Marking progress in Puerto Rico’s behavioral health strategies

One innovative effort the NY Fed and SAMHSA teams are contributing to is the mapping of all mental health and substance abuse services in Puerto Rico. “Creating a print and digital tool—similar to a subway map—is a goal of the PRPH Trust,” said Silva.

“If you’re feeling stressed or suffering a relapse of some kind, you can reference this map to find resources near you, anywhere on the island,” Silva explained. “The map would serve both practitioners and patients, while the resources can be continuously updated online.”

Silva described how the NY Fed connected PRPH Trust with the local small business ecosystem that uses a similar tool created by Colmena66. “The map, called Tu Camino Empresarial, is successful in connecting entrepreneurs to the resources they need, whether it’s financial, marketing, sales, etc.,” he said. “By applying that concept to mental health, we are leveraging an existing tool in another field and customizing it for this sector.”

The idea came from previous scans of behavioral health resources conducted on the island by Romero’s agency after the hurricanes. “This is a great example of the collaboration between SAMHSA and the NY Fed,” Silva remarked.

Another local partnership between SAMHSA and Puerto Rico’s Menonita Hospital stems from last fall’s conference. “The hospital is currently one of three recipients on the island of large SAMHSA CCBHC grants” Romero noted. “The grantees are helping us test the newest iteration of an integrated model of primary care and behavioral health care.” By linking these health services together—a whole-person approach—they hope to demonstrate the potential benefits of a “continuum of care” to the overall wellbeing of residents, and ultimately, to residents’ ability to contribute to local economic prosperity.

A path forward doesn’t mean reinventing the wheel

Seven years after hurricanes Maria and Irma, Puerto Rico is still recovering from the devastation. Fly over the island today, and you can still see the blue tarps covering damaged roofs in many places. Romero acknowledges that there’s lots of trauma out there.

“Resilience is a great quality, but one that Puerto Ricans unfortunately know too well,” he said. “The truth is they’re exhausted from having to be resilient. They need coordinated support from many different sectors to help them deal with their interconnected issues.”

The NY Fed and SAMHSA teams continue to explore behavioral health and economic intersections in their respective community-building work. When you look at economically thriving communities, they point out, you often see that they’re thriving in terms of public health. They hope elevating this conversation will lead to new partnerships, better use of proven strategies, and more buy-in and backup from diverse sectors.

Romero noted, for example, that the Puerto Rico Chamber of Commerce brought behavioral health into its conversation for the first time last year. He presented to that audience and considers it a milestone in efforts to shine light on the connection between the economy and mental health and addiction.

Society doesn’t need to reinvent the wheel to find a path forward. There are opportunities to share, adapt, and expand what’s already working. It’s an approach that acknowledges and leverages the connections between different aspects of human wellbeing and links together entities in different but related fields.

Drawing out data to inform solutions

To find effective solutions, stakeholders also need accurate data on the roots and extent of these problems. More local data would be particularly valuable.

As mentioned earlier, SAMHSA conducts an in-depth national survey on substance abuse and mental health indicators each year. Yet US territories are currently not represented in those numbers, so they can only rely on local data collection. This is something that SAMHSA is actively working to change. 

Silva agrees. “That kind of data is vital. There’s a huge, missed opportunity in not including the territories in robust, national datasets,” he said.

On the economic side, Silva noted that employment on the island is starting to improve, and FEMA dollars also offer growth potential. “Funds for hurricane rebuilding will create many jobs over the next 10 years, as we’re already starting to see in the data,” he said. “But federal recovery money has been slow to make it to the ground. Of Puerto Rico’s $85+ billion allocation, only around $32 billion has currently been disbursed.”

“That gets back to residents’ stress over how long it’s taking to rebuild,” Silva added. “When you know there will be more natural disasters, folks develop ‘eco-anxiety.’ Getting the money out faster to address critical needs is important to healing the emotional and economic scars of these events.”