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SILVER HILL HOSPITAL COMMUNITY HEALTH NEEDS ASSESSMENT February 2014

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SILVER HILL HOSPITAL COMMUNITY HEALTH NEEDS ASSESSMENT February 2014 Silver Hill Hospital FEBRUARY 2014 Community Health Needs Assessment An in-depth assessment of the mental health and substance abuse needs of the Fairfield County community. SILVER HILL HOSPITAL COMMUNITY HEALTH NEEDS ASSESSMENT February 2014 TABLE OF CONTENTS Executive Summary ....................................................................................................................................................... 2 Introduction ................................................................................................................................................................... 4 Silver Hill Hospital...................................................................................................................................................... 4 Definition of Community Served ............................................................................................................................... 5 Process and Methods ................................................................................................................................................ 7 Community Interviews .............................................................................................................................................. 8 Community Health Needs Assessment: Data and Research........................................................................................ 10 Substance Abuse ..................................................................................................................................................... 10 Alcohol ................................................................................................................................................................ 10 Illicit Drugs .......................................................................................................................................................... 14 Tobacco ............................................................................................................................................................... 18 Mental Health ......................................................................................................................................................... 20 General................................................................................................................................................................ 20 Mood & Anxiety Disorders .................................................................................................................................. 23 Psychotic & Personality Disorders ...................................................................................................................... 24 Eating Disorders .................................................................................................................................................. 25 Suicide ................................................................................................................................................................. 26 Dual Diagnoses ........................................................................................................................................................ 28 Community Input and Existing Resources ................................................................................................................... 30 Themes from Community Input .............................................................................................................................. 30 Existing Resources in the Community ..................................................................................................................... 38 Prioritized Health Needs of Our Community ............................................................................................................... 47 Endnotes ...................................................................................................................................................................... 50 1 SILVER HILL HOSPITAL COMMUNITY HEALTH NEEDS ASSESSMENT February 2014 EXECUTIVE SUMMARY Silver Hill Hospital (SHH) is a not-for-profit specialty hospital for mental health and substance abuse needs for adolescents (ages 13-17) and adults (ages 18+). Silver Hill Hospital’s primary community comprises Fairfield County, Connecticut, a county of an estimated 933,835 residents according to the 2012 U.S. Census. We determined our community by looking at historical volume experience for inpatient, outpatient and residential admissions. Between May and November 2013, we conducted primary and secondary data research and interviewed over 20 community stakeholders to develop the Community Health Needs Assessment and the accompanying 2014-2017 Implementation Plan. We assessed the following issues in our community: 1) Substance Abuse (alcohol, drugs and tobacco); 2) Mental Health Issues (mood and anxiety disorders, psychotic and personality disorders, eating disorders and suicide); and 3) Dual Disorders (co-occurring mental health and substance abuse issues). When possible, we examined Fairfield County or the Southwest Region as opposed to the state of Connecticut or the U.S. overall. We also paid particular attention to potentially underserved populations in our community including adolescents and young adults, women, minorities and seniors. FINDINGS IN BRIEF Fragmentation of Services. Somewhat counter-intuitively, people on public assistance often have more and better services than those available to people with insurance, who make up the bulk of Fairfield County. The state system offers wrap-around services focused on the full continuum of care, housing and supported employment, education and peer services. There are no corollaries in the private sector. As a result, the mental health system for youth and adults alike is fragmented and less holistic than it should be. In addition, there is a gap in services for young adults (ages 18-25). Despite the negative view many hold of the public sector’s mental health and substance abuse programs, there is something we, as a private-sector provider to a mostly well-off patient population, can learn from public assistance programs. Alcohol Abuse Among Adults, Adolescents and Seniors. Fairfield County has a particular problem with alcohol abuse. The rate for binge alcohol use and alcohol dependence here is higher than in Connecticut and the U.S. as a whole. The problem is not limited to adults. Connecticut adolescents aged 12-17 are second only to Montana in binge alcohol use. The growing community of seniors, whose bodies no longer metabolize alcohol in the same way, are also in danger of abusing alcohol. There is also a treatment gap, with 7.8% of adults aged 12 and over needing treatment for alcohol use compared to 6.9% nationwide. Marijuana and Prescription Drug Abuse Among Adults and Adolescents. There is an increasing need for treatment of illicit drug use in the Southwest Region. Over the last several years, the incidence of prescription drug abuse has climbed, mirroring national trends. Unfortunately, there is a gap in knowledge in the provider community regarding treatment for opioid addiction. Marijuana is also a serious issue for adolescents in the region. Despite its perception as less dangerous than alcohol or other drugs, marijuana is an addictive drug with long-term side-effects for adolescents. Parents’ understanding the facts and legal implications is critical to changing use patterns among adolescents in Fairfield County. 2 SILVER HILL HOSPITAL COMMUNITY HEALTH NEEDS ASSESSMENT February 2014 Mental Illness Among Young Adults, Women and Hispanics. Adults in Connecticut do not differ significantly from the U.S. as a whole in major depressive episodes, serious mental illness or suicidal ideation. Young adults (ages 18- 25), however, have a slightly higher rate of serious mental illness than the U.S. population as a whole. Women nationwide are more likely than men to report poor mental health; Connecticut is no exception. Girls are also much more likely to be depressed than boys, and at younger ages. Likewise, Hispanic youth in Connecticut are more likely to be depressed than others. Stigma associated with seeking medical treatment for mental illness in the Hispanic community, however, acts as a barrier to care. In general, the high-pressure environment of our mostly affluent community contributes to pathological behavior, and the community could benefit from education around coping skills and mindfulness, particularly for the “sandwich generation,” who must care for both aging parents and school-aged adolescents. A Dearth of Resources for Eating Disorders. Over 4% of women in Connecticut have an eating disorder, twice the rate for men. Sadly, the rates in Connecticut are driven by younger teens. According to community stakeholders, there is a real lack of resources – both inpatient and outpatient – for those suffering from eating disorders. There is also a lack of understanding by providers, parents and school administrators regarding how to handle an emerging or suspected eating disorder, particularly for adolescents. Suicide Among Adolescents and Young Adults. Both adolescents and young adults are disproportionately affected by suicide in this community as evidenced by the three high school suicides that have taken place this school year. In the state of Connecticut between 2005 and 2010, suicide was the third leading cause of death among adolescents aged 10-14, the
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