Guiding On-Island Mental Health Care

by Eleni Sinnis

Nantucket is considered one of the most idyllic places to summer on the East Coast, but living here year-round has many challenges and can be isolating, especially in the deep winter. This, coupled with the struggle to retain mental health professionals on-island full-time, has resulted in difficulties matching locals to needed mental health resources.

In 2021, the Nantucket Behavioral Health Initiative (NBHI) was formed with members from the Nantucket Cottage Hospital, Fairwinds Center, the Community Foundation for Nantucket, and NAMI. These individuals became the heart of the initiative, and were joined by community leaders from across the island from town government, schools, police, EMS, health and human services organizations, the spiritual community, independent clinicians, and community members. The rapid rate at which the community came together and the wide reach of the organizations that joined shows the mutual understanding of the need present on the island. This group worked together for two years to create a sustainable path to redesign the behavioral healthcare system on the island and to address the system-wide gaps.

They accomplished this through the creation of Community Solutions for Behavioral Health. Think of the non-profit as providing a guide to mental health resources available to Nantucket residents. The organization is not designed to provide patient services, but rather to coordinate mental health options on the island to bring more resources to the people of Nantucket. The organization brings together Nantucket Cottage Hospital, Fairwinds, NAMI, Addiction Solutions, and other essential partners to anchor this organization. Our House and the Nantucket Boys and Girls Club, which do not provide mental health services but help to care for, support, and aid the island community, are also helping with this important initiative.

Community Solutions for Behavioral Health was created as a result of a report commissioned by the NBHI. This report outlined the gaps within mental health services on the island and the steps the island community would take to move forward. Of the 15 gaps identified in the island’s continuum of behavioral healthcare, five were identified as “system enablers”:

~ a lack of person-centered collaboration across the continuum

~ underrepresented access and navigation supports

~ fragmented system oversight with limited data utilization

~ reimbursement levels insufficient for Nantucket’s true cost of service

~ how lack of housing impacts demand, recruitment, & retention of professionals.

The 10 additional gaps within the system ranged from a lack of access to community providers and a fragmented crisis response to under-resourced family and school-based supports. These extensive gaps had a far-reaching effect on the entire community of Nantucket.

The primary goal of Community Solutions for Behavioral Health is to streamline the process of receiving mental health care on-island, ensuring that all the

organizations that are able to provide care are working together. These resources will be able to provide the care that the community has needed for a long time.

According to Margaretta Andrews of the Community Foundation for Nantucket, Nantucket “has one of the highest needs of mental health services in the Commonwealth but the lowest number of providers per population.” Nantucket has a provider-to-resident ratio of 1:370. To bring the local ratio up to 1:270 (the national average of top-performing counties across the country), 20 to 25 providers would have to be added. The ratio on Dukes County (Martha’s Vineyard) is 1:140; the ratio in Barnstable County is 1:190. The state-wide ratio is 1:150.

Nantucket’s Fairwinds Center has been designated the Community Behavioral Health Center and Crisis Responder for Nantucket by the Commonwealth of Massachusetts, and they will respond to crisis calls 24/7 for 365 days a year. In addition to addressing crisis calls in the community and in the schools, Fairwinds clinicians provide crisis evaluations in the hospital emergency department and provide consultation for treatment of patients waiting for discharge to on-island outpatient services or transfer to an off-island in-patient facility.

This new model is a unified system of care for mental health crises on-island, whether the patient is in the community or at the hospital and regardless of

their insurance status. The new entity is driven by the conclusion that full-time dedicated resources will accelerate and sustain this work. Jason Bridges, the executive director of Fairwinds, believes that Fairwinds cannot take this all on alone. “There are system-level changes that need to happen and one entity cannot take it on alone we must work together to fill in the system-level gaps.” Patients are receiving better and more appreciative care than was available just a year ago because of the increased resources focused on mental health.

The major lapse in mental health resources on Nantucket can partially be accredited to its position as an island. Living on an island has always brought about challenges that do not occur on the mainland. Cooperation is a necessity of living on the island, when speaking to Jason Bridges he explained just that: “On Nantucket, we have to be innovative in a way that mainland communities do not, so it is essential for us all to work together to solve island-wide challenges.” The community leaders here noticed this from day one at the NBHI: in order to create sustained changes in the community they had to create a coalition and come together in a way only an island community can.

The Community Behavioral Health Entity will revolutionize and streamline the mental health resources on our island; and, hopefully, will add muchneeded year-long support to residents. To access more information visit fairwindscenter.org. If you need emergency mental health services, the Fairwinds Mental Health Crisis Response Hotline is 508-2213315–never hesitate to reach out.