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Martha’s Vineyard Hospital donated a house that will be used to fill a critical gap in addiction and mental health treatment on the Island.

Community Services executive director Julie Fay and hospital chief executive officer Tim Walsh stand in front of the new home of the community crisis stabilization program.

In what health professionals describe as a major step forward in providing care for Islanders in crisis suffering from substance abuse and mental health issues, Martha’s Vineyard Community Services (MVCS), will establish an on-Island community crisis stabilization program (CCSP) on the grounds of the Martha’s Vineyard Hospital.

Tim Walsh, hospital chief executive officer, confirmed to The Times the hospital will donate  the “red house,” a former residential property located in front of the main hospital building that currently houses the billing department, to Community Services, the Island’s umbrella social services agency.

A CCSP treats patients in acute distress due to addiction or mental health issues for the first 24 to 48 hours of a crisis. It’s a less restrictive and voluntary alternative to inpatient psychiatric hospitalization. The goal of a CCSP is to stabilize the patient, to give clinicians time to chart an appropriate course of action, and to find the resources with which to implement it, according to treatment specialists.

“It’s going to be a huge resource for the Island,” Juliette Fay, Community Services executive director, told The Times. “When somebody is in crisis and needs evaluation, instead of going to the emergency department they’ll come to the red house. There will be individual therapy rooms, a group therapy room, crisis-stabilization beds, clinicians that are tied to emergency services, and also staff from our New Paths program.”
Currently when MVCS gets a call on the 24-hour hotline, a clinician is sent to the hospital emergency room to make an evaluation and determine if the person needs to go off-Island for inpatient care. Ms. Fay said the CCSP will spare people in crisis the cacophony and chaos of a busy emergency room.

“The emergency room staff has been wonderful, but a busy ER is not a good place to try to calm a situation down,” she said. “Consequently we have a very high rate of hospitalization. Right now, on the Island, 60 percent of the people we evaluate in the ER get hospitalized; off-Island it’s somewhere between 12 and 15 percent.”

A CCSP is not a detox facility, but the treatment it provides can potentially help an Islander avoid the onerous ordeal of going to an off-Island clinic.

“We don’t have to do an evaluation right away,” Ms. Fay said. “24 hours or 48 hours of crisis-intervention activity can forestall an evaluation and come up with a plan B, which is not going off-Island. Often when people are in the ER, that’s just the beginning of the ordeal. Our clinicians then have to start calling inpatient facilities, and finding an open bed is not easy. Once they find a bed they have to arrange an ambulance to the ferry, an ambulance on the ferry, and an ambulance to meet the ferry on the mainland to take the patient to the facility, which could be in Springfield or the Cape or Boston, you don’t know.”
A CCSP can also save valuable hospital resources. Currently, it’s not uncommon for a patient who could be treated in a CCSP setting to stay in the hospital ER for several days before a bed is found at an off-Island facility. During this time, patients who could be starting treatment in a CCSP are in a state of limbo, and often the patient requires 24-hour supervision from hospital staff or law enforcement personnel.

Collaboration pays off

Ms. Fay, Community Services staff, and board members began discussing the need for a CCSP about a year ago.

“We thought if we had access to a crisis-intervention program we could probably cut our hospitalization rate in the first year,” she said. “We thought if we could do it at the hospital, that would be ideal. About four months ago, Tim Walsh offered us the red house, and things really came together.”

“Initially, Community Services wanted to set up in the old hospital building, but that was problematic for the Medicare reimbursement process,” Mr. Walsh told The Times.

Mr. Walsh said the question was how to provide a venue that would work but be separate and accessible: “Having the red house where everything is separate, and where we can keep all the expenses separate, is a better solution for us.” Mr. Walsh invited MVCS representatives to inspect the red house at the beginning of the summer. “They thought it was a really good fit. With that, we started trying to accelerate our own renovations in the old hospital so we could get the billing department in there as soon as possible. We have a lot of balls in the air, like renovations to the dialysis unit, but we’re hoping that we can be out of there by December, January, so we can hand it over to Community Services and if they’re ready to start something, they can.”

Getting ready

MVCS will be ready, according to Ms. Fay. “We have a private donor who has made funds available to do the startup,” she said, adding that she has also met with commissioners from the Massachusetts Department of Public Health (DPH) and Department of Mental Health (DMH) to obtain additional funds and to navigate the bureaucratic maze.“We may have a volunteer architect, but we haven’t finalized that yet,” she said.

Estimated renovations will take two to three months, during which time MVCS staff will be trained in crisis-intervention stabilization. “It’s a very different model from what is used in emergency rooms,” Ms. Fay said. “You work proactively with individuals and family members about how to keep somebody safe in the community instead of going off-Island for inpatient care.”

The CCSP will be staffed on an as-needed basis. “We don’t think there will always be someone in the red house, but when someone is, we are committed to provide 24/7 staffing,” Ms. Fay said.

Contrary to the usual ebb and flow on the Island, the winter and spring will be the busiest time for the CCSP. “Our busiest time is January through May; that comports with a seasonal economy, the dark months,” she said.
If all goes as planned, the CCSP will be operational before the dark months on the Island have passed.

“You have to give all the accolades to Julie,” Mr. Walsh said. “I’ve been an advocate for a crisis-intervention center for years, but she really pulled it all together and made it happen.”

Ms. Fay said MVCS still needs funding to keep the momentum going for the CCSP. Donors can contact her at 508-693-7900.

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When Bill Howell hires a recovering addict, he knows their situation first hand.

Bill Howell, owner of Concrete Bill. "Education and treatment is the silver bullet when it comes to overcoming addiction." (Photo by Michael Cummo) — Photo by Michael Cummo

This is the seventh installment in a continuing look at drug abuse and its effect on the Island community by Times reporter Barry Stringfellow. The series began on Jan. 2 “Opiate addiction hits home,” and was followed on Jan. 22 “Martha’s Vineyard police and physicians confront opiate abuse,” on Feb. 12 “Opiates, a love story,” and on May 7 “Battling Addiction on Martha’s Vineyard,” on June 5 “Section 35—when addiction calls for drastic action” and on June 25, Intervention—tackling addiction head on.

Bill Howell arrived at the Vineyard House construction site off Holmes Hole Road in Vineyard Haven early on a recent sunny Monday morning with his dog, Keeper, kicking up a cloud of dust behind him. Mr. Howell didn’t look like a typical cement contractor in baggy shorts, low-cut Chuck Taylor All-Stars and faded “Keep off grass” tee-shirt. He also bucked the stereotype with his easy-going, soft-spoken manner.

Jamie Kergaravat hauls boards that will make the form for a concrete foundation. (Photo by Michael Cummo)
Jamie Kergaravat hauls boards that will make the form for a concrete foundation. (Photo by Michael Cummo)

He gave instructions to his young and eager five-man crew as they put the finishing touches on an expansive foundation for the men’s dormitory at the new Vineyard House, the Island’s only sober living facility. The job has special significance for Mr. Howell. “I was one of the first residents of Vineyard House; I started living there in 1999,” he said. “I bid low on this job. I really wanted this one.”

Mr. Howell started Concrete Bill, his cement contracting company, in 2001 when he was still a resident at Vineyard House. He’ll have 15 years clean time on November 29 — “5,377 days clean, but who’s counting?” he said.

Mr. Howell has hired many Vineyard House residents and alumni over the years. “A lot of people in recovery won’t hire people in recovery. I don’t get that,” he said. “I did from day one. This is not a not-profit company. But I can’t not hire these guys.”

Four out of five of his crew today are in recovery. “We were five out of six, but we lost one last week,” he said. “He needed to borrow $500 for a new car, that’s the last I’ve seen of him.” Mr. Howell shrugged. “I don’t fire people who are struggling. In the past 10 years, I only had to fire one person.”

Solid reputation

Mr. Howell’s company, Concrete Bill, is well respected in the Island building community. “Bill has been doing foundations for me since he first started out,” Bill Potter, CEO of Squash Meadow Construction, told The Times. Squash Meadow is the general contractor for the new Vineyard House. “Integrity and honesty are core principles that we believe in as a company and we expect from the people we work with. Bill Howell lives up to that in every respect.”

“Bill’s easy to work with and his crews are quality,” project manager Woody Mitchell told The Times. “When you’re doing modular homes like Vineyard House, foundations have to be perfection. It’s not like you’re framing in the field when you can make adjustments on the fly. Bill does a quality job every time.”

Rock bottom

Originally from the Cape, Mr. Howell, 51, came to the Island because he was “basically homeless,” and he hoped the move would lead to the path of recovery.

Initially, it didn’t.

“Pills, cocaine, heroin, I took whatever was there,” he said. “It doesn’t matter to an addict. It has nothing to do with logic. lt’s a form of insanity.”  Mr. Howell began using drugs and alcohol at the tender age of 9. Addiction runs deep on both sides of his family. “My father died of complications from alcoholism, my grandfather was an alcoholic,” he said. “Being around addicts was normal for me, and I just kept doing it.”

In the end, the move to the Island was key to his recovery. In addition to gaining a foothold at Vineyard House, “It felt good to have an ocean between me and the people I was spending time with,” he said.

Pillar of the community

Mr. Howell is active in the Island recovery community. In addition to providing employment, he’s a sponsor, mentor and he helps organize an annual celebration of recovery that the Vineyard community has hosted for the past 26 years.

Per 12-step program protocol, no individual can speak to a particular  recovery program. While the ultimate goals are the same, there are differences in dictum. “The goal for us is not abstinence, it’s recovery,” Mr. Howell said, adding that he relapsed for the last time in the 90’s. “There’s zero hope or expectation when you start in recovery. All you think about, all day, every day, is using again. But if the times a person uses are shorter, and the clean times last longer, that’s a win.”

Mr. Howell said the dark days create a special bond among recovering addicts. “We’re all survivors of the same near-fatal catastrophe,” he said. “We pull for each other. If you need support, go to a meeting. There’s one on this Island every day.”

Mr. Howell also had a suggestion for people who aren’t sure if they need help. “If you’re wondering if you have a problem, ask your family and friends what they think,” he said. “They’ll tell you.”

De-stigmatizing addiction

Mr. Howell was unfailingly forthcoming about his addiction and his recovery and he didn’t hesitate to give his last name. “I think people are more comfortable doing that because the perception of addiction is changing,” he said. “It has to change. Education and treatment is the silver bullet when it comes to overcoming addiction.”

Two of Mr. Howell’s crew also elected to give their full names.

Jamie Kergaravat, 29, has been working for Concrete Bill for three months. He has the build and the close-cropped hair of a Marine who just finished boot camp. “I was homeless three times,” he said, lighting a cigarette. “I lived in halfway houses, homeless shelters, outdoors. I was not into my recovery.”

Like Mr. Howell, he was down to his last stop when he came to the Island. His aunt took him in after yet another rehab stint at the Brockton Addiction Treatment Center. He’d stolen so much from his mother that she had a court order to keep him 50 feet from her house. “Now, I can’t get her off the phone,” he said laughing.

“The best thing I ever did was going to my first meeting here. I raised my hand and asked for help. It was hard to do. It was like putting my tail between my legs. I was scared. I sat at a table afterwards, and there was a line of people who wanted to help.”

Mr. Kergaravat has six months clean time. He’s lived at Vineyard House for the past five months. “It’s a great group of guys — we all click,” he said. “It’s impossible to do this alone. It’s all about surrounding myself with people who are doing the right thing.”

Which is not to say it’s been a smooth ride. “There’s definitely white-knuckle times, especially in the beginning,” he said. “But I’m not going back. I love living here. This Island has so much to offer.” Mr. Kergaravat reached into the back of his pick-up and picked up a brand-new surf rod and reel. “I haven’t caught anything yet, but I figured it’s time to start learning.”

Emmett Cook, 21, went to 12-step meetings with his father when he was a child. “He did work at it,” Mr. Cook said. By the time his father moved the two of them to the Island for a fresh start, Mr. Cook had been a frequent guest of Rhode Island and Connecticut state youth facilities, starting at age 13.

He enrolled at Martha’s Vineyard Regional High School but dropped out after a year. His appetite for drugs grew unabated. “My drug of choice was ‘More,’” he said. “It didn’t matter what it was, just ‘more.’”

Mr. Cook’s father has since moved back to the mainland and is no longer in recovery. Mr. Cook stayed and, after one relapse, has been clean for over a year. “April 17, 2013,” he said.

Mr. Cook had turned 21 the day before he spoke to The Times. He celebrated with a cake and a dip in the ocean, and a meeting. “I usually go to a meeting every day,” he said. “It’s an hour a night: there’s no excuse not to go.”

As the crew packed up, Mr. Kergaravat surveyed the finished job. “It’s very cool that we got to build the foundation for this place,” he said. “If someone wants help, I’d say come to Vineyard House. There’s always a bed. The new place will have tons of beds.”

For more information about Vineyard House, call 508-693-8580 or go to VineyardHouse.org.

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The difficult process of placing an addict into involuntary rehab comes with additional hurdles for Islanders.

In order for family members to file a Section 35, they must go to Edgartown Court, or file a petition via fax. — Photo by Susan Safford

This is the fifth installment in a continuing look at opiate abuse and its effect on the Island community. The series began on Jan. 2 “Opiate addiction hits home,” and was followed on Jan. 22 “Martha’s Vineyard police and physicians confront opiate abuse,” on Feb. 12 “Opiates, a love story,” and on May 7 “Battling Addiction on Martha’s Vineyard.”

The Section 35 commitment is the final stand in the battle against addiction. When voluntary rehab, reasoning, begging and pleading have failed, and an addict’s family, doctor, or local law enforcement officer believe that there’s an imminent threat of serious harm to the addict or to others, Section 35 enables them to request that the court put the addict into involuntary inpatient rehabilitation for up to 90 days.

“Section 35 is the last resort,” said Dr. Charles Silberstein, resident psychiatrist and addiction specialist at Martha’s Vineyard Hospital. ”For a lot of people it feels cruel to say ‘you can’t live with me anymore’ for worry that it will backfire. But it’s reasonable to say, from a place of compassion, ‘I can’t tolerate this anymore. I worry I am enabling you and I can’t bear it.’ The problem is when people say it and don’t mean it and it becomes meaningless, or worse, it tacitly says ‘I’m powerless and I’m going to continue tolerating your addiction.’”

On the rise

Due to the increase of opiate and heroin addiction, Section 35 commitments have been rising steadily in Massachusetts. According to the Massachusetts Department of Public Health (DPH) there has been a 67 percent increase in the number of Section 35 commitments since 2006. A total of 4,982 Section 35 commitments were made in fiscal year 2013 (FY 13), which began on July 1, 2012. The numbers were particularly grim for the Cape and Islands in FY 13. According to the office of state senator Jennifer Flanagan, there were 975 Section 35 commitments in the Cape and Islands region, which is by far the most in the state. The MetroWest region was a distant second with 597 commitments; there were 218 in Boston, which has a population of roughly three times the Cape and Islands.

An Islander who wants to initiate a Section 35 petition must go to Edgartown District Court and file an application with clerk magistrate Liza Williamson, who will guide them through the process.

“It’s very difficult for loved ones to file a Section 35,” Ms. Williamson said in an interview with The Times. “Our judges, the police, every department here is very sensitive about it.”

Although the  judges are only in Edgartown district court on Monday, Thursday, and Friday, Ms. Williamson said the petition can also be handled via fax.

“We find a way to make it work, no matter what day of the week it is,” she said. Ms. Williamson said the local chapter of the National Alliance on Mental Illness (NAMI) is an excellent resource for family members who are considering petitioning for a Section 35.

It’s not uncommon for police to file a Section 35 petition.

“When I review police reports, if I see we have a lot of interaction with that person and it’s clear that substance abuse is a problem, we can fill out the [Section 35] paperwork,” Edgartown Det. Sgt. Chris Dolby said. He added that the definition of family member is blood relative or spouse.

Live-in companions, even if they have children together, cannot file a petition for commitment under current Massachusetts law.

An Edgartown District Court judge reviews the petition and decides it has merit, a warrant of apprehension will be issued, which enables the police to take the person into custody and transport them to the Duke’s county courthouse. Before a judge can issue a commitment the individual must be examined by a Department of Mental Health (DMH) approved physician. This is where the Island complications arise. There is no DMH approved physician on the Vineyard. Consequently, commitments are handled in Falmouth District Court.

“If the judge decides to issue a warrant, it’s only good for the close of that court day,” Mr. Dolby said. He said he must get the individual on the boat to Falmouth, hope the doctor is available in court, and hope he or she can see the person before 4 pm. “If not, the person walks,” he said. “I had a recent case where the person, who clearly needed help, walked off the boat because time ran out.”

Getting an early start is important. “They’re called sunset warrants,” Ms. Williamson said. “I advise people to file as early in the day as possible. Getting someone off Island is a time-sensitive puzzle with a lot of moving parts. The sheriff’s department makes every attempt to get people transported in timely fashion. The Steamship Authority is as helpful as they can be. Dr. [Jeffrey] Zack and the emergency department at the hospital do a great job coordinating their efforts. But if you get the person to Falmouth and there’s no doctor there, it doesn’t matter,” she said, highlighting a major Island complication.

Island exigencies

“Unfortunately, in order to commit, you need an evaluation from a department of mental health (DMH) designated forensic psychologist, and we don’t have one on Martha’s Vineyard,” Ms. Williamson said. “There’s one DMH doctor, Donna Maynard, who does evaluations for the entire region. That covers from New Bedford to the Cape and Islands. Donna does a great job but there’s only so much one person can do. When I get a Section 35 I’ll call her and ask, “Can you help today, yes or no?”

Ms. Williamson works on the Committee for Public Counseling Services with the goal of finding on-Island DMH doctors and psychiatrists. “I’ve reached out to several psychologists and psychiatrists to ask them about getting DMH designated certified,” she said. “But it’s difficult when you already have a very busy private practice. The mental health system on the Island is extremely overburdened.”

If the Islander is seen by the appropriate doctor in Falmouth and committed before the sun sets on the warrant, the judge will order him or her to a licensed inpatient substance abuse treatment facility, such as the Women’s Addiction Treatment Center (WATC) in New Bedford, or the Men’s Addiction Treatment Center (MATC) in Brockton. If no beds are available, which is often the case, men are sent to the Bridgewater Correctional Complex and women are sent to the Framingham Correctional Institution, state-run prisons, where they are kept separate from the criminal population.

“It’s frustrating because there are so few beds available,” Ms. Williamson said. “Sometimes the only beds are at Bridgewater or Framingham. It can be traumatic for someone to go to one of these places but when you get to a Section 35, you’re out of options. You’re trying to save that person’s life.”

Mr. Dolby, a member of the Vineyard drug task force, was sharply critical about the support system that currently exists on the Island. “We’re up against it. We’re in a tough situation,” he said. “There’s no rehabilitation on this Island. It’s ridiculous that someone has to go to Falmouth to be evaluated. Addiction is a huge problem here. I see how frustrating it is for the addicts and the families of addicts. New Paths and Vineyard House do good work, but they’re just putting a finger in the dike.”