2014-15 Regional Priority Needs Assessment and Planning Report
Jointly prepared by
Janine Sullivan-Wiley, Northwest Regional Mental Health Board, Inc.
Jennifer DeWitt, Central Naugatuck Valley Regional Action Council
Allison Fulton, Housatonic Valley Coalition Against Substance Abuse
The purpose of this report:
The purpose of this report is to assess the status of priority service needs identified in the 2014
priority reports, including those reported in the statewide priority report as well as this region.
It includes any resources or environmental changes that may have had an impact upon identified
priority service needs that have made the situation better or worse.
It identifies whether identified needs stayed the same, got worse or better and why.
It identifies new and emerging issues.
Issues identified in last year’s report are indicated in italics.
The report is divided into the following sections:
 Mental Health and Addiction Treatment:
1) Stigma
2) Access
a. Outpatient treatment
b. Access/ issues of awareness
c. Access to Substance Abuse treatment
d. Other services
3) Funding for services
4) Service availability
5) Client complexity
6) Opioid use and overdoses
7) Young Adults
a. Mental health system
b. Youth in Recovery from substance use disorders
8) Group homes
9) Data and regulatory demands
10) Individual therapy
11) Specialized treatment for eating disorders







Issues identified in our report as beyond the purview of DMHAS to fix, but still having a
major impact on people in their recovery journey
Update on issues identified in 2014 Provider Surveys administered by DMHAS
Issues identified in the State-Wide report, but not in our regional report, and the status
Update on overarching recommendations and suggestions for improvement not noted
elsewhere
New trends and emerging issues
Given changes in regional resources, needs, and emerging issues, the priorities for substance
abuse and mental health treatment and mental health promotion seen as being most important.
Additional comments
1|Page
Mental Health and Addiction Treatment
1) Stigma impacts virtually all aspects of care and support in the community. While better than it
was years ago, it still represents a barrier to individuals needing or seeking care and recovery. In
the state-wide report, this was identified as “Community Education.” In our report, stigma was the
issue and community education the answer. There was a RECOMMENDATION to address stigma
through community education:
- To reduce stigma and increase understanding of mental illness and substance use
disorders and awareness of resources
- Including Mental Health First Aid
- About substance use and abuse
- For parents
Update: According to reports from across the region, it is worse. Category: environmental change.
One telling comment reported that “There is a new level of stigma in the community… a sense that
people with mental illness are not safe to be around.” It was noted that the media seem very fast to
label any criminal activity as related to mental illness. Mass murders or other highly publicized
crimes (by white males) seem to be attributed to mental illness. This undercuts so many other
initiatives to counter the public perception that people with mental illness are dangerous.
Stigma against people who are addicted to opioids is also pervasive. It is evident in the response of
some in the community to the availability of Narcan, some expressing that it is just one more
reason for people to keep using. The perception of addiction as moral weakness persists.
On a positive note regarding negative stereotypes of people with mental illness, some Local
Prevention Council and other Committee partners of the Regional Action Councils are reporting
that the new DMHAS Mental Illness PSAs are well-received, generating reflective conversation
about the radio messages being heard. This is welcome news, and we hope that these conversations
can effectively counter the news media.
Very recently it was reported that community fear of people with mental illness has impacted the
ability of clients to obtain housing and jobs.
It resulted in the near passage of a law in the 2014-15 session that would have severely challenged
community residences. It is expected that it will be resurrected in the next legislative session.
How this was addressed this year:
- Regarding zoning issues: The NWRMHB is working closely with the provider most
associated with the impetus of this bill (a group home for people discharged from CVH,
located in New Milford.)
- In order to address this need, the NWRMHB has continued and expanded its Community
Education Project. In FY 2014-15, The NWRMHB Community Education Project placed
over 10,000 pamphlets, resource sheets and flyers in 42 towns and 128 locations within
those towns. The Statewide report suggested that such resources reach a variety of
locations. All of these were included in this project, such as many libraries and schools,
many police departments and fire departments, town halls, senior centers, schools and park
& rec offices, town clerk office, children’s center, school psychologist offices. Some of the
more interesting locations this year were a local bakery, at a combined luncheonette/liquor
store, Heritage Village office (serving possibly the largest concentration of elderly persons
in CT), in a presentation at the Brass Mill Mall and another in front of the Danbury Public
library.
2|Page
-
-
-
In addition, each of the Regional Action Councils regularly disseminate public awareness
information at health fairs, back-to-school rallies, fresh-check events at colleges, as well as
at community forums and venues addressing the prevention of substance abuse and other
risks across the lifespan. Regional Action Councils also provide ongoing education and
training to each of their respective Local Prevention Councils who in turn deliver this
information and other education resources to parents, schools, police departments, senior
centers, youth service bureaus, prevention professionals, civic and volunteer groups, faithbased organizations, youth councils, Drug Free Schools and Community grantees, and the
general public.
Mental Health First Aid classes have now trained a total of 178 people in 36 towns,
including Beacon Falls, Bethel, Bridgeport, Bristol, Brookfield, Burlington, Danbury,
Goshen, Hartford, Middlebury, Morris, Naugatuck, New Hartford, New Haven, New
Milford, Newtown, Norfolk, Norwalk, Oakville, Oxford, Plymouth, Redding, Ridgefield,
Roxbury, Sandy Hook, Southbury, Southington, Stamford, Torrington, Washington,
Waterbury, Watertown, Wilton, Winsted, Wolcott, and Woodbury. There were two people
whose town of origin were unknown, and three from New York State.
A special training in community mental health strategies and interventions was given to six
people who would be working as volunteers in the new Gathering Place in Torrington.
Recommendations:
- Continue to provide Mental Health First Aid training throughout the region and state.
- Continue to provide community education through the NWRMHB Community Education
project and Regional Action Council core functions.
- Continue to work with the provider, community and local legislators in New Milford.
2) Access:
Access, especially to mental health Outpatient Services, is at the crisis level in this region. It is
especially acute in the Waterbury area, where a person seeking treatment is likely to have a long
wait or find no appointment available. This is inclusive of both the private sector (PNP outpatient
services and the four general hospitals that provide the vast majority of outpatient care) and the
state-operated programs. The latter have been hard-hit by retirements, and the slow or nonreplacement of staff.
There was a recommendation for the development of additional residential treatment in all levels
of care, especially supervised apartments and non-MRO congregate care.
2a) Outpatient treatment:
Update: Much worse. Category: resources and environmental change.
In this region, the general hospitals continue to provide the bulk of OP treatment for people with
more severe and prolonged mental illness. Their condition has a profound effect on this area of
services. At this time, access to outpatient mental health services is either unavailable or severely
restricted in three of those hospitals, and very difficult to access in the state-operated programs as
well. A client who wants to switch providers is best advised that even a poor match should be
retained as the alternative could be NO outpatient provider.
There are several FQHCs in the region, but they generally restrict their behavioral health services
to those individuals who are clients of their medical services.
The problem has been most critical in the Waterbury area. Even when we have heard reports that
access has opened up a bit, we then hear from other providers that clients cannot gain access.
3|Page
During FY 2014-15, after a planned sale fell through, one of the largest providers in the area –
Waterbury Hospital – closed their regular outpatient program access entirely for many months,
even to clients leaving their own inpatient unit or served by their crisis program. This shifted
demand to the other providers, who became overwhelmed. Most other programs had stopped or
severely curtailed admissions. Even the state-operated program curtailed access, and by May and
June 2015, even St. Mary’s Hospital had to limit admissions as they were operating a staggering
400 clients over capacity, 200 of those DMHAS clients.
In Danbury, the Western CT Health Network – parent organization of Danbury Hospital and their
Community Behavioral Health Center, is in the process of transitioning ALL of their outpatient
programs over to a FQHC – the CT Institute for Communities (CIFC). Medical outpatient
programs are beginning the transition this summer; behavioral health services are slated for
transitioning next year. The Regional Board is meeting with the CIFC CEO and monitoring this
situation closely to assure that services for people with serious mental illness are not reduced in this
change. However, as of July 2015, the Danbury Hospital Community Behavioral Health program
(CCBH) also has no access within a “reasonable” time, as they are now booking into September.
Even people who are already clients there cannot get an appointment before the end of August,
even when a community residential provider called and clearly indicated that the person was in
crisis.
Torrington is the least affected by access constraints. It is likely that their status as an Enhanced
Care Clinic (ECC), with its higher reimbursement rate, is a major factor in their ability to meet the
demand.
There was a recommendation last year to stimulate and support collaboration and innovation in the
delivery of outpatient services. A Community Care Team has been established in Danbury, and one
is beginning in Waterbury. Based on the experience of other areas, this collaboration should bring
improvement to high-utilizer individuals as well as improve coloration in general.
2b) Access/ issues of awareness:
Access also has an informational component. While 211 is the “official” portal, long waits have
made its utility questionable for many situations. The awareness of this resource is still not
commonplace among certain populations. For example, during focus groups with youth and young
adults from across the CNVRAC service area this past year, only about 1 in 10 were aware of 211Infoline as a resource available to them. Nevertheless, we would encourage fixing this resource
rather than adding others that might overlap and contribute to community confusion. If 211 could
also function as an entry point for services, so much the better.
Update: Same. No change.
2c) Access to substance abuse treatment is not coordinated, and there is no simple way for
people needing these services to know what is available and where. Services may not be available
for the length of time needed. Inpatient substance abuse treatment is particularly hard to get.
Update: No reported change.
2d) Other services:
There was a recommendation for the development of additional residential treatment in all levels of
care, especially supervised apartments and non-MRO congregate care.
Update: There are no new resources for the clients already seeking these levels of care, but two
new programs opened to serve individuals coming out of CVH, one in New Milford (operated by
CHD), and one in Torrington (operated by MHAC).
4|Page
Needed:
- There is still a need for residential options that are lower than having staff onsite 24/7, but
higher than residential support or CSP which may only provide support one day a week.
Without that step-down level, clients may decompensate even below the level when they
were first admitted to 24/7 programs.
- There is a need for residential services that also have a medical component to serve
individuals coming from a hospital level of care, or with increasing medical needs that
cannot be managed by regular programs.
- Respite care for the Danbury area. This resource is currently available in Waterbury and
Torrington, but without transportation between those cities, individuals receiving clinical
or other services in their home town of Danbury find their recovery supports compromised
or unavailable.
- ACT level services are being added to the greater Waterbury area but not yet available in
the other two parts of this region.
3) Funding for services is inadequate: this includes the reimbursement rate for outpatient
services (a major contributor to the crisis in access noted above) as well as over a decade of
essentially flat funding to the private-non-profit programs. High staff turnover is one result, and is
a hardship to the agencies and the clients who remark in most reviews on its negative effect on
their recovery.
In last year’s report there was a recommendation to support increases in reimbursement rates for
services so that they are cost-based, and support PNP funding to reach a level that is competitive
and sustainable.
Update: Worse. Category: Resource.
- PNPs did not get increases in 2014-15.
We opposed the many CUTS that were proposed for the FY 2015-16 budget.
- The bill that would have tied PNP funding to inflation died in this year’s session. There
should be some improvement next fiscal year with a 1% COLA in the budget (although
that does not even keep pace with inflation) and purported increases in the DSS rates for
some providers. One PNP program experienced 100% staff turnover, leaving for higher
salaries. This represents a serious hardship for agencies in constant recruitment and
training and for clients as relationships are disrupted repeatedly. In the PNPs, staff are
usually required to use their own cars to transport clients. The reimbursement provided
generally does not cover the cost, and the increased prevalence of bed bugs has made this
even more onerous for staff.
- Staffing reductions are already happening.
4) Service availability: Where services should be expanding to meet the need, they are
shrinking. After many years of stretching to meet client need without the necessary funding, this
year has seen many programs reducing staffing, hours and days of operation.
Update: Worse. The need for expansion remains. Category: Resource.
The threats to funding this year were a major blow. Many had thought that the community
emphasis on mental health care and services would mean those resources would be expanded.
Many in the community are appalled to find that was not and is not the case.
Programs that are state grant-funded are increasingly stretched and seeing substantial and growing
deficits. Last year we noted programs that had cut hours and or capacity. This has not happened
yet this year but such reductions are very likely given the lack of increases for the private sector in
the new budget.
5|Page
5) Client complexity: More and more of the clients entering the system are very complicated
and challenging, with multiple co-occurring issues that include mental health, substance abuse,
medical and legal issues.
Update: Worse: The acuity of clients has increased, with more complex needs (psychiatric,
substance abuse, medical and forensic) as well. New is the report of increased acuity on inpatient
units in community hospitals.
Improved: A Community Care Team has begun in Danbury, and one is under development in the
Waterbury area.
6) Opioid use/ overdoses:
The need for methadone treatment resources was noted for the north and northwest part of the
region. Despite zoning challenges - a program should open in Torrington within the year.
Suboxone treatment is hard to get; one of the psychiatrists with a full Suboxone caseload left the
region this year. There were two recommendations: 1) Develop the full array of essential substance
abuse treatment services in each catchment area including medication assisted treatments of
methadone maintenance and Suboxone treatment and 2) Planning for timely, easy access to
essential substance abuse and mental health services
Update: Improved:
- A methadone maintenance program opened in Torrington this year.
- The expanded use of Narcan has been an excellent development.
- The legislature has enabled provisions to increase caseloads of Suboxone providers.
- There is a new, specialized opiate case manager in the ED of Charlotte Hungerford
Hospital. This was an outgrowth of the Opioid Task Force in that community, and is jointly
funded by DMHAS and CHH.
- Pharmacists will now have the ability to become trained to not only fill prescriptions, but
also to prescribe Narcan to individuals who need access to this important opiod antagonist.
No change:
Overdoses continue to be a problem. Last year, about 500 people died in Connecticut due to
overdoses involving heroin, fentanyl, oxycodone and other opiates. Often there was a combination
of opiates or opiates and other drugs.
There have been several advances legislatively:
- Regional Action Councils worked diligently this past year to support HB 6856- An Act
Concerning Substance Abuse and Opioid Overdose Prevention, the Governor’s proposal
that dealt with the growing concern over opioid abuse. Expanded use of the prescription
drug monitoring program and ensuring the ready availability of opioid antagonists were
crucial to those efforts. This bill passed.
- Connecticut legislators also took a giant step toward preventing overdose deaths last year,
by granting immunity to anyone who distributed naloxone, which went into effect in
October of 2014. Availability of this life-saving drug is still not as widespread as it needs
to be. Additional education and community awareness-raising is needed to increase
knowledge about the factors that increase someone’s risk for overdose. HVCASA
developed and both RACs work jointly to disseminate an information card about the risk
factors that increase a person’s chances of overdose, as well as the warning signs,
symptoms, and proper way to use Narcan and other response measures, for someone who
may be experiencing an opioid related overdose.
6|Page
7) Youth and Young Adults
7a) Young Adults needing mental health services now have excellent, dedicated services
across the region, but the demand exceeds the supply and young adults who have not come through
the DCF system are generally unable to access the specialized services. They generally are not
comfortable with many of the existing services that serve an older population. Young adults in one
program emphatically did not see themselves as “DMHAS” – they were in the “YAS” program.
There are also challenges where there is not an appropriate level of care/services in the adult
system for some high need young adults when they age out of YAS at 25. Individuals with Autism
Spectrum Disorders face particular challenges, and there are few supports for them.
Update: New services for young people with autism were to begin this year through a new DSS
initiative. However, CAC #20 noted that there are more young adults with Autism Spectrum
Disorders aging out of the DCF system.
There has been good development of “alumni” groups for Young Adults, and these are apparently
highly valued. The addition of the AU Super Advocates has given rise to several innovative and
sustainable initiatives that have helped this population support one another as they become more
involved in the community. The addition of mini-grants in this region has been especially valuable.
These were funded with a donation of $15,000 by an individual in recovery from another region
who wanted to see this replicated in Region V. It is hoped that DMHAS will be able to cover this
initiative once those funds have been exhausted.
However, this year it was reported that young adults who are still actively “using” present unique
challenges. The environment successful with older clients is not effective with this age group.
Needed: A Young Adult recovery model, with embedded clinical services and high levels of
support.
7b. Youth in recovery are still experiencing difficulty with re-entry into their schools and
community after treatment for a mental health or substance use issue. Recovery supports are not
typically age-appropriate.
Update: Though there are some 12-Step recovery meetings particularly in the towns of Wolcott
and Woodbury that have been identified as having a respected reputation as a “Young Person’s
Meeting” of Alcoholics Anonymous or Narcotics Anonymous, there continues to be a lack of
additional community-level supports for young people in recovery returning to their schools and
communities. Local Prevention Councils welcome the participation of these individuals, to address
local-level prevention needs in the area, but often times, additional supports are required for the
individual to maintain stability.
8) There are group homes in this region, but the demands of the Medicaid Rehab Option (MRO)
for payment has been a major challenge. There are some clients identified who could benefit from
the group home setting, but cannot meet the programming demands involved. There are many more
individuals who need supervised apartments or homes with 24-hour supervision/support than are
able to get it. The wait lists for this level of care are long.
Update: This level of care continues to have wait lists.
9) Data and regulatory demands continue to siphon resources away from direct care, and pose
barriers to some clients.
Update: Worse.
- The unfunded data requirements were the reason that at least one provider did not apply
when the PATH funds were re-bid.
- The increased data demands have led directly to reduced service capacity in at least one
agency.
7|Page
-
In addition to the data demands, for the first time in over a decade, we have also heard
reports that providers are spending more time on evaluations, including DDS audits,
DMHAS chart reviews, Value Options reports and CAC reviews.
For MRO (Medicaid Rehab Option funded) group homes, and CSP (Community Support
Program) services, the need for agencies to hit outcome targets has meant that some clients
are not eligible for those services when it would otherwise be the right type of care. The
level of skill-building required is beyond those clients.
10) Individual therapy is becoming increasingly hard to get.
Update: Generally still the case although one provider in Waterbury has expanded the availability
of individual therapy within their substance abuse treatment program.
11) Specialized treatment for eating disorders in the region. None exist.
Update: No change.
Issues identified in our report as beyond the purview of DMHAS to fix, but still having a
major impact on people in their recovery journey is the recurring need for:
-
Safe, affordable housing
UPDATE: Housing in the greater Danbury area is some of the most expensive in the state.
The lists for affordable housing only opened at the very end of the year but are not nearly
enough to meet the need. The greater Waterbury area has more affordable housing but
those units are often in parts of the city that are not safe, particularly for people trying to
maintain sobriety. Torrington has the most affordable housing which has resulted in shifts
in population within the DMHAS population to this area.
-
Public transportation to jobs, homes and leisure activities
UPDATE: No improvement. The lack of public transportation is a barrier to accessing
treatment, jobs, housing and leisure activities. The development of telemedicine for
behavioral health would help this, especially for individuals of cultural or linguistic
minorities.
-
Jobs and supports for jobs
UPDATE: No improvement. Waterbury has the highest unemployment rate in the state.
This has a particularly hard impact on DMHAS clients as more people are looking for
fewer job opportunities. Clients with criminal backgrounds are at an even greater
disadvantage.
8|Page
Update on issues identified in 2014 Provider Surveys administered by DMHAS:
 There was considerable confusion about the roles and work of the Boards, Catchment Area
Councils (CACs) and the Regional Action Councils (RACs) evident in the responses. It was
noted in our report that membership is not only “permitted” but also appreciated. Of the
twelve agencies who responded, five have current membership on the RMHB or one of the
local councils, another is a regular guest, and one more has been at meetings convened by
the board to foster collaboration and local solutions. One other serves on their local RAC.
Comments about lack of communication or collaboration seemed at odds with many
activities and committees. For example, The Regional Board has played a strong role in
facilitating communication between many agencies over the years, with particular recent
emphasis on the situation with outpatient services.
Recommendation: Provider surveys should be targeted to staff at the organizational level
most likely to be aware of other community providers. This is often NOT the CEO if the
organization is a large one with many sites.
The RMHB and RACs in this region should work to clarify their roles with the providers in
this region.
Regarding the desire to have RACs/RMHBs to “share with them feedback about
strengths/weakness, policy and legislative issues, as well as reports and
recommendations” the RMHB in this region includes strengths and areas needing
improvement in all evaluations and these are given to the agencies reviewed. However, as
only publically funded agencies providing mental health treatment are reviewed, it might
be helpful to expand this to other agencies based on this agency feedback to DMHAS.
Legislative issues are covered at each CAC meeting; guests are always welcome including
any provider in the area, providing any kind of service from any funding source.
 Providers were interested in more training. Our local LMHAs often have training but it is
often limited in access for PNP providers. Training provided in Middletown adds drive
time and expense to PNP providers which are already stretched to provide their core
services.
 Provide assistance to clients: While providers might like us to take on this role, it is not
within our statutory mandate and beyond our resources to add.
 Help us to coordinate Behavioral Health with Primary Health Care: The Director of the
NWMRHB serves as an appointed member of the Behavioral Health Partnership Oversight
Council and in that role works to bring this about on a statewide basis. Doing this on a
local basis with primary care providers is not within our current scope of service but might
be an area that could be explored if the roles and responsibilities of the RACs and Boards
were revised.
Taken as a whole it is clear that indeed many respondents did not know what the Boards or
RACs do.
Based on the comments and suggestions, some agencies seemed to have used the opportunity
presented by the survey to suggest roles for the Boards and the RACs, including many
activities they do not do, have no time or resources to do, but see a need for.
9|Page
Issues identified in the State-Wide report, but not in our regional report,
and the status observed in this region:
 Prevention:
This year’s sub-regional priority setting report from the Regional Action Councils indicate that for
service area 5-B, structured youth development activities and the availability of after-school
programs as well as in-school, evidence-based life & social skills training programs are seen as
having the greatest impact on primary prevention. Respondents are also aware of and identify that
limited financial resources to support these programs continue to be the biggest barrier to their full
implementation. Prevention priority setting results further identify that insufficient community
awareness of problems, the “not my child, not here in this community” inaccurate perception of
substance abuse and mental health issues remains a barrier as well, fueling continued stigma and
undermining of proactive prevention efforts.
Through collaborative community forums, presentations, workshops and focus groups on substance
abuse issues, opioid overdose prevention, problem gambling, medical marijuana, and related
topics, the Regional Action Councils continue to work to address and reduce stigma and to increase
awareness and accurate information dissemination about problems, prevention, and resources to
address macro-level community change.
 Lack of long-term inpatient beds:
This remains a problem. A particularly critical situation has been reported regarding the need for
youth (under 18) inpatient beds. This population was reported to be “overwhelming” one
emergency department, with one 12 year old spending five-six days in an ED in Waterbury as
there were no inpatient beds within CT or even other states. The question of the relationship of this
situation to the closure of youth group homes by DCF was brought to the BHP-OC for their
attention.
 Mobile Crisis:
The efficacy of mobile crisis varies in this state. The Regional Board obtains information indirectly
through all of its reviews but could evaluate this service on a region-wide basis if that was
suggested as a state-wide review.
 Cultural and ethnic minorities:
There are sizable populations of individuals from other cultures, speaking other languages, in this
region, including notably large populations of people from Brazil, Central America and the
Caribbean, as well as those speaking Albanian and several Asian languages/dialects (incl.
Vietnamese and Hmong). There are not adequate staff in the service system to meet those needs.
For example, there is only one Spanish-speaking clinician in the entire Danbury DMHAS-funded
service system; she sees hundreds of clients. Were she to leave, the impact would be enormous. For
years, the state-operated program in Danbury had a Chinese-speaking clinician. During that time,
the number of Asian clients increased. When she left a couple of years ago, those clients stopped
coming. It was noted that many Latino individuals are served by their churches. In Waterbury, St.
Mary’s Hospital still has one Spanish-speaking psychiatrist
Recommendation: The use of telemedicine should be explored as there are not enough clinicians of
various ethnic and linguistic backgrounds such that all agencies could hire their own.
10 | P a g e
Update on overarching recommendations and suggestions for improvement
not noted elsewhere in this report:
-
-
-
-
Recommendation: Increased peer-delivered services for outreach and engagement,
recovery support and innovative services
Update: No change.
Recommendation: Workforce development for psychiatry and APRNs
Update: No change. The Western CT Mental Health Network is now down two prescribers
due to time-limited situations which do not even allow for the use of Locum Tenen
psychiatrists or replacement. As noted elsewhere in this report, there is a dearth of Latino
and Asian clinicians, as well as staff to serve people of a variety of ethnic origins and
languages.
Recommendation: Enhanced attention to the mental health and substance abuse needs and
services for older adults
Update: There has been date collection in this area with focus groups conducted by
UCONN researchers in collaboration with the regional boards. As noted under Community
Education above we have made increased efforts to get information into community
locations that serve elderly persons in this region.
Recommendation: Integrate mental health, substance abuse and medical treatment.
Update: While there could be debate that this has not yet occurred, providers and the
community do not yet see an integrated behavioral health system. Some providers have
made noteworthy progress, for example CNV Help in the Waterbury area has integrated
mental health and substance abuse treatment to a noteworthy extent.
Medical care is not integrated with behavioral health except at some of the FQHCs in the
region, and even there the silos are often quite separate.
New Trends and Emerging Issues Identified in this Region
 Persistent funding crises leading to organization fatigue and diversion of energy from
core missions:
The last legislative session was highly stressful for all human service providers and clients.
The struggle for organizational survival caused many agencies to divert staff time at the
highest levels from normal activities to legislative advocacy and meetings.
 Suicides of police officers:
There was a tragic and well-publicized suicide by the Deputy Chief in the Waterbury
police department. When that department spoke to neighboring departments, they learned
of four other suicides of police officers in a neighboring community – these had NOT
received any publicity. Ironically, the Regional Board had a meeting with the Waterbury
Police Chief the day the funeral took place for them. At the rescheduled meeting the Chief
and the entire force were eager for more information on mental illness and suicide
prevention for internal use.
This may be similar to the very high rate of suicide already noted among military
personnel.
Recommendations: The Regional Board and RACs in this area will be providing more
resources and training (including Mental Health First Aid and Suicide Prevention) to this
vulnerable group, whose wellness is so closely tied to community wellness.
11 | P a g e
 Support for clients with intermittent needs post-discharge:
An issue identified in this region since before 2003 has resurfaced as a service system
need. Currently, clients return to the most familiar, trusted staff person at their previous
provider when they encounter a bump in the road, such as papers from DSS that are not
understood, or a relapse of symptoms.
Typically these individuals are served in short-term (often one) intervention by that
provider. This may, however, represent many hours of staff time. This client care is not
captured as the single intervention does not warrant the time consuming process of reopening a case. In an increasingly data-driven system, this penalizes agencies and staff
that provide this care. Strategies to address this such as the use of Recovery Support
Specialists on CSP teams have not met this need because from a client-centered
perspective it is “all about relationship.”
Recommendation: At this time the greater Danbury service system is working on a
system-wide collaborative process to attempt to address this issue. The NWRMHB has
long advocated for a “consulting level of care” that could be used by staff/providers of
different types. We suggest that the pilot process being explored in the Danbury, to begin
implementation by October 2015, be given time to see if it meets this need.
 Medical marijuana:
This was well-described by one substance abuse treatment provider as “a can of worms.”
The changes in marijuana for medical use have had unforeseen and problematic
consequences in substance abuse treatment facilities. There is also a concern about the
increased availability and acceptance of marijuana for vulnerable populations (youth and
people with vulnerability for development of psychosis). Research for both issues of
medical and potential legalization of recreational marijuana use is still rare in the country,
and reliable data is scarce or unavailable.
The NWRMHB brought this issue to the attention of the State Board of Mental Health and
Addiction Services as this issue needs state-wide consideration, discussion and policy
development.
Currently, the Regional Action Councils develop, disseminate, and provide education on
marijuana decriminalization and the available research on medical marijuana. RACs have
worked closely with Smart Approaches to Marijuana (SAM) affiliate partners who address
marijuana policy based on reputable science and sound principles of public health and
safety. RACs have further collaborated with the CT Association of Prevention
Practitioners (CAPP) to share concerns with state leaders over the unintended
consequences that marijuana currently brings to CT such as the potential for increased
abuse among youth, increased crash fatalities, an industry that has already marketed
marijuana to our kids, and confusion by the medical field on side effects, safety concerns
and dosage amounts for the various approved medical conditions.
Recommendation: Continued attention to this on a state-wide level, with a conference or
high level round-table to bring all of the knowledge together and support the development
of sound, research-based strategies.
12 | P a g e
 Destabilization of homeless supports: The new CAN (Coordinated Access Networks)
process and re-bidding PATH funding has greatly strained and de-stabilized homeless
services. This has exacerbated the existing challenges.
 Medical/dental service availability: Problems in this area were noted years ago, but had
not been in issue for many years. In Danbury, access to dental and especially specialist
medical care is “again very bad.”
Limited access to dental care is especially acute for individuals who have Medicare (which
does not cover dental care) but not Medicaid. Poor dental care has resulted in infections
and often that teeth are simply pulled. The problem persists that people with a behavioral
health history seem to get less adequate medical care. As noted above, a level of residential
support with medical supports included is needed.
Given changes in regional resources, needs, and emerging issues,
these priorities for substance abuse and mental health treatment
and mental health promotion are seen as being most important.
These take into consideration any major changes (e.g., new resources, emerging issues, new
legislation, etc.) since the 2014 priority process in this region, and other areas needing
attention that DMHAS should be aware of as it prepares for the 2016 priority setting process.
-
-
-
Increase funding to PNP agencies. To continue to expect these agencies to provide the
same services, with the same staff and program hours while funding has remained
essentially level for a decade is unrealistic and inhumane as they attempt to do just that,
burning out staff and stressing clients with staff turnover.
Streamline data and contracting demands:
o To the extent possible, DMHAS should work with the other state agencies to
continue to develop uniform reporting and contracting processes.
o While data is necessary to track outcomes, program funding should reflect this
demand and include funding to cover hardware, software and staff expenses so that
it does not siphon resources from direct care.
Provide financial support to the RMHBs and RACs so that they can expand their
community education efforts including MHFA and suicide prevention training.
Additional Comments
Other concerns, solutions, and suggestions regarding the DMHAS service system:
-
Where possible, DMHAS should avoid re-bidding service types. It is incredibly stressful
and de-stabilizing to services and collaborations in the community. The process that was
used in the transition from case management to CSP was a better model. It allowed
agencies the choice: are they willing to adapt their methods and services at a specified
price? It has also allowed for adaptation where the original design did not work as
expected.
13 | P a g e