Fairwinds and Nantucket Cottage Hospital are preparing to launch a new mental health crisis response initiative to help close one of the gaps in the island's fragmented behavioral health services.
The new mental health crisis response program will begin on Tuesday, Jan. 3, when a new mental health crisis phone number - 508-221-3315 - will become operational. Fairwinds will then begin responding to all crisis calls in the community and schools, as well as providing evaluations in the Nantucket Cottage Hospital emergency department, and consultation for treatment of patients waiting for discharge to on-island outpatient services or to an in-patient facility on the mainland.
Fairwinds expanded role comes by virtue of it being designated the "Community Behavioral Health Center and Crisis Responder" for Nantucket by the state, a contract which was recently awarded by the Massachusetts Behavioral Health Partnership (MBHP), through the state Executive Office of Health and Human Services.
While the state’s guidelines and contracts only apply to Mass Health patients, the new system on Nantucket will be “payer blind” giving every person access to the same system regardless of insurance status. Patients who need in-patient care will get placement in an off-island facility through Mass General Brigham’s central access program which provides a single team to manage all behavioral health inpatient placement throughout the MGB system and beyond.
Fairwinds and NCH had been working on the collaboration for months, attempting to close a gap identified by the 2021 Nantucket behavioral health assessment.
That report stated that "Nantucket is facing an escalating demand for behavioral health crisis response to increasingly complex needs. Individuals experiencing a mental health or substance use crisis may be served by up to five organizations, including Gosnold, Fairwinds, the Nantucket Police Department, Nantucket Fire Department, and Nantucket Cottage Hospital. Beyond initial crisis call “fact finding,” subsequent steps in response depend upon the insurance status of the person experiencing crisis and the problem type. The multiple systems of crisis response and care drive inefficiencies given the island’s small population."
For the leaders of Fairwinds and NCH, the new collaboration is a step toward an improved, more integrated system.
“This collaboration between Fairwinds and the Nantucket Cottage Hospital will provide better care for those in crisis while significantly improving the overall behavioral health care for our island," said Jason Bridges, executive director of Fairwinds. "Driving towards one integrated system with first responders, the schools, human services organizations, and the broader
community will put people first and improve our overall level of care and well-being."
Earlier this year, the state Executive Office of Health and Human Services (EOHHS) and MBHP announced the providers that will be designated as Community Behavioral Health Centers (CBHCs) in January, a list which included Fairwinds. The designation of 25 CBHCs is intended to expand access to routine, urgent, and crisis treatment for mental health conditions and substance use disorders starting in January 2023.
“When the state came up with its new approach to community crisis response we were well positioned because we were already at the table working collaboratively to make it better,” said Amy Lee, President of Nantucket Cottage Hospital. “When Fairwinds applied for and was selected to be the CBHC (Community Behavioral Health Center) for Nantucket – which was a big step and a huge commitment – it just made sense for the community for it to be one integrated system that we all commit to support.”
For Fairwinds in particular, the new program means an expansion of its services that will be significant. The financial implications, Bridges said, will have to be navigated with increased fundraising and community support.
"It’s a huge loss financially for Fairwinds to operate crisis services 24/7 365 anywhere on the island," Bridges said. "We will have to fundraise even more to cover the loss of running full crisis response service on Nantucket. The volume is so low here, which is also a good thing, the reimbursements don’t cover the costs as you have to have two clinicians on at all times and psychiatric consults and evaluations on the ready 24/7. There are a lot of hurdles and it is a very expensive program to operate but it is what the island community needs. With Fairwinds, the hospital, schools, police and fire, and human service organizations all working together, we will have system level change that the whole community will benefit from."