CENTREVILLE — The challenges facing mental health response on the Mid-Shore are numerous — with a lack of prescribers, affordable housing, and crisis bed availability topping the list, followed closely by limited access to transportation. Although not unique problems, they are the areas most difficult for rural communities to address.
Carrie O’Connor, psychotherapist at Bridges’ Behavioral Health and Wellness in Centreville, highlighted the stress of compromised housing. When a person’s housing is compromised, she said, it undermines all of their stability. Rural homelessness tends to look different than urban homelessness — instead of living on the street, here it often looks like living in a camper or couch surfing from one temporary location to the next, she said.
On the Shore, there are two inpatient treatment facilities: the A. F. Whitsitt Center in Chestertown, a 24-hour, seven-day-a-week residential treatment facility offering treatment to adults ages 18 and over suffering from chemical dependency and co-occurring disorders; and the Eastern Shore Hospital Center in Cambridge, a mental health facility under the jurisdiction of Maryland’s Behavioral Health Administration, Maryland Department of Health.
ESHC houses four psychiatric units for a total of 80 beds. Its mission is to provide the highest quality inpatient mental health services on the Eastern Shore for adults. ESHC is accredited by the Joint Commission and is certified by the Centers for Medicare and Medicaid Services.
The Whitsitt Center is primarily geared towards those seeking assistance with substance abuse treatment with 40 beds for those patients and just four for those with psychiatric conditions. Although frequently the two are co-occurring, according to inpatient admissions coordinator Carol Johnson.
O’Connor noted it can take a week — sometimes longer — to get a patient into the center. At her facility, the dual diagnosis rate averages 50 percent with many medicating their mental health conditions with non-prescribed substances.
More crisis beds, more availability, is definitely a need for this area, O’Connor said.
There is also a shortage of prescribers, she said, those specialized doctors who can prescribe the appropriate medication in addition to therapy and other resources that are needed by those with mental health conditions.
We are limited in that area, she said. For someone who wants to get in and get help, it can take up 4 to 6 weeks before they can be seen by a professional who is licensed to prescribe medication.
Bridges, which is an outpatient mental health facility, really cares about the well-being of the client, O’Connor said. Under the guidance of psychiatrist Dr. Desmond Kaplan, it focuses on behavioral health, the integration process between substance use and mental health, and it has added nurse practitioners on staff who can help fill the gap needed by the demand for more psychiatrists.
It is important to establish a continuity of care, O’Connor said, and at Bridges, they try to reach out to patients primary care doctors as part of the process on the way to seeing a prescriber, gathering a detailed history, and determining what the clients needs are and what goals they can meet, while putting together a treatment plan. They also use routine urinalysis to make sure nothing is missed or contraindicated when prescribing a new medication.
As a counselor, O’Connor has worked with the mobile crisis unit and visited other facilities, and she noted some of them are a better fit than others for different individuals. However, lack of transportation and what can turn into a four-hour process to get County Ride or some other form of transportation to appointments can be a challenge that is often too much for individuals already struggling with their current situation and is often the biggest deterrent to individuals receiving care, she said.
One positive, she noted, is that with approximately half of their clients on Medicaid, funding has changed so insurance is not necessarily directing all of those clients to the health department, but giving them access to a choice of other providers. More access means more opportunity for individuals to be seen and provided services.
Another alternative Bridges offers is a school-based therapy program. Currently in Queen Anne’s County, a parent or guardian may seek supportive therapy for a student enrolled in Queen Anne’s County Public Schools. An initial intake appointment is scheduled in the office and all additional therapy follow-up appointments are conducted in the child’s school with minimal disruption to class time.
“We have helped students successfully address a wide variety of issues related to school, home, family and peers, in addition to increasing the parent support and involvement in the child’s academic and social environment,” Bridges states on its website, and parents are encouraged to be involved in the therapeutic process.
This helps the parents, as well, by establishing care that is able to be worked into the family’s schedule, O’Connor said.
With one in four individuals now affected by a behavioral health issue, there is still a lot of stigma, but O’Connor said she hopes that with more access to services more people will seek treatment and acceptance will follow. She said mental health is part of the whole care and well-being of the individual.
We are seeing a policy shift, even here locally, she said, noting that Centreville Family Practice houses a therapist and is able to help its patients get mental health care through family care.
The shift has come from the 1980s and previous philosophy of housing groups in mental hospitals, toward community homes, and even now allowing the criminal justice system to become the default for handling mental health crisis, but identifying and addressing mental health concerns early on can hopefully change that cycle.
However, O’Connor said, clients need to be motivated for treatment and have a sense of personal responsibility. She likened it to joining a gym — everyone wants to lose 20 pounds, but not everyone wants to get on the machine and put in the effort.
O’Connor said the biggest need facing Queen Anne’s County remains adequate, affordable housing, but she is hopeful for other positive changes as well, people connecting with other people, not being isolated with their mental illness, helping each other, and taking the time to say, “Hey, how are you doing?”