The trappings of a resort community may be the Vineyard's bread and butter, but the flipside - the seasonality, the economic pressures, a housing market far out of reach of most working people and even the private beaches - may be the ingredients underlying rates of depression, substance abuse and suicide that are higher than the state and even national averages.
That was the upshot of Sunday's health forum, Stress, Alcohol, Pills and People, which tried to pull the lid off the problem of mental illness and the prevalence of drug and alcohol use on Martha's Vineyard.
"There's a great divide here between the haves and the have-nots, and it creates an enormous amount of stress," said panelist Susan Curnan, director of the Center for Youth and Communities at the Heller School for Social Policy and Management at Brandeis University in Waltham.
Ms. Curnan spoke of a "social distance" in the population that is eroding the community.
"There's a high degree of anxiety on this Island," said Rick DeTucci, acting director of Martha's Vineyard Community Services.
While much of the two-hour discussion focused on root causes, hard evidence of the scope of the problem came largely from panelist Dr. Timothy Tsai, director of emergency services at the Martha's Vineyard Hospital. Dr. Tsai dug deeper into data about the mental health of Islanders and reeled off a series of blunt and troubling statistics to kick off the forum.
* The number of cases of patients treated annually at the hospital for alcohol or drug abuse soared from almost 200 in 2002 to just over 750 in the 12 months preceding March 31.
* The caseload of patients struggling with depression grew from 40 in 2002 to 92 in the last year.
* People seeking help because they had thoughts of suicide (suicidal ideation) went from 16 to 25 in the same three-year time period.
* Suicide attempts climbed almost tenfold, from three in 2002 to 29 in the last year.
Sunday's forum, held at the Martha's Vineyard Hebrew Center in Vineyard Haven, drew a crowd of more than 60 people and came less than a month after a group of mental health counselors convened their own public meeting at the regional high school because they were alarmed by rates of depression and the increase in the number of completed suicides on the Vineyard. That group reported knowledge of six suicides on the Island in the last 18 months.
Dr. Tsai said Sunday that after consulting data at the hospital and speaking with emergency medical workers on the Island, he counted three completed suicides in the last 12 months and none in the preceding two years.
More statistics - drawn from the Health Report of Martha's Vineyard (completed last September) and the behavior risk surveys of Island teenagers - reached similar conclusions. The rate of problem drinking on the Vineyard, defined as consuming five or more drinks in one sitting at least twice a month, is almost twice the national average. Among the youth, there were also worrisome numbers to consider: Five per cent of Island teens had attempted suicide and there's been an upswing of cutting or self-mutilation among Island teenaged girls.
"It certainly is a crisis right now," said panelist Hazel Teagan, the lead substance abuse counselor at Martha's Vineyard Hospital.
Dr. Charles Silberstein, the moderator of the forum and an Island psychiatrist, asked participants to pinpoint the reasons driving these numbers.
Ms. Teagan suggested that one cause is the Island's seasonality, the abrupt shift from scant numbers of people and infrequent events to an onslaught of visitors and activities. She said another problem is that there are 500 fewer beds available in the state's alcohol detox facilities for uninsured people.
Freddy Rundlet, health director for the Wampanoag Tribe of Gay Head (Aquinnah), stood up from the audience to offer his insights.
"Obviously things are not good. To me, the bottom line is that in our day to day living, people here are not experiencing love and joy, value and benefit. You think we're in la-la land, but look at the statistics," he said. "What are we not doing right here?
"We have acres and acres of trails here and nobody on them. And beaches, and most people don't go swimming," Mr. Rundlet continued. "We've got a major disconnect here."
A stream of people offered their own assessments.
"I think it's very tough to live here," said Trudy Taylor of Chilmark, contrasting the Island's image as a laid-back place with the economic pressures to gear up for the summer season.
Jan Pogue, who moved to the Island two years ago and now serves as the president of the YMCA of Martha's Vineyard, singled out the complacency of parents.
"You don't worry about your kids because it seems so safe here," she said.
Panelist Rick Beinecke, chairman of the public management department for the School of Management at Suffolk University, agreed that resort communities are afflicted by unique problems.
"There are lower income levels, and people are less likely to have health insurance," said Mr. Beinecke, who pointed out that he grew up on Nantucket. "There's much greater stigma and barriers around confidentiality. Confidentiality is virtually nonexistent."
Kathy Logue, town treasurer in West Tisbury, faulted mental health care providers for refusing to accept insurance coverage from health maintenance organizations (HMO) such as Harvard Pilgrim.
But amidst the problems, there were also success stories. People cited the thriving 12-step programs, Alcoholics Anonymous, Al-Anon and others, that host 60 meetings a week on the Vineyard. Others cited the Island's spirit of volunteerism.
Panelist Eric Adams, director of the YMCA teen center which opened in January in Oak Bluffs, said the center has already served 150 teenagers.
"On an average night, there are 40 to 60 kids in the building," he said. "We're giving them options, other choices, a safe supervised environment. It's a place to find some connection."
The discussion wrapped up with recommendations for combating the mood of disconnection felt by Islanders who are battling depression, substance abuse and possibly even thoughts of suicide.
"You need to bridge those divides, create a sense of belonging, belonging on the trails and belonging on the beaches," Ms. Curnan said. "Make sure every kid has a caring adult their life."
Mr. Beinecke pressed people to collaborate, telling therapists they should band together and form a collective that would enable them to pool resources to hire a bookkeeper and accept Medicaid, Medicare and other forms of insurance.
"All of us are here to care for people," he said. "As an Island community, you have a huge possibility to build on things."