For several years, Vermont’s hospitals have reported increases in emergency department visits for mental health. Downtown Montpelier has a new option for people in distress who need help immediately.

At Washington County Mental Health Services’ Access Hub, that help arrives first in the form of peer support. It opened on Oct. 2.

“If I was in a mental health crisis and I went to the hospital and I was sitting under the very bright lights in the waiting room, probably at the ER for a while, that definitely would not help with all of the symptoms going on,” said Kallie Hunton, a peer support worker. “We can keep the lights dimmer, and it’s a more one-on-one situation.”

Before the Access Hub’s opening, the WCMHS building at 34 Barre St. already housed two programs staffed partly or entirely by peers: the Sunrise Wellness Center for daytime activities and Maple House, a crisis bed. In a small, partitioned room with an entrance on Downing Street, administrators found space for one more.

It may not look like much, but according to staffers, it has already made an impact. They’re still working to get the word out, but in the first three and a half weeks, they had counted 16 visits.

“We’ve had some people come in for suicidality,” Hunton said. “Mostly, it’s been for depression, anxiety. We’ve had one person who’s come in multiple times, pretty dysregulated and having a lot of issues going on, and they’ve been able to meet with our peer support staff and kind of work through their stuff and be able to talk about what’s bothering them in an appropriate setting.”

Hunton or one of Access Hub’s two other peer staffers typically greets arrivals. After discussion, if the peer sees a need for additional support, they can call in a clinician from an office located just steps away in WCMHS’s intensive adolescent outpatient clinic, Polaris.

Access Hub, which serves adults, operates from 8 a.m. to 4 p.m. on weekdays, with hopes of expanding to evenings and weekends. During its development, WCMHS solicited input from consumers through its Local Program Standing Committee and studied comparable projects from other states, according to Director Tammy Miller.

The most successful examples, in Miller’s view, didn’t operate as stand-alone emergency department alternatives. With its central location and adjacency to additional resources, including spaces for rest and relaxation, Access Hub aims not only to stabilize crises but to serve as a welcoming and informative point of entry for newcomers to the community mental health center.

“What we’re finding at Access Hub is there’s a whole demographic of folks who need services, but they don’t know how to navigate services,” Miller observed. “They can access short-term case management, access short-term therapy, and it’s immediate. So you’re not on a 12-week waiting list – if someone is in some kind of duress, come on in.”

Access Hub emerged out of a request for proposals for urgent care services, issued by the Vermont Department of Mental Health in October 2022. DMH subsequently distributed seven Medicaid-funded grants across the state for new programs, the majority of which proposed to use a primarily clinical model.

But more than a year after the RFP, some have yet to get off the ground. Meanwhile, a statewide mobile crisis service, originally scheduled to start operations in September 2023, no longer has a clear launch date.

The urgent care grants end after two years, upon the expiration of a period of enhanced federal funding for community-based crisis care. Miller doesn’t know what will happen then.

“It is something I think about a lot,” Miller said. “My hope is that if it is successful and that we continue to provide these resources that the state can recognize based on the data, then they’ll continue to fund it in the future.”

In August, the Counseling Service of Addison County opened a community crisis center in Middlebury called Interlude, based on the same state-approved “living room” concept that informs WCMHS’s approach. Per DMH, the model should offer a “warm” and “safe” environment that promotes “respect, hope, empowerment, and social inclusion.”

But while Interlude’s clients require a referral, anyone can use Montpelier’s Access Hub. WCMHS has asked visitors to call ahead (802-301-3200) if they can, but the program doesn’t turn away walk-ins, of which it has already received a few..

Amid a labor shortage in the mental health field, WCMHS managed to stand up Access Hub by shifting existing employees or adding to their responsibilities. Hunton, who still works with lower-acuity clients at Sunrise, received extra training for her new role.

“It’s really, really great to be supporting people who are doing pretty well and being pretty stable and their work on recovery, but I see how important it is to be able to support folks who are going through crises,” Hunton said. “I kind of have been working myself up to doing this type of work.”

Hunton started at WCMHS as a part-timer before taking on more hours. In the past, her own mental health challenges had left her unable to hold a job or “to do much for multiple years,” during which she “relied a lot” on the support of family and friends.

After that, Hunton wanted to spend her time “helping other people be able to improve their lives and work on managing mental illness in a way that they could have a life that feels worth living.”

On one occasion, an Access Hub client’s needs appeared to exceed the program’s capacity for treatment, and they ended up at the hospital after all. But much of the time, as Hunton sees it, peer support and community-based care represent the best option.

“Probably, at least in some cases, folks going to the hospital are going there because they don’t know what else to do,” she theorized. “So if they come here, then we can help them come up with some ideas of what else they could do and ways that they can kind of work on things.”

“Especially if they’re not already receiving very much mental healthcare, if at all, then we can kind of be an easier stepping stone into doing that,” Hunton continued. “With all the stigma around mental illness, this is, I think, a little bit easier to come into, as a walk-in clinic, and you don’t have to end up enrolled if you don’t want to or if that’s uncomfortable for you.”

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