Advocates map the gap in Island addiction health services
Local public health advocates say large gaps in local health services, including the absence of any medical detox facility on the Island, present significant barriers to addicts trying to stay clean and sober.
But medical providers say that, while imperfect, the Island's network of addiction services offers the necessary treatment options. A new outpatient program launched this summer by Martha's Vineyard Community Services is designed to provide critical aftercare for people discharged from off-Island medical detox centers.
Scope of the problem
According to the Martha's Vineyard Health Study, a comprehensive survey of Vineyard residents completed in 2005, substance abuse is far more prevalent on the Island than it is on the mainland. According to some measures documented by the study, substance abuse here is more than twice the statewide average. Of the people surveyed, 15 percent of full-time residents, and 12 percent of part-time residents reported excessive alcohol consumption. The national average at that time was 9.6 percent, according to the study.
Martha's Vineyard Community Services provides an umbrella of social services for Island residents. Addiction services include evaluation, counseling, and offender programs for those arrested for drunk driving.
Statistics collected in 2009 show Community Services treated an average of 1,110 unique individuals for substance abuse problems in its various programs each month. The wait list for those services averages 24 people per month.
An addition to the Island's web of addiction services welcomed by the health care community is New Paths Recovery Program. Jill De La Hunt, a lawyer and licensed social worker, recently moved to the Vineyard to get the program up and running.
Based at the Community Services complex on Edgartown-Vineyard Haven Road, New Paths is an intensive day-treatment program. To enroll requires a commitment to counseling, group sessions, and family education at least three days per week. The structure helps addicts recover.
"For this many hours a day, this many hours a week, this is what you're doing," Ms. De La Hunt said.
Evidence shows early recovery, the days and weeks immediately after returning to the Island from medical detox, is the most vulnerable time for relapse.
"People come back… and they have all these cues and triggers in their social world and their work world and their family world and their environmental world, all sort of bringing it all up again, and making it very hard to continue with that sobriety," Ms. De La Hunt said.
Community Services is working with the state's low cost health insurance program, and private insurers, to arrange contracts for insurance payments to fund services.
"It's going to be a four- to six-week stay in the program," Ms. De La Hunt said. "Lovely if people could do it for longer. I don't know that Mass Health is going to allow that. The model we're using contemplates a 16-week program. I think — the realities of insurance and people's lives — we're expecting four to six weeks."
She said she hopes the program will be able to handle all who need its services. "I'm the program right now. Eventually we hope to broaden that out but we're going to need a little more financial help to make that happen. Part of the idea of this program is there isn't really going to be a wait list. When people need this, they need it now. We want to be able to be that net, when they get off the boat on a recovery, or when they're waiting to go on the boat. We're that in-between place."
Service gap map
The addiction services network, a local task force assembled from Island police, hospital, public health advocates, and outpatient care providers, explores ways to fill the gaps in addiction services.
The group has identified transportation, prevention services, community education, screening, and case management as areas where adequate Island-based services are missing.
Rob and Cindy Doyle both have long experience in public health advocacy and addiction counseling. Ms. Doyle, a member of the Dukes County Health Council, echoed the thoughts of several health advocates who say the community would benefit from an on-Island medical detox center.
"When you have someone who is in crisis, the important thing is to take advantage of their willingness to seek help," Ms. Doyle said. "If that person has to take the additional steps and spend the additional money to go to the mainland, you're going to lose quite a few people."
Rob Doyle serves on the addiction services network task force. "From my perspective, generally people prefer to get treated locally," Mr. Doyle said. "You have a window of opportunity. The sooner you can get them to a detox, the better. I really hoped when the new hospital was built, it would include a detox."
In a recent telephone conversation with The Times, Martha's Vineyard Hospital chief executive officer Tim Walsh said the hospital works closely with community services to provide for patients who arrive at the hospital and need treatment for substance abuse. He said, depending on a patient's needs, he or she may be transferred to an off-Island facility capable of providing treatment.
"It is a coordinated effort, and everyone tries to make it work," he said.
Mr. Walsh said he has been approached by people who say there is a need for an on-Island facility and therefore the hospital should provide one.
"But the volume of patients needed to effectively run an in-house treatment facility is not there," Mr. Walsh said.
Mr. Walsh said state regulations control how an in-patient facility is constructed, staffed, and operated.
"It takes a lot, and it is expensive," he said.
The most effective strategy is to send patients who require in-house care to established facilities on the mainland, Mr. Walsh said. "What is needed is a good out-patient facility," Mr. Walsh said.
That goal was part of the discussion with the Department of Mental Health (DMH) over a piece of property the hospital considered acquiring to provide additional parking. In turn, DMH was considering establishing a facility on the Vineyard, but that proposal is now suspended, a victim of budget cuts.
Mr. Walsh said Community Services has the experienced counseling staff and is best positioned to provide out-patient treatment programs for substance abuse.
As part of the state's approval process for the new hospital building, the hospital is required to contribute more than $1 million to community health initiatives. The process that will be used to determine how that money is distributed is taking place now. It is a process independent of the hospital and supervised by the Department of Public Health (DPH). At some point, health organizations will respond to requests for proposals and a still-to-be-formed committee will determine who receives the cash grants
Mr. Walsh said he would like to see all the money go into supporting an out-patient clinic.
There is broad concern in the health care community about the effect of tight budgets on addiction services. According to the Massachusetts Hospital Association (MHA), since the 2001-2002 fiscal year, funding has been reduced 30 percent, from $48.3 million to $33.8 million in 2009. The report shows hospital-based behavioral health services are often the first casualty of cost-cutting measures.
"Over the long run, substance abuse and mental health programs often are costly and underfunded service lines for hospitals," said James Kirkpatrick, MHA senior vice-president. "As a result, in times of economic difficulty, these are both vulnerable areas when cutbacks are needed."
On and off
According to the state records, in 2008, 121 people were referred from Island medical facilities for detox services at an off-Island site. In 2009, 127 Island people were admitted. The statistics count only referrals to facilities funded by DPH.
Many people referred to off-Island detox centers are admitted to Gosnold on Cape Cod, the largest provider of addiction and mental health services on Cape Cod. Gosnold is staffed by 350 professional and support staff, who handle about 4,000 admissions each year.
Ray Tamasi, chief executive officer of Gosnold, said he works closely with Island doctors and the Martha's Vineyard Hospital staff to get patients into medical treatment as soon as possible. "There is some wait time involved," Mr. Tamasi said. "We admit a very high percentage of Vineyard referrals — if not immediately then certainly within a day. When the hospital calls, our admissions folks are instructed to take that patient, even if we don't have a bed. We'll figure it out."
The addiction services network task force credits Mr. Tamasi with valuable advice as it examined the need for addiction services on the Island. He said the numbers just don't add up. "From an economic point of view and the critical mass perspective, we just felt like there was not enough critical mass to support an inpatient service on the Vineyard," Mr. Tamasi said. "Doesn't mean that it wouldn't be of use.
"If the problem is perceived in the context of detox beds, it's a very, very myopic view of a chronic problem. Detox is like an emergency room. You get patched up, then you go to a primary care doctor or you go to physical therapy.
He said that with Vineyard House, a well-regarded living facility for people recovering from addiction, and a very strong 12-step community including Alcoholics Anonymous and Narcotics Anonymous, the Island has the elements to sustain treatment.
"The issue in addiction is how do you sustain and retain patients in a treatment net. Detox is the first step for some people. It's like any other condition, if you have a system of assessing and identifying and motivating and referring, then your objective is to avoid having people go to the hospital.
"Not only is it cheaper, it has better outcome possibilities. If you can catch people before they get to the point where they need to be hospitalized, like any other illness, you've got earlier intervention, and greater likelihood of remission."