EASTHAM — Accessing mental and behavioral health care can be a complex and overwhelming process. In the U.S., the mental health care system is often criticized for its fragmentation, scarcity of providers, and the unpredictable nature of insurance coverage. Rural areas face even more challenges, with the Outer Cape experiencing particularly high demand for mental health care, yet lacking sufficient clinicians to meet these needs.
In response to this longstanding crisis, the four Outer Cape towns — Eastham, Provincetown, Truro, and Wellfleet — collaborated with the nonprofit Outer Cape Community Solutions to secure a $381,375 grant from Barnstable County in June 2023. The grant, part of the county’s $41-million allocation from the American Rescue Plan Act (ARPA), was largely dedicated to funding the hiring of a full-time behavioral health clinician and a public health nurse to serve the four towns. Eastham took the lead in managing the grant, while Outer Cape Health Services (OCHS) won two 18-month contracts to hire and oversee the new positions.
Cassie Baker, a licensed independent clinical social worker, and Kerry Cox, a registered nurse, were hired in February 2024. The services provided by Baker and Cox are free of charge, as specified in Eastham’s request for proposals (RFP), and residents do not need to show proof of insurance to access care.
A Dynamic Duo for Mental Health Care
Eastham Health Director Hillary Greenberg-Lemos referred to the two clinicians as a “dynamic duo” for their work across the Outer Cape. Since February, Baker and Cox have been providing much-needed services to residents, seeing individuals in their homes, at OCHS offices, or virtually, depending on the patient’s preference.
“I think of them as the dynamic duo, because they’re out in the community,” said Greenberg-Lemos. “They’ve seen residents in each of the towns, and they seem to be making headway.”
Though Baker was unavailable for an interview, she spoke to Provincetown’s Board of Health on October 17, where she shared some insights about her work. “Oftentimes I find people are looking for just some short-term support, and if I have residents who are in need of longer-term support, I bridge that gap,” she explained. “I will work with them to identify a therapist in the community or through a virtual platform if they’re able to access that.”
Filling Gaps in the Health Care System
The services provided by Baker and Cox are designed to fill a crucial gap in the region’s mental health care system. Baker primarily offers short-term outpatient therapy sessions — typically ranging from 6 to 10 meetings — for patients who are waiting for longer-term therapy. This “bridging” model aims to ensure that individuals get the support they need during periods of waiting for more stable care.
The scope of the services, as outlined in Eastham’s RFP, states that the behavioral health clinician will maintain a caseload of ten patients per town at any given time, totaling 40 patients across the four towns. This model aligns closely with Provincetown’s five-year mental health plan, which advocates for immediate crisis counseling services that can help people in urgent need, with the goal of transitioning them into longer-term care.
Baker noted that since she started, she has worked with patients experiencing a range of mental health challenges, including depression, anxiety, trauma, grief, ADHD, substance use, and adjustment disorder. She highlighted the significance of outreach services, which allow for therapy to be provided at home — a rare and vital service that is difficult for most agencies to offer.
Bri Smith, the Director of Behavioral Health at OCHS, emphasized the importance of outreach services. “It’s an outreach service — it has the availability to be therapy at home, which almost no agency provides,” she said. Smith supervises Baker and Cox and is instrumental in managing the program’s operations.
Managing Demand and Referrals
Given the high demand for mental health services and the free nature of the program, OCHS has had to be strategic in managing referrals and maintaining capacity. The referral process is currently controlled to ensure that Baker does not become overwhelmed by requests. At present, referrals must come through town staff or other human services workers.
“If you needed some mental health help, you couldn’t call up Cassie directly,” explained Greenberg-Lemos. “You would go through someone, or someone would recognize within the town structure that you needed help.”
Residents can reach out to various local departments for support, including the police, fire, health, and community development departments. These staff members are trained to direct individuals to the appropriate services, ensuring that no one slips through the cracks.
Between February and October 2024, Baker received 20 referrals from Provincetown, including from the health department, police, recreation department, and the council on aging. Eastham referred 17 individuals during the same period. Though data for Truro and Wellfleet was not provided, Smith confirmed that referrals were relatively consistent across all four towns, as the grant stipulates that resources must be shared equally.
Smith added that while it is possible that there could be a wait to see Baker in one town, she has been able to meet with everyone referred so far. “We know that there’s a tremendous need,” Smith said. “So, being thoughtful about how we are able to triage and being realistic about the resources that we have has been important.”
Next Steps: Expanding Services
As the program progresses, OCHS and the towns are beginning to look at ways to expand access to these critical services. Smith noted that the next phase will involve refining the referral process and making it more open. Currently, referrals are somewhat limited to avoid overwhelming Baker, but the goal is to gradually open up access to more residents.
The ARPA funds supporting this program will expire in 2025, prompting the need for long-term funding plans. Smith emphasized that this is a priority, with all four towns recognizing the value of the service and putting plans in place to fund it beyond the grant’s expiration.
“I know all four towns are seeing the value in the service,” Greenberg-Lemos said. “And I believe all four towns have put into their budget” plans to continue funding the two positions for another year.
Budget discussions are ongoing, with draft budgets expected to be presented to select boards for approval in late winter, followed by votes at town meetings in spring.
Conclusion
The ARPA-funded behavioral health clinician and public health nurse program on the Outer Cape offers vital mental health support in a region that has long struggled with access to care. By providing free, short-term therapy and outreach services, this initiative is addressing urgent mental health needs and helping to bridge the gap for those waiting for long-term care. With continued funding and expanded access, this program has the potential to significantly improve mental health outcomes for the Outer Cape’s residents.
Related topics:
