Telemedicine – A Post from Board Member Socha Cohen, published in the BI Times

Is Doing the Numbers Enough?

Since its inception, the Tele-Medicine program provided on Block Island has serviced 29 patients, three of whom were escorted off-island by the case worker, Tracy Fredericks. Butler Hospital and Brown University offer the services of a psychiatric intern free of charge under the condition that Block Island pay for the salary of a case worker who receives an hourly wage: the more patients she helps, the higher her wage. In conjunction with a large donor, and the financial support of the Town, NAMI-BI has been raising funds to support Tracy’s salary which ranges from year to year depending upon her case load. “We are providing services to a community where there had been none in the past,” says Gloria Redlich, coordinator of the Coalition for Seniors. “Inherent in mental illness is that for many there are obstacles to reaching out for care.”

National data support Dr. Brownstein, NAMI-BI largest donor, stating, “it’s estimated that 30% of people will have a mental health problem at some point in their lives.  In all populations studied, 1% suffer from schizophrenia, and 5% have major depression.  9.3% of people 12 and over needed treatment for illicit drug or alcohol use in 2009.  Things have gotten worse since then.  So whether they’re taking advantage of the telemedicine program or not, it seems likely that a significant fraction of folks on the island are likely to need it sooner or later, and when the population swells to 10,000 or more in the summer months, the need expands markedly.”

Elspeth Crawford, board member of NAMI-BI and leader in Emotional Education, adds, “Provision of health service of any kind is not about monetary capital, e.g. what you get when you re-model the pavilion, it is about social capital, what a healthy community looks like in the future. Not providing the service has hidden costs on the future that affect us all. There would more disruption and expenditure in relation to other community services, and also, each person who is ill is not a lone person, but may have family and others, all of whom, including the ill person, are less able to contribute to our community and economy if their energy has to be directed in countless ways keeping stability.”

“In short, the bad news is that we’re still not serving as many people as we probably should be”, continues Dr. Brownstein, “and we need to figure out how to “market” the program better. The good news is that we have a program to market–one that probably saves lives.  What’s a life worth?

NAMI BI thanks Block Island Times for publishing the letter below as “Featured Letter” on 9/18/15.

In June I wrote to say that NAMI Block Island [National Alliance on Mental Illness] would be taking up the challenge from SAMSHA [the national Substance Abuse and Mental Health Services Administration of the US department of Health and Human Services] to create community conversations about Mental Health. We were aware that this is a frequently taboo topic that can affect anyone, anywhere, and that has impact of some kind on us all. I am writing now to say how wonderfully those to whom we have spoken so far have been responding, how much we appreciate their time and thoughtfulness, and also to let everyone know that we are learning a lot, how much we don’t know as well sharing together much that is already understood. As community conversations develop, we hope we will achieve our aim: That the various responses to behavioral health issues on the island issues can be addressed in ways that complement existing local activities, are better coordinated, consistent, and in the best interests of all.

We don’t know, yet. But, we are hopeful and invite everyone who wishes to join in. Briefly, an outline of what we have heard in talking with more than 20 people representing different island groups: the people here care, and are aware, and as might be expected, each of us sees a different bit of this elephant. We have raised some awareness of each other’s “bits”.

In considerable detail, we found many frustrations, often systemic in origin (rather than negativity). That is, organizations, local or national, may enable individuals to act in their own sphere of authority, but because the nature of mental illness crosses so many boundaries the right kind of action can be difficult to find, and frustration follows. Important matters such as confidentiality, trust, and rights of both family and ill person have to be protected. There were many suggestions about the right kind of “go-to” person or facility that we all know our island does not have, or cannot afford. We heard imaginative ideas for addressing the gaps. We will soon be talking with our community organizations for help in finding ways to develop protocols, say for emergency responses, or prevention of fragmented care, as are appropriate to each organization’s first area of responsibility. We also ask individuals to think about taking part in the programs and trainings that hope to continue bringing to the island, for example our mental health discussion meetings and possibly a repeat of the praised Mental Health First Aid course brought by the school and the library last winter?

Can we improve communication and co-ordination, so that we all feel more competent, whether we should happen to be the “first responder”, or whether we have a particular duty of care? We think that we can, but it will be a developing process. There is work to do in factual research and sharing of information, and finding how lines of communication will work with accountability and confidentiality dilemmas.

Another discovery has been that there is even more confusion and difference in perceptions than we knew. We ourselves in NAMI BI are equally unsure, e.g. there is no accepted definition of Mental Health, and no consensus on “best treatment”. Or, what is the difference between NAMI BI and Block Island Wellness Coalition (working to prevent of substance abuse and create wellness)? We know there is overlap, but what is it? Is NAMI BI a Harbor Church group? [No, it is not, it is a separate 501c organization that is grateful to the church for providing a meeting place.]

We plan a series of communications on specific topics that have arisen as well as more meetings. In the meantime, remember that there is a free telemedicine service provided by psychiatrist residents from Butler Hospital. Phone the Case Manager, Tracy Fredericks [CSP certified], 207 229 6349. Also, see some summaries of issues and suggestions, and previous articles in the BI Times on https://blockislandmentalhealth.org/

We found a very clear sense that Community Conversations are worthwhile and should be continued. We do have a very special place here, thank you Block Island people.

Yours sincerely, Elspeth Crawford