BRATTLEBORO—A local radio station’s forum on mental health attempted to shed light on the experiences of people trying to find health in the Windham County mental health system.
WKVT’s forum, “A Call to Action,” drew a large crowd to the Brooks Memorial Library.
Unfortunately, according to the stories shared by panelists during the March 31 forum, the system is struggling.
Most support programs kick in only when a person experiences a full-blown crisis. Beds for in-patient programs are too few and far between. Community housing, which could allow a person to transition from an in-patient program to the community, is in short supply.
Jean Clough shared her pain, struggle, dismay, and hope in caring for her son, who started dealing with a mental illness in 2000.
“I rejoice in the small things like, ‘Good morning, mom,’” she said.
Clough said she has taken her son to the emergency room, has called the local crisis team, has had police remove him from her home, has filed a restraining order, and has sent her son to in-patient programs. He has been homeless more than once, she added.
“If only intervention had been in place before he was in crisis,” she said. “There is a desperate need for help in the mental health care system.”
She said her son is at the Brattleboro Retreat. Without support, Clough believes more hospitalization lies in her son’s future.
Clough hopes to eventually move him to a “step-down” program like Vermont-based Spring Lake Ranch therapeutic community. This organization provides therapy, work programs, and transitional housing for people recovering from mental illness or addiction.
The system must shift its focus toward maintaining recovery and away from crisis intervention, she said.
Judy Siler, second vice president of the NAMI Vermont board and Brattleboro representative, said that caregivers often experience isolation.
Community response to mental illness differs from the “casserole illnesses” like cancer or broken bones, Siler said.
“When you don’t know how to help, it can be frightening,” Siler said.
Stigma surrounds mental illness, she continued. Sometimes the person dealing with the mental-health issue will ask loved ones, “Please don’t tell anybody.”
Siler noted some behaviors by people who struggle with mental illness also complicate situations by wearing down their own support networks. These behaviors include causing chaos, creating strife, or manipulating people and splitting relationships.
It’s important to provide everyone involved with tools and relationships to help move them from anger and frustration to a place of compassion and empathy, Siler said.
NAMI offers classes like the 12-week Family to Family Education Program, designed to teach loved ones of people with mental illness how to support the person in crisis while taking care of their own well-being.
For 30 years, the Brattleboro chapter has hosted a support group on the first Wednesday of the month at 6:30 p.m. in the First Congregational Church, 880 Western Ave., West Brattleboro. Call 800-639-6480 for more information.
The pharmaceutical connection
Peter “Fish” Case, the co-host of the forum with Chris Lenois, remarked that many pharmaceuticals “tamp down” patients’ behavior for the benefit of those around them. The pills, however, can leave patients feeling like “they’re walking through rubber cement.”
Siler agreed, saying that the broader mental-health system does not always support individual wellness plans. Depending on the person, pills might represent only a little piece of a long-term plan.
According to Siler, scientists discovered many mental- health medications by accident while testing drugs for other conditions. National regulations require only that a pill reduces symptoms.
“The FDA does not require you to show that you can have a productive life,” she said.
Case and Siler commented that many caseworkers, social workers, and mental-health workers at all levels of the system are overloaded.
Siler said the state has a huge need for community-supported housing. This model would allow professionals and caregivers to see the whole of the patient’s quality of life — How are they eating? How is their quality of sleep? Are they paying their bills on time? — rather than inside a one-hour window during an office visit.
The state’s dedicated agencies, like Health Care & Rehabilitation Services of Vermont (HCRS), need more money, she added.
Brattleboro Retreat Director of Ambulatory Services Kurt White, LADC, LICSW, noted an increase in the population of people he works with who have both mental-health and substance-abuse issues.
The Retreat and Groundworks Collaborative launched a joint effort last year to help reduce the barriers that discourage people from using Groundworks’ services and other mental-health services. The program started with 12 hours a week. This year, the number of hours increased to 16.
The days and months following release from an in-patient program can be risky for patients, White said, noting that a smooth transition into post-hospital programs is crucial.
Health-care delivery is changing from paying providers for each widget to paying them for maintaining wellness, he continued. There’s a need for building flexibility into the system so providers can match treatment to the patient, he noted.
Almost everyone will experience some form of mental health issue at some point in one’s lifetime, White said. People with mental-health issues are not some secluded separate group.
“‘They’ are literally, us,” he said.
Police cope with mental-health issues
Brattleboro Police Chief Michael Fitzgerald said his officers never expected to act as social workers. But when a person is in crisis, it’s often law enforcement that receives the call.
“Police officers are not mental-health workers,” he said. “Cut and dry.”
Fitzgerald continued that addiction and mental illness are not against the law. The community can’t expect the police to use their capacity to arrest people as a solution to the crisis.
Twenty years ago, officers would arrest people in crisis, put them in a cell overnight, then release them in the morning, Fitzgerald said.
“That accomplished absolutely nothing,” said Fitzgerald, who noted that the BPD remains committed to community policing, which means focusing on quality-of-life issues.
He is grateful for the in-department social-worker program through HCRS that embeds a mental health professional in the department. The social worker, Kristen Neuf, responds to situations with officers.
Neuf offers different choices for people needing mental health services where the police can’t.
“There is no recipe,” she said.
Neuf said she has sat with people for days in the emergency room while they wait for a program bed to open up. More and more often, the beds are outside Vermont.
Drew Hazelton, head of Rescue Inc., said the ambulance service sees many repeat patients dealing with mental-health issues. They’re back in the ambulance multiple times a year because often they couldn’t receive the proper services in the first place.
“The [emergency room] is not a place to treat mental health issues,” he said.
Hazelton said that Rescue Inc., is transporting more patients to programs outside Vermont.
“When an in-patient bed is available, it is a very precious resource that may not be there for long,” he said.
Funding mental-health needs
HCRS CEO George Karabakakis estimated that his organization serves fewer than 20 percent of the people in Windham County who need help.
That means 80 percent of people needing services don’t get them. “The numbers that make up those statistics are people’s lives,” Karabakakis said.
He continued, “But the harsh reality is we need more money to do the work.”
“We need to be on par with health care [funding],” Karabakakis said. “Our services drive health care costs.”
Mourning Fox, Vermont Department of Mental Health clinical services and operations director, said that for three years his department’s budget has received level-funding. This level-funding equates to cuts in funding.
Costs keep increasing, Fox said.
Who is ‘the system’?
Not all audience members felt prepared to let “the system” off the hook too easily.
Emilie Kornheiser reminded the audience and listeners that people make up “the system,” and people can change policy.
The increase in mental-health issues is not the fault of people or the system, she said. We live in a stressful society.
Malaika Puffer, a self-identified “psychiatric survivor” who works for HCRS, said that some of the morning’s comments offended her.
Puffer said she has survived a system that harmed as much, if not more, than it helped.
The ideology and narratives within the mental health system must change, she said. For example, why are patients’ thoughts, feelings, or beliefs viewed as sick rather than understandable within the broader context of their lives?
It’s nice that the community discusses reducing stigma, she said.
But, she added, did the community pause to consider that the approach itself is stigmatizing?