Two days after an article appeared in the Martinsville Bulletin citing a terribly low ratio of mental health providers in Henry County, Piedmont Community Services Executive Director Greg Preston assembled several PCS officials to convey a message.

Sharon Buckman, Piedmont’s director of clinical services, was there. So were Prevention Director Bonnie Favero, Human Resources Director Ron Hairston and Katie Whitlow, who works with individual and community relations for Piedmont.

Preston was alarmed at the article’s headline — “Residents in county have little mental aid; Henry County has low ratio of mental health providers. Martinsville is much better” — and he said on April 16 that he wanted to “make sure we establish community confidence we are providing good services, adequate services, accessible services.

“One of the things I want to make sure is that we do have the community’s confidence in the services we are providing,” Preston said.

The recent County Health Rankings showed Henry County had a ratio of 1 mental health provider per 10,250 people, the fifth-worst ratio among Virginia’s 133 localities. However, the city of Martinsville tied the city of Richmond for the 13th/14th best mental health provider ratio: 1  per 250 people.

County Health Rankings, a project of the University of Wisconsin Population Health Institute and Robert Wood Johnson Foundation, provides statistical analysis for a variety of mental-health-related topics, such as statistics for poor mental health days, frequent mental distress, and excessive drinking.

Rhonda Thissen, executive director of the National Alliance on Mental Illness of Virginia, suggested in an interview that the major reasons for the disparity between Henry  County and Martinsville’s rates include that Piedmont Community Services’ main office is in Martinsville and that Martinsville has a smaller population. She also said that, despite those allowances, Henry County’s mental health provider ratio is very low.

Favero said she feels the fact that Piedmont’s headquarters and clinical services office is on Clay Street in Martinsville skews the data because employees serve both Martinsville and Henry County.

She also said she feels it’s misleading to use the percentage of mental health providers to the general population. “So I kind of feel like they should be taking five percent of the population and comparing it to the ratio of providers, because that’s all that’s going to be using your mental-health providers,” Favero said.

Expanded services

Piedmont promotes a wide-array of services, such as clinical services, youth and prevention services  and community support services. These can include after-hours crisis, psychiatric, counseling, mental health support and therapeutic day treatment services. Piedmont also works with youth and prevention services. Its website offers a complex menu.

As part of a statewide initiative to improve behavioral health services, Piedmont in April 2018 implemented same-day access to services.

 “The model is anyone  who wants to get enrolled in services here could come in any time between 8 a.m. and 3 p.m.  Monday  through Friday,” Buckman said. “They would get an assessment that same day. They would get enrolled in recommended services that they might want that have been recommended for them. We get them back in to start that service within 10 business days is the expectation.

“Generally we do better than that. We can generally get them  in about five business days depending on the service. We are not required to have hours for same-day assessment every day….  We do that because we want to make it easier for people to get care at a time that can fit into their schedule.

“That’s been going for a year, and it has increased the number of people that we’ve served. We have added substance-use disorders treatment groups because of the demand that same-day assessment has created. We’ve seen an improvement in follow-up with substance abuse treatment because we are able to get people started on services in the day they come in and ask for it.  We have a significantly better follow-up rate with those services than we did prior to implementing same-day assessment.”

Because of those efforts and other increased demand for services, Piedmont has hired 143  employees, increasing its total workforce to 445, of whom about 130 work out of the Clay Street office. Piedmont has a clinical services office in Patrick County and one in Franklin County.

Piedmont had a 5.4 percent growth in provision of services from 2017 to 2018, according to information Preston provided. Piedmont served 7,439 people in Martinsville and Henry, Franklin and Patrick counties in 2018, compared with 7,056 in 2017.

Skewed data?

Favero said she thinks reports such as County Health Rankings that isolate small cities from counties, such as separating Martinsville and Henry County, may skew data and make things appear worse than they really are.

For example, she pointed out that those same rankings showed that the ratio of primary-care physicians to the population was much worse in Martinsville (1 to 13,450) than in Henry County (1 to 1,560). She feels those data calculate where the doctors’ offices are located and the relatively small size of Martinsville’s population compared with Henry County’s but don’t consider that doctors likely see patients from both Martinsville and Henry County.

She said she believes a report last year indicating that Martinsville had the highest opioid prescription rate in the United States “was skewed because of the small size of Martinsville and how many prescriptions were being filled at drug stores in Martinsville, when you know, if your hospital is in Martinsville, then yeah,  probably a lot of your opioids are being prescribed in Martinsville.

“There were extenuating circumstances beyond that with having a doctor that came here just to sell pills, but it really was inaccurate data,” she said. “When that came up, everybody was like … we have the worst in the country. But it’s because, Martinsville’s population is small, and so then it’s easy to get a big ratio number or percentage number to a small population.  But those opiate prescriptions also probably were also being prescribed to people in Henry County too. They might have just been filled in Martinsville.

“So that’s what happens with data. I love Martinsville’s data for writing grants because it always looks worse than it really is. [She laughed.] So it can get you some good grants. When  we  look at it, you really have to understand what it is they’re really saying. When I look at it, even though I might understand, that makes it look much worse than it is in reality.”

However, she concedes that County Health Rankings uses the same methodology for localities throughout the country.

“Everyone is on the same playing field, but it’s still not always really accurate to look at. That’s the problem. … There’s a lot of places that won’t let you use County Health Rankings for your data, for that reason.”

Working with community

As a clear example, Buckman cited one of Piedmont’s many community-based services, Program of Assertive Community Treatment

”It’s targeted toward people who don’t do well keeping traditional appointments, who have multiple hospitalizations due to mental illness or maybe because of their mental illness or combination of mental illness and substance use, go  to jail from time to time,” Buckman said.

PACT is a multidisciplinary team that includes a physician, nurses, therapists, case managers.

“We can deliver medications to people, sometimes twice a day , to their homes or wherever they want us to meet them, to make sure that they are taking their medications. We work with them on vocational goals, addressing their substance use. We go all over Henry County with that service. You should see my gas bills,” she said.

Buckman also mentioned Piedmont’s school-based services, which tries to make it easier for the families to get children the services they need, including providing transportation and serving as a liaison between the school and the  home, being available for “supportive counseling,” if that student needs it.

Preston said he feels a key service for Piedmont is in case management.

“We consider case management services to be the gate keeper of services if you are receiving behavior health services, substance-use services or developmental-disability services, because that case manager actually monitors, coordinates a host of services for individual that may need different services,” he said.

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