FY 2024 Behavioral Health Service Expansion - Population to be Served. The mission of the Duffy Health Center is to provide equitable, integrated primary health care and support services to adults who are experiencing homelessness or at risk of homelessness on Cape Cod, and to improve the quality of life for vulnerable and marginalized populations through community collaborations, leadership, and advocacy. Duffy Health Center provides outreach, primary care, mental health, case management, spiritual care, addiction treatment and recovery support services to over 3,000 persons throughout the 15 towns of Barnstable County, MA (Cape Cod). Over 83% of our patients are defined by HRSA as homeless (including those doubled up with others), the remaining 17% are at risk of homelessness, i.e., persons living in poverty who have experienced prior homelessness, incarceration, domestic violence, tenuous housing situations, chronic physical illnesses, and/or mental health and substance use disorders (SUD). With HRSA funding, Duffy Health Center will increase access to behavioral health services by expanding mental health and SUD services. Program objectives are to increase the number of patients receiving mental health services and to increase the number of patients receiving SUD services, including treatment with medications for opioid use disorder (MOUD). Needs to be Addressed. There is a great need for mental health and SUD treatment among those experiencing homelessness or who are at risk of homelessness. The prevalence of co-occurring disorders (any combination of two or more SUDs and mental health disorders) is estimated to be 52% in the homeless population, compared to 28% in the general population. Being unstably housed both exacerbates and causes poorer health outcomes of chronic medical conditions and behavioral health disorders (especially mood and substance use disorders), reinforcing the importance of psychiatric care, mental health counseling, SUD treatment and recovery support. In 2023, of our 3,008 patients, 24% had mental health and SUD diagnoses which included alcohol-related disorders, and 34% of patients had other SUD diagnoses. (excluding tobacco use). Depression and other mood disorders were diagnosed in 41% of patients, with 44% with anxiety disorders, including PTSD; attention deficit and disruptive behavior disorders at 13%, and 36.5% of patients had other mental disorders, excluding drug/alcohol dependence. Services. Poor health outcomes highlight the need for evidence based practices, including continuous outreach and a harm reduction, low-threshold approach to engage vulnerable individuals and help them navigate their path to mental health and SUD recovery. Duffy staff are trained to provide care that seeks to mitigate the widespread impact of trauma while recognizing paths to recovery and actively avoiding re-traumatization. Duffy offers a multidisciplinary team approach to provide a ‘whole health’ support system for its patients. Duffy will add targeted services and staff to reduce barriers to care, offer additional services, and intensify peer support for SUD services, including MOUD. Enhanced services will be available at Duffy’s main facility in Hyannis and through its REACH mobile unit. The project will add the services of a Community Health Worker (CHW) to initiate outreach to persons at high risk for harm, offer peer support and assist patients with access to basic needs and other community resources. Additionally, a Post-Overdose Harm Reduction Specialist will follow up with individuals after an overdose incident to provide education and information about risk factors, overdose recognition, naloxone use, and options for Medication for Addition Treatment and MOUD. The Project Behavioral Health Therapist will increase access to care for additional behavioral health patients. All three roles will support special populations that are at extremely high risk for overdose and harm.
