Mental Health and Substance Abuse on Martha’s Vineyard Anecdotal evidence as collected by UMASS Medical and Graduate Nursing Students

Introduction 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 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 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? 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? 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… 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… 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… 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? 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 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 People who are “a little whacky” Population that is creative, talented, non- mainstream 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 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? 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? 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? 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… 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