As an alternative to inpatient mental and behavioral health services, Nuvance proposed expanding outpatient mental health services in Norwalk. Until recently, the exact plans for the outpatient expansion weren’t public.

In Norwalk Hospital’s community forum held virtually on Feb. 8, hospital President Peter Cordeau discussed the new behavioral mental health outpatient facility that is being phased open.

The center, located at 14 Westport Ave., will provide adolescent intensive outpatient, intensive outpatient and dual diagnosis intensive outpatient treatments, Cordeau said. All insurance companies would be accepted at the center, which is atypical, officials said. 

“As we talked about changing our delivery of care, we also have to change what we consider to be acceptable and the acceptable norms,” Cordeau said. “We find it acceptable that psychiatrists in the community can take no insurance, only accept cash and leave the most vulnerable out to only utilize an emergency department as their means for psychiatry.”

However, that should no longer be acceptable, he said. 

Treating more than emergencies

The goal of the center is to broaden outpatient treatment availability and treat disorders before they reach the point of requiring an emergency room visit.

“A hospital inpatient bed is not your answer to behavioral health care, it’s meeting these patients in the community, where they are,” Cordeau said.

Now, patients experiencing a behavioral health crisis are often held in the emergency department because staff do not have another safe place to discharge them to. 

“These are people that come in under the influence of drugs and alcohol and may state that they want to kill themselves,” Cordeau  said. “Once they’re sober and once they’re seen by a psychiatrist, they may be deemed not a harm to themselves they didn’t mean it. If we don’t have a safe place to discharge them, whether it’s a weekend, whether it’s the inability to pay for services, to find someone to accept them, it keeps patients in the emergency department.”

Plans to decrease the hospital’s inpatient mental health services were in the works since a 2016 internal assessment of the psychiatric care, according to the OHS application. Nuvance Health was formed in 2019 and an additional review was conducted.

While the COVID-19 pandemic exacerbated the need for youth mental health services, Nuvance had plans to increase outpatient treatment prior to the virus’ spread, Chair of Psychiatry for Nuvance Health Dr. Charles Herrick said. Plans for and the execution of the outpatient center came together within six months, Cordeau said.

Westport Avenue center accepting patients, seeking staff  

The new Westport Avenue center, which already has an operational adult Intensive Outpatient Program, or IOP, and clinic for medication and therapy, is accepting patients, Herrick said. The adolescent and dual diagnosis IOPs will begin once therapists and psychologists are hired.

Patients can be evaluated on site to determine whether an IOP treatment would be recommended, or referred through other hospitals or clinicians, Herrick said.  

Expanding outpatient care and working toward preventative means, including treating physical ailments and conditions that lead to mental health concerns, is reliant on hiring enough clinicians, he said.

“We take all insurance companies, which is quite unique for lower Fairfield County because most of the community doesn’t accept any insurance,” Herrick said. “That is what created the need down there. The clinics that take Medicaid and Medicare were overwhelmed and we needed to step in to really improve access for all patients and that is really the philosophy of expanding outpatient services down there.”

Norwalk Hospital will refer patients that require inpatient mental health treatment to Nuvance’s Danbury Hospital, less than an hour drive from Norwalk, Herrick said during December’s hearing.

The Norwalk inpatient mental health unit is under-performing, Herrick said. The proposal would also result in financial benefits, as a day in inpatient care can costs a few thousand dollars while a day at an IOP typically costs between $200 and $300.

“The current average volume is seven to eight patients and historically hovered around nine to 10 for the last 15 years, because patients can access other services in area,” Herrick said. “They go to Hall-Brooke (Mental Health Services), Silver Hill (Hospital) or freestanding facilities, Stamford, Bridgeport, many ask to go to Yale and a lot of it has to do with the environment of care.”

A final decision on whether the hospital will be permitted to close the inpatient unit is still pending. However the administrative record for the case is closed as of Jan. 17, according to OHS spokesperson Tina Hyde.

“The closure of the record triggers the 90-day period for OHS to submit a decision,” Hyde said. “So, unless OHS files an extension for some reason (up to 60 days), the decision should be issued by 4/17/23.”

Expansions outside of Westport Avenue

Along with the outpatient mental health center, Nuvance is increasing social worker presence across the county, Vice President of Population Health Solutions Rowena Bergmans said during the forum. 

“In addition to increasing psychiatrist and social workers in outpatient settings, we continue to provide training to our health care and social service agencies around screening, brief intervention and referral to treatment for substance abuse,” Bergmans said. “So instead of being diagnosed and cared for in inpatient settings, the more we can get out in the community and identify when someone has a substance misuse disorder we are able to address it sooner before it escalates into something more catastrophic.”

Nuvance also plans to establish an urgent care center in Norwalk as well, Nuvance Health Chief Strategy Officer Jean Ahn said during forum. No appointments will be needed at the urgent care centers, Ahn said. 

“We are excited we will be announcing shortly a launching of urgent care centers to serve patients in our communities, starting with Norwalk and the Norwalk community,” Ahn said. “The same great quality you receive from Norwalk Hospital and Nuvance Health you will receive here as well.”

Abigail Brone can be reached at abigail.brone@hearstmediact.com.