van service that picks up and returns patients home. This service costs the hospital $50,000 annu- ally, 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 hospital- ized 25 times over the years and is fragile upon dis- charge. "The idea of going out and standing at a bus route and making what for her would be com- plex 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 chal- lenges. 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 clini- cians, 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 commu- nity 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 com- plex 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

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