Leaders of behavioral health facilities need to apply a chess master's forethought to their decisions during the COVID-19 crisis, knowing that how they serve current patients today could affect their next move involving new patients tomorrow. At Brattleboro Retreat, a medically focused mental health and addiction treatment facility in Vermont, this has resulted in implementing significant changes on the inpatient side.
First, leaders have decided to limit new admissions to in-state residents only, for the foreseeable future. Kurt White, senior director of ambulatory services, tells BHE that two factors drove the decision: the importance of ensuring that Vermont behavioral health patients with immediate needs aren't confined to already burdened emergency services in the state, and the wisdom of limiting interstate travel at this time.
In addition, the southern Vermont facility has moved some of its current patients within its campus in order to prepare a unit that will be capable of treating patients who have tested positive for the novel coronavirus but have only mild symptoms. This type of service is feasible in part because of the organization's strong relationship with Brattleboro Memorial Hospital, with which it can coordinate care when necessary, White says.
“We want to be able to take care of these individuals if they start arriving,” White says. “We're close to pressing 'go.'”
Signs of progress
White says that while COVID-19 has left no aspect of work or life unaffected, he also is seeing some remarkable progress in health and human services in the surrounding community. For example, the local hospital has allocated resources for physicians and nurse practitioners to be embedded in local shelter service systems that serve homeless individuals. “No one is on the street here right now,” White says.
For Brattleboro Retreat's outpatient treatment, leaders executed a quick pivot to telehealth for many services. In-person groups at the partial hospitalization and intensive outpatient levels were the first to shut down regular operations, but those have been more challenging to resume virtually. “We're working on a fully telehealth version of those,” White says.
For individual outpatient care, the organization collected laptops that weren't being used in order to equip as many staff and patients as possible to engage in counseling sessions through telehealth during the crisis. “Telehealth is providing access to some people in an improved way,” White says.
He adds, “Home telehealth is a disability rights issue.” He cites the example of a chronic pain patient with whom he has worked, who had become used to losing all supports anytime a flare-up of his condition occurred and he couldn't leave home. White's only explanation to the patient about the lack of telehealth at the time was, “Well, the payers don't like it,” he says.
“Now they like it,” he says. “We better not go back [after the threat recedes]. We will need a strong lobbying effort.”
For the buprenorphine treatment services it provides, Brattleboro Retreat has maximized the relaxed rules on take-home dosing while altering protocols for individuals who because of their condition still have to come in regularly for their medication. The state had required the Retreat to operate its medication-assisted treatment clinic seven days a week, but it has now been allowed to drop that to six days so that a weekly deep cleaning of the facility can happen each weekend, White explains.
A one-day closure each week generates another much-welcomed benefit. “It's exhausting for staff right now,” White says.
For many behavioral health treatment agencies, conference calls with colleagues in their surrounding area have become almost a daily occurrence in recent weeks. Susan Hillis, treatment director at AdCare Hospital in Massachusetts, says agencies in the Worcester area have been discussing the possibility of developing a detox unit that could admit patients who have tested positive for the virus.
At the moment, census numbers are down at Brattleboro Retreat and many other behavioral health facilities across the country, though a communication this week from the executive director of the National Association of Addiction Treatment Providers (NAATP) stated that some centers are beginning to report some stabilization in the numbers. If demand for behavioral health treatment were to continue to lag behind coronavirus-related health needs in a community, could there be a scenario where the medical staff of a specialty treatment facility would be enlisted to assist?
“I think all health care providers have in their mind an idea that 'all hands on deck' would be needed in a worst-case scenario,” White says. That of course would not be ideal, he says, as it continues to be clear during this crisis that “mental health and addiction needs aren't going away.”