Like many states, Vermont is in dire need of mental health reform. Sarah Squirrell, Vermont’s newest mental health commissioner, said there are no easy answers to the complex challenges.
However, Squirrell welcomes the opportunity to address these issues, which, she said, require collaboration, innovation, and commitment.
“Our communities and service delivery systems must commit to work together to advance solutions to improve the care of individuals with mental health needs, and to always keep the needs of those we serve and their families at the center of our work,” Squirrell said.
“Sometimes we think our best way to serve the system is to optimize our part in it. I think we need to optimize the relationships between the parts to get the outcomes we’re after.”
For the past three years, Squirrell, who has a master of science in counseling psychology, was the executive director of Building Bright Futures, where she advised the governor on systems, policies and practice improvements for young children.
Previously, Squirrell was the founding executive director of Vermont Cooperative for Practice Improvement and Innovation, and the director of a school-based mental health program in rural Vermont.
In her new role as commissioner, Squirrel is focusing on “strengthening and expanding the overall capacity of the mental health system, including promotion, prevention, early intervention, treatment, and recovery.”
One of the biggest problems Vermont faces is long wait times and lack of beds in emergency rooms for people experiencing mental health crises, said Squirrell.
She noted this issue is symptomatic of a larger problem: lack of flow in the system. That is, there are kinks in the chain of moving patients through the different stages of treatment and care.
Several pilot programs have already shown promising results in tackling this problem.
The Emergency Department Pilot Project with Northwestern Counseling and Support Services and Northwestern Vermont Medical Center reduced ER visits by sixty-one percent for individuals with mental illness who were considered high utilizers.
They accomplished this improvement through a collaborative approach with patients’ designated agencies and crisis clinicians.
The Community Care Team at Southwestern Vermont Health Care reduced ER visits by 40 percent for individuals with chronic mental health problems and/or substance use disorders by creating wraparound services through partnerships with different agencies.
Squirrel also emphasized ensuring ER staff is well-trained and well-supported, and bringing in mental health workers into the ER.
Another priority area, she said, is childhood mental health. “The earlier we intervene, the better the outcomes.” This effort includes building “robust school-based mental health systems” and partnering with pediatricians.
The rate of children in residential settings also is a concern. “We want children and youth to be served in the least restrictive settings in the community,” Squirrell said.
Fixing this situation involves having appropriate step-down programs, such as “lower intensity facilities and support, and short-term housing.”
Squirrel also wants to build community outreach programs. One successful example is the Street Outreach Program in Chittenden County, where six communities matched state funds. The program coordinates services for individuals with mental health challenges, homelessness, and unmet social service needs.
Squirrell’s 10-year vision for Vermont’s mental health system is integrated, coordinated care between primary care and mental health care. For instance, “programs with embedded mental health workers in pediatric offices” can support children and their parents early on, she said.
“It’s also about coordination and communication”: “[having] a quick assessment and referral process, working closely with mental health agencies and getting [individuals] to the right supports at the right time,” she added.
Margarita Tartakovsky, MS, is a Florida-based freelance writer and an associate editor at PsychCentral.com.