The Mental Health Clinical Collaborative is a new program of the Brattleboro Retreat, a psychiatric hospital and addiction treatment center located in southeastern Vermont, and Morningside Shelter, a year-round homeless shelter. Launched in 2015, the program aims to improve the mental health of Morningside Shelter residents by offering onsite therapeutic services. Through this new collaboration, a Brattleboro Retreat clinician works onsite at the Shelter twelve hours per week providing individual and family therapy, general milieu support, clinical counseling intern supervision, and case manager consultation. The clinician facilitates connections to other mental health resources and serves as a bridge to longer-term mental health care.
The Retreat clinician helps maintain a calming, therapeutic, and ordered shelter environment. With the availability of this clinical expertise, residents with mental health and addiction challenges are able to access support before challenges reach crisis levels. The program’s goal is to reduce medical and psychiatric hospitalizations, as well as incidents of residents losing temporary housing and dropping associated provider relationships. Additional anticipated outcomes include reduction in length of stays, decrease in shelter recidivism, increase in successful transitions to sustainable housing, and increase in health and well-being.
Mental health care is difficult for many people to access; barriers include transportation, mistrust of authority, and provider availability. Homelessness exacerbates all of these barriers, creating additional challenges for those without housing to access treatment. These barriers translate to a high prevalence of people in the shelter who need care and are not accessing it. In addition to poor health outcomes for individuals, untreated residents can create a domino effect of consequences in the shelter environment: their suffering disrupts the milieu, their path to sustainable housing becomes more complicated, and crises (hospitalizations, relapse) become commonplace.
This program’s innovation is to remove both treatment location and structure as initial barriers to mental health care. Working outside these traditional constraints, the program brings flexible and responsive therapeutic services directly to those in need—people who are poised to make significant progress in their lives by stabilizing and improving their mental health.
The inspiration for this program began when the Retreat hosted a community dialogue, “Dreams of Home,” on the subject of homelessness with Deborah Luepnitz. Dr. Luepnitz shared about the innovative work in Philadelphia of Project Home, a nationally recognized program for breaking the cycle of homelessness.
With Project Home as inspiration, leaders from the Morningside Shelter and Brattleboro Retreat worked collaboratively to develop a pilot project model and were awarded funding from the Vermont Community Foundation’s “Innovations and Collaborations” grant program, which considers potential for replicability in its award process.
As a part of this grant award, the program partners—both leaders in their respective areas of expertise—will refine the project goals and strategies and share the program model others considering similar initiatives.
For this first year of the Mental Health Clinical Collaborative, the Brattleboro Retreat and Morningside Shelter have taken an approach that assumes none of the clinical activities will be billable to insurance. The purpose of this approach is to provide the freedom to experiment within the pilot’s model and take risks in order to identify best practices for moving forward. The first year has been funded primarily from an Innovation and Collaboration grant through the Vermont Community Foundation, and there is likelihood for partial grant-funding from this source for the second year.
In year two, project revenue will move towards a mix of private support and insurance billing. Moving forward, the Retreat and Morningside Shelter will seek to align this initiative with broader health care reform, as it moves away from fee-for-service towards public health. Working collaboratively, the partners will seek new funding streams through a public health care lens.
Mental health and addiction disorders can lead to homelessness; in turn, the lack of housing can worsen these disorders. Mental illness and addiction can perpetuate a deteriorating cycle of poor health, hospitalization, incarceration, and poverty, while also burdening health care, social service, and corrections systems as well as increasing taxpayer costs. Exacerbating this complex interplay of issues is a rapidly changing healthcare landscape.
This project can help demonstrate the savings associated with a more collaborative population-health approach. For example, it costs $35 per day for a resident to stay at Morningside. If that same resident has a psychiatric crisis or relapse, one day of inpatient psychiatric hospitalization costs approximately $1,000. Simply put, one day of crisis health care translates to one month of shelter services.
The Mental Health Clinical Collaborative program presents the opportunity for significant system-level savings and, by demonstrating these cost-savings, provides incentive for replication of this model.
The goal of this project is to create a smoother, faster, less expensive, consumer-focused return to sustainable housing for those facing homelessness, mental illness, and/or addiction. By extension, the goal of this project is to improve the mental health and well-being of this population.
Anticipated outcomes of this program include reduction in length of stays at the Shelter, decrease in shelter recidivism and inpatient psychiatric hospitalizations, increase in successful transitions to sustainable housing and health and well-being of some of the community’s most vulnerable citizens.
Outcome measurements include shelter length-of-stays, resident hospitalizations, resident expulsions, and residents regularly accessing mental health and addiction treatment as reflections of the program’s success. Additional measurements are gathered from a pre- and post-intervention survey which measures residents’ self-reported analysis of symptoms and satisfaction with service delivery, as well as perception of the access, quality, and integration of the therapeutic services into the Shelter’s core services.