What is it about Nantucket that seems to exacerbate mental health and substance abuse issues? According to an island-wide report released over the winter, Nantucket is grappling with fifteen gaps in adequate treatment for addiction and related mental health issues. Among the gaps detailed in the Nantucket Behavioral Health Assessment is a lack of appropriate step-down care for people who have gone off-island for detox or other intensive treatment and now want to reintegrate into life on Nantucket. One organization standing up to bridge this critical gap is Gosnold Behavioral Health.

Marking its fiftieth anniversary this year, Gosnold offers treatment for behavioral health and substance use disorders and has recently introduced its SOAP program to Nantucket. An acronym for Structured Outpatient Addiction Program, SOAP is more intensive than the once-a-week-type therapy that has traditionally been available to islanders, whether at Gosnold’s offices on Old South Road or from other Nantucket-based therapy providers.

Led by clinical social worker Glenn Gemma, SOAP attendees come together in a group setting three times a week, for three and a half hours each meeting. SOAP’s thrust is largely to help people transition from detox or rehab, but it can also be used by people struggling in the community who need a higher level of care—more frequent therapy with longer-lasting face-to-face time—than they have been able to access on-island.

Gosnold’s SOAP program on Nantucket is sponsored by the Cape Cod & The Islands affiliate of the National Alliance on Mental Illness (NAMI) via grants secured from the Town of Nantucket and the Community Foundation for Nantucket. That makes it free to all comers regardless of health insurance status. Not that Gosnold hasn’t been chipping away at problems associated with addiction in other ways.

“I had a really good program of sobriety for thirteen years,” says one Nantucket resident, an educated professional, “and then in 2019 I picked up my drug of choice, and my life started falling apart again…Because of my addiction I was not being a good husband, not being a good father, not performing well at work, causing a lot of pain. Wracked with guilt, I wanted to end it all. I came pretty close. But I credit David with saving my life. He’s an amazing, amazing man.”

“David” is David Nawrocki, a nurse practitioner at Gosnold who provides outpatient psychiatric services to help people with addiction recovery and mental health. Nawrocki is one of many Gosnold clinicians involved in providing a continuum of care depending on where people are in recovery—everything from one-on-one therapy to a residential treatment facility off-island in Falmouth for detox.

And the need for treatment only seems to be increasing. The latest Nantucket Chronic Disease Report shows, for instance, that in 2017, a total of 513 hours were devoted to “Drivers Alcohol Education,” a court-mandated course for people who have been convicted of a DUI. In 2018 the number of hours devoted to that course increased to 668, and in 2019, 1,292. The course is administered on the island by Fairwinds, which offers therapy for mental health issues in general in addition to therapy that addresses addiction specifically.

“Nantucket is one of the worst-off communities in the commonwealth,” says Jason Bridges, Fairwinds executive director who serves on the Nantucket Behavioral Health Initiative leadership team. “The average number of clinicians is one for every 150 people. Here, there’s one clinician for every 250 to 300 people.” Bridges says that “we need more Gosnold on the island, more Fairwinds… Gosnold has played very needed roles on the island.”

For another novel way of filling in gaps, Gosnold offers a Monday evening group for family members of those with addiction struggles, run (on Zoom during the pandemic) by island resident Candice Tetrault Kelly. Like SOAP, it is free, thanks in part to a grant from the Siasconset Union Chapel. “Initially, people who come think they’re going to figure out how to get their loved one to stop misusing a substance,” Kelly says. “But they soon learn that they’re embarking on their own recovery journey.” Part of the aim of the group, she adds, is to “find insight as to who you are in this dynamic and why it keeps perpetuating itself.”

One group member, whose son has been suffering from addiction for twenty years, since he was a teenager, talks of Kelly’s likening the people in the dynamic as parts of a mobile. “If one part acts,” she says, “it affects everything else. But if you change how you act, it changes the dynamic.” She says it was hard for her not to keep trying to do things for her son, to keep him from trying to take missteps, especially because as a parent you believe that’s exactly your role. But her backing off has not only been what she calls “a tremendous relief.” It has also led to her son calling her more instead of pushing her away. “My recovery—how I’m able to listen, how I’m able to respond, my empathy—these have been impacted tremendously,” she says.

“Our goal is to care for as many people as possible, whether through Gosnold or not,” says Gosnold Senior Director of Operations Danae Young. Gosnold is pleased to be able to deploy a multipronged approach to helping people across the spectrum—from people who love someone with a substance use disorder to those needing detox or who are at other points on their recovery journey. As Young puts it, Gosnold works consciously to reach “underserved populations struggling to find care. How we expand directly reflects…the needs of the community.”