The Access Hub, which recently opened in downtown Montpelier, is not unlike the emergency department at Central Vermont Medical Center, about four miles away.
Actually, that’s the problem.
Open since early October, just a few blocks off Main Street, the place is small, just a few connecting rooms in a squat brick building on Barre Street owned by Washington County Mental Health Services. But the idea – to provide a quiet place outside of the hospital for people seeking care during a mental health or substance use crisis – is huge and is taking root across Vermont, planted seed from federal funding.
Karen Kurrle, director of specialty care services at the Washington County Department of Mental Health, said the Access Hub for adults 18 and older has had many visitors in its first few days. The staff is trying to spread the word about it.
She said she is excited about this addition to our continuum of care and hopes it is helpful and safe for everyone.
People have long sought help for serious mental health challenges in hospital emergency departments because of a lack of other options, especially overnight and on weekends. But the surge in patients after the Covid-19 pandemic subsided was unprecedented, said Alison Krompf, deputy commissioner of the Vermont Department of Mental Health.
Life lost its regular rhythm. People don’t see their regular care provider. Then, when that delay in care begins to wear people down, they show up in larger numbers and in greater need, Krompf said.
The crisis has led to an outcry from both patients, who often have to wait days in emergency rooms for appropriate care, and from hospital staff, who are frustrated that they are receiving too little armed to do and wary of increasing verbal and physical attacks against them.
Increasing capacity for inpatient psychiatric care is one answer, Krompf said. But the department also recognizes the widespread desire for community-based urgent care, and has additional federal funding from the 2021 American Rescue Plan to support community-based programs copper.
Five mental health service agencies were awarded more than $3 million to develop or expand alternatives to emergency room programs. Two are for adults and three are for children and adolescents. Although different in design and staffing, they share the same goal of providing a more comfortable and welcoming location to meet urgent non-medical needs.
In Bennington, Unified Counseling Services is using its funding to expand hours and staffing for its four-year-old program called pediatric psychiatric emergency care, or PUCK.
The program occupies a suite of rooms in one of the agency’s buildings. Since July, a dedicated clinician, care coordinator, and advocate has been available from 8 a.m. to 5 p.m. for youth in crisis, often referred from school districts in the area.
They are there to respond when needed, just like the staff in an emergency room. When someone comes in with a broken leg, you can’t schedule it, right? said CEO Lorna Mattern. During their free time, staff will communicate with children, parents and school counselors or schedule additional services.
In the first six months of 2023, before the expansion, the program saw 67 children and teens who otherwise likely would have been taken to Southwestern Medical Center, Mattern said. Vermont.
Greater funding for staff also allows United Counseling to provide space for children to transition back to their daily routine after a stay at Brattleboro Retreat for treatment. Additional funds were also used to purchase a passenger van that is currently being customized to serve as a mobile PUCK clinic that can be taken to more rural areas of Bennington County, she said.
Now two other agencies, Lamoille County Mental Health Services and Health Care & Rehabilitation Services in southeastern Vermont, are following their lead. Both have received funding to develop a similar program in their area.
Before the PUCK program opened in 2019, Mattern said, teachers and principals sometimes had to take students to the emergency room because there were no other options. Combined with the difficulties of a children’s hospital environment, school staff are forced to leave their regular jobs.
I think they find it hugely beneficial for many reasons,” she said.
Their own room
A place like The Access Hub is not only a better environment than a hospital emergency department for people in crisis, but also a more direct way to connect them with quick counseling, Kurrle said. case management or psychiatric care.
Currently, the space is open from 7 a.m. to 4 p.m., Monday through Friday, although the agency hopes to expand hours even further into the evening.
Kurrle said the public can register themselves, but the agency will also take referrals from the mental health emergency hotline, 988, and from emergency rooms, area police departments and families and concerned friends, Kurrle said. Walk-ins will not be turned away during opening hours, she said, but whenever possible, the agency asks people to call before arriving.
In August, Addison County Counseling Services created a similar space for adults called Interlude in an office inside the Marble Works building in Middlebury. It is available by referral from the agency’s emergency response team, from 10 a.m. to 6 p.m.
Both The Access Hub and Interlude are built on a practice called the Living Room model, first developed in substance use disorder recovery programs and staffed staff are experienced colleagues with similar challenges as well as clinicians.
In Middlebury, instead of a packed waiting room, there’s a wide sofa on a cozy rug surrounded by bright posters and cheery potted plants. Instead of a busy reception desk where doctors and nurses are triaging hemorrhages and heart attacks, the plan is for visitors to be greeted by someone focused solely on the person in front of them.
We’re really trying to understand: Can we meet the needs of people in different settings,” said the Addison County organization’s executive director, Rachel Lee Cummings.
Both Kurrle and Cummings say the low-key vibe at both The Access Hub and Interlude doesn’t mean they’re unwilling to work with people in real need.
“If they are in an agitated state, like someone is screaming, but they can stay safe in their body, then they can absolutely be with us,” says Kurrle, starting to list the hypothetical emergency.
If someone is crying in great depression and everyone is worried about it; (If there is) someone who has cut themselves but doesn’t need serious medical attention but needs someone to talk to, they can come see us,” she said. In addition to peer support, the goal is to provide quick access to a counselor or psychiatric provider, either in person or through telehealth.
Only people who may need medical treatment or must be detained to avoid hurting themselves or others will be transferred back to the hospital in Berlin. But people can also return after being medically cleared, such as after a panic attack, Kurrle said.
Also in the Barre Street building is the agency’s Sunrise Wellness Center, a bustier center for social connection and support services that opened in May 2021, as well as overnight hospital bed of the agency. (There is also a bed at The Access Hub, but it is only for resting and napping.) Someone may join one program but be referred to another, depending on their needs , Kurrle said.
A person in urgent need may need a quieter, less stimulating setting than a wellness center, she said. The variety of options is just about recognizing that we all need different things when times get tough.
Addison County’s Interlude is separate from the agency’s other services. A traveler can be consulted there or referred from there to another location once it becomes clear what is possible and necessary, Cummings said.
“We don’t want people in crisis to have to navigate our complex, bureaucratic internal operations,” said Cummings. We want it to be as seamless for everyone as possible.
Although it can only accommodate one patient or client at a time, it has been used by many people over the past two months, including existing clients needing a quiet place as well as newcomers to the university. Manager has contacted us. 988 needed a safe space to decompress, Cummings said.
Two other agencies are accessing similar funding to launch adult urgent care programs that are still in development.
Northeast Kingdom Human Services will use the funds to purchase a new building for emergency mental health services with an overnight stay feature.
In the Burlington area, the Howard Center plans to partner with the University of Vermont Medical Center and Community Health Center to open a 24/7 urgent care clinic to provide behavioral health treatment services. en in addition to basic medical care services. Additional funding will come from about $3 million of the UVM Medical Center’s $18 million in excess revenue from 2018.
The Department and agencies know that these new programs will not keep everyone in mental health crisis out of the emergency room, Krompf said. There will still be people whose medical needs or severity of their symptoms may make a hospital the best place.
But by providing urgent care options in the community, there is a greater chance of more people being seen and treated before their illness reaches that stage.
Hopefully, these spaces will be designed for people who are struggling before then, Krompf said. If you can catch them before that time, you will give them that welcoming space, in hopes of meeting that need.
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