Screening for Island Screening for Island Mental Health Issues and Mental Health Issues and

Substance Abuse:Substance Abuse:An interdisciplinary An interdisciplinary

approachapproach

A project by students of the University of A project by students of the University of Massachusetts Graduate School of Nursing Massachusetts Graduate School of Nursing

and School of Medicineand School of Medicine

“ “It is becoming clearer and clearer that It is becoming clearer and clearer that mental health agencies cannot directly and mental health agencies cannot directly and alone solve the mental health problems that alone solve the mental health problems that confront a community, and that the mental confront a community, and that the mental health system is simply a part of the network health system is simply a part of the network of community agencies which overtly or of community agencies which overtly or covertly provide mental health services.”covertly provide mental health services.”

Milton Mazer, Milton Mazer, People and PredicamentsPeople and Predicaments

IntroductionIntroduction

• According to the 2005 Martha’s According to the 2005 Martha’s Vineyard Health Report, rates of Vineyard Health Report, rates of substance abuse and mental health substance abuse and mental health issues are higher on the island than issues are higher on the island than the national average. the national average.

• Research has shown that people in Research has shown that people in rural areas are less likely to seek help rural areas are less likely to seek help for mental health issues than they are for mental health issues than they are for physical conditions.for physical conditions.

IntroductionIntroduction

• Last year’s research found that there Last year’s research found that there is a need for more screening of is a need for more screening of mental health and substance abuse mental health and substance abuse issues on the island.issues on the island.

• In addition, only 12-15% of In addition, only 12-15% of individuals surveyed in the Martha’s individuals surveyed in the Martha’s Vineyard Health Report indicated that Vineyard Health Report indicated that their provider discussed alcohol use their provider discussed alcohol use with them.with them.

Research in action, Research in action, courtesy of Oak Bluffs courtesy of Oak Bluffs

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IntroductionIntroduction

• Screening should be done via an Screening should be done via an interdisciplinary approach, not interdisciplinary approach, not exclusively by mental health exclusively by mental health workers and Primary Care providers. workers and Primary Care providers. By increasing the number of By increasing the number of professionals screening for illness, a professionals screening for illness, a greater population can be reached. greater population can be reached. Because of this, any screening tool Because of this, any screening tool must be useful in a wide variety of must be useful in a wide variety of settings. settings.

Process of Developing the Process of Developing the ToolTool

• Research was undertaken to look at Research was undertaken to look at existing tools used by the health care existing tools used by the health care fields and the information that was fields and the information that was extracted from these tools was chosen extracted from these tools was chosen for its’ likelihood of applying to issues for its’ likelihood of applying to issues facing the island community. facing the island community.

• The questions found within this tool The questions found within this tool come from frequently used professional come from frequently used professional modules and therefore have been modules and therefore have been demonstrated to be effective in a variety demonstrated to be effective in a variety of settings. of settings.

Process of Developing the Process of Developing the ToolTool

• Alcoholism, substance abuse, anxiety Alcoholism, substance abuse, anxiety and depression were shown to be and depression were shown to be more prevalent on the island than more prevalent on the island than the national averages, according to the national averages, according to the Martha’s Vineyard Health Report. the Martha’s Vineyard Health Report.

• Based upon this data, these four Based upon this data, these four topics were chosen to be topics were chosen to be components of the tool.components of the tool.

Process of Developing the Process of Developing the ToolTool

• The combined background of the The combined background of the students involved in creating students involved in creating this tool included various clinical this tool included various clinical and educational experiences that and educational experiences that facilitated effective teamwork facilitated effective teamwork and a diverse knowledge base.and a diverse knowledge base.

Martha’s Vineyard Martha’s Vineyard Comprehensive Screening Comprehensive Screening

ToolTool

Martha’s Vineyard Martha’s Vineyard Comprehensive Screening Comprehensive Screening

ToolTool• The tool is divided into two main segments, The tool is divided into two main segments,

one screening for alcohol and substance use, one screening for alcohol and substance use, and the other for depression and anxiety. and the other for depression and anxiety.

• Each question is weighted and a combined Each question is weighted and a combined score of 2 or greater in either of the two main score of 2 or greater in either of the two main sections should result in further evaluation or sections should result in further evaluation or referral. An exception is the two noted referral. An exception is the two noted questions, which should result in immediate questions, which should result in immediate referral.referral.

• The questions asked are based on general The questions asked are based on general signs and symptoms of alcoholism, substance signs and symptoms of alcoholism, substance abuse, depression and anxiety, and are by no abuse, depression and anxiety, and are by no means diagnostic of any one specific illness or means diagnostic of any one specific illness or disorder.disorder.

Companion to the ToolCompanion to the Tool

Interviewing Island Interviewing Island ProfessionalsProfessionals

• Vineyard Nursing AssociationVineyard Nursing Association

• Wampanoag Tribal Health CenterWampanoag Tribal Health Center

• Rural Health Clinic (PA and Psychiatrist)Rural Health Clinic (PA and Psychiatrist)

• Elder Services, MVHElder Services, MVH

• ER, MVHER, MVH

• Substance Abuse CounselingSubstance Abuse Counseling

• County SheriffCounty Sheriff

• Island Counseling CenterIsland Counseling Center

Interviewing Island Interviewing Island ProfessionalsProfessionals

Questions for IntervieweesQuestions for Interviewees

• Are there methods you use to screen for mental Are there methods you use to screen for mental illness/substance abuse? If so, are there questions you illness/substance abuse? If so, are there questions you adapt or wish were included in these tools? What are the adapt or wish were included in these tools? What are the strengths of the tools that you use?strengths of the tools that you use?

• Do you feel that this tool would be useful to you in your Do you feel that this tool would be useful to you in your role in dealing with members of the community?role in dealing with members of the community?

• Do you think that we should ask patients if Do you think that we should ask patients if theythey feel that feel that they have a drinking or substance abuse problem?they have a drinking or substance abuse problem?

• What should be included in this tool to make it island-What should be included in this tool to make it island-specific?specific?

• Do you feel that substance abuse and alcoholism can be Do you feel that substance abuse and alcoholism can be combined in the same questions (as demonstrated by this combined in the same questions (as demonstrated by this version of the tool), or do you feel that these should really version of the tool), or do you feel that these should really be kept separate? be kept separate?

• Do you think that this can be used as an interdisciplinary Do you think that this can be used as an interdisciplinary tool? Do you feel that there should be separate tools used tool? Do you feel that there should be separate tools used by different providers/law enforcement?by different providers/law enforcement?

Interviewing Island Interviewing Island ProfessionalsProfessionals

• Feedback from interviews included:Feedback from interviews included:– Keep the tool briefKeep the tool brief– Use simple wordingUse simple wording– Questions should yield yes/no responsesQuestions should yield yes/no responses– For simplicity, combine alcohol and For simplicity, combine alcohol and

substance abuse questions, but mention substance abuse questions, but mention both.both.

– Keep it general to be used by different Keep it general to be used by different professionals.professionals.

– Separate alcohol and substance abuse as Separate alcohol and substance abuse as two unique issues.two unique issues.

– Ask patients directly if they feel that they Ask patients directly if they feel that they have an issue.have an issue.

Interviewing Island Interviewing Island ProfessionalsProfessionals

• This feedback resulted in This feedback resulted in significant changes in the significant changes in the scoring, question type and scoring, question type and wording of the screening tool. wording of the screening tool.

• One question that was added as One question that was added as a result of feedback related to a result of feedback related to isolation from society and daily isolation from society and daily activities. activities.

RecommendationsRecommendations

• Use of the tool should be encouraged Use of the tool should be encouraged for a variety of professionals, for a variety of professionals, including medical professionals, law including medical professionals, law enforcement officers, counselors, enforcement officers, counselors, religious officials, and other religious officials, and other community service providers.community service providers.

• The tool must be adapted for use for The tool must be adapted for use for non-English speaking clients (i.e. non-English speaking clients (i.e. Portuguese, Spanish). Portuguese, Spanish).

A Growing Need A Growing Need • We feel that there is a grave lack of critical resources on the island. We feel that there is a grave lack of critical resources on the island.

If this tool is effective, the need for the following resources will only If this tool is effective, the need for the following resources will only increase:increase:

◊ ◊ The island desperately needs more social workers, mental The island desperately needs more social workers, mental health counselors and other professionals.health counselors and other professionals. ◊ ◊ The hospital needs detox programs and a crisis stabilization The hospital needs detox programs and a crisis stabilization unit as well as psychiatric support staffunit as well as psychiatric support staff ◊ ◊ More support groups must be developed, including a Portuguese More support groups must be developed, including a Portuguese

AAAA ◊ ◊ Non-English support groups and providers are in short supply, Non-English support groups and providers are in short supply, especially those catering to the Portuguese-speaking especially those catering to the Portuguese-speaking community community ◊ ◊ Greater support for and understanding of the unique Greater support for and understanding of the unique needs of mental health and substance abuse populations needs of mental health and substance abuse populations throughout the island community.throughout the island community.

◊ ◊ Continually updated, detailed information on referral processes Continually updated, detailed information on referral processes

Opportunities for Future Opportunities for Future StudyStudy

• A detailed implementation plan for A detailed implementation plan for the utilization of the screening tool the utilization of the screening tool

• A study of who is using the toolA study of who is using the tool• A study of the tool effectivenessA study of the tool effectiveness• A count of the number of referrals A count of the number of referrals

made from those professionalsmade from those professionals• A study of ways to improve the tool to A study of ways to improve the tool to

meet the changing needs and meet the changing needs and diversity of the island communitydiversity of the island community

Thank You…Thank You…

• Cindy Mitchell, Murray Frank, Tom Cindy Mitchell, Murray Frank, Tom Bennett, Olga Church, Terry Bennett, Olga Church, Terry Appenzellar, Ron RappaportAppenzellar, Ron Rappaport

• Suzanne CashmanSuzanne Cashman• Rural Health Clinic, Health Care Access Rural Health Clinic, Health Care Access

Program, Island Counseling Center, Program, Island Counseling Center, Martha’s Vineyard HospitalMartha’s Vineyard Hospital

• Interviewees: Joyce Cleavenger, Carol Interviewees: Joyce Cleavenger, Carol Ann Lindsey, Betsy Van Landingham, Ann Lindsey, Betsy Van Landingham, Jacque Cage, Hazel Teagan, Michael Jacque Cage, Hazel Teagan, Michael McCormack, George Cohn, Tom McCormack, George Cohn, Tom Bennett.Bennett.

ReferencesReferences

• Martha’s Vineyard 2005 Health ReportMartha’s Vineyard 2005 Health Report• Mazer, Milton. Mazer, Milton. People and PredicamentsPeople and Predicaments. .

Cambridge, MA, Harvard College, 1976.Cambridge, MA, Harvard College, 1976.• AUDIT screening toolAUDIT screening tool• CAGE screening toolCAGE screening tool• Hamilton Anxiety ScaleHamilton Anxiety Scale• Hamilton Depression ScaleHamilton Depression Scale• Michigan Screening toolMichigan Screening tool• ““Utilization of mental health services in Utilization of mental health services in

rural and remote communities”, Journal of rural and remote communities”, Journal of Rural Community Psychology. Vol. E7, Rural Community Psychology. Vol. E7, Spring, 2004.Spring, 2004.