There is no drive-through testing for the pandemic of mental illness that has followed COVID-19 into Indian River County. And there will be no vaccine against depression, substance abuse and suicidal thoughts, though rates of all three are surging.
But the alarming increase in psychiatric patients, particularly among the young, has propelled community health officials to create a service that has never existed here before – an intensive outpatient mental health treatment program for children and young adults.
A request for proposal, or RFP, went up on the Hospital District website Friday, hoping to draw interest from not only local but national mental healthcare providers. With the urgent need, the winning bidder will have to act fast. Proposals are due Nov. 13, and a center is expected to be up and running within a year.
Currently, the lone intensive-outpatient program in the county is only for adults, and only those with substance abuse as a primary diagnosis. Phoenix Rising Wellness Center, which opened in Vero in 2018, treats mental illnesses, but only as a secondary diagnosis.
The new county program will do the reverse, treating young patients with a primary diagnosis other than substance abuse, though it will treat that issue as well.
Both problems are on the rise since the pandemic began, said Pedro Bernabe, Phoenix Rising’s CEO. He blames boredom and unemployment for an increase in relapses.
There is also a sharp rise in depression. A study published in September on JAMA Network Open found a three-fold increase in depression symptoms since March nationwide, as compared to pre-pandemic levels. In Indian River County, there were 29 suicides by the end of September, the same number as in all of 2019.
And that may not come close to the pandemic and post-pandemic mental health toll.
“FEMA says the peak of crisis in terms of suicidality and hospitalization happens 12 to 18 months post-event,” said Brett Hall, who leads the Mental Health Collaborative of Indian River County. “We’re not even post-event yet, and there’s a rise already. That’s why we’re working on this now.
“The surge is already here. Medical practitioners are busy now,” Hall went on. “But in terms of mental health, we’ve got to be working in many, many directions to be ready for when our peak hits.”
In Indian River County, the mental health hospitalization rate for children under 18 is twice the state average and the third highest among all Florida counties.
Hall cites two suicides within 9 days in September to illustrate the problem – one, a 14-year-old, the other, a 24-year-old. He said there is solid research pointing to 18- to 23-year-olds being hardest hit by the pandemic in terms of mental health.
The RFP suggests the program would be for ages 9 through 25, but Ann Marie Suriano, who wrote the document as executive director of the Hospital District, expects providers to tailor that age span to the services they can best provide.
The Hospital District considers the intensive outpatient treatment program the first – and most urgent – step to come out of a group conversation among mental health professionals held in early March. Hosted by the district, the meeting addressed the possibility of uniting a wide range of mental health services on a single campus, ideally near Cleveland Clinic Indian River Hospital.
Work on that ambitious project got “preempted” by the pandemic, said Suriano. Then the county school district’s director of mental health services, Sharon Packard, seeing children emotionally overwhelmed by the pandemic, approached the Hospital District for help in starting an intensive outpatient treatment option.
Such treatment, two levels of treatment under inpatient hospitalization, involves more hours of therapy than the usual weekly session, typically with individual and group sessions several times per week, for up to two months. It is intended to be less disruptive for the client than partial hospitalization programs, which can involve five-day-a-week therapy for five hours or more and can cause interruption of school or work schedules.
Suriano believes there could be CARES Act funding for the program, since there is a demonstrable increase in need due to the COVID-19 pandemic. In addition, she is approaching local foundations to contribute to the effort.
She said she doesn’t yet know how much the program will cost, since proposals may or may not include new construction as well as staffing. She does, however, believe the program will eventually relocate to the proposed mental health campus that has been put on hold due to COVID-19.
“We thought we could move forward and work in small pieces to eventually include adults and then some kind of campus,” said Suriano. “We think we can make it work.”
The district will hold a meeting Nov. 10 to answer questions posed by participants in the RFP process. The sealed proposals are due Nov. 13 and will be reviewed Nov. 16 by a committee that includes Hall, Suriano, District Board Chairwoman Marybeth Cunningham and Vicki Soule, CEO of Treasure Coast Community Health.