Community buy-in key to treating opioid epidemic

By Chelsea Rice | September 25, 2017

Drive through scenic Petersham, Massachusetts, and you're likely to be struck by the beauty of its historic homes, acres of open fields, and quaint New England town center.

Less obvious to the passing eye: Petersham and other rural towns surrounding the Quabbin Reservoir in the north-central region of the state are in the grip of a vicious opioid epidemic.

Opioids impact rural communities to a greater degree than urban centers, exacerbated by social disparities and limited access to treatment and recovery resources. In the rural towns around the Quabbin Reservoir, opioid-related deaths range as high as 31 deaths per 100,000 people, nearly four times the national average.

Heywood Healthcare hopes to turn that statistic around, navigating complex state regulations and working to win over a concerned community in its quest to build an innovative treatment center for dual-diagnosis substance use disorder and behavioral health patients.

The independent health system, based in neighboring Gardner, is transforming a former sanctuary of the Sisters of the Assumption of the Blessed Virgin into the Quabbin Retreat, which will offer a wide continuum of care, from outpatient and residential to inpatient and detox services.

Rebecca Bialecki, BSN, and Brian Gordon, program supervisor, look over the Quabbin Retreat's
raised vegetable garden beds.

The bucolic property, which offers 82 acres of rolling hills and woodlands, attracted the attention of CEO Win Brown and Heywood's trustees in 2014 as the community was beginning to feel the impact of the opioid epidemic.

“We knew that we needed to step up and address this problem," says Brown. “Substance abuse and behavioral health are the No. 1 community health concerns in North Central Mass and Franklin County, and we feel that with the Quabbin Retreat, we are developing an innovative, community-owned solution that can truly address this devastating health crisis in our region."

The need is urgent in a community where opioid cases overwhelm the current infrastructure for treatment. “Patients are dying 25 years sooner than they should be," says Rebecca Bialecki, BSN, Ph.D., a longtime local resident who, along with Brown, led Heywood's charge to explain its mission to an initially cautious local populace.

“People are just starting to look at addiction and behavioral health as a diseases, which has been a long time coming," says Bialecki, who, as vice president of community health, is charged with supporting Heywood's focus on population health. “While we aren't so stuck in stigma as we used to be, we still need to have honest conversations about what expanding treatment in the community looks like."

Comprehensive care for an underserved region

When it's completed, the 75,000-square-foot site where the Canadian religious order formerly provided nursing care for its elderly sisters will offer comprehensive addiction treatment and behavioral health services to patients.

“We've tried to set up a continuum of care under one roof so we have the ability to move a patient from one program to another as their needs evolve," says Brian Gordon, a licensed mental health counselor and Quabbin Retreat's program supervisor.

Before Quabbin Retreat, Heywood Hospital, the organization's nonprofit, 134-bed acute care hospital in Gardner, and Athol Hospital, its 25-bed critical access hospital, could address overdoses or life-threatening episodes in their emergency departments and ICU, but staff had nowhere nearby to send patients still in desperate need of help.

The closest beds for 30-day detox and recovery were in Worcester and Springfield – at least an hour away and already in high demand. (Admissions at substance use disorder centers in Massachusetts for opioid-related treatment have increased by more than 50 percent in 15 years.)

At least half of substance use disorder patients also have behavioral health issues. Mood disorders, including depression and bipolar disorders, are the most common psychiatric co-morbidities among patients with substance use disorder.

Research shows that treating behavioral health issues and substance use disorders concurrently is more effective, but before the Quabbin Retreat, the closest treatment center for dual-diagnosis patients in central Massachusetts was almost 90 minutes away in Belmont near Boston.

“Being large enough to accommodate at least four discrete levels of care on one campus makes it possible for someone to connect with us wherever they are [in their treatment] and come back to us whenever they need it," says Bialecki.

Heywood chose to preserve some of the original building's religious elements when
developing the Quabbin Retreat.

The first phase, the Dana Day Treatment Center, opened in the summer of 2017. It offers outpatient detox treatment and behavioral health support services for up to 20 patients a day.

The clinic is open each weekday and staffed with three licensed counselors who guide patients through group and individual therapy sessions. The clinic offers medication-assisted treatment and also provides food and transportation to and from the site — a crucial service for patients and families.

Currently under construction is a 40-bed adult residential wing, where patients can receive treatment for two-to-three weeks. A separate, 30-bed adolescent wing and a 10-bed inpatient detox facility will comprise the final phases of the project. As of now, staffing is projected to be 165 full-time employees.

Because support services are also crucial to facilitate successful recovery, the outpatient clinic also provides a clinical care coordinator, whose job is to connect the patients with local, community-based resources to support them outside the Quabbin Retreat.

A portion of the sisters' old infirmary will be transformed into a primary care clinic and community-based mental health center – the closest access to this type of care is currently 30 minutes from Petersham. The original home, where the sisters lived in the 1950s, will be the administrative and outpatient clinic office entrance.

Forging community support

Heywood closed on the sale of the building in October of 2015, then went “on the road" for 10 months, conducting 27 public forum meetings in and around Petersham to communicate the importance of the Quabbin Retreat to the community.

When residents thought of opioid addiction treatment, Bialecki says, they imagined lines of desperate people outside methadone clinics. “We had to educate them on what more compassionate treatment could look like."

The most common misconception was that a substance use treatment center would increase the prevalence of drug problems in the area. Especially in a picturesque town like Petersham, with one country store and no gas station, it was hard for residents to believe that the opioid epidemic even existed.

“Once you scratch the surface, you find there's a sibling or brother dealing with substance issues, and yet there's still denial," says Gordon, who has been a mental health provider in the community for 17 years.

“We had to educate people about how quickly someone can spiral into addiction. And that it's not the people you might think. Middle-aged parents aren't immune, and neither are elders or young people," says Bialecki. 

So crucial was the support of the townspeople to the success of the project, Bialecki gave her contact information to anyone who wanted it, and she encouraged local residents to call any time during the process.

“Rebecca was willing to go out and knock on people's doors and talk to them over tea," says Gordon. “It was a matter of trying to address people's fears and be present for them and their concerns."

And it worked. Bialecki says some of the townspeople who had the most concerns are now among the retreat's biggest supporters. There's an active group of about a dozen community members who continue to meet every quarter about the Quabbin Retreat and act as her “eyes and ears in town," Bialecki says.

“Trust was the key in creating community acceptance. Helping them to understand that we aren't coming in from the outside. I grew up here, so it's my community too," Bialecki says. “That's essential — making sure people understand that you really have a stake in this."

Finding the right place

Today, Bialecki and Gordon feel confident that the retreat — a former spiritual center — will help heal a desperate community reeling from the emotional toll of the opioid epidemic.

“It feels restorative and healing and peaceful, which is the best possible outcome," says Bialecki.

Landscape features like raised vegetable garden beds and a traditional English garden tea house are designed to serve as “meditation stations" that have the potential to promote mindful healing as much as some of the guided therapy and treatment. After all, Gordon says, much of addiction recovery is an independent, reflective process.

“Philosophically, when you're talking about healing from addiction, that involves the restoration of dignity," says Gordon. “It's a gorgeous landscape. To be able to sit in a place with rock walls and gardens, it provides for a restoration of humanity."

Chelsea Rice is a contributing writer to athenaInsight.

Community buy-in key to treating opioid epidemic