DARIEN — The town is considering a partnership with Silver Hill, a 129-bed non-profit psychiatric hospital in New Canaan, that local officials hope will ease access for Darien residents to timely mental health services, even as some officials are voicing concerns that the proposal won’t be enough to address what could be overwhelming demand for mental health services.
Dr. Andrew Gerber, president of Silver Hill Hospital in New Canaan, presented the idea to the Board of Selectmen in a meeting on May 16.
The program, which is being piloted in neighboring New Canaan beginning July 1, will offer five three-hour slots per week to town residents who feel in need of mental health services, but have not yet reached a point when they would need to go to the emergency room. Each slot would allow local residents seeking help to meet with a psychiatrist for an hour, and time with other mental health workers, such as social workers, leaving with a “comprehensive assessment” of their needs.
Gerber said that the partnership would make it easier for patients to connect with mental health providers quickly.
“One of the things that we hear over and over again is that even in an area that has a relatively large number of providers – therapists, counselors, psychiatrists – it is hard to get in,” said Gerber. “When you call for an appointment, you get told it’s three weeks, four weeks, months sometimes.”
The shortage is in part the result of a nationwide mental health crisis that has overwhelmed psychiatric services for those in need, particularly youth and adolescents. Connecticut is no exception. The Connecticut state legislature recently passed three sweeping laws in an attempt to address the crisis, and Mark D’Antonio, spokesperson for Yale New Haven Health, said on Monday that Yale New Haven Children’s Hospital, like many hospitals around the country, has all 39 of its child and adolescent psychiatric beds filled, with more children waiting for beds in the pediatric emergency department.
In Darien, the mental health crisis among adolescents has become apparent with the recent deaths of two high school students in the town, one in March and one this past weekend.
Darien First Selectwoman Monica McNally said during the meeting that Kevin Moynihan, the first selectman of New Canaan, had contacted her in February to discuss the idea. New Canaan, she said, has already offered to pay $250,000 in federal coronavirus relief funds to support the program for a year. If Darien were to put in the same amount of money, Gerber said, the program would be extended to two years.
Moynihan told CT Examiner that New Canaan had been working with Silver Hill since 2018 or 2019 to develop an emergency facility for people experiencing drug overdoses. After the pandemic, he said, the community decided to expand the idea to include mental health crises as well.
“It just makes sense to use their expertise and to try to get people help as soon as they can,” said Moynihan.
According to Gerber, mental health providers would be more likely to accept patients who had already had a complete assessment done.
But Mallory Grimke, a Connecticut-based social worker, told CT Examiner that each provider is “ethically responsible” to assess any new client themselves, even if that patient has already had an assessment done. She said that while a prior assessment could include “valuable information,” it might also put an additional burden on the patient trying to get services.
Amanda Craig, a marriage and family therapist who spoke at the meeting, told CT Examiner that while she thought Silver Hill was “fantastic,” she did not believe that an initial assessment would necessarily translate into a provider making space for someone.
“I don’t agree that if you hand a therapist, psychologist, family therapist, a report, they’re necessarily going to have an opening for that client, just because you have that eval,” she said.
Gerber told CT Examiner that while providers did have to conduct their own assessment, the organization’s assessment, which would be done by a psychiatrist, would help providers when deciding whether or not to take a patient, and would help Silver Hill match people with the providers most likely to help them.
“Obviously our goal is not to repeat anybody’s work, but to be helpful,” said Gerber.
Gerber said during the meeting that after the assessment had been completed, the hospital would be able to connect the person with a provider using a network of local non-profits and resources available through the towns. He said that the federal coronavirus relief dollars were necessary to make the assessments free because insurance providers do not pay enough to cover the cost of an assessment.
Selectman Jon Zagrodzky said he was “skeptical” that Silver Hill’s proposal could solve what he saw as the primary problem for people in the area seeking mental health supports — the lack of mental health providers.
“There’s an awful lot of people who have an enormous amount of money and very good health coverage — they simply can’t find the people to get the services they need,” said Zagrodzky. “This is not a question about they need to be subsidized in some way or paid by town government in order to get this done.”
One of the major concerns that board members expressed was that Silver Hill and the towns did not know how much demand there would be for the services. Gerber said that if the demand exceeded the weekly five slots split between the two towns, the towns would have to figure out together how they would fund the excess demand.
McNally said she was concerned that the partnership would involve a “leap of faith” that there would be enough providers available to help the individuals who were able to receive assessments from Silver Hill.
Gerber also said that the program would need to be “subsidized indefinitely” in order for it to continue, meaning that the town would need to find a way to continue paying for the services after the coronavirus relief funds ran out. Moynihan said that New Canaan planned to set up a community foundation that would raise funds to continue the program once the federal money runs out.
Ali Ramsteck, the town’s director of human resources, said that she thought the partnership would be “invaluable” for the town. She said at the meeting that she had spoken to a number of parents over the course of the last six weeks who were worried about their child’s state of anxiety or depression.
“If someone’s willing to get help, and you have to wait three weeks for them to talk to a professional, you might miss that opportunity,” said Ramsteck.
Gerber said that part of the program would involve creating a “steering committee” made up of representatives from both towns, to make sure that the towns were getting the services they needed. He also said that Silver Hill would monitor the organization’s response time to calls and the length of time it took for assessed patients to obtain an appointment with an outpatient provider, and would follow up with people 30 days after the assessment.
Wendy Ward, a Darien resident who runs the mental health screening company futuresTHRIVE, and who spoke at the meeting, told CT Examiner that she saw the Silver Hill partnership as one piece of a “larger community effort” to address mental health needs.
Ward said one of the biggest problems she sees with access to mental health services is the lack of reimbursement from the insurance companies. She also said that it’s critical to educate parents about how to recognize the signs of a mental health crisis — she said she has heard many stories about parents that didn’t know that their child was struggling.
Along with the importance of educating parents about the signs of mental health struggles, Ward emphasized the need for mental health screenings at physician offices. She also said that Darien needed to become a “trauma-informed community” and train teachers, community centers, government officials and anyone else in contact with children how to respond to a mental health crisis.
“We’re always going to be dealing in a crisis manner if we’re not doing early signs and symptoms work,” said Ward.
According to Craig, the Silver Hill program needed to be one of multiple interventions in the community. She agreed with Ward about needing to train educators to support students having mental health struggles.
“There’s got to be some training so that educators know how to help students or where to support them and send them, based on what the needs are,” she said.
Craig also pointed out the lack of providers as a barrier for people being able to access treatment; she suggested having a “clearinghouse,” possibly run through the town, that could help connect people to providers with openings in the area. She added that there needed to be a way to integrate interns and therapists just out of school into the community resources.
Gerber told CT Examiner that while Silver Hill already had many partners in New Canaan, if the program were to expand to Darien, the organization would expand their database of providers to include providers based in Darien.
Gerber said he hoped to have a decision from the town before the program was scheduled to begin in New Canaan in July. McNally said at the meeting that the town would revisit the idea “in the near future,” after the community had time to offer thoughts and questions about the proposal. She encouraged the community to reach out to the first selectman’s office or to Ramsteck.