Town Floats New Health And Human Services Division, Combining Healthcare Access, Mental Health, Housing and Social Services

HARWICH – Acknowledging that community wellness is about more than public health, town officials have proposed creating a new health and human services division that would combine the health department with youth and family services, housing and human services functions. 

 The idea came jointly from Health Director Carrie Schoener and Town Administrator Joesph Powers, who told the select board last week that the health and human services model has been adopted by other levels of government and will position Harwich to meet the demand for services “we see in the present day and what we see in the future.” 

 Schoener said the need for a more comprehensive approach to public wellness is underscored by the results from two recent public health needs surveys conducted by Lower Cape health departments and by Barnstable County. The assessments made it clear that there is a strong need for housing, healthcare access, food, substance abuse support and mental health services, she said.

 “Further, it was noted that 50.8 percent of respondents to the survey stated that they did not know, or were not sure, where to turn in a mental health crisis,” Schoener said. She said that the town can address some of those needs better by creating a health and human services division that oversees the youth and family services coordinator, the housing advocate and the health department.

While the existing departments work well together, “they are limited by the nature of their departments, by staff sizes, by budgets, and for some, demographics served,” Schoener said. The surveys identified that some town services are hindered by “organizational silos,” and having the functions together under a single direction would ensure collaboration.

 “The intent of the health and human services division is to bring more social services to our residents,” Schoener said. It will involve public education and health prevention programs, office hours for residents in need of services or referrals, collaboration with other town departments and organizations, and policy advocacy. “This will be an expense incurred by the town,” she said. But the investment by the town will pay benefits to residents, mostly in healthcare savings, she said.

 “The department can reduce the incidence of costly emergency care and hospitalizations, preventing chronic disease and managing healthcare conditions,” Schoener said. “Early help avoids expensive treatments in the long run and reduces emergency healthcare costs.” The savings will come largely as a result of better preventative care like immunizations and early diagnosis clinics and will particularly benefit working families and residents who earn less than the area median income.

 “But it would not be limited to residents meeting those criteria,” Schoener said. “We would be looking to assist anybody that needed it.”

Currently, the Harwich Council on Aging provides a robust set of services for seniors, but many of those services are unavailable for younger people.

 “I have heard time and time again that we need to help keep our young families here, and that doesn’t always mean affordable housing or recreational programs,” Schoener said. 

 Power said the town charter gives the administration the right to reorganize departments under its management authority. While some of the proposed changes would be subject to collective bargaining, discussing the creation of a new division is worthwhile, he said. The costs to make the change would appear to be minimal to begin with, he said.

 “Mental health is, in my opinion, the most overlooked and underserved aspect of traditional healthcare,” select board Chair Jeffrey Handler said. Finding ways to improve mental health services for young people and those with lower incomes is a forward-thinking approach, he said.

 Also presenting to the select board last week was Youth and Family Services Director Ashley Symington, whose department would be under the new health and human services umbrella. A licensed mental health counselor, Symington reminded the board that she provides short-term counseling for people up to age 24, free of charge. 

 “We are insurance-blind. We don’t take insurance,” she said. In addition to one-on-one counseling, Symington provides caregiver coaching to parents and grandparents, support groups on various mental health topics and intervention groups for young people experiencing conditions like anxiety or ADHD. By focusing on prevention and resiliency-building in young people, “we head off a lot of problems later down the road,” Symington said. She also provides referrals to Harwich residents and others who are trying to access the region’s scarce mental health resources, she said.

 But with her varied duties, Symington said she is struggling to meet her full caseload of individual counseling; she has included a request for another mental health clinician in this year’s budget, a position she said might allow the department to expand some of its services to include residents aged 24 or older. 

 “I enjoy the work and I’m happy to do it, but from a realistic standpoint, we’re pretty close to the maximum of what I’m able to offer as that one person” in the department, she said. The time to add a clinician to the staff is right, she said, because there is an acute shortage of mental health providers in the region, with Gosnold moving its detox center off-Cape soon and with state budget cuts threatening to close a key inpatient facility in Pocasset. The surveys make it clear that the demand for services is increasing.

 “There is a greater need for mental health care than what we currently provide,” she said.

 Select board member Julie Kavanagh agreed that the need is strong.

 “What frustrates me is, at the state level, how they continue to abandon the Cape in terms of mental health, in terms of regular health care, whether it’s children, adults, elderly,” she said. Kavanagh said she supports helping “members of our community who need it most,” but acknowledged that finding the money in the town budget will be challenging.

 Board member Donald Howell agreed with the focus on prevention when it comes to encouraging wellness, and said it’s clear that school counselors can’t be the key providers. 

 “Your kids don’t have problems that go away at three o’clock,” he said. Since Symington provides some services to Chatham youths who attend the Monomoy schools, “personally, I think the time is right to have a conversation with Chatham about underwriting part of this department, because they benefit from it,” Howell said. 

Chatham has plans to hire its own youth mental health clinician but has so far been unable to fill the position.