Darien Selectmen Consider Town Partnership With Silver Hill Hospital

DARIEN, CT — The Darien Board of Selectmen is considering using $250,000 of American Rescue Plan Act (ARPA) funds to enter into a partnership with New Canaan's Silver Hill Hospital.

The partnership would allow Darien residents access to important urgent assessment services related to mental health issues. New Canaan First Selectman Kevin Moynihan thought Darien would be interested in the partnership, and he reached out to Darien First Selectman Monica McNally in February.

On Monday, the board heard a presentation from Dr. Andrew Gerber, president and medical director of Silver Hill, which is located at 208 Valley Road in New Canaan.

"We're in a time of unprecedented mental health need," Gerber told the board. "Even prior to the pandemic, it was clear that mental health in this country has not been addressed in a way that our citizens need."

Gerber said one in 20 adults in the United States suffers from severe mental illness, and one in five suffers from any mental illness. Prior to the pandemic, he said, 17 percent of youth had experienced a mental health disorder.

"When the pandemic hit in 2020, it became clear that we were in for an even rougher ride," he noted.

Gerber said Silver Hill consulted with it's patient and family advisory committee, and found that even though the area has a relatively large number of providers, therapists, counselors and psychiatrists, it's hard to get in the front door, and the option of waiting a long time to be seen is not on the table.

"People are really kind of looking in the dark for their first therapist provider," Gerber added. "A good assessment, done by people with significant training, that includes an MD — that is hard to find."

That's where urgent assessment services come in.

"We want to intervene when someone says, 'I want help. It's not at the crisis level yet, but I don't want to wait three, four, five more weeks until I can get an appointment with a psychiatrist or a therapist in town,'" Gerber said.

Under the partnership, which New Canaan will begin in July, there would be five open slots for residents per week. Urgent assessments would include a psychiatrist, medical evaluation, case management and immediate referral, along with next day follow up.

Gerber described the assessment as "comprehensive and multi-dimensional," taking into account a patient's biology, psychology and social environment, and said establishing diagnoses is rarely the solution.

Services would come at no cost. Insurance would be billed, but the deductible, co-pay or a lack of approval is covered, Gerber said.

Selectman Sarah Neumann had concerns about the number of slots.

"What if you have 10 people from New Canaan and three from Darien? How are we going to make sure that our residents are served in a manner in which we are hoping with this investment?" she said.

"We're starting where we think it will be a reasonable guess," Gerber said. "We'll only know when we start it."

Selectman Michael Burke asked what would happen after the ARPA funds are used.

Gerber noted that on the New Canaan side, the town's community fund has committed to raising funds to carry on the partnership beyond the first or second year.

"I wish there was another revenue model. I wish there was a sustainable model that I could roll out. This is why services like this don't exist. Insurance companies won't pay for this, or they'll only pay a small piece of it. We will need to be subsidized indefinitely," Gerber said.

Selectman Jon Zagrodzky said he was skeptical of the proposed partnership.

"How did you make the leap from what I'm hearing from the patient advisory committee and what a lot of town people are saying, which is, 'We've got a ton of money and insurance coverage and we can't get the service we need,' to saying now towns need to come forward and start to pay for this?" Zagrodzky said.

"Insurance doesn't pay for these things. People can pay privately, but they don't know where to start," Gerber said, adding that seeking help is often viewed as a barrier.

"This is what people need. I think what we would see is a lot of people coming to care who haven't otherwise come," Gerber added. "We would get there before it would become the kind of crisis that we unfortunately see when people end up in the emergency room or worse."

Zagrodzky said he'd be worried about where extra funds would come from if there's a huge need in the community.

"I don't doubt that there's an exploding mental health need. I'm just worried that we haven't thought through the implications of two local town governments coming together to try and fund a little piece of this, which is the assessment work," he added.

Darien Director of Human Resources Ali Ramsteck said the partnership would be "an invaluable resource to our town."

"To be able to get in within 48 hours and be seen by a professional, even that initial intervention can make a big difference. If someone's willing to get help, and they have to wait three weeks to speak with a professional, you miss that opportunity," Ramsteck said.

Gerber said he hoped Darien could join and start with New Canaan on July 1. The board did not take any action during Monday's meeting.

"I think what we'll do is give the community a little bit of time to come forward with their thoughts and any questions they have," said McNally, noting that the board will revisit the issue "in the near future."

Residents can send questions or concerns to Ramsteck in Human Services, or McNally in the First Selectman's office.

You can view Gerber's presentation here, starting at the 15:30 mark.