A coalition of advocates and mental health providers are calling for more investment in mental health and addiction services, and while much of that request would go toward state-run services, a few proposals could provide a novel approach to services at the community level.
Advocates at a press conference on Thursday said that an investment in the state-run services is necessary because they have been drastically underfunded. The requests, spelled out in a letter to Gov. Ned Lamont, include filling at least 800 staffing vacancies at the Department of Mental Health and Addiction Services and setting aside $33.7 million to hire staff for the recently closed Young Adult Services programs and increase staff at Connecticut Valley Hospital, Whiting Forensic Hospital and Blue Hills Hospital,
But advocates also made suggestions of potential intervention models involving programs through local agencies, public-private partnerships or peer support.
One of the ideas was a pilot program that would put licensed social workers in pediatric offices across the state. Steve Wanczyk-Karp, executive director of the Connecticut branch of the National Association of Social Workers, said this would allow pediatricians to easily connect children in need of mental health services with a mental health expert.
“We all know that health and mental health are connected. We have this healthcare system that separates that,” he said.
Wanczyk-Karp said that even when pediatricians refer children to mental health practitioners, half the time the families don’t follow through on those referrals. He said he believed it would be much easier if the pediatrician could simply “walk them down the hall” to see the social worker.
Wanczyk-Karp said he spoke with State Rep. Sean Scanlon, D-Guilford, the chair of the state finance committee, about a proposal in which the state would pay pediatric offices 50 percent of the cost of hiring the social worker, and the private provider would pay the other 50 percent. Wanczyk-Karp said he estimated it costs about $100,000 per year to cover salary and benefits for a social worker.
“Given all the problems we’re seeing among children, and given the importance of intervention early, this would really be, I think, a fabulous model,” said Wanczyk-Karp.
Scanlon told CT Examiner that he believed $67 million was certainly “doable” given that the state has a billion dollar surplus. However, he said that the legislature would need to look at the proposals being made and determine which were the most effective and practical based on the budget.
Scanlon said he has long supported peer support specialists because they are effective and do not require state funding. He also said that one of his biggest goals was to create an opioid “czar” at the state who could coordinate the available services, which he said sometimes end up “siloed.”
State Rep. Holly Cheeseman, R-East Lyme, ranking member on the finance committee, agreed that the $67 million was “insignificant” when compared to the size of the state budget. However, she said that she was concerned about the cost of hiring between 800 and 1300 employees at DMHAS.
“Obviously, anything we do we have to do with the realization that we should not be just filling a hole,” said Cheeseman. “If we are going to provide the funding, we should find a way to make sure it’s not just for this year or the next year.”
Cheeseman said that she wanted to look at how to incentivize insurance companies to widen their provider networks. She also said she wanted to look into cross-state licensing, so that people can get telehealth services from someone in Massachusetts, Rhode Island or New York.
Cheeseman also pointed out the need to fund the Youth Service Bureaus and Juvenile Review Boards, a request that was also on the list presented by the coalition. She said that since the passage of a law that directs juvenile offenders toward the bureaus rather than into the criminal justice system, the bureaus have found themselves overwhelmed. Additionally, she said, the statewide legalization of marijuana has sent more cases to the bureaus.
In January, Justin Carbonella, Youth Services Coordinator at the Middletown Youth Service Bureau, told CT Examiner that the Youth Services Bureaus need greater infrastructure support. In particular, he said, he’d like the bureaus to be able to contract with in-home service providers in the same way that the court system can.
While Carbonella said there were “pockets of funding” for Juvenile Review Boards around the state, he said that the model is designed for a situation where a child has already been arrested, rather than focusing on supporting young people before they reach a point of crisis.
“There is a ton of promise in the statewide diversion system plan,” said Carbonella.
“More than a piece of paper”
Another community-based program floated at the press conference was one of having formerly incarcerated people being hired by community health centers, clinics and hospitals to act as a guide for people who have recently been released from prison and need to navigate the health system.
James Bhandary-Alexander, legal director of the medical-legal partnership at the Transitions Clinic Network, said that people coming out of prison are more likely to trust other people who have been incarcerated than they would a state worker or a physician.
“The cliché is [that the] people who are closer to the problems are closer to the solutions,” said Bhandary-Alexander. “What I see from the interactions is just a level of trust and credibility.”
Bhandary-Alexander said that many formerly incarcerated people are given little help when they are released from prison. Additionally, he said, many of them come out with complex, chronic conditions that require them to navigate the mental health system.
“They can come out with no ID, left on the green, 75 bucks in their pocket or something,” said Bhandary-Alexander. “That person needs more than a piece of paper with some phone numbers.”
Bhandary-Alexander estimated that they would need 40 to 50 formerly incarcerated community health workers for the entire state. The coalition included a request for $2 million for the program in the $67 million package, although Bhandary-Alexander said the program may cost closer to $3 million to fund.
The idea of peer-run respite centers was also raised at the conference. Jordan Fairchild, coordinator and community organizer for the Keep the Promise Coalition, said that these centers provide “homelike” spaces that people can seek out as an alternative to hospital emergency rooms or inpatient services when undergoing a crisis.
Fairchild told CT Examiner that in these houses, unlike in hospital settings, the residents have the autonomy to direct their own recovery.
“The most important thing is that the person is in control,” said Fairchild.
Having the houses staffed by “peers,” or people who have gone through similar situations, said Fairfield, is also critical.
“The peers in this case … would have some context of what actually is valuable as far as a service that they could put out, because a lot of them have been through it themselves,” said Fairfield.
Included in the $67 million is $5 million for the peer-run respite services. Fairchild said the funding would pay for five respite centers with four beds each to be set up across the state. He pointed to the Afiya Center in Massachusetts as an example. He said that, according to a report from the center, a quarter of the residents said they would have ended up at hospitals, and a quarter said they would have “stayed home” if Afiya had not existed.
According to Fairchild, the peer-run respite center costs half to a third of what it costs to hospitalize someone in crisis, and that these services reduce the risk of people later ending up in hospitals. Generally, the houses are available for people to stay in for up to a week at a time.
“These are really geared toward sort of a long term way of thinking and putting people on the path to recovery,” he said.