Health Resource Capacity Assessment for Putnam, Connecticut, May 2001

Health Needs/Barriers to Care: Mental Health and Substance Abuse

Behavioral health issues were rated as Putnam's greatest health concern by Day Kimball Hospital management, providers, schools, and other stakeholders. ⁴⁶ Several providers stated that they have no place to refer patients, particularly teens. "There are absolutely no pediatric psychiatric resources in the community." "When you have a suicidal teen, you can't do anything for them. There is no place to send them. You have to send them home." During one study visit to Day Kimball Hospital, a suicidal teenager had been waiting for 72 hours in the emergency department for a suitable placement. According to hospital staff, this is not a rare event. Middle school students in the focus group noted a need for "someone to talk to."

Putnam's needs for behavioral health services is higher than other communities in the state. Physicians stated that alcohol abuse rates are very high in the community, with substance abuse rates increasing. 1.7% of Putnam students receive special education services for emotional disturbance compared to 1.4% statewide. ⁴⁷ Mental health problems are two of the most frequent reasons for visits to the Emergency Dept. at Day Kimball Hospital. Anxiety State and Major Depressive Disorder were the 19th and 21st most frequent diagnosis for ED non-admission visits from 10/1/98 to 9/30/99, respectively; they were ranked 40th and 172nd statewide. ⁴⁸ Within Putnam's Educational Reference Group (13 towns similar on social indicators), 8.7% of youth and 8.3% of adults need alcohol or substance abuse treatment. These rates are among the highest in the state, not significantly different than the needs in the state's largest cities. ⁴⁹ Rates of arrest for driving under the influence are significantly higher for Putnam residents than the rest of the state. ⁵⁰

A survey of Putnam middle and high school students in 1997 found that the most widely used substance is alcohol. Half of 11th and 12th graders reported recent alcohol use and 39% stated that when they drank during the past month they had three or more drinks at one time. For some ages alcohol use was lower than the state average, for other age cohorts rates were similar to state averages. Students perceived alcohol, tobacco and marijuana to be easily available and perceived more alcohol and drug use in their neighborhoods than students statewide. However Putnam students also reported higher levels of protective factors than students statewide (such as understanding the harm that comes from substance use, less favorable attitudes toward substance use, high levels of family management and more likely to report parental intolerance of substance use). ⁵¹

There is a severe lack of treatment slots across behavioral health needs, including inpatient, outpatient, detox, alcohol, and substance abuse treatment. The only treatment slots available are far from Putnam (in many cases on the other side of the state) with long waiting lists. Inadequate reimbursement rates for those services were blamed for the shortage. At the time of the study, there were only three psychiatrists in the Putnam area and none were accepting new patients. ⁵²

Day Kimball Hospital has reversed an earlier decision to reduce behavioral health service delivery. New management has strongly reaffirmed the hospital's commitment to providing the community with in-patient behavioral health treatment. However concerns remain about the financial viability of those services. The hospital has instituted critical efficiency initiatives in this area. ⁵³

There is optimism but also considerable anxiety among providers, both institutions and individuals, about the state's recent KidCare proposal. The majority of providers support KidCare's shift in treatment priority from residential to community-based care. However there is concern that capacity is not sufficient to handle the need. Rates for outpatient treatment have not kept up with inflation and investment in infrastructure has been inadequate. Providers are concerned that their responsibilities will increase without sufficient resources. ⁵⁴

Footnotes

46. Interviews and focus groups,“The Health of Connecticut’s Hospitals”, Office of Health Care Access, 1/16/01.
47. Town of Putnam, Special Education Profiles, CT Dept. of Education, 1999-2000.
48. Day Kimball Hospital, the Bristol Group. Anxiety State and MDD were ranked 20th and 15th from 10/1/99 to 3/31/00 compared to 41st and 152nd statewide.
49. "Connecticut Compendium on Substance Abuse Treatment Need", UConn Health Center, Dept. of Community Medicine & Health Care, Yale University School of Medicine, April 2001.
50. State of CT Social Indicator Data, Putnam, Department of Mental Health and Addiction Services, 1/30/01.
51. "Connecticut Substance Abuse Prevention Student Survey", Putnam Public Schools, UConn Health Center, Dept. of Community Medicine and Health Care, DMHAS, 4/30/99.
52. Interviews, focus groups, provider survey
53. Interviews
54. Interviews