Behavioral Health: A Conversation with Debbi Cutler from Hearth

Center Post

Behavioral health and substance abuse issues can present a major challenge to organizations that house formerly homeless older adults. 

LeadingAge asked Debbi Cutler, director of behavioral health at Hearth, to describe how her organization helps residents address these issues. Hearth offers housing plus supportive services to 198 formerly homeless older adults in Boston, MA.

How does Hearth help residents who have behavioral health issues?

Debbi Cutler: Hearth receives funding from the Massachusetts Department of Mental Health (DMH) to provide the Community-Based Flexible Support Program to 40 residents with chronic persistent mental illness. The money we receive from DMH helps fund on-site teams that include master’s-level social workers and nurses.

These teams do a lot of one-on-one work with individual residents. We help those residents identify goals and objectives for themselves, develop independent living skills and become more engaged in the community. In a therapeutic and supportive manner, we also help them understand how certain behaviors impact their ability to communicate with others or to achieve the objectives or goals that they have set for themselves.

We help people develop better techniques for managing their anxiety. We help them learn to identify triggers to their anxiety that can help them to de-escalate quicker. We also help people identify what they can do and who they can call if they feel that they are in a crisis.

What if a housing provider doesn’t have these resources? Can it still help residents with mental health issues?

Debbi Cutler: We are fortunate to have some good resources within our agency, but we still depend a great deal on our community partners. Developing relationships with community service providers is really key because no one organization can do this on their own.

Who are your behavioral health partners?

Debbi Cutler: We have a host of wonderful partners in the Boston area, including community health and mental health centers, area universities with master’s and doctoral students in need of placements, and world-class health care providers. We try to take advantage of as many of these resources as we can.

For example, we are a training site for geriatric fellows from Harvard Medical School. These are physicians who are receiving advanced training in geriatric medicine, psychiatry, dentistry and pharmacy. They meet with residents and client of our outreach program. They also provide consultation to our staff.

We also work with a number of graduate programs in social work and expressive therapy. This brings us another group of professionals-in-training who can facilitate groups for our residents or work one-on-one with individuals. Physical therapy and nursing students also work with our residents. Students from the Massachusetts School of Professional Psychology come in to talk with our residents about medication misuse.

We take full advantage of the Recovery Learning Communities in Boston. Anyone who identifies as living with a mental illness can participate in these hubs of information and support. They offer our residents opportunities to take classes in computers or writing or to join relapse prevention groups.

There are also a number of "Clubhouses" operated by the DMH’s Massachusetts Clubhouse Coalition. These clubhouses are similar to a traditional adult day health or senior center, but they are geared to people with mental health issues.

Some residents do go out to traditional adult day health centers as well. This gives them an opportunity to get out of the residence and socialize with other people.

Where would a housing provider start its search for similar behavioral health partners?

Debbi Cutler: Start with area universities and colleges. Call your local community mental health center to find out about groups offered there. These centers might have staff who conduct outreach in the community.

If you have a good relationship with a particular physician practice or geriatric physician practice, that may be a good way to find out if there are any geriatric fellowship programs in the area.

Then, of course, your Area Agency on Aging really knows about resources like bereavement groups, women's groups and substance awareness groups.

How can housing providers help reduce the stress that a resident’s difficult behavior may have on housing staff?

Debbi Cutler: We have had good success with an evidence-based program called SBIRT, which stands for Screening, Brief Intervention, Referral to Treatment. SBIRT features some rather easy-to-use tools to help staff identify and respond to residents who have difficult behaviors associated with substance use and mental health issues.

The people conducting SBIRTs screenings need not be clinicians, but rather people who are working with older adults in varied settings. Service coordinators and other housing staff could be trained in this technique. There is significant data suggesting that it is very effective.

In addition, you really need to do your homework ahead of time to find partners who can work with you. No matter how many resources you have on site, you never want any member of your staff to feel that they have no place to turn for help when they need it.