NEWS, COMMENTARY, AND ARTS BY PSYCHIATRIC SURVIVORS, MENTAL HEALTH PEERS, AND OUR FAMILIES
VOL. XXXVI NO. 1
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FROM THE HILLS OF VERMONT
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SINCE 1985
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SUMMER 2021
Activist Voices Heard
Residence Drops Restraint, Seclusion Plan By BRETT YATES
MONTPELIER – A flood of opposition directed to the legislature by psychiatric survivors and their supporters led to an abrupt change of course in the Department of Mental Health’s plan to allow the use of restraint and seclusion at a state-run locked program under development in Essex. “We understand that there have been significant concerns raised to the department regarding the proposed use of seclusion and restraint at the recovery residence, and I think what I can say is that we’ve heard you,” Commissioner Sarah Squirrell told members of the House Health Care Committee. “We’ve heard your feedback; we’ve taken it into consideration, which is why we’re no longer proposing the use of seclusion and restraint at the expanded program.” Advocacy organizations had opposed any policy allowing use-of-force since seeing initial
floor plans with a seclusion room last summer. Still, department officials had initially told legislators that it was essential to the program. The same opponents, however, were unsuccessful in blocking the overall plan to build a $16 million, 16-bed locked facility to replace the current 7-bed secure residence in Middlesex. That construction received final approval from the legislature in May. It still requires approval by the Green Mountain Care Board, which is expected to review the plan this summer. The new building is planned as a replacement for a pair of temporary trailers surrounded by a chain link fence that has served for eight years as a makeshift hospital step-down program after Tropical Storm Irene’s destruction of the Vermont State Hospital in Waterbury. According to the department, the program
is for patients who “are no longer in need of inpatient care but who need intensive services in a secure setting.” The new locked residence is planned for the former site of the Woodside Juvenile Rehabilitation Center and will expand the locked hospital step-down capacity by nine beds. The expansion in the number of locked beds in the state was the other focus of opposition. Until the state’s policy reversal, it would have also added a seclusion room and a restraint chair, which are not present in the Middlesex program. The department had argued that the availability of restraint and seclusion would permit a greater number of patients to transition from hospitalization to a residential setting, thereby freeing up more costly beds at the Vermont Psychiatric Care Hospital and relieving backlogged emergency departments. Vermont Psychiatric Survivors, NAMI-VT and other groups were joined by individual opponents who contributed the bulk of the 39 (Continued on page 4)
Child ER Waits Recognized As Crisis By ANNE DONAHUE
MONTPELIER – A letter from a Counterpoint reader about long waits in the emergency room for children in mental health crises sparked a legislative inquiry and an action plan by the Department of Mental Health.
Data show a growing trend since 2010 in the number of children waiting and the length of time they are held waiting for admission to a treatment program, with a spike of as many as 19 children one day in April. Some had been waiting for weeks.
Members of the House Health Care Committee listen to Andy Anderson (lower right) testify at a Zoom hearing about his child’s four-day wait in an emergency room.
UVMMC Faulted In Patient’s Death
5 The Arts12
The University of Vermont Medical Center reported that the number of children and adolescents between 10 and 18 whose reason for an ED visit was a psychiatric crisis has nearly tripled since 2010, from 4.3% to 12.3%, with the length of stay increasing “exponentially” from 12 hours to 62 hours – more than 2 ½ days. Delays in psychiatric admissions have been a topic of alarm in the past but usually focused on adults. “The emergency room is a really bad place for kids,” Andy Anderson testified at a House Health Care Committee. “It’s really isolated. It’s confined. There’s no activities. “What surprised us the most, and took us 24 hours to realize, [was] that there was zero care that was going to take place in the emergency department,” he said. They waited four days for a placement for treatment. DMH Commissioner Sarah Squirrell said she agreed the situation was “completely unacceptable” and said the department would work on short and long-term solutions. A (Continued on page 5)
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Call to Action For Peer Support
2 Peer Leadership and Advocacy
Fall 2018
Meeting Dates and Membership Information for Boards, Committees and Conferences Peer Organizations VERMONT PSYCHIATRIC SURVIVORS BOARD
A membership organization providing peer support, outreach, advocacy and education. Must be able to attend meetings monthly. Experience with boards preferred, but not necessary. For information call 802-775-6834 or email info@vermontpsychiatricsurvivors.org.
COUNTERPOINT EDITORIAL BOARD
The advisory board for the Vermont Psychiatric Survivors newspaper. Assists with policy and editing. Contact counterpoint@vermontpsychiatricsurvivors.org.
ALYSSUM Peer crisis respite. To serve on board, contact Gloria at 802-767-6000 or info@alyssum.org. DISABILITY RIGHTS VERMONT PAIMI COUNCIL
Protection and advocacy for individuals with mental illness. Call 1-800-834-7890 x 101.
State Committees ADULT PROGRAM STANDING COMMITTEE
Advises the Commissioner of Mental Health on the adult mental health system. The committee is the official body for review of and recommendations for redesignation of community mental health programs (designated agencies) and monitors other aspects of the system. Members are persons with lived mental health experience, family members, and professionals. Meets monthly on 2nd Monday, noon-3 p.m. Check DMH website www.mentalhealth.vermont.gov or call-in number. For further information, contact member Daniel Towle (dantowle@comcast.net) or the DMH quality team at Eva.Dayon@vermont.gov.
LOCAL PROGRAM STANDING COMMITTEES
Advisory groups, required for every community mental health center. For membership or participation, contact your local agency for information.
Advocacy Organizations DISABILITY RIGHTS VERMONT
Advocacy in dealing with abuse, neglect or other rights violations by a hospital, care home, or community mental health agency. 141 Main St, Suite 7, Montpelier VT 05602; 800-834-7890.
ADULT PROTECTIVE SERVICES
Reporting of abuse, neglect or exploitation of vulnerable adults, 800-564-1612; also to report violations at hospitals/nursing homes.
PEER WORKFORCE DEVELOPMENT INITIATIVE
Webpage provides an up-to-date account of statewide peer training and registration information as well as updates about its progress and efforts. www.pathwaysvermont. org/what-we-do/statewide-peer-workforce-resources/
NAMI-VT
VERMONT CENTER FOR INDEPENDENT LIVING
Family and peer support services, 802-876-7949 x101 or 800-639-6480; 600 Blair Park Road, Suite 301, Williston VT 05495; www.namitvt.org; info@namivt.org
HEALTH CARE ADVOCATE To report problems with any health insurance or Medicaid/Medicare issues in Vermont 800-917-7787 or 802-241-1102.
MadFreedom is a human and civil rights membership organization whose mission is to secure political power to end discrimination and oppression of people based on perceived mental state. See more at madfreedom.org
Peer services and advocacy for persons with disabilities. 800-639-1522.
VERMONT CLIENT ASSISTANCE PROGRAM
Rights when dealing with service organizations such as Vocational Rehabilitation. Box 1367, Burlington VT 05402; 800-747-5022.
MADFREEDOM
MENTAL HEALTH LAW PROJECT
Representation for rights when facing commitment to a psychiatric hospital. 802-241-3222.
Hospital Advisory VERMONT PSYCHIATRIC CARE HOSPITAL
RUTLAND REGIONAL MEDICAL CENTER
BRATTLEBORO RETREAT
UNIVERSITY OF VERMONT MEDICAL CENTER
Advisory Steering Committee, Berlin, check DMH website for dates at www.mentalhealth.vermont.gov
Consumer Advisory Council, fourth Tuesdays, 12-1:30 p.m., contact Director of Patient Advocacy and Consumer Affairs at 802-258-6118 for meeting information.
Community Advisory Committee, fourth Mondays, noon, call 802-747-6295 or email lcathcart@rrmc.org. Program Quality Committee, third Tuesdays, 9-10 a.m., for information call 802-847-4560.
Conferences ALTERNATIVES
The National Coalition for Mental Health Recovery is hosting the (free!) 2021 (Virtual) Alternatives Conference on July 8, 10, 15 and 17. The theme is “Connecting, Organizing, Activating!” In addition to workshops, the conference will invite attendees to join action groups to develop strategic plans. To register go to www.alternatives.org/our-mission For contact info@ncmhr.org
NATIONAL RIGHTS PROTECTION
The National Association for Rights Protection and Advocacy’s 2021 conference, to be presented
this fall, will offer six free, 90-minute webinars. Look for updates at www.narpa.org, or contact NARPA at narpa4rights@gmail.com or 256.650.6311.
WORLD HEARING VOICES
The 12th World Hearing Voices Congress, whose theme is “Solidarity in Times of Adversity: The Global Voice Hearing Community Reconnecting,” will be held September 1-3. If restrictions do not allow to have a hybrid Congress in Cork, then Congress will move fully online. For more information go to hearingvoicesnetworkireland.ie/intervoicecongress-2021/
The Service Building, 128 Merchants Row Suite 606, Rutland, VT 05701 Phone: (802) 775-6834 email: counterpoint@ vermontpsychiatricsurvivors.org MISSION STATEMENT:
Counterpoint is a voice for news and the arts by psychiatric survivors, ex-patients, and consumers of mental health services, and our families and friends. Copyright 2021, All Rights Reserved FOUNDING EDITOR Robert Crosby Loomis (1943-1994) EDITORIAL BOARD Joanne Desany, Kara Greenblott, Emma Harrigan, Calvin Moen, Sara Neller, Dan Towle The Editorial Board reviews editorial policy and all materials in each issue of Counterpoint. Review does not necessarily imply support or agreement with any positions or opinions. PUBLISHER Vermont Psychiatric Survivors, Inc. The publisher has supervisory authority over all aspects of Counterpoint editing and publishing. EDITOR Anne B. Donahue News articles without a byline written by the editor. Opinions expressed by columnists and writers reflect the opinion of their authors and should not be taken as the position of Counterpoint.
Counterpoint is funded by the freedom-loving people of Vermont through their Department of Mental Health. Financial support does not imply support, agreement or endorsement of any of the positions or opinions in this newspaper; DMH does not interfere with editorial content.
Counterpoint is published by Vermont Psychiatric Survivors three times a year, distributed free of charge throughout Vermont, and also available by mail subscription. Vermont Psychiatric Survivors is an independent, statewide mutual support and civil rights advocacy organization run by and for psychiatric survivors. The mission of Vermont Psychiatric Survivors is to provide advocacy and mutual support that seeks to end psychiatric coercion, oppression and discrimination. Counterpoint does not use pseudonyms in its reporting without stating that a pseudonym is being used and without an explanation for why the person’s identity is not being disclosed. Counterpoint does not use anonymous sources under any circumstances.
Department of Mental Health 802-241-0090 www.mentalhealth.vermont.gov For DMH meetings, go to web site and choose “more” at the bottom of the “Upcoming Events” column. ADDRESS: 280 State Drive NOB 2 North Waterbury, VT 05671-2010
Don’t Miss Out on a Counterpoint! Mail delivery straight to your home — be the first to get it, never miss an issue. c Enclosed is $10 for 3 issues (1 year). c I can’t afford it right now, but please sign me up (VT only). c Please use this extra donation to help in your work. (Our thanks!) Checks or money orders should be made payable to “Vermont Psychiatric Survivors.” Send to: Counterpoint, The Service Building, 128 Merchants Row, Suite 606, Rutland, VT 05701
Access Counterpoint online at www.vermontpsychiatricsurvivors.org
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NEWS .
Summer Fall 20182021
3
ROUND UP In the News
In Commentary
Activists Heard on Force
The voices of activists contributed to reversing a planned policy to use restraint and seclusion in a locked facility to be built in Essex (see Page 1).
psychiatric survivors and recognizes psychiatric Editorial disabilities as a source of discrimination and What the eugenics movement teaches us about inequity that cause poorer health outcomes (see the social construct of psychiatric diagnoses (see Page 10). Page 16).
Child Waits Draw Response
Annual Budget Set
A letter to Counterpoint brought a spotlight on the extensive wait times experienced by children in emergency departments (see Page 1).
UVMMC Faulted in Death
CMS cited UVMMC in the suicide death of a patient who been to the emergency department five times in the prior three days (see Page 5).
Keynote Cites Peer Support
The annual Mental Health Advocacy Day speaker cited the peer support that helped him, and their role as healers (see Page 6).
Forensic Review Initiated
A work group will review whether there are gaps in Vermont’s forensic care system, including for a new locked facility (see Page 7).
Apology for Sterilizations
The state issued a formal apology to those, including psychiatric survivors, who were institutionalized and sterilized to prevent them from having children and passing on “bad genes” as part of a eugenics policy (see Page 11).
Reflections on 22 Years
In the Arts
A town review of policing needs in Brattleboro Book Review led to a report that cited overuse of police in “A Stranger in Never-Never Land,” a book by mental health crises (see Page 8). A sidebar long-time Counterpoint contributor Vesna Dye, article looks at what is happening in other states is reviewed (see Page 12). to reduce police use (see Page 9).
Prose Contest Winner
The second place winner from last year’s A new study supports peer recommendations Louise Wahl Writing Contest, titled “Gratitude,” that slow tapering of medication reduces the is presented (see Page 14). chances of relapse (see Page 9).
Health Equity Gets Action
Opponent Letters
Activists flooded legislators with letters opposing the new locked psychiatric facility; read some of the excerpts (see Page 17).
Children Waiting in ERs
A reader is shocked by the children she sees waiting for emergency room care (see Page 18).
Ed Paquin, retiring as executive director of Ending Homelessness Disability Rights Vermont, reflects on changes The writer asks what it would take to end in the mental health system over the 22 years he homelessness in Vermont (see Page 18). has been an advocate (see Page 22).
Police Reforms Examined
Tapering Is Best for Meds
Publisher’s Commentary
The state’s annual budget for the year The Vermont Psychiatric Survivors Executive beginning in July includes funding for a pilot Director explains his support for the new locked family mobile response unit in Rutland and residence (see Page 16). funding for peer outreach (see Page 10).
Poetry and Paintings
Experiences from Front Line
Giving help often means receiving it as well, a staff member reflects (see Page 19).
Pushing for Peer Support
The COVID pandemic has further demonstrated the lack of resources in Vermont, says a patient representative (see Page 19).
A Call to Action
A peer support worker exhorts legislators to recognize the value of the work (see Page 20).
What People Really Need
A writer challenges society about the realities Art from contributors is featured in the Arts A new Health Equity Commission includes section (see Page 13 and 15). of suicide (see Page 21).
! y c i l o P h t l a e H l re. u a t t la n is e g le M e n h i t y d b e d v e l h stablis e s Get Invo n io s is m m o c r o s work group Be appointed to
people who have Positions for two . em st sy re ca services. health s delivered peer ithin the overall ha w n ho io w at e gr on te g in in Addressing Vermont, includ page 7. health services in working group on received mental w ne e th t ou ab nce in the article rson with experie nsic facility. See re pe fo e a on r t fo as le ed at ne g ic laws and the perience, includin Addressing forens tal health lived ex en m ith w le op e pe mitment. Positions for thre or with civil com em st sy e ic st ju on page 10. criminal e new commission th t ou ab le tic ar e. disparities. See th lived experienc Addressing health with mental heal on rs pe e on r fo Stipends available. Position
tion Council ra g te In h lt a e H l ta n - Me up - Forensic Work Gro mission - Health Equity Com
Positions appointed by Vermont Psychiatric Survivors. Contact Karim Chapman at info@vermontpsychiatricsurvivors.org
Louise Wahl Memorial Annual
Writing Contest Enter the 2021 Contest: Deadline July 10 $250 in Total Prizes!
Named for a former Vermont activist to encourage creative writing by psychiatric survivors, mental health consumers and peers. One entry per category (prose or poetry); 3,000 word preferred maximum. Repeat entrants limited to two First Place awards. Entries are judged by an independent panel. Winners will be published in the fall, 2021 Counterpoint. Send submissions by email to: counterpoint@vermontpsychiatricsurvivors.org or by mail to: Counterpoint, The Service Building, 128 Merchants Row, Suite 606, Rutland, VT 05701
Include name and address.
4 NEWS
Summer Fall 2018 2021
ACTIVIST VOICES HEARD • Continued from page 1 recorded pieces of written testimony received by the committee in February and March. When Commissioner Squirrell announced that restraint and seclusion were being removed from the plan, legislators and advocates at the hearing expressed surprise. Committee chair Rep. Bill Lippert paused the meeting momentarily to make note of what he termed “a very significant alteration of the proposal.” Witnesses who had expected to testify about their opposition to restraint and seclusion that day suddenly had to revise their prepared comments. “Much of my testimony was about involuntary procedures and how they simply don’t belong in a therapeutic community residence,” said Kate Lamphere on behalf of Vermont Care Partners, the association of the community mental health centers. “A residence that was designed to achieve wellness and recovery does not and should not include forced medications, restraint, and seclusion,” she said. “So, I am thankful that the Department of Mental Health has listened to those Vermonters who have said the same thing.” That shifted the focus to the expansion of the secure program’s size. Lamphere, a division director at Health Care & Rehabilitation Services of Southeastern Vermont, said that Vermont Care Partners did not support a 16-bed locked facility even with the policy change. She said the community-based agencies had doubts about the immediate need for additional high-security treatment options in the mental health system, given the state’s recent investment in the Brattleboro Retreat, which will add 12 new high-security beds starting this summer. Many of the plan opponents had objected to using what the Brattleboro-based LGBTQ+ nonprofit Out in the Open termed psychiatric incarceration. Vermont Psychiatric Survivors and others argued that the investments should be made instead in “peer respites, community supports, and long-term housing.” “Even without the seclusion, the restraint, the forced drugging, it is still not a therapeutic space. It is still not a residence,” activist Calvin Moen of Brattleboro said. “If I’m locked inside, that’s not home. That’s confinement. That’s institutionalization. It’s not healing, and it’s not community.” The department has pointed to its commitment to enhancing community-based services with federal funds, a total of $7.8 million that the state must spend on community supports by 2025. In the meantime, officials say that they must accommodate a rising number of patients whose “safety needs” make them unable to be placed in other community-based programs. Ward Nial, a board member at NAMI-VT, referred to this as the department’s “but first” approach. “It’s this, ‘But first, we need to add beds, before we invest in community resources.’” Peer specialist Malaika Puffer testified that there were better ways to meet needs. “I think there’s this idea that people in the emergency department must necessarily need to be there and people admitted to the hospital must necessarily need to be in a locked setting,” she said. “But in reality, so many of us are simply experiencing unmet needs in the community,
The current 7-bed locked residence in Middlesex uses temporary trailers built for replacement beds after Tropical Storm Irene closed the Vermont State Hospital. The new facility in Essex would increase the size to 16 beds. unmet basic needs like housing, which you can that addressed the facility’s interior design and get [through hospitalization] simply by saying exterior space, requiring features that, without that you want to kill yourself.” altering the basic construction plan, would Puffer added that a 24/7 community crisis make it possible for the building to function as a center would stand a better chance of resolving pair of eight-bed “communities,” instead of one emergency department logjams than an 16-bed institution. expansion of locked step-down treatment by “Sixteen beds is not really a residence,” diverting those who never required confinement Donahue said. “It’s a big facility – it’s not what in the first place. you’d have in a group home.” “Some of us end up [in the hospital] simply DMH has said the construction and staffing because what we need is human connection and timeline would allow operations to begin at the someone to be with,” she explained. locked facility in January of 2023. Committee vice-chair Rep. Anne Donahue The plan still requires approval by the Green proposed a change to require the construction Mountain Care Board, which has health care to be split into two phases. construction oversight. An eight-bed locked residence to replace DMH filed its application for the required Middlesex would be approved immediately with certificate of need on May 1, and told the board a design that would allow for the addition of that it was essential to receive approval before another eight-bed wing. August to allow construction to begin prior to During the first phase of construction, the winter and prevent a delay in opening of a least department would conduct a thorough needs six months. assessment and review alternative programming Two advocacy organizations – MadFreedom proposals submitted by peer-run agencies and and Disability Rights Vermont – have received others to determine whether the second phase status to provide supplemental information to was necessary. the board in its review. The Vermont Legal Aid The Health Care Committee supported Health Care Advocate has an automatic right the recommendation on a 5-4 vote, but it was to choose to participate directly in presenting rejected by the committee in control of the capital evidence or appealing a decision, and said that budget bill, the Committee on Corrections and it would be participating. Institutions, based on an estimate that a two-phased construction plan would cost an extra $7 million. That committee retained a portion of the health care language, requiring the department to formally solicit ideas for community r e s i d e n t i a l programming that could offer alternatives for transitions from inpatient care.Those proposals are to be reported back to the legislature next year. The following week, the House agreed to an a m e n d m e n t The draft plan for the new locked facility includes two pie-shaped outdoor areas between proposed by Donahue the main building and the existing gym. The large dotted lines marked the fenced boundand Rep. Mari Cordes aries. The legislature required that there be at least 10,000 square feet of outdoor space.
NEWS .
Fall 20182021 Summer
5
UVMMC Faulted in Patient Death By ANNE DONAHUE
BURLINGTON — The Center for Medicare and Medicaid Services alleged treatment failures and placed the University of Vermont Medical Center under a threat of losing federal funding after a woman died of an overdose on December 28 after five visits to the emergency room over three days. Four of the visits were for deep lacerations inflicted by one of the patient’s “alters,” or separate identity states. The report said she told staff the alter “’wants to be dead” and “at this time states with certainty that [her] alter will cut to kill... as soon as [she] is alone.” According to the CMS documentation, she had been diagnosed with disassociative identity disorder, depression and borderline personality disorder. It also described a prior history of multiple occasions of severe lacerations and two attempted overdoses. The survey report said UVMMC clinicians had discussed that “while the patient has what can be considered terminal psychiatric illness and has persistently high baseline risk of death by self-mutilation,” inpatient care was not recommended because it had previously worsened the severity and frequency of selfharm. The team said the ongoing plan should be to allow her to be discharged after emergency room treatment for injuries, it said. UVMMC’s director of ethics, Dr. Tim Lahey, said the report didn’t include any context about the “hundreds of prior conversations” about the woman, “desperate to come up with something” to help her. It was “an intensely harrowing situation” with clinicians “visibly distressed” in the process of “trying to figure out what we can do” to address the woman’s condition, he said. The term “terminal” was shorthand to indicate “how desperately concerned” they were as they tried all treatment options but saw her continue to deteriorate, Lahey said. However,
an implication that there was a certainty of that as a prognosis was “not how [the term] was ever used,” he said. The 59-page report said her condition had worsened due to a recent relocation from a homeless shelter to an isolated hotel room where she “has been alone more often which allows... other personalities to injure... more often.” During one of the December emergency room visits, staff reported that “on some level there is a sense of resignation and hopelessness” in that she “does not have the capacity to subdue” the alter’s intent. The next day she was brought to the emergency room unresponsive after a drug overdose and she died a day later, December 28, the report said. CMS found that the hospital had violated “conditions of participation,” which are the requirements for federal funding, in the areas of failure to provide sufficient interventions and treatment, failure to include the patient in the plan of care, failure to meet emergency needs in accordance with acceptable standards of practice, and failure to have adequate personnel trained in anticipated needs for emergency care. All Medicare and Medicaid funding could have been cut off by July 15, the letter from CMS warned, but it approved a plan of correction by the hospital on April 29. Lahey said the CMS review was discouraging for members of the treatment team, who felt they were “told they were to blame” for the death when they “tried really hard to try to save her.” According to the report, in April of 2020 a treatment team from psychiatry, an outpatient provider, and the ethics department “met to discuss protocol for ongoing care” due to the patient’s “level of self-harm that has led to the need for medically based admissions” and the “overall chronic risk of death by self-lacerations.” The team concluded that because the increase in severity and frequency of self-harming upon
discharge from past hospitalizations had only led to increased self-injury, the ongoing plan should treat immediate injuries but not admit her to the hospital, the CMS report said. That also was a basis for ruling out an involuntary treatment hold, it indicated. In addition, clinicians were quoted as saying that she “numerously denied any safety concerns” and was “agreeable and able to properly safety plan;” that her risk was “high for continuing acts of self-harm, however, no current stated intent or intent to die;” and that she was “adamant that [she]was not suicidal.” The plan of correction approved by CMS included quality oversight planning and required training in federal emergency services requirements for medical screening, stabilization and transfer. UVMMC said it has met the plan completion date of May 26. The plan of correction recognised the factor of implicit bias, including “training with content on patient-centered care that acknowledges potential unconscious emotional and cognitive biases and how it can impact medical screening and decision-making” as part of the plan. Lahey said implicit bias was “a big focus of attention” for the UVM medical network, “racial or otherwise.” Although it was not evidenced in case at hand, the network recognizes that “patients with mental health diagnoses are stigmatized” and need to be a part of the effort to address “historical inadequacies of care for marginalized people,” he said.
CHILD ED WAITS RECOGNIZED AS CRISIS • Continued from page 1
pediatric emergency medicine specialist at the University of Vermont Medical Center said that “we cannot measure the additional trauma that we are inflicting on children who already have a history of trauma by holding them in an inappropriate therapeutic environment such as the ED. We cannot measure the developmental consequences of boarding an elementary schoolaged ‘aggressive’ child for days in the ED.” Christian Pulcini, MD, went on to say that “perhaps most importantly, we will never be able to measure the propagation of the mental health stigma we are normalizing in our society by making it clear that the child with the broken arm or fever is in the ED for a few hours and the child with a mental health issue is there for several days to weeks.” The day before his testimony, “there were five children waiting at least five days in the emergency department for an inpatient mental health placement. One of those children has been waiting two weeks.” “This is, unfortunately, becoming the norm,” he said. The House Health Care Committee was first alerted to the crisis after Counterpoint forwarded it a letter from Jodi Girouard, a reader and contributor, who said she wanted “to challenge the state to find ways to immediately relieve the despair, the tragedy, the hurt that I saw locked in those young eyes I passed” when she was in
the emergency room for other reasons. “A young girl about ten sat on a bed, her eyes wet with tears, the safety worker at the door plugged into the internet, the young girl’s gaze settling on me for just a moment,” Girouard wrote. “She knew I was just walking by, no lift of hope, no realized dream that I could help her out of the limbo she was in.” A week later, the committee held its first hearing with testimony from DMH, the hospital association and parents. Committee chair Rep. Bill Lippert said his awareness of the long-term issue led him to ask, “What is it that we would need to do to never have another child or young person wait in the emergency room for mental health treatment... it should really be our goal. It should be for all Vermonters but particularly our young people.” After initial testimony, the committee sent a letter to DMH and the Vermont Association for Healthcare Systems identifying progress deadlines. The letter asked for monthly reports through the summer and fall. It also asked the hospital association to take immediate steps to improve the environment for those children who are waiting. “We don’t want to lose our sense of urgency” as the legislature goes out of session, Lippert said. The letter said there should be “a guiding principle to ensure that every moment of
involvement with children in the mental health system is used to provide treatment and promote recovery.” It said the system should “immediately establish the expectation that services in the community are robust enough to ensure that there is not reliance on emergency departments.” The steps included to “establish a target date by which the average length of ‘boarding’ time in emergency departments shall not exceed 24 hours” by June 1 and to immediately solicit input from family and peer stakeholders. Devon Green from the hospital association testified that “we are going to really look intensively to see what is possible to change those spaces and make them more therapeutic.” She said VAHHS was committed to being a partner with DMH to address the crisis. Squirrell said that the COVID pandemic was contributing to the pressure because schools were closed, reducing mental health support access, and that there was reduced capacity in both residential and hospital beds because of capacity limits. Staff shortages were also an ongoing obstacle for programs, she added, and one of the longterm strategies was to address the workforce issues. She said that in the short-term, DMH was strategizing directly with emergency room directors, community mental health agencies and the Brattleboro Retreat.
NEWS 6 NEWS
FallSummer 2018 2021
Peer Support Is Keynote Talk Focus
By BRETT YATES
MONTPELIER — Keynote speaker and psychiatric survivor Chacku Mathai narrated a personal journey of alienation, attempted suicide, hospitalization and then healing through peer support at the annual Mental Health Advocacy Day this past winter. The event traded its usual venue — the statehouse in Montpelier — for Zoom last winter, creating a virtual forum for public officials to discuss problems and priorities with psychiatric survivors, care providers and nonprofit leaders. Mathai told the audience that only candid, insistent self-disclosure can spur approaches to mental healthcare that — using peer and lived experience models — account for the particular needs of diverse individuals and the socioeconomic circumstances that drive psychological stress. He urged legislators to protect “the supports that are not necessarily traditional services, that are not necessarily going to be part of the mainstream mix of funding,” while taking a hard look at some of the “evidence-based practices” that may contribute to racial inequities. “Vermont is filled with healers that are ready to come forward,” he said. “From a financing perspective, we’ve kept them out.” Mathai is a project director at the Columbia University Department of Psychiatry’s Center for Practice Innovations. Born in Kuwait to an Indian family that immigrated to New York during his childhood, Mathai said he faced psychosis and drug addiction as a teenager – challenges that, in his view, grew out of the tension of growing up in Rochester. It was a city “where Kodak had just started hiring people of color. We were only seen as people taking other people’s jobs and moving into other people’s neighborhoods,” he said. Xenophobic bullying in school led him to keep his guard up all the time, including at home, where he said he developed an unfounded conviction that his mother intended to harm him. Mathai struggled at times to find therapists or counselors “who understood that my immigration story and history were part and parcel with my experience with the world and my experience with my mental health, that my mental health and racial oppression were not separate issues but were actually co-conspiring forces in what I was going through.” A teen
recovery center located in a renovated horse barn eventually brought him to “a peer community that I didn’t think I would trust.” However, “the warmth and love and support even from people who didn’t look like me or talk like me” disarmed him enough that he could begin to open up about his frustrations. “Next thing I know, I’m being asked to talk to kids at other adolescent treatment centers,” he recounted. When U.S. Representative Louise Slaughter asked Mathai, as a young man, to testify in a Congressional hearing on mental health in the 1980s, he agreed, “but on the condition that I get to say what I think. I needed to be able to believe that our voice could be expressed, that healing could begin – whether it was personally, inside of me, or externally, out in the community – when people were able to bring their voices forward and say what was really on their minds.”
“Vermont is filled with healers that are ready to come forward,” he said. “From a financing perspective, we’ve kept them out.” Then, “the examination of policies” could become an “examination of the contradictions between our experience and what’s happening in the real world,” as long as there were no “missing voices.” As Mathai sees it, that hasn’t fully happened yet. “A young person to this day still cannot disclose having heard voices without being connected to a dangerous outcome,” he noted. “Even the very funding that we received for first-episode [psychosis], although wellintentioned, was connected to Sandy Hook, which was an assumption that if you increased mental health services you would reduce school
shootings,” Mathai said. “That is an actual false assumption,” which “ends up perpetuating an attitude that makes it more difficult for somebody to want to live next to somebody like me.” For this reason, among others, Mathai has continued to speak up. “If you know me, you
Chacku Mathai know that one of the things that I need when I’m struggling is to be able to tell my stories,” he said, praising the NAMI Vermont organizers for including a “story-sharing process” within Mental Health Advocacy Day, where people like him could mingle with others. “I’m just taking a turn.” Mathai said community is crucial, which could be why he’s dubious of “core competency” standardization initiatives that may threaten to deaden the vibrancy of peer support groups. He said he hopes existing providers can figure out how to become “partners” with their clients by “honoring and aligning with what matters most to that person.” Survivors, in turn, must find the courage to put themselves “in the driver’s seat” of their own processes, exchanging mere compliance with professional treatment for an uncertain path toward self-determination, he said. “There’s a lot of expertise in this room,” Mathai observed. “Trust yourselves. Trust that voice inside of you. “I have voices that I hear today that I trust. Not all of them. And I started to mistrust the ones that were so sure of themselves. That was part of my process.” NAMI Vermont, Vermont Care Partners and the Vermont Association of Mental Health and Addiction Recovery sponsored the event.
Updates from The Key The following items are reprinted from The Key Update, a monthly e-newsletter from The National Mental Health Consumers’ Self-Help Clearinghouse which offers news and resources on a variety of mental health-related topics. For the latest edition, go to www.mhselfhelp. org/the-key-update-latest
Report Highlights Peer Specialists
A new report by the Bipartisan Policy Center Behavioral Health Integration Task Force — “Tackling America’s Mental Health and Addiction Crisis Through Primary Care Integration: Task Force Recommendations” — highlights the effectiveness of peer support. The 124-page report, published in March, includes numerous mentions of peer support. “One provider type that should be considered for coverage under Medicare is peer support specialists,” it said. “These professionals use their lived experience and training to help patients navigate care systems and sustain recovery,
especially in patients with severe mental health conditions or substance use disorders.” The free report can be downloaded at bipartisanpolicy. org/wp-content/uploads/2021/03/BPC_ Behavioral-Health-Integration-report_R01.pdf
Hearing Voices Network Online
“There are now online opportunities to connect, share experiences, and find mutual support,” the Hearing Voices Network writes. “These groups are accessible via web-based platforms and by phone… Online groups are specifically for those with personal lived experience with hearing voices, seeing visions, and/or negotiating alternative realities. They are voice-hearer facilitated. For information, contact info@hearingvoicesusa.org.”
Crisis Line Will Track Callers
In July 2022, 988 is scheduled to replace 1.800.273.TALK, the current federally funded National Suicide Prevention Lifeline. But some mental health advocates say that the new number
— which will include geolocation technology, as 911 does — has the potential for police showing up at the caller’s door. “Autonomy and choice outweigh any benefits of geolocation services,” said disability rights activist Jess StohlmannRainey of Rocky Mountain Crisis Partners in Denver. For the article, on the Disability Visibility Project website, go to disabilityvisibilityproject. com/2021/04/19/the-new-national-mentalhealth-crisis-line-wants-to-track-your-location/ And for a Mad in America article, “Suicide Hotlines Bill Themselves as Confidential — Even as Some Trace Your Call,” go to www. madinamerica.com/2020/11/suicide-hotlinestrace-your-call/ Also, Mad in America is collecting information about suicide hotlines in order to provide a list of numbers that do not trace or send help without consent under any circumstances. To participate, go to form. jotform.com/210945953137157
NEWS . NEWS
Summer Fall 20182021
7
Forensic Care, Facility, To Get Study By BRETT YATES
Counterpoint News Analysis
MONTPELIER — Public safety concerns expressed by several crime victims helped drive the legislature this spring to take action to reform the state’s forensic mental health system, including the possibility of constructing a separate facility for patients committed by a criminal court. While the new law authored by Sen. Dick Sears of Bennington will make only minor immediate changes, it may lay the groundwork for a more significant future overhaul of how the Department of Mental Health treats those accused of a crime, and what restrictions they may face. “Forensic mental health” refers to psychiatric services for individuals who’ve faced criminal charges. Upon a judge’s declaration of incompetency to stand trial or a verdict of not guilty by reason of insanity, a defendant may enter the custody of DMH. What happens next — and how that process might benefit from change – will become the subject of study by a “working group of interested stakeholders” over the next year. This reflects a compromise — or perhaps only a delayed reckoning — between victim advocates and civil libertarians, one year after Sears introduced a hard-charging bill that sought to attach a mandatory three-year involuntary commitment to any successful insanity defense following homicide charges. DMH Deputy Commissioner Mourning Fox wrote then that the bill would violate a law requiring the department to provide care “in the least restrictive setting possible” according to a clinical judgment. The Senate passed a rewritten version during the 2020 legislative session, but it failed to gain Sen. Dick Sears traction in the House of Representatives after the coronavirus pandemic reduced legislative capacity. In early 2021, however, a murder of a young woman in Bennington prompted a new outcry for safeguards after details emerged about the suspect, including a court’s earlier dismissal of an alleged parole violation on the basis of incompetency. The suspect was reported to have a diagnosis of schizophrenia. The victim’s mother was one of those who testified before the legislature. She has lobbied for a separate forensic facility and more restrictive laws. Sears then reintroduced his bill, but instead of attempting to immediately impose new statutory requirements for involuntary commitments, he now sought only to compel DMH to examine models for a public safety board – such as the Connecticut Psychiatric Security Review Board – that might impose additional barriers to release for psychiatric patients deemed potentially dangerous by the public. His bill also gave prosecutors the right to ask for a second opinion when a court-ordered examiner finds a defendant incompetent to stand trial and provided for a notice to victims if a person was released from a secure hospital. Although the Senate passed the bill in March, substantial revisions in the House, in particular regarding the timing of the working group’s
reports, gave rise to a lengthy back-and-forth between the lower and upper chambers until an agreement was reached just a day before its adjournment for the session. One disagreement with the Senate version was a section also opposed by advocates. The clause aimed to prohibit an examination of a defendant’s sanity unless a psychiatrist or psychologist has first found the defendant competent to stand trial.
A new forensic facility would increase the number of locked beds in the system. While the question of sanity applies to the defendant’s state at a fixed point in time – the moment of the alleged offense – that of competency remains ongoing, which means that a new trial may take place upon its restoration. In a March interview with Vermont Public Radio, Attorney General TJ Donovan could not recall a single instance of a Vermont jury issuing a verdict of not guilty by reason of insanity. Prosecutors, however, do often drop charges if a psychiatrist’s evaluation suggests that such a verdict would likely occur. Before the House Committee on Health Care, Wilda White, founder of the advocacy organization MadFreedom, urged lawmakers to allow sanity examinations to take place without postponement. “If a person is undergoing a competency exam and the attorney knows that they’re going to be raising the insanity defense, it’s in the best interest of the defendant and justice to allow the examiner to examine both sanity and competence at the same time,” she said, “because if the person is adjudicated incompetent, there could be a long delay before they ever get to trial, and evidence could be lost because of that delay.” White gave an example from her own life. “I was a person who experienced psychosis and mania for a long period of time, but after it was over, no one could tell that I had been incompetent, and no one could believe that I had been psychotic or manic. “I had a civil trial following my period of psychosis, and many of the witnesses couldn’t remember things that had happened when I was psychotic, and I was less able to present my case at trial.” In the enacted law, a defendant may request simultaneous evaluations of competency and sanity. Other changes proposed by the House which the Senate accepted included elimination of any explicit mention of the Connecticut model for mitigating “public safety risks” and a stipulation asserting the rights of defendants to obtain personal copies of medical professionals’ reports about their sanity and competency. The House also blocked – until a further study – notice to the courts when a forensic patient on an order of nonhospitalization fails to comply with the required treatment order. Legislators pointed out that the bill had not specified the extent of noncompliance necessary to trigger the notice. By a separate provision that was accepted by the House, the victim of a criminal offense will receive notice prior to a hospital’s or secure residential facility’s release of a forensic mental
health patient previously charged with that crime. The House required the working group to include “three individuals with lived experience of mental illness, at least one of whom has lived experience of the criminal justice system or the civil commitment system, or both, appointed by Vermont Psychiatric Survivors.” They will join a team of at least 20, including three crime victim representatives, as well as representatives from the Department of State’s Attorneys and Sheriffs and the Vermont Medical Society. The final bill requires the study to include “due process requirements for defendants held without adjudication of a crime and presumed innocent,” models for competency restoration that don’t rely on forced drugging, communitybased forensic treatment models, and other topics at the intersection of mental health and criminal justice. The longest tug-of-war between the House and Senate focused on the dates upon which DMH would deliver up to five reports to the legislature. The reports include making a recommendation on whether public safety and patient treatment requires a segregated DMH facility for forensic psychiatric patients who currently are held in the same hospital with others in the state’s involuntary mental health system. Currently, about 20% of the state’s 45 Level 1 beds for highest security inpatient care are in use by forensic patients. They represent about 6% of Level 1 admissions but have a longer average length of hospitalization. A new forensic facility Wilda White would increase the number of locked beds in Vermont’s mental health system, a prospect that yielded fierce objections from psychiatric survivors during the legislature’s separate discussions this spring on DMH’s ongoing plan to build a secure long-term facility in Essex. In the end, legislators decided that the first report will arrive no later than January, 2022 and the final report by that September. A separate report requires DMH and the Department of Corrections to evaluate the state of mental healthcare within Vermont’s prison settings by next February.
Average Annual Psychiatric Inpatient Hospital Admissions, 2015-2000
5,500 5,000 4,500 4,000 3,500 3,000 2,500 2,000
1,500 1,000 500 0
Forensic Involuntary Admissions 45
All Involuntary Admissions 520
All Inpatient Admissions 5,250
NEWS .
Fall 2018
8
Town Hears the Voices of Survivors By BRETT YATES
BRATTLEBORO — The confluence of psychiatric treatment and policing became one of the major subjects of a 224-page report exploring alternative approaches to public safety commissioned by the Select Board. The report came in response to public demands to reduce the police budget amid nationwide unrest following George Floyd’s murder at the hands of the Minneapolis Police Department last year. The report is now a blueprint for emerging work by the town leadership. Stories about involuntary psychiatric interventions and the Brattleboro Police Department’s role in supporting them were prominent in the facilitators’ summary of the process. “I was policed and controlled rather than supported and regarded as a dangerous person rather than someone who might potentially be in danger,” one person said. Residents also told a pair of town-appointed researchers about practices they had encountered at local institutions such as Brattleboro Memorial Hospital and the Brattleboro Retreat. Shea Witzberger, an educator, and Emily Megas-Russell, a psychotherapist, were hired by the select board to examine law enforcement and related structures from the perspectives of marginalized groups while attempting to chart a path “toward a community that is free from white supremacy in all of its manifestations.” They wrote in the report that some of those interviewed had “named their experiences in the local mental health system as torture, particularly around experiences of coercion, forced drugging, restraint, seclusion, and use of force or violence. “Being punished for noncompliance in totally noncriminal situations, enforcement of mental health warrants, and other carceral responses to nonconsensus beliefs or extreme or altered states were described by one respondent as the functional criminalization of mental illness,” the report said. The select board agreed to spend $40,000 on the law enforcement review after turning down protesters’ demands to reduce police funding. The request for proposals, issued in August, emerged out of a coalition of nonprofit directors and activists (including Witzberger and MegasRussell) who proposed a project rooted in “social justice, healing, and liberation.” Witzberger and Megas-Russell won the contract in September. As the facilitators of the Community Safety Review Process, they used surveys and public forums to solicit input from townspeople about local threats and support systems. In order to pay special attention to “people who have high contact with policing and policelike interventions,” they said they enlisted some of their allies – organizations like Out in the Open and the Root Social Justice Center – to convene private conferences with the LGBTQ+ community, people of color, young people and people with psychiatric labels. The facilitators reviewed these accounts alongside a paid nine-person committee composed of “a cross-section of Brattleboroarea residents,” including one self-identified psychiatric survivor, the report said. “Respondents who have experienced police response to an actual or perceived need for help related to mental and emotional health reported negative and harmful impacts from these responses,” they wrote.
“These harms include use of coercion, force, violence for noncriminal behavior, loss of autonomy over their healing, added trauma, and fear of seeking future help from mental health organizations that collaborate with the police and have the power to psychiatrically incarcerate them.” Direct testimony appended their observations. “Our needs for safety are not being discussed. Instead, it’s about how the community needs safety from us,” one participant said. “Why can the hospital call the police on patients who are resisting violence being done to them, but patients can’t call the police when they are being mistreated or abused?” another asked. Malaika Puffer, a peer specialist who assisted professionally in one of the review’s listening sessions, also spoke out personally about the problems of psychiatric screenings during a public forum. “I think it’s quite rare that there are opportunities to talk publicly about harm in the way that this process made space for,” she said later.
“Our needs for safety are not being discussed. Instead, it’s about how the community needs safety from us.” She also said she was enthusiastic when she saw the results in print. “My sense reading it was, ‘Wow, this is so meaningful and exciting to have out there in the world for people to engage with,’ because I think the average person who hasn’t been immersed in the mental health system would have no idea that the kind of harm that’s mentioned there is happening all the time.” The report, released at the end of the year, did not advocate directly for defunding the police but concluded with a set of 41 recommendations for shrinking the police department’s footprint and building new safety responses. It met with “quite a lot of support, at least publicly,” in Witzberger’s view. Several members of the public weighed in at select board meetings. Among them was a doctor who had retired from a career in emergency medicine in New Hampshire who took issue with the report’s indictment of the mental health system, saying there were dangers posed by patients during mental health crises. “We actually had to end up building a little mini prison in the emergency room in Keene. And it was terrible,” he recalled, “but there was a reason we had to do that. “And the reason is that once someone says that they’re at risk of hurting themselves or someone else, we have a legal and moral responsibility to make sure that doesn’t happen. “And to talk of all these gentler and noncoercive systems is great, but at some point we also have to recognize that there are things pushing us in the opposite direction.” A response came promptly from a former patient, who said that “I have my own personal experience with that mini prison that was constructed in Keene, and I don’t think it helped any. In my experience, it was a dark room and being ignored, and it did not involve any effort
to prevent people from harming themselves.” Each member of the select board stated their gratitude and admiration for the report, but debate over how to begin to act upon it lasted for three meetings. In January, the board decided not to adopt any of its suggestions as a binding mandate, choosing instead to turn the document in its entirety over to the town manager, Peter Elwell, who, with his staff, would evaluate their feasibility. Elwell returned in March with a chart that explained whether its unilateral implementation lay within the town’s powers in the case of each recommendation. He requested permission to develop a discretionary plan to incorporate as much of the report’s guidance as possible over the following weeks, months, and years, with “periodic status reports” provided to the board. Elwell urged the board to view the report “as a body of work, rather than as particular pieces of action to be taken.” The board agreed to his proposal; the first status update will take place in August. Witzberger called it a “soft commitment” – but a commitment nonetheless – by the town to “move forward with the spirit of the recommendations.” She and other organizers plan to hold officials “accountable to that in an ongoing way.” Elwell deemed that the town had the “legal authority and capacity” to follow through on 30 of the report’s 41 reforms. Most of the proposals pertaining specifically to mental health response, however, belonged to the minority of recommendations that, in his view, fell outside the town’s exclusive jurisdiction. The town had the power to move away from what were described as “harmful” training courses offered by Mental Health First Aid, NAMI-Vermont and the Vermont Suicide Prevention Center, and to end its Police Social Worker Liaison program, he indicated. But according to the chart, any endeavor to “invest in noncoercive supports as alternatives to police and police-like interventions in mental and emotional health,” such as “a psychiatric survivor-led mobile ready response, a crisis/ freak-out space, and unlocked, homelike crisis beds” as the report recommended, would be “more complex” than funding other recommended resources like community gardens or subsidized housing. Fulfilling a request to “decouple police from welfare checks,” similarly, would require expertise that the town alone did not possess, the chart indicated Witzberger said that as she sees it, this doesn’t mean the town won’t act. She said the chart merely reflects an awareness that “they would need to collaborate with or encourage collaboration among other organizations to make those things happen.” At 2021’s Representative Town Meeting, Brattleboro raised its human services budget from $190,105 to $276,400, with notable increases for organizations that had been praised in the community safety review, such as Root and Out in the Open. In the meantime, Witzberger hopes “that this report has broader utility than just for the town manager’s office. “We’ve listened to a lot of people’s experiences about social services, and I think that the responsibility for a lot of these changes will lie within social service agencies directly.”
NEWS .
Fall Summer 20182021
9
Police Reforms Spread Across US
Media from around the country are reporting on cities that are developing alternatives to using police to respond to people in a mental health crisis, according to updates provided by The Key, a publication of the National Mental Health Consumers’ Self-Help Clearinghouse. There are also new federal funds that can assist with implementing such alternatives, The Key reported, citing an article from the Associated Press, “Feds Fund Mental Health Crisis Teams to Stand In for Police.” The article reports that “Dispatching teams of paramedics and behavioral health practitioners would take mental health crisis calls out of the hands of uniformed and armed officers, whose mere arrival may ratchet up tensions. In Eugene, Oregon, such a strategy has been in place more than 30 years, with solid backing from police.” The article can be found at apnews.com/ article/health-police-government-and-politicsmental-health-coronavirus-f8931f4907b46b49 dfb4dea651d7e1e7 Reports on initiatives already underway include: A local news station in New York City reported that a pilot program that diverted police officers away from many mental health crisis calls in parts of Manhattan is to be expanded to every precinct citywide. The program relied on social workers and emergency medical services to respond to non-violent mental health crisis calls and was tested in the spring in three Harlem and East Harlem police precincts. The station quoted Mayor Bill de Blasio as saying that, “We’re now convinced that this approach is going to work citywide... So, for mental health crisis calls, we’re going to take that civilian approach and use it in all precincts in the city in the course of the upcoming fiscal year.”
The Inquirer in Philadelphia reports that, “Following other cities, Philly will soon send specialists alongside cops to some mental health calls: Other jurisdictions are trying more aggressive plans that leave the first response to mental health emergencies entirely up to healthcare providers, not police. It could be in Philly’s future.” The article can be seen at www.inquirer. com/news/philadelphia-police-mental-healthspecialists-co-responder-unit-20210504.html. A report on multiple initiatives was published in The Guardian. It was introduced with the headline, “These US Cities Defunded Police: ‘We’re transferring money to the community’” and opened by saying, “More than 20 major cities have reduced police budgets in some form, and activists are fighting to ensure that is only the start.” See, www.theguardian.com/us-news/2021/mar/07/ us-cities-defund-police-transferring-moneycommunity. An article in the American Bar Association Journal headlined that, “Police are often
first responders to mental health crises, but tragedies are promoting change.” See, www. abajournal.com/magazine/article/police-areoften-first-responders-to-mental-health-crisesbut-tragedies-are-prompting-change An article on a program in Fort Collins was titled, “How a Colorado Town Is Untangling Behavioral Health Care from the Criminal Justice System.” See, https://www.coloradoan. com/in-depth/news/2021/03/22/fort-collinscolorado-mental-health-untangling-criminaljustice/4624239001/ Opinion articles are also promoting alternatives to police responses. “People with mental health issues are 16 times more likely to be in a police encounter than other civilians,” Current Affairs reported. “[W]hen we continue to invest in police, prosecutions, courts, jails, and prisons — instead of true mental health intervention and response — our communities are not made safer or healthier. Instead, people die. “But police shootings and killings don’t tell the full story of the impact of the criminalization of mental health issues on the people, families, and communities most targeted by police, especially Black and Brown people.” See, www. currentaffairs.org/2021/03/our-normalresponses-to-mental-health-crises-are-notworking An opinion column in the Washington Post said, “We rely too much on the police. Rather than defunding the police, we need to reimagine public safety. “When we need help, we need someone other than armed officers to call for help. We can make neighborhoods safer just by changing the physical environment.” See, www.washingtonpost.com/opinions/ interactive/2021/reimagine-safety/
Slow Tapering May Reduce Relapse
A new study supports the recommendations of a 2007 peer guide that slowly tapering the dose of antipsychotic drugs can enable patients to reduce the risk of relapse when seeking to discontinue unnecessary long-term use. The study, “A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse,” was published in the Schizophrenia Bulletin’s March issue and can be found at doi.org/10.1093/schbul/sbab017 The study reported that “it should be recognized that tapering periods of weeks down to a minimum or half-minimum therapeutic doses of medication are likely to be inadequate to avoid withdrawal symptoms, including early relapse.” Instead, it suggested that “in those who have received antipsychotics over prolonged periods, tapering regimes over months and years down to small portions of drug doses are more likely to be effective.” The concept of a slow reduction of doses over a
longer period of time for a successful withdrawal was described in 2007 in the publication “Harm Reduction Guide to Coming Off Psychiatric Drugs,” published by the peer-run Icarus Project and Freedom Center. Like the 2007 peer report, the new study observed that “Abruptly stopping antipsychotic medication is the method most likely to induce relapse and withdrawal symptoms.” When physicians do not consider patient requests to reduce or stop an antipsychotic medication, patients are more likely to stop medications abruptly, the study authors said. It also pointed out that, “Although evidence for the benefits of antipsychotic medication in short-term treatment is established, there is an ongoing debate about the need for and benefit of prophylactic long-term antipsychotics in every person with schizophrenia.” Because of “adverse effects of long-term antipsychotic medication (movement disorders,
such as tardive dyskinesia, metabolic effects, and effects on brain structure) and, importantly, patient preference, it may be reasonable to attempt reduction or cessation of antipsychotics in people with nonaffective psychotic illnesses who have remitted after treatment, guided by psychiatrists,” it said. It noted that “there is currently significant uncertainty about what proportion of patients might be able to stay well without antipsychotics, with numerous antipsychotic discontinuation studies in progress, but some suggest it may be up to 40%.” It added that “these concepts are germane to the broader context of the practice of deprescribing in medicine, as part of highquality prescribing practice, aiming for an optimal balance of benefits and harms in the use of medication.” It suggested that there was a need for the establishment of formal guidelines for tapering antipsychotics.
DRVT Announces Its New Director
MONTPELIER — A.J. Ruben will become the new Executive Director of Disability Rights Vermont, replacing Ed Paquin, who served for almost two decades, Board President Sarah Launderville has announced. “We are excited for A.J. to begin his new role with us and at the same time, the reality of Ed leaving us is now in
sight,” Launderville said in a press release. “Ed’s work within DRVT and the disability rights movement has been extraordinary. To say he’ll be missed is an understatement.” Ruben has worked at DRVT as the supervising attorney under Paquin’s leadership for the past 18 years and was quoted in the release as saying
that “it has been a singular honor in my life. Ed embodied the best attributes of people striving to help others overcome unjust and unnecessary barriers to full and equal participation in our society.” Paquin said in the release he was comforted to be leaving with the agency in such able hands.
NEWS 10 NEWS
FallSummer 2018 2021
Health Inequities Bill Enacted
MONTPELIER — The legislature has passed a bill to create an Office of Health Equity to work towards “eliminating avoidable and unjust disparities in health” that includes psychiatric disability and race, ethnicity, other disabilities, and LGBTQ status as causes of worse health outcomes. The Health Equity Advisory Commission the bill creates to “amplify the voice of impacted communities” includes members to be appointed by Vermont Psychiatric Survivors, the Another Way Community Center, the Vermont Center for Independent Living and the Vermont Federation of Families for Children’s Mental Health. The commission is scheduled to begin this year and develop recommendations for the new office, which will be established by the end of 2023. “We have heard over and over from people with psychiatric disabilities who delay or avoid seeking care, having had the experience of medical providers dismissing physical symptoms as psychological, to those patients’ detriment,” Ed Paquin of Disability Rights Vermont told the House Health Care Committee. He said that the “negative effects of an unbalanced system” include not only the reduction in life expectancy but “on the personal dreams and ambitions that people daily forego.” Laurie Emerson from NAMI-VT also testified in support, and cited extensive data on the health disparities experienced due to psychiatric diagnoses. Americans with serious mental
illnesses die 15 to 30 years younger than those without mental illness, and that gap is growing, she said. Emerson pointed to one study that found that “nearly half of all patients withhold critical information about their mental health out of fear, embarrassment and judgment,” and that “over 70% of those surveyed said the reason they would not disclose information about suicidal thoughts or depression was because they were embarrassed, feared being judged, or lectured.” Emerson testified that some people would not seek out help because of distrust of the medical system, “in fear of being harmed, involuntarily committed or treated with disrespect.” She gave as an example that people who are seen in the emergency room for a mental health crisis are required to strip down into a gown, “sometimes in front of a stranger whose job is to ‘watch them.’” “We would recommend that medical professionals — especially emergency room professionals — receive additional training to better understand trauma informed care that will benefit their care and treatment of someone who may be experiencing a mental health crisis,” she added. Emerson told the committee that access to treatment and providers is a barrier, including waiting lists. “We need to ensure that individuals with mental illness can access the care they desperately need” to reduce health disparities, she said in her testimony. She also pointed out that disparities due to lack of access to “the basic necessity of a stable home” and the reliance on use of psychiatric medication can have adverse long-term side effects that “shortens life and adds more physical issues.” “The lack of safe and affordable housing is one of the most powerful barriers to recovery,” Emerson said. Emerson said she learned at one meeting that “doctors who have a
Studies have shown that health outcomes are strongly affected by “social and economic factors” such as housing and poverty. People diagnosed with psychiatric disabilities are frequently noted as among those disproportionately affected by those factors. specialty in physical medicine are paid double if not more than a primary care doctor which is understandable since they have a specialized expertise. “However, someone with a specialty in mental health counseling is paid the least. Why do we devalue our mental health as a society and not pay the same as specialists in physical health?” Also testifying in support of the bill was Wilda White, founder of MadFreedom, an “advocacy organization whose mission is to secure political power to end discrimination and oppression of people based on perceived mental state.” She said that MadFreedom was a member of the Racial Justice Alliance, another group supporting the bill, and she was speaking on its behalf as well. She pointed out to the committee that “people who are discriminated against based on their perceived mental state is a very unique population because we cross all demographics... all races, all genders.”
Budget Adds to Mental Health By BRETT YATES
MONTPELIER — Including its annual budget for the new year, the legislature passed two appropriations bills during the 2021 legislative session. The first, which became law on April 17, fasttracked $63 million in federal COVID-19 relief from the American Rescue Plan Act, sending $5.3 million to the Department of Mental Health. Of these one-time funds, $4 million are targeted to making “existing housing and
community-based service facilities providing mental health services more accessible, safe and compliant with the Americans with Disabilities Act or to expand capacity in community settings.” At least one such grant is to go to a peer-run or peer-directed organization.
A priority is “organizations that demonstrate the greatest ability to respond immediately to the need for housing;” they are not permitted to be for projects that will require additional state funds for operating costs in future years. “These are unusual opportunities,” Rep. Bill Lippert, who chairs the House Committee on Health Care, said. “The numbers that we are using are extraordinary compared to the numbers that we would ordinarily have available to even think about.” Another $150,000 of the DMH funding will allow peer support agencies to offer emergency outreach services to address a pandemic-induced uptick in mental health needs. In the past, DMH grants for peer services have included services at Alyssum, Pathways Vermont, Vermont Psychiatric Survivors and Another Way. In May, the legislature passed its annual appropriations bill, which will fund government operations for fiscal year 2022 at a total of $7.17 billion.
The “big bill,” as it’s called, includes a pilot program for a mobile mental health response team in Rutland using $600,000 in onetime money, meaning it will require a new appropriation if it is to continue beyond a year. In a presentation before the House Committee on Appropriations, DMH Commissioner Sarah Squirrell said an increase in the number of Vermont children who visit emergency departments for mental health crises – especially in Rutland, per data produced by DMH and the Department of Vermont Health Access – was the basis for the program. She cited a Child Health & Development Institute study that, she said, suggested that the same service in Connecticut had cut ED trips by 25% among the children it reached. Mobile response teams’ interventions – which, according to Squirrell, can also forestall “the need for law enforcement” in the lives of children facing emotional or behavioral challenges – typically take place at a child’s home or school and use a family approach. “When we think about a comprehensive crisis system of care, we really want to lean into ensuring that, for children, youth, and families, we can have a much more proactive, home(Continued on page 11)
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State Apologizes for Sterilization MONTPELIER – Ninety years after Vermont passed a law to encourage the sterilization of “the insane and feeble-minded” that were filling state institutions, a formal apology was issued by the legislature. The resolution passed by both House and Senate chambers states that the General Assembly “sincerely apologizes and expresses sorrow and regret to all individual Vermonters and their families and descendants who were harmed as a result of State-sanctioned eugenics policies and practices.” According to Nancy Gallagher, in her book Breeding Better Vermonters, the practice of eugenics was based upon the scientific theory that socially undesirable traits were genetic and that the population could be improved if individuals with those traits did not have children. With the help of laws passed by the Legislature, the eugenics movement quickly became focused on sterilization, segregation and
with a corresponding increase in burden cast upon the communities and the State.” “The Supervisors of the Insane in their biennial report recommend the enactment of a properly safe-guarded sterilization law. You will do well to give this matter serious consideration,” he said. A Burlington Free Press editorial of the time asserted that “something must be done to control the mental defectives in Vermont, both for the sake of improving the population generally and in order to control the rapidly mounting costs of the department of public welfare.” It went on to say, “The question arises whether we are going to continue trying to keep up with the increase in mental defectives by adding more buildings and appropriating more money to operate them, or adopt the new policy of confining only the more dangerous cases and allowing others their liberty after sterilization to guard against reproduction of their kind.” The Rutland Herald later reported that, “Increasing difficulties in meeting the growing population of insane and feeble-minded are indicated in a statement... [by the] superintendent of the State Hospital at Waterbury.” “‘The overcrowding,’ he says, ‘at the present time is especially urgent...’” The House Committee on General, Housing and Military Affairs, which took testimony and worked on the resolution for almost three years, found that stigmatized ethnic or racial populations were identified as being “degenerate” and thus included in those considered to be “mental defectives” addressed by the law. The resolution said that “the legacy of the eugenics movement continues to influence some of Vermont’s current policies and legislation” and that the legislature needed to continue “to work to eradicate the lasting legacy of its prior actions by listening to and working with the affected individuals and communities.” The legislature should take further action “to address the continuing impact of Statesanctioned eugenics polices and related practices of disenfranchisement, ethnocide, and genocide,” the resolution said.
MENTAL HEALTH INITIATIVE BUDGET • Continued from page 10
Commissioner Leaves
institutionalization of any Vermonter deemed “less-than,” Senator Brian Collamore said when he presented the resolution to his colleagues. “We did not apply these same principles of delinquency, dependency and deficiency to everyone — only the poor, those deemed by others to have defects and those who were clearly of a different ethnicity than those making the determinations,” Collamore said. Individuals were first institutionalized to prevent “the increase in mental defectives.” Still, the growth of state institutions – the Vermont Asylum for the Insane and the Brandon Training School – were becoming costly. In 1931 the legislature passed a sterilization law so that patients could be released without fear they would procreate, Gallagher reported in her book. The efforts at legislation began in 1912 when a bill was passed to “authorize and provide for the sterilization of imbeciles, feeble-minded, and insane persons, rapists, confirmed criminals and other defectives,” but was vetoed by the governor, the resolution said. The policies “also targeted individuals, families, and communities whose heritage was documented as French Canadian, French Indian, or of other mixed ethnic or racial composition and persons whose extended families’ successor generations now identify as Abenaki or as members of other indigenous bands or tribes,” it said. Vermont Psychiatric Survivors shared research with legislative committees that demonstrated discrimination against those who were deemed to be insane as underlying the law. The history included comments made by the new governor in his 1931 inaugural address, telling the legislature that, “I call your attention to the fact bes her reri sc e d e sh h that the numbers of our ook, in whic Gallagher’s b y c n a N f o r insane and feeble-minded ve The co Vermont. in s ic n e g u e is constantly increasing search on
based, community response,” Squirrell said. “When we’ve had roundtable discussions with children and families, in terms of needs in the system of care, this is always at the top of the list.” While DMH encourages its contracted community mental health centers to offer mobile response services, Squirrell acknowledged that some don’t have the resources to do so. They also do not do targeted family response, she said. Squirrell said she views the pilot in Rutland, which will be paid for with state funds, as “an opportunity to see how we can leverage Medicaid” for future funding that could take the program statewide. The new year’s budget includes a 3% increase for the community agencies, which contrasts with an average of 4.1% salary increases for state staff doing similar jobs. The agencies have cited ongoing inadequate funding for the challenges in maintaining staff and access to their services, pointing to a statewide vacancy rate of 780 positions. The overall budget allocates a $282.8 million budget to DMH, an increase of $5.1 million over
fiscal year 2021, with most of the total coming from federal dollars through the state’s Medicaid Global Commitment Fund. State salary increases, electronic health record upgrades, and a “justice reinvestment” of $400,000 to strengthen community mental health services for parolees account for some of the budget’s growth.
WATERBURY – Sarah Squirrell, Commissioner of the Department of Mental Health for the past two years, has announced that she will be stepping down as of July 1 for a family move out of state. The Agency of Human Services has stated that a search is being conducted for a replacement. The position is an appointment made by the Governor.
Voluntary Patient Rights Added
MONTPELIER – The legislature passed a bill this spring that requires the Department of Mental Health to track use of restraint and seclusion with voluntary psychiatric patients just as it is tracked for involuntary patients. Legislators took up the bill after reviewing data from the Brattleboro Retreat that showed extensive use of restraint on a mostly voluntary adolescent unit there. The new law requires that patients being admitted to a psychiatric unit in a hospital be informed that the unit may be locked and that they can be prevented from leaving and placed in involuntary status if a treating physician
believes they are a danger to themselves or others. Involuntary patients must also now be informed of the right to request a change to voluntary status as part of the posted notice of patient rights. The law extends the date for DMH to report to the legislature annually regarding the length of stay in emergency rooms for individuals who are seeking psychiatric care, whether voluntarily or involuntarily, as well as the number who are admitted and their length of stay. A requirement for collection of data on use of restraint and seclusion for psychiatric patients in emergency rooms was discontinued.
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Summer 2021
Book Review By ANNE DONAHUE
Counterpoint
Vesna Dye, who moved to the United States from Croatia in 1982, describes the “Slavic soul” as one known for depth, strength and compassion within a people “of a melancholy disposition, with very deep emotions, often suffering from some psychological ailment, for example, depression.” Croatia is a land of starvation, hardship and war, Dye says, and she immigrated to America because she was tormented by the heaviness of that soul and wanted to find the optimism and resilience she admired of Americans. “(B)ut deep inside, I still carry my wounded, heavy and brooding Slavic soul.” It is that soul, however, that brings such depth to her stories and poetry, including those she has collected into a book, “A Stranger in Never-Never Land.” (RA Press, 2019) They reverberate deeply for anyone who has struggled with darkness and sought the light. Her book, much like her life, divides her stories and then her poetry into memories from Croatia and America. She moved to Vermont in 1996, and some of her later poetry is sprinkled with references to familiar places – Cherry Street, Huntington Gorge and the Burlington waterfront. On one October drive, she reflects on the Vermont countryside: “With the river flowing between a meadow and a hillside, Farmhouse and horses, it reminds me of my homeland. Half of me is already back – The landscapes blend together But I feel I am flying with the birds And feel homeless in both places.” That captures her feelings of being a stranger in both of her homelands, “living alone in my memories and in the world of my imagination.” Her memories of Croatia include stories of personal struggles such as her flight out of the war-torn country, and her strained relationship with her father, who was an engineer who built bridges and dreamed of a daughter who loved math, not poetry. In a paragraph that captures a writing style that blends memory and symbolism, she writes, “Over time, my father’s bridges began to crumble. I waited at the opposite shore, waving to him. My father refused to build a bridge to me. I jumped into the water while pages from a math book drowned all around me.” Her writing is deeply descriptive and evocative, as in this opening verse from a poem that recalls a village in Croatia: “Summer brands the flat land, Muddy water swells the village river, Clear blue sky opens above young corn stalks. Horses become restless in stables Feeling the warm wind in their nostrils.” Dye has been published in Counterpoint a number of times, winning the Louise Wahl Memorial Writing Contest recently for the short story, “Face in the Moon,” which is among those in the book. Her poetry won first place three times, which led Counterpoint to change its contest rules to limit entrants to one first-place award. (The contest has a changing panel of independent judges, and writers are not identified, but other emerging artists were being closed out by her entries.) Reading this collection, that should come as no surprise. Available on Amazon: Vesna Dye’s “A Stranger in NeverNever Land,” is the world of not only change and transition, but of alienation and dislocation – both in physical and spiritual sense. Croatian/English poet, writer and translator Vesna Dye weaves tales and poems that span from the partisans of World War II, to the author’s early life during Yugoslavia’s wonder years under the President Tito, to the Civil War in the 90’s, to the author’s life in America.
The photo on the jacket cover, taken by Dye, is from the balcony of her family’s apartment in Zagreb, with a view over her old schoolhouse.
Empowerment for Gina
You and I on the waterfront on a swing near the lake While people roller-skate and bike on the path Their radiant faces tanned. We talk about our lives Wondering why we carry so many scars That don’t allow us to move on. Is it possible to just replant them in another pot And see them grow anew, shooting for the sky? “Where is our home? I ask you. “We live everywhere and nowhere, There’s no place we belong to,” you reply. “We are upper class homeless.” I laugh first, then you laugh as well As we watch the sailboats gliding over peaceful water. The clouds are already gathering, A storm will break tonight. Barefoot we’ll dance in the streets, Raindrops filling our scars, Washing away our past. from “A Stranger in Never-Never Land” by Vesna Dye
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The Old Friend Calls Beautiful old evenings ago knowing the worries for our children’s future would show through – the painted still lives we wanted to awaken before the unpainted alarms could not be mistaken for what we took for granted in those days of freedom... a joy now tracking and tracing anxiety of friendship deployed. They canceled the world to make it our own commercialized soul traded out for their phone... disturbing the comfort of your bed filled with bad dreams from coronavirus messaging the dead.
By TA MA By COLBY LYNCH
Bridges
Montpelier
A short story from “A Stranger in a Never-Never Land.” For book review see page 12.
(A tribute to my father, a civil engineer who passed away in 2012 at the age of 89.) For thirty years, every day from 7 a.m. to 3 p.m. my father drew plans for roads and bridges in a small office with his two friends. My father was never late for work, except when the streetcar or his Ford were the cause. My father never got drunk on his job, not even when I was born. My father had great hopes for me. I was a big, fat baby who liked to sleep a lot. Later, I grew into a small, fat little girl who liked to daydream a lot. My father hoped I would like math. Bridges were smaller and narrower thirty years ago. As time passed the bridges started to grow, became stronger. The roads got broader. My father’s name never appeared in the newspapers; he worked in anonymity and walked the streets incognito, a leather case under his arm. No one was ever able to look into the constructive brain of my father — he drew, calculated, erased, calculated again and at the end, the bridge would be named for someone or something else, according to the whim of those in charge: the bridge of a National Hero or the bridge of Unity and Brotherhood. I did not inherit the constructive brain of my father. I always failed my math tests in school. My father hired tutors — slim, starving students who devoured my mother’s wiener schnitzels with the appetites of sharks. “I like poetry,” I told the students. “You need my father’s money, but, you see, not even if my life were in jeopardy would I ever study math.” Firmly, I would then close my math books.
? t r A t o G
The rejected formulas ground their teeth, functions increased from fury, the circle chased the square, the hypotenuse slammed the naughty short side of a right triangle. At the end of each school year, I would earn a D in math. The reason I did not fail the course was that my mother knew my math teacher personally. The son of our neighbor was my math teacher’s husband. My mother, dressed in her red coat with matching red hat and shoes, came to visit my math teacher at the end of each school year. My mother had been a model before she married; her figure was still slim. My classmates would stare at my mother’s red heels and that red hat. Once, my mother bought me a pair of boots that looked like a chess board. “Where did you get those boots?” I remember my math teacher asking with her deep laugh. The walls shook. The circle on the blackboard jumped. The straight line danced rock n’ roll. After I graduated from high school, I studied English and Art History at the University of Philosophy in Zagreb. Here, there was no math. I burned all my former math books, ripped up all my math notebooks, broke rulers and tossed compasses into the garbage. Over time, my father’s bridges began to crumble. I waited at the opposite shore, waving to him. My father refused to build a bridge to me. I jumped into the water while pages from a math book drowned all around me. Math was vengeful. It came into my dreams. “Vesna, you didn’t learn the lesson again.
You didn’t do your homework. You will fail again.” Pythagoras crawled from the math cabinet to beat me with a ruler. I obediently stood in a corner. Heavy, gray Zagreb rain was falling. The bridges faded into mist, the roads became more slippery. One day I packed a few things in my backpack and jumped a train. My father stood at the station in his gray flannel suit with a black umbrella under his arm. I escaped into the wide world to become a poet. I burned all the bridges behind me. American roads were large, smooth, infinite. Cars rolled over them like jetpropelled roller skates. American bridges were so long and high that the people, in despair, threw themselves into the cold ocean waters from them. I sent my father a postcard of the Golden Gate Bridge. During the full moon, my father now travels in his astral body across the bridge. He wears a blue suit topped by a French beret. My father tries to cross the bridge to me. The cables shine in the moonlight. The noise of the cars cannot silence the song he sings to himself. The song of a bridge that connects all the waters on earth. The song of the bridge that connects us to each other. I still can hear him, his song and slow steps across the concrete. The mist falls, covering the shores. But my father is not tired. He walks through the fog, throwing breadcrumbs to seagulls ...
By VESNA DYE Burlington
Share It! Send it to us at: counterpoint @ vermontpsychiatricsurvivors.org or by mail to: Counterpoint, The Service Building, 128 Merchants Row, Suite 606, Rutland, VT 05701 Please include name and town
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Louise Wahl Memorial Writing Contest
Gratitude:
A Story of Becoming Free of Torment from Voices I had an ego when I was young. I watched television a lot and TV and film stars were how I understood success. School wasn’t my gig. I had no ambition for work or in achieving anything. My ego was tied in with my parents’ status. With where they had gotten me, not where I had gotten by myself. I graduated from high school but I really did not know how I did it. I didn’t worry about my future. All I knew was my parents were sending me to college. I measured success not by achievement or work but by money and materialism. It was probably a good thing that my parents sent me to college. I would see a challenge I could not attain. Finishing school. It turned out even going to college became too much for me. I was not smart enough even though I didn’t want to admit it. I had an ego and did not want to lose but I started having episodes with schizophrenia and had to drop out of school even though that wasn’t the only reason I had to leave. I wasn’t doing well enough. These voices would torment me so that I could not cope. So, my mother tried to get me on some medicine that would stop voices. It didn’t work and these voices would stay to taunt me until I was in my late fifties. I was living in Vermont then and found a book about how to cope with voices. When I was in college I did learn about literature and reading and learned therefore a little about what real life was built upon. I also met a friend there who told me he used to be a certified nursing assistant and talked about what he did. When I dropped out of college this was a job I thought I could work. So, I worked and heard voices every now and then. I didn’t have much of a life. It was sometimes miserable. I usually couldn’t understand the voices but I was paranoid about them and thought they were trying to hurt me. I didn’t read about people accepting their voices until many years later when I had a support system that helped me lose my voices altogether. Sometimes when I was driving a car I would hear the voices and think they were in another car trying to scare me and distract me from my driving, which is what I believed. That experience was dangerous. I also thought the voices were laughing at me and fighting against me so that it was a terrible kind of challenge to me. In my episodes I was trapped in a barrage of communication against my will. No medicine I took stopped me from hearing the voices until I was living in Vermont and in my late fifties. And I also read a book that said you must work with the voices, you must not let them control, you must let the voices know you will not give them power. This helped my voices disappear I believe with the help of the medicine. Before this I was living homeless and that’s
when the voices got worse and the voices became specific characters. My life has had no top and ‘til now it has also no bottom. I lived the lowest point when I became homeless and it turned out on the contrary to be not that bad of an experience. When I would walk places when I was homeless I would encounter cars that would be chasing me. They would be my voices but I really thought it was happening. I came to Vermont after being homeless for about four years. And by then I was hearing voices so badly that I couldn’t sit in a room without yelling right back at the voices. But here it was different, people wanted to help me in spite of the pressure of voices. I even got in trouble with the police disturbing the peace because I was yelling again “back at the voices.” People would think there was something I could do to stop yelling but my mind
Photo credit Brett Jordan
would force me to talk back for my sanity. The voices had to be told they were wrong. I got into a shelter and the Pathways to Housing people who were helping me got me into an apartment. I stayed in this apartment for about six months and was very grateful and astonished these people from Pathways were still wanting to help me. This first apartment didn’t work out because my neighbors didn’t want to listen to my yelling. So, Pathways helped me get an apartment a little further away from town and I thought because it was quiet that the voices would stop. Well, they didn’t and I couldn’t sleep at night because of the incessant yelling of the voices. I tried to stay and put my pillow and blanket out on the porch thinking if I was not in the apartment trying to sleep, the voices would not be trying to bother me. I was mistaken, they did still try to bother me. I would then get up and go for walks along the roads. I would also hitch rides trying to get away. One time I went to Lake George, NY, another time I went to Cooperstown, N.Y. I would have no place to go and the police would take me to the psychiatric hospital of their town and I would tell them where I lived and call Pathways to Housing and they would work out a way home for me, such as getting me a bus ticket. After this happened I didn’t want to be homeless anymore or left alone. Then my people wanted to see me get more help and I went to Brattleboro Retreat.
2
I was hearing voices and calling my family from the hospital yelling at them not to go along with the voices who I thought were real people in film asking people to come and see them for a part in a movie. Then the voices would kill whoever came out. Fortunately, my family didn’t believe it and the voices remained a piece of my imagination. I could do nothing to help myself even though I was scaring them. Since they knew I was in the hospital they thought also I was trying to get some help. The hospital kept me there in a safe, stable place for a few weeks. I got involved in therapy classes I really liked, and got on a new medicine with a new doctor. This medicine was not the one that would stop my voices but it kept me sleeping which was a long time needed. My days weren’t swallowed up with worrying about the voices. I was also making a lot of friends with the nurses and my doctor. I remember once I was having to talk back with my voices and the nurse said to the others to leave me alone so that time they didn’t put me in a sound proof room. And they began working with me so that at the end of my stay they believed that I was trying to help myself. I went back to the same apartment that Pathways to Housing had gotten for me before I went into Brattleboro Retreat. And I was just so pleased that they had kept my apartment for me. I was building a bond of trust with my people. I was still hearing voices and I took one step at a time. I was making friends also at a dropin center called Another Way. They are sensitive to a following of psychiatric survivors who deal every day with mental illnesses. I went there for their patronage also. I was eating community meals with friends. And I was seeing Pathways to Housing caseworkers on a weekly basis or sooner. I tried not to hear the voices and then Pathways sent me back to Brattleboro upon my permission and they got me on another medicine. It was on this medicine and reading about how not to give the voices power that the voices stopped. It was an answer to prayers, everything became peaceful. All the craziness and torment stopped and I was free. I had someone who helped me turn everything around and realized that I wasn’t trying to hurt anyone. Now I have a beautiful apartment in a quiet neighborhood, am receiving social security and rental assistance. I am living a very positive, normal life with no voices. Pathways people help me twice a week and I welcome those services. I have a steady boyfriend who my caseworkers accept and value as he is my life support. They encouraged me to have a wonderful relationship with my family. I couldn’t be more thankful to everyone.
By BELLE CASHMAN Barre
The Louise Wahl Writing Contest first place winner in prose was published in the winter issue of Counterpoint.
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Summer 2021
Time’s Practical Joke, Miss Me Please Serene happenings garnered not without the gentle caring that goes along with considering one’s self
That’s 20, twenty years too soon. That’s a full 20, where i could speak to my sister... tell her the usual, and more pointedly, the unusual. Not to mention gems of friends i’ve cultivated friendships with... i miss them already. My inner fortress rusting and getting primarily dusted from lack of attentive seriousness at these very daunting facts. Feeling restless sadness at the real possibility of my symptoms getting worse. I think of that elder warrior, almost slain in the movie ‘Gladiator,’ by Maximus... blood running from his mouth as he knelt in pain. Like every moment like it is your last... well yes... alas... those moments should not be rushed, but for me, they are.
Rutland
Up On His Shoulders Every once in awhile I notice my forehead rests on the tips of the fingers of my left or right hand. Like I’m pondering something serious. It’s a gesture that often makes me think about my Dad. My Dad in church, especially. A somber and prayerful position of the head and hand. He had reason to be sometimes downcast. As a boy, in the Great Depression, he’d gotten familiar with foster homes. Tuberculosis and one or two too many alcoholic parents, I have to guess. But he somehow came through. Grew up and raised a family. No damage you’d call permanent. A dry sense of humor that I guess he passed along to his kids. But sometimes I see him, in my mind’s eye, in that serious and ponderous pose. Like that bent-down, crouching guy you see pictures of. A sculpture. Holding the world on his shoulders.
By DENNIS RIVARD, Windsor
letting go one’s past, present, future, hopes, dreams, ambitions, envy, desires, regrets, fears, anxiety, and, anything else not otherwise wholly experienced within the moment of a single breath deeply and intently inhaled and exhaled that is most essential to either life or living more fully.
By MORGAN W. BROWN Montpelier
Thinking aloud On a pink cloud With a shroud Doing our best To live with zest In our chest Is hope To cope With our pain
Feeling folly at the possibility of dying 20 years before i potentially could.
by ELAINE GAWRYS
Thinking Aloud
I ponder the white winter day outside my window searching for solace, hoping for time’s practical joke to miss me, most entirely.
Everywhere they go People like to show Kindness and generosity Blisses’ kiss To not be angry This way or that Under the sky For all to see In hope for thee In God’s line For us to divine Way up to Heaven For the twelve To serve God’s way Is help today To think our way Up on high Let out the poetry pie For us to have a try Paradise Denying the dice Each and every way To see our every day With light, love and liberty For us to be A friend to thee God Jehovah Allah in Heaven A prayer to thee For all eternity
By RON E, Williamstown
By GEOFFREY L. MCLAM, St. Albans
Louise Wahl Memorial
Writing Contest Enter the 2021 Contest: Deadline July 10 $250 in Total Prizes!
Named for a former Vermont activist to encourage creative writing by psychiatric survivors, mental health consumers and peers. One entry per category (prose or poetry); 3,000 word preferred maximum. Repeat entrants limited to two First Place awards. Entries are judged by an independent panel. Winners will be published in the fall, 2021 Counterpoint. Send submissions by email to: counterpoint@vermontpsychiatricsurvivors.org or by mail to: Counterpoint, The Service Building, 128 Merchants Row, Suite 606, Rutland, VT 05701
Include name and address.
16E EDITORIAL PAGE Editorial
FallSummer 2018 2021
Opinions
Social Constructs
What is a “social construct”? People sometimes use that term when they are saying that what society labels as a psychiatric illness isn’t an actual illness. And that is exactly what the definition is: a label that society gives a meaning to, which would not otherwise be true. Language itself is the best example. A bird is only a bird because we have all agreed to use the word “bird” to mean those things with feathers flying in the sky. The same critters would be gtuyrcs if we had chosen that word to identify them. The resolution apologizing for eugenics that was passed by the legislature this spring demonstrates that mental illness was used in the past as an invented term used to repress the “unwanted” in society. The forced sterilization efforts of the state were used against people in the state’s institutions: both the institution for the “insane” and the institution for the “feeble-minded.” A rallying cry of the eugenics movement was to prevent those who were unfit from having children because they would pass on their negative traits. Keeping them in state institutions was the only way to keep them from “breeding,” and the growing numbers were costing the state too much to care for. Sterilization would allow them to be released without worrying about unfit children being born. Who were these “unfit” people? According to the resolution – based on research – they were Vermonters of Native American Indian heritage, including Abenaki, French-Indian and French Canadian families, persons of mixed ethnicity, the poor and persons with disabilities. Society wanted more “good old Yankee stock” and fewer of those who were spoiling the gene pool, so these people were deemed to be insane and feebleminded to have a reason to place them in state institutions then sterilize them, and then allow them to leave. The “mental illness” they suffered from was society’s illness: determining people to be unwanted. In more recent times, the Diagnostic and Statistical Manual listed homosexuality as a mental illness. Those individuals could be kept from doing what society did not want them to do if they were in an institution. When society changed its views, homosexuality was dropped from the DSM. Bingo! A mental illness, cured. Either that or another social construct of mental illness eliminated. Is there a parallel to eugenics when we forcibly medicate people so that we can discharge them and keep the numbers down in our institutions? Is there a parallel to mental illness being a social construct for people of color or of a different sexual orientation, and it being a social construct for people who don’t behave in the ways society deems to be “appropriate”? It took the hindsight of history for society to apologize for eugenics to keep the “unfit” from bearing children and to acknowledge that homosexuality was not a mental illness. It may take history to tell us if society will acknowledge that some other causes for a diagnosis of mental illness are also primarily a social construct.
Publisher’s Commentary
Meeting the Needs of All Peers By KARIM CHAPMAN The conversations about secure (locked) residential facilities in Vermont are difficult. There is an obvious need to replace the existing secure facility. Middlesex was constructed using two unpleasant, deteriorated, connected trailers. The Department of Mental Health states there are seven beds in this facility. Unofficial reports are that these seven beds are constantly in use, and there is often a waiting list. Vermont should consider itself fortunate to house people who need this level of care in a facility located in Vermont. Our peers with psychiatric labels should be thankful that Vermont is willing and able to build a new, safe, clean and adequate facility to meet the particular needs of some while keeping aware of future needs and expansion. Those opposed to replacing this facility argue that the money budgeted for a new secure facility would be better spent on peer support and community-based services. I say that both peer services and residential facilities are needed. Usually, secure facilities restrain, seclude and deliver unwanted medications. I do not support these treatment methods, yet I want to offer options rather than demand that we stop using them. There are cases where restraint and seclusion might be necessary to prevent people from hurting themselves or those who care for them. However, using these methods requires strict oversight by a doctor or charge nurse and prior agreement from the person to convey their treatment wishes. Further, at a recent meeting, DMH
announced it would not use such methods in the new facility. DMH will remove rooms for seclusion and restraint from the design plans. This change was achieved through the efforts of advocates talking to DMH. At a recent meeting of the Board of Directors for VPS, the Board took a stand on the issue with the following statement: “VPS does not endorse the use of restraints, seclusion or forced medication treatments for any person. However, there are cases where restraint and seclusion are necessary treatment methods to prevent people from hurting themselves or the people trying to care for them. Yet using these methods without strict oversight by a doctor or charge nurse, and prior agreement from the peer if they are able to convey their treatment wishes, is not in the best interests of the peer or the facility. “VPS endorses and supports the use of a peer support network or specialists who work for an independent, peer-operated organization. Peer specialists are trained to work inside facilities establishing relationships with the peers in a facility before an incident occurs. Peer specialists would be trained to deescalate a situation with passive, no-touch methods. “VPS endorses the building of a new, clean facility and keeping it in-state under state control, and building it with the future in mind so we will not have to send a Vermonter out of state for help and safe care. We must recognize that some peers need special services, and peer agencies must work together to provide the necessary services. “We also need to cooperate on developing adequate peer support services, so all needs are adequately met. We must not deny the existence of special needs, even for one person. It does not matter if we serve one or fifty, we must help, and it should not hurt to do so.” Karim Chapman is the Executive Director of Vermont Psychiatric Survivors.
17
COMMENTARY
Fall 20182021 Summer
Survivors Lobby Against Locked Residence During this year’s legislative session, psychiatric survivors spoke out against the plan to build a new, locked, 16-bed facility in Essex and the use restraint and seclusion there. These are excerpts from some of the letters they sent to legislators. Under pressure, the Department of Mental Health backed off of its plan to include use of restraint and seclusion at the facility. The legislature did still vote to fund the construction of the facility. See article page 1.
state hospital I am a former to been subjected patient who has le clusion innumerab restraints and se . re he w PCH and else times, both at V and always punitive Restraints were to ed ution never us a form of retrib ses ne else safer. Nur yo an or e m ep ke ts ed to use restrain lied about their ne ey ,” when in fact th “strictly for safety ey th e r and becaus use them in ange ve tients they percei get fed up with pa .. k. ea whereof I sp as difficult. I know setting up a The notion of “residence” involuntary locked “in from a hospital that is different , t in no other way intention only” bu ry makes a mocke is a travesty and ite needs — for resp of real Vermont wssum and for lo centers like Aly e housing income supportiv ER PHOEBE WAGN
over public reckoning At a time of deep rceral punitive and ca by ne do rm the ha ter to Black Lives Mat om fr , ns tio itu st in massive d Paris Hilton, a Britney Spears an and the e most punitive th of n io ns pa tal ex of Vermont’s men ts en em el al er rc most ca restraint, ture (namely: uc tr as fr in th al he isely drugging) is prec ed rc fo d an n io seclus ion to be going. the wrong direct e of fundamentally on t no is is is cr e ... th agination, t one of a lack of im mental health, bu ten willingness to lis un an , ly nt re pa and, ap vocates the wisdom of ad to the ideas and d its tal health crisis an en m of s or iv rv and su onses. institutional resp FHAR MIESS
As an LGBTQ+ person in a multiracial family, I am especially concerned because facilities like these disproportionately harm LGBTQ+ and BIPOC people. ISAAC LESLIE
There is no disagreement that the current Middlesex TCR can no longer be used. However, in replacing it at more than double its capacity with a facility that practices restraint, seclusion, and forced drugging, Vermont would be taking a huge and toward step unprecedented “care,” coercive expanding to nt despite its commitme moving toward an all-voluntary system. All along, psychiatric survivors and advocates have been left out of the process, beyond a few superficial “stakeholder” meetings where our input was not heard or recorded. However, it’s not too late to hear us now. CALVIN MOEN
cause “compliance” be ith w lp he t no es do iders and it ...Coercion really dialogue with prov e th om fr nt tie e real it alienates the pa they can avoid th so ut tc or sh a sy o ea like an easy gives providers to tients. It seems pa ith w g in at ic b while work of commun not doing the jo of ay w a st ju tually “out” but it’s ac the job. e job pretending to do doing the job, th ly al re t no ith w ay the form of If we try to get aw -- in this case, in us r fo g tin ai w e will still be ther broken people. the resources broken lives and e job -- providing th g in do ly al re ality If we focus on d having good qu an g in al he le op e pe ng term and that will facilitat ss work in the lo le t lo a be ly al th do lives, it will actu thrive. Which pa ill w le op pe r ou and ut? Or the real our communities s to be the shortc ar pe ap t ha W ? we want to take le’s lives we are thing? Because it’s peop g. in th al re e th Let’s choose talking about. HEIDI HENKEL
Please vote ag ainst a new ps ych prison. We need to decriminalize mental health break dow ns and provide su pport to people with mental health issues before it becomes a crisis. Locking more people up away from the commun ity is counterproductiv e. KATHRYN PARLI N
lth Vermonters with mental hea yment challenges need housing, emplo nt has and social connection. Vermo ources, invested so little in community res ating its that its lack of investment is cre ntions own need for more intrusive interve pitals. such as carceral, psychiatric hos It’s time to invest in Vermonters. WILDA WHITE MadFreedom
I am the executive director of Alyssum, the State’s first and only 100% peer run crisis respite... [T] he most frequent comment from people is “when will there be mo re Alyssums?” As a state why do we continue to put more money into hospital bed s, and ignore what the population DM H is supposed to be serving continu e to ask for... more peer sup port programs? The State’s 10 year “plan” includes more peer sup port. Peer support is evidence based and adequate funding for peer suppor t is desperately needed. GLORIA VAN DEN BERG
Photo credit Scott Graham
Our state needs to invest in com munity solutions that are effective for all involved, and not dependent on incarceration of those who need sup port and connection. This is an opportunity to take tha t step, or at least not walk backwards towards what has been proved again and again as harmful, violent, and ineffective. I encourage you to listen to those who have experienced these forms of “treatm ent” and their allies to recognize that there are better alternatives. Dedicating a large set of funds to building this facility would counter the experiences, demands, and visions from those whose voices should be front and center in these decision-making processes ANNE LOUISE WAGNER
18 COMMENTARY
FallSummer 2018 2021
Children in the ER: A Call for Help By JODI GIROUARD
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thought I was going to die. I was in the emergency room getting tested for my liver function, for my life to continue, for my world to go on spinning with me inside it. Behind the drab curtain my thoughts filled with the dim light, the realization that this could actually be it. But it was not to be as dark as that. There were other plans for me later. I was to write again. To read again. To hold my children and to fall into my husband’s arms and together sob for life come back. Life would be more complicated now but it would be a life still. Yet while I walked through the emergency room to my own room waiting for results, I could see the lines of safety workers in front of doors to other patients. The doors were half open and I could see the children, the young teens, the lost blank stares of ones who had been waiting too long for help and were instead locked in as boarders of the emergency room. A young girl about ten sat on a bed, her eyes wet with tears, the safety worker at the door plugged into the internet, the young girl’s gaze settling on me for just a moment. She knew I was just walking by, no lift of hope, no realized dream that I could help her out of the limbo she was in. I read a memo from a doctor that said a child with a broken leg gets treatment in four hours in the ER and that a child who goes in for mental
health treatment is held for an average of 72 hours before treatment can be realized.
The doors were half open and I could see the children, the young teens, the lost blank stares of ones who had been waiting too long for help and were instead locked in as boarders of the emergency room. My heart aches for these children living with a mental health disorder and also trying to get through the pandemic that has aggravated their symptoms. How many children are home more, with
neglect and abusive guardians? How many have no friends to talk to, now that there is social distancing? How many are burdened with trying to adapt to school on a computer? How many are lost and lost and lost because they aren’t seen as needing the social make up of a normal world? I want to give hope to those children that are called boarders of the emergency room. I want to challenge the state to find ways to immediately relieve the despair, the tragedy, the hurt that I saw locked in those young eyes I passed while in the emergency room. Please help them. Find a place for them to heal. Stop the wasted hours, the waiting room of a hospital bed for days and days and days. I believe that there must be a better alternative. I got my life back this week. It is now more complicated and still lived with a severe mental illness. I want those children to get their lives back. I want them to have the help that could bring back life to those listless stares, give them treatment to find that there is still much life worth living for them.
Jodi Girouard is a Counterpoint contributor from Burlington. After this commentary was shared with legislators, officials from the state were asked to report on immediate steps to address the crisis. Weekly counts from the Vermont Association of Hospitals and Healthcare Systems showed up to 19 children waiting on a given day.
How Can We End Homelessness? By MORGAN W. BROWN
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hat Will It Take to End Homelessness? The answers to the question posed might appear to be rather complicated as well as varied, depending upon who one bothers to ask and then carefully listen to. However, in the end, it is not necessarily merely about having enough permanent, affordable, decent and safe housing as well as deep subsidies available with which to make it possible for people with little or no income to be able to eventually become and remain housed (though these are, of course, sorely needed). It is also not merely about what many assume to be some of the reasons behind why people end up living unhoused (aka homeless) in the first place. It is always far too easy to blame those who experience living unhoused for what are assumed to be the reasons behind why and how they ended up there. Those and other widely and long held assumptions, myths and stereotypes must be consistently challenged and debunked by those who should know better. If there is ever to be a real sense of hope to find an answer to the question of what it will take to end homelessness, one must be willing to
explore more deeply (read: earnestly) as well as honestly what is actually behind the root causes of homelessness. Among the many root causes that can be found are age-old prejudice and discrimination, classism, sexism, racism, economic disparity, social inequity and injustice, enforced poverty, domestic abuse and violence, as well as deliberate indifference to all of the above and then some. Why is it, as a society, do we essentially deny people without certain means access to adequate housing as well as other basic human needs and, on a personal basis, shun them when our paths cross or otherwise avoid contact with them altogether?
Stereotypes must be consistently challenged. Absent providing the necessary housing and other needs in the meantime, and at the very least, why do we deny people living unhoused access to public bathrooms, bathing or showering facilities, places to do laundry, secure lockers to store their possessions, reliable transportation and indoor facilities to shelter from the elements? And, when they are forced to camp outdoors, why do we not protect them from harassment and being made to move on and having their possessions taken, seized or discarded, including when they might be camping on public land?
In the end, it is up to all of us to help answer these and related questions by educating both ourselves and each other concerning these and related matters as well as becoming better acquainted with those living unhoused, whether in general or on an individual basis if so inclined. Unless and until we do these things, nothing will change and the constant misery people living unhoused face on a daily basis will go unchecked and unchanged. If we manage to rise to the challenge, we might be better able to make a meaningful difference, not only in the lives of those who are most in need, but also within our community as a whole. We, as a society, can and must do better in these regards. It is up to each of us to see that it happens, particularly because elected officials as well as entrenched bureaucrats are often unwilling to do anything real and meaningful about these and other issues. It takes them being regularly informed (i.e., having their feet constantly kept to the fire) about how it should be an urgent priority and that humane action must be seriously undertaken, if there is going to be actual resolution. Morgan W. Brown formerly lived without permanent housing for several years and currently resides permanently housed within Central Vermont. He previously served on the Montpelier Homelessness Task Force.
Have Your Own Ideas About the System? Share with Your Peers! Send a letter or commentary to: Counterpoint, The Service Building, 128 Merchants Row, Suite 606, Rutland, VT 05701, or to counterpoint@vermontpsychiatricsurvivors.org.
COMMENTARY COMMENTARY. .
Fall 20182021 Summer
19
From the Front Lines
Sharing Experiences, Despite Odds By LAURA SHANKS
“Helping [one] to cross And [two] to cross: Such a bridge I wish to be, Yet I am merely helped to cross.”
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recently came across this poem by a female Zen priest, Shundo Aoyama, through a wellness studio I work with here in Vermont. Its truth has stuck with me lately. In helping others, we inevitably help ourselves. As a teacher, I learn just as much from my students as I hope they learn from me. As a patient representative with Vermont Psychiatric Survivors, I am helped just as much as I hope to help those I represent. As I consider how my role as a patient representative has unfolded over the past six months since my last article, my heart smiles. While we never received essential worker status, regularly scheduled weekly and bi-weekly virtual visits have now been implemented at all designated facilities here in southern Vermont
and their reception and popularity continue to grow. As a colleague recently brought to my attention, research surrounding virtual versus in-person support doesn’t exist yet. So, while yes, in-person assistance will always offer more authenticity, in a time when masks are still mandatory, being able to offer a maskless smile to peers through a screen has been invaluable.
As a patient representative with Vermont Psychiatric Survivors, I am helped just as much as I hope to help those I represent. By far, the biggest concerns voiced to me by peers have been those surrounding housing (or lack thereof) and the decline of community support services such as groups. On my end, these concerns have often left me feeling helpless. The affordable housing shortage
and drop off of groups during the pandemic are out of my hands, but I offer what I can; resources and connections paired with acceptance. The same way we must accept ourselves and each other as we are in order to truly change, we must also look at the world as it is; see both its horror and its beauty. “Do you have the patience to wait Till your mud settles and the water is clear? Can you remain unmoving Till the right action arises by itself?” ― Lao Tzu So, while resources remain limited due to the pandemic, I have found the greatest contribution I have been able to provide is that of peer support. Offering emotional reassurance, a smile, and just being someone to call for those who may not have anyone else, has been instrumental. Connection, mutual support and understanding provide fertile soil for blossoming relationships with those of shared human experiences, and despite the odds, we have still been able to provide this.
Laura Shanks is a patient representative for Vermont Psychiatric Survivors in southern Vermont.
Aiming for Greater Peer Support By NICOLE JULIAN
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e have all been experiencing what has become known as “COVID fatigue.” Frustration with businesses being closed, recreational activities canceled and missing our family and friends as we stay huddled in our residence attempting some sort of normalcy, which doesn’t seem to exist as the definition we all knew. We have turned towards technology to allow us connections to the outside world whether socially or for employment. But what about those who do not have access to a phone or computer and feel that isolation even more so than everyone else? After a year of dealing with this world-wide pandemic, mental health crisis and addiction has become an epidemic for even more people, even children. Why do I mention this? Because Vermont is experiencing this crisis front and center, without enough resources to assist and, most importantly, facilities to help our community. After the flood of 2011, Vermont scrambled to find a location for people in a mental health crisis, as there was not another location big enough to accommodate the needs of Vermonters. Today, this is still the case. The University of Vermont’s emergency department has seen an influx of patients, all
ages, waiting for “a bed” at a facility to open. Whether it’s UVM’s Shepardson units, or the Brattleboro Retreat (which is the only approved location to treat those under age 18) there continues to be a huge need for more available facilities. Simply put, I feel there are not enough resources or current hospital beds to accommodate the need of Vermonters who are experiencing a mental health crisis. I wish the answer was simple. I personally wish Vermont could magically come up with the millions of dollars needed to for community resources. Unfortunately, that’s just not realistic. While members of our community and state representatives fight for more resources for our mental health community, what can we do to help now?
I personally wish Vermont could magically come up with the millions of dollars needed to for community resources. Working at Vermont Psychiatric Survivors has taught me how important peer support is out in the community. That feeling of hopelessness that many people feel is something we need to begin to correct immediately. Having support from outside resources and a place to go for support should be at the forefront
to assist anyone experiencing a mental health crisis. Currently, recovery couches are able to go into the emergency room to assist a client who is experiencing a relapse, overdose or any substance abuse. However, I’ve found that this is not allowed for mental health patients. The stigma of a mental health crisis seems to exist even within this small state. I think a program allowing peer support in the emergency department for mental health crises would be a benefit for those who do not have that support on their own. There is a huge opportunity and need for community and peer support — whether it’s more local groups to assist people in crisis or actual programs aimed to negate the need for hospitalization. A major need is for drop in sites that offer peer support and a place to work through trauma without needing to go to the hospital. This will decrease the strain the emergency department is currently experiencing as patients wait for help. Vermont’s rural communities need more than just a place to call. People experiencing a mental health crisis in a small Vermont town are even more at risk as there are not enough programs reaching the nooks and crannies of this beautiful state. I believe we should use this pandemic as a learning experience and work towards building a better support system within our communities.
Nicole Julian is a patient representative for Vermont Psychiatric Survivors in northern Vermont.
Reactions to Our Commentaries? Share Your Thoughts. Send comments to: Counterpoint, The Service Building, 128 Merchants Row, Suite 606, Rutland, VT 05701, or to counterpoint@vermontpsychiatricsurvivors.org.
20E COMMENTARY COMMENTARY
Summer 2021
A Call To Action to Our Legislators By DAN TOWLE
Testimony provided at a state legislative hearing on peer support. hank you for including me in today’s schedule. I am representing myself which reflects a number of roles in mental health that I will discuss later. The topic of my testimony today is community mental health services, specifically peer support. In summary I want to talk to you about “the power of peer”
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1. Defining peer support
What is peer support? Peer support has been described as “a system of giving and receiving help” based on key principles that include “shared responsibility, and mutual agreement of what is helpful.” Peer support workers use their own personal, lived experience recovering from a mental illness to support others in their recovery. This lived experience distinguishes PSW from traditional mental health service providers. What is a peer support worker? Peer support providers are people with a personal experience with mental health, substance use, or trauma conditions who receive specialized training and supervision to guide and support others who are experiencing similar issues toward increased wellness in a spirit of mutuality and compassion. In general, a peer supporter is an individual who has made a personal commitment to his or her own wellness and recovery and is willing to share what he or she has learned about their own MH journey in an inspirational way. What are peer support services? Peer support services include a wide range of activities, including advocacy, connecting individuals in recovery to resources, sharing experience, community and relationship building, group facilitation, skill building, mentoring, and goal setting. Peer support workers plan and develop groups, services or activities, supervise other peer workers, provide training, gather information on resources, administer programs or agencies, educate the public and policymakers, while all the time working to eliminate stigma and discrimination.
2. What about the benefits?
Peer support has been well researched and documented as a highly cost-effective, evidencebased practice with a myriad of benefits. Just to cite a few examples: ● In a 2003 study of patients diagnosed with schizophrenia, bipolar disorder and major depression some were treated with peer support services and others without. The patients who had peer support had better health outcomes and at lower cost. Moreover, those receiving peer support services experienced significant reduction in drug/alcohol use, improved mental and physical health, and increased social support for people experiencing homelessness. ● In 2003, the President’s New Freedom Commission on Mental Health identified peer support as the vehicle for psychiatric survivors,
peers, to share their knowledge, skills and experiences of recovery. ● In 2007, the Center for Medicare and Medicaid Services deemed peer support “an evidence-based mental health model of care” and issued guidelines to states for how to pay for peer services with Medicaid. ● Other research has demonstrated peer support is associated with significantly fewer inpatient and emergency service hours and significant improvements in healing, empowerment, and satisfaction.
3. What is my call to action?
● I am urging you to make peer support an integral part of mental health and substance abuse service delivery here in Vermont. ● People with extensive experience in peer support should be involved at multiple levels of planning and implementation of peer support services within the Agency of Human
Services and Department of Mental Health, the designated agencies and other major mental health organizations. For example, create a position within the agency or department for a seasoned peer support worker/volunteer/ advocate to oversee the comprehensive implementation of an advisory support for peer support services not only in mental health but also law enforcement and correctional. ● State statutes governing the practice of mental health professions should be amended to remove barriers that artificially restrict the scope of activities of peer support workers. ● Vermont should set aside an appropriate percentage of state funds that are specifically earmarked for peer support programs. ● Family and adolescent peer support services should be developed to complement adult peer services. ● We should assure that trained peer advocates are included among the groups of people permitted to provide crisis support in emergency preparedness and response plans. Specifically, as we are now looking at the intersection of law enforcement and mental health we should be looking to the optimal ways to use peer support workers in crisis situations
to help establish connections, deescalate and prevent violence while diverting those afflicted from emergency rooms and from traumatizing, locked inpatient psychiatric facilities. ● To help foster the growth of peer support workers, including at small, nimble nonprofits, state statues should seek to minimize the reporting burden while maintaining accountability in order to facilitate service provision and entry of peers into the services environment. ● Continue to support the Peer Workforce Development Initiative in developing Peer Specialist Certification. Certification and advanced certification play a critical role in promoting professionalism and in obtaining reimbursement for services, but opportunities for peers without certification to provide support should also be available. ● Suggest the Peer Workforce Development Initiative be funded to support research on the efficacy of peer support programs and different structural and training considerations that promote greater efficacy. In conclusion, I urge you to recognize, support and fund “the power of peer.”
Dan Towle presented an overview and call for action to the Health Care Committee in the legislature this past winter, and provided this written testimony. He included this background about becoming involved in peer support services. “I was... diagnosed with major mood condition 25 years ago in the middle of a career in corporate finance in Connecticut. I am also a survivor of multiple inpatient psychiatric hospitalizations. During the first 20 years of my mental health journey my two treatment modalities were medication and talk therapy... Finally, five years ago my worsening condition forced into me into retirement and I moved to Vermont. “Soon after moving to Vermont I discovered a peer support group run by NAMI-Vermont. Attending this group, tapping the power of peer changed my life. Over the years, since immersing myself in peer support, my recovery improved steadily and my mental health stability has been the best it’s been in many, many years. “My sustained recovery has enabled me to not only become a peer support worker and volunteer but also a mental health and peer support advocate and organizer. I am an operator answering calls for the Pathways Support Line and a volunteer support group facilitator and trainer for NAMI-Vermont. “In my advocacy work I represent the voice of Vermonters with lived mental health experience specifically on the Department of Mental Health’s Adult State Program Standing Committee and federal SAMSHA Block Grant Planning Council. Organizationally I am vice chair of the Peer Workforce Development Initiative which, among other tasks, is creating and delivering training to peer support workers across Vermont and developing a peer specialist certification program.”
COMMENTARY.
Summer 2021
Suicide: What Do People Need? By BONNIE L. BARROWS
I write this from my own perspective and do not proclaim to speak for all suicidal persons. Let it be known: The struggle is real. he world asks: Why do people c o m m i t suicide? They will ask what is wrong with them, how could they be so selfish, and why would they do this to me? They will say why did the person not want to live? Oh, how horrible, and what will their family, friends and loved ones do now? All of a sudden those asking these questions have become the “victim” of this suicidal person. People will spout mock sympathies, grief, care and concern. They will talk as if they were close to the suicidal person. They will even fight over the measly possessions and try to stake claim to whatever pieces the dead may have left behind. Too bad they didn’t fight this hard for the suicidal person to live. Ah, but you see, there is one thing they will not take from the person who is now dead. That is the blame. How dare one even suggest such an appalling thing. The nerve. The shame of it all! Let’s return to the topic at hand. Why do people commit suicide? I’m sure you would all love to know, right? Well let me, from my perspective, be the one to enlighten you. People commit suicide because they are tired. It is as simple as that. They are tired of fighting their own inner and outer demons, of fighting the world within and the world around them. They are tired of fighting systems and tired of fighting society. They are tired of being alone in their struggles and never getting a break. They are tired of existing and never being allowed to live. They are tired of always being in survivor mode. They are tired of fighting for safe housing, for healthy food and water, for the very basics of life so as to get by. They are tired of the nightmares, the daymares and the never ending tv’s that play in their heads. They are tired of feeling like they do not matter and worse, being told that and shown that by the world at large again and again. They are tired of pretending that things can and will change. They are tired of being fed false hope and lies when life has shown them there is nothing left to believe in. They are tired of mind games and heartbreaks. They are tired of classifications, society’s forced roles and the masks they must wear to please everyone else. They are tired of being used and abused. Did I mention they are tired of being abused: Spiritually, mentally, physically, sexually, financially, socially and medically? They are tired of being neglected. They are tired of the cruelness of others and the dark side of humanity. They are tired of fighting to belong. They are tired of losing everything time and time again. They are tired of being judged. They are tired
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of being labeled. They are tired of being ignored. They are tired of being burdens. They are tired of being talked down to. They are tired of being told and shown that they are not good enough or worthy enough. They are tired of just scraping by to get through another day. They are tired of being kicked when they are down. They are even tired of their own pathetic selves, for even one’s body and one’s own mind can betray oneself. They are tired of all of the platitudes of buck up; it’s not that bad; you’ve survived worse; you are strong; you’ll overcome; you’ve been through worse; you need to focus on helping others; you need to calm down; you’re not being rational; you are too sensitive; tomorrow’s a new day; you need to think positive; you are being too emotional; you are just being manipulative; you to need to pray more and tum to God, and you need to be saved. You are putting everyone you love through hell or you are going to go to hell if you don’t straighten out, and more such bullshit. I’ve got news for you, the suicidal person lives in hell and they are tired of it.
People commit suicide because they are tired. It is as simple as that. They are tired of fighting their own inner and outer demons, of fighting the world within and the world around them. They are tired of fighting systems and tired of fighting society. Is it really suicide if the person is sick of the world that has been slowly killing them over their life time? If the medical world neglects them? If the medical world refuses to diagnose or treat them? If the medical world goes out of their way to block them from seeking answers and/or getting help elsewhere? If the medical world tries to put you in a box and refuses to think outside of that box? If the medical world has used you for testing and experimentation purposes? Is it suicide when the “Blueprint for Health” provides care based only on your “value to society?” Is it suicide when the medical world plays GOD determining who should live and who should die? Is it really suicide when society and systems force people into poverty, denying them help? Society and systems force people to endure hardships, more abuse and trauma and then they try to cover it up and sweep it all under the rug. All of these things and more can slowly kill a person. When you crush a person’s spirit, break their soul, you have succeeded in killing them.
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So, can you really call it suicide when that person is tired of it all and no longer seeks to fight, deciding to let the world win? Do you want to know what a suicidal person needs? They need systems and society to stop abusing them, stop treating them like they are gum stuck to the bottom of their brand new shoes. They need society and systems to change. They need society and systems to start owning their shit and for them to be held responsible and accountable. They need people to listen, to really hear them and to do so without passing judgement, without issuing their own platitudes and without giving advice unless it’s asked for. They need a place to feel and to actually be safe. They need to see action, not hear words from people. You must prove you are there for them and actually help them in whatever way they may need. They need to know that someone has their back and will stand up for them and stand with them. They need to know they are not alone. They need people to be honest, trustworthy and loyal to them, and for people to say what they mean and mean what they say. They need follow up and follow through. They need to know that when the going gets tough that you will not walk away. They need to know that someone cares enough. They need society to stop beating them up, medical systems and other systems to stop devaluing them, labeling them and working against them. They need to know they do matter. They need you to show them in life, the care and concern that you pretend to show for them, when they are dead. They need a break. They are tired. They need you to really hear this, to know this and to do something to help them with this. To those very few, very rare people who really did care about the suicidal person and who truly do try to help a suicidal person and who now blame themselves when the person follows through with their plan to end it all ... I say this to you: You tried, you did your best and they appreciate you for caring enough to have tried and for your being there for them. They would want you to know that the reason you could not save them is simply because they were so beyond tired that they no longer wished to be saved. They made up their mind and it had nothing what-so-ever to do with you. They were tired of being tired and had enough. If anything, you are probably why they hung in there for as long as they did. You are not at fault here and that is one regret they carry with them into the next realm. The choice to commit suicide was theirs and theirs alone. They need for you to understand this. Bonnie L. Barrows is from Middlebury. She identifies herself as being disabled with a multitude of serious autoimmune diseases and other chronic health issues and as someone who struggles with Complex PTSD, DID, Major Panic Disorder and Major Depressive Disorder.
Tell Your Story. Gain Strength from Sharing. Share your journey to healing: counterpoint@vermontpsychiatricsurvivors.org, or Counterpoint, The Service Building, 128 Merchants Row, Suite 606, Rutland, VT 05701
NEWS . 22E NEWS COMMENTARY
FallSummer 2018 2021
Reflections on 20 Years as Advocate By ANNE DONAHUE
MONTPELIER — It wasn’t his own sudden and serious disability that opened Ed Paquin’s eyes to the need to fight for disability rights. It was the voices of others who perceived him as an advocate because of that disability, he says. Now, more than 20 years after taking up the mantle for equal rights, Paquin is retiring from his position as executive director at Disability Rights Vermont and can look back from that vantage point to see both progress and continuing obstacles to achieving those goals. In an interview with Counterpoint reflecting on the past two decades, Paquin said he has seen a “much greater awareness” of what helps people – such as what peers have to offer – but “that hasn’t worked into policy yet.” “We’ve not progressed to the degree that I would have hoped,” he said, citing the “atrophy of our system” in supporting people over the long term with the kind of help they need. The opportunity for change exists, he said, but systems move slowly. Paquin nearly died in 1988 when he stopped to help at an accident scene where a truck had hit a power pole, and he came into contact with a downed wire. After a lengthy rehabilitation, he ran for the legislature and won a seat in 1994; his interests were health care and property tax reform, he said. However, because he used a wheelchair, organizations such as the Vermont Center for Independent Living saw him as an ally for their priorities and “introduced me to a rights perspective” of disability, Paquin said. “When I saw things framed that way, it made a lot of sense to me,” he said. He noted that he saw some major changes for those with disabilities during his seven years as a state representative, such as the closing of the Brandon Training School, an institution for people with developmental disabilities, and the legislation that allowed evaluations for involuntary psychiatric hospitalization to take place at community hospitals rather than bringing every patient to the Vermont State Hospital. Over the more recent years of decentralized care, however, Paquin said “the use of forced treatment has increased dramatically.” In 2002, Paquin left the legislature and took on his position at Disability Rights Vermont, a federally designated agency for the protection of rights of people with psychiatric and developmental disabilities. DRVT does mental health advocacy work directly and contracts out the developmental disability work to Vermont Legal Aid. That gave him a more direct vantage point for seeing both successes and failures. Paquin said he thinks the biggest steps backwards came in the 1980s when a change in philosophy led to the system becoming “more medicalized” with a much greater percentage of people left to remain dependent on Social Security disability support. He pointed to the renowned studies of Courtney Harding in the 1960s and ’70s, which found that as patients were transitioned from the state hospital with a robust focus on their individual needs, they progressed to living independently and to no longer needing to rely on the system. Community mental health center case managers now look at addressing the immediate needs of their clients in a system that “is not
geared to figuring out the best thing they could be doing” over the long term, he said. As a result, people who go too long without the kind of help they need and reach a point of emotional crisis and turn to emergency rooms, Paquin said. That exacerbates the crisis and often leads to forced treatment and a perception in the system that there is a need for an increased number of hospital beds to address people in crisis, he said, Ed Paquin at a Rights and Democracy rally against Medicaid cuts. “when what they need is closeness to other people and a healing progress that had been made with an individual. Disability Rights Vermont had a lawsuit environment.” against that state entity at the time, but despite Paquin believes much of the shift over time can be attributed to money. The medical that the commissioner wanted “to share a little parts of the system – which respond to crises bit of joy” about that person’s situation, he said. Nonetheless, he said, the system does need — automatically are funded through health constant pressure to improve. It can be difficult insurance to meet their inflation needs, he said. The private insurance market doesn’t cover for advocates to see positive change because long-term care needs, which depend on state they are “paying attention to what people need funding, and “there is a fear of increasing taxes that they are not getting” as their focus, he said. But despite seeing many things in the system at the same rate as private insurance,” he said. However, the solutions need to come through going in the wrong direction, with reduced community systems and through close human community supports and increased use of forced treatment, Paquin said that he has also seen key contact, Paquin said. He also thinks that medical professionals fail elements of progress. He cited the Housing First program, the fact to understand the harms that can result when that parts of the state were integrating peer they follow the route of involuntary treatment, saying that the professionals often “try very, very support and smaller organizations like Alyssum and Soteria. hard” to achieve outcomes that curtail rights. Alyssum is a peer-run crisis respite program “Due process rights are incredibly important,” in Rochester, and Soteria is a residence in Paquin said. “I just don’t think they understand the impact... that [it isn’t] as real for them Burlington that supports alternatives to medical as it needs to be.” He said that the lack of approaches for psychosis. Like Housing First, understanding becomes an implicit bias in how Soteria is under the umbrella of the peer-run agency Pathways Vermont. they address their patients. Those are programs that are really working, Paquin said that one of the great myths that he added, and they tell us that instead of has affected public policy is that the closing of large mental institutions resulted in filling assuming that hospitals will “get what they ask for” financially (leaving little for community prisons instead. While it is true that a high percentage of programs), we need to argue for more balanced people in prisons are being treated for mental overall funding. Paquin pointed to two areas of particular health conditions – some 40% of the people in pride in the work of DRVT over his years there. Vermont prisons are on some type of psychiatric One is the impact it has had as a partner “in medication – those are not the same people with improving a really bad system in Corrections” long term serious illnesses who once would have and in having “maintained a certain level of been at the state hospital, he said. Instead, it is the CRT program (community awareness and presence” there, he said. While support and rehabilitation) that supports most there are many issues yet to resolve on behalf of those several thousands of individuals who of prisoners with mental health diagnoses, it would have been institutionalized in the past, is “way ahead of where we would have been” without DRVT’s involvement, Paquin said. Paquin said; they are not in prison. He said it would be a mistake to only look Paquin said that he had “a great deal of at his agency’s legislative and policy work, respect” for “the people across the table” he has worked with over his years of advocacy. “There however, because helping individuals within the system “is most of what we do.” are people who care at every level.” “I’m very proud to have been connected “They may need [to develop a] different way with the excellent staff” who fight for those of looking at issues; they may need resources,” individuals every day, Paquin said. he said, but they do care. “It makes a huge difference in their situation. Paquin shared an anecdote about the commissioner of one department who called Win, lose or draw, they feel their humanity has him one evening to let him know about the been respected.”
Summer 2021 23 NEWS
Fall 2018 COMMENTARY
23
Around the World
Norway Offers Med-Free Wards
A new hospital option in Norway offers medication-free treatment wards, according to a news report by BBC. “Globally, there’s a reassessment of the way people with mental illness are treated and a will to reduce coercion,” the article said, but “while medication-free treatment is available in some other countries, Norway became the first country in the world to embed it as an option in the state-run mental healthcare system.” Now, “Psychiatrists and patients around the world are watching what happens in Norway, where the government has taken decisive action to try and improve the lives of psychotic people by giving them more power over their lives,” it said. The program developed after years of advocacy, led by a “patient user group” known as “We Shall Overcome,” the BBC said. “The most easy way to reduce force is to give people a choice, to give them a treatment they can say yes to,” the group’s chair was quoted in the article as saying.
In 2016, regional health authorities were first ordered by Norway’s health minister to develop medication-free treatment wards, the BBC said. Dr. Magnus Hald former director of mental health and substance abuse at the University Hospital of northern Norway, told the BBC that “he’d worked for years in units where a lot of drugs were used and was keen to explore an alternative treatment -- so he took on the job of running the hospital’s new drug-free department.” “To me, the most important thing is that people are allowed to try different kinds of possibilities,” the article reported him as saying. The BBC also quoted him asserting that, “You have to tell the truth to the patient about how the medication works and what you know about it. “And it seems that in co-operation with the pharmaceutical industry, they’ve told people things that are not completely correct about how medications work and what the risks are. “For instance, there is a myth that there is some kind of chemical imbalance in the brains of people with serious mental problems [and] there is actually no research that really supports this. The program has critics, the article said, including those who believe “the medicationfree movement is driven by ideology rather than evidence.” The BBC quoted Dr Jan Ivar Rossberg, a psychiatrist who lives and works in Oslo, as
saying, “We don’t have treatment approaches shown to be effective without medication,” and as pointing to “evidence that shows the best outcomes for people with psychosis involve medicating through the initial acute phase, when delusions and hallucinations are strongest, and staying on the drugs for around two years before trying to taper down to a lower dose.” The article, written by Lucy Proctor and Linda Pressly and published in February, can be found at www.bbc.com/news/stories-56097028. Vermont resident Heidi Henkel, who brought the article to the attention of Counterpoint, said the article didn’t surprise her. “Finland has been doing drug-free treatment for psychosis since the 1980s... [and] research shows better long-term outcomes with psychosis without drugs,” she said. “There are lots of excellent, very successful treatment options for psychosis, that don’t involve drugs. People who don’t want drugs should not be given drugs,” Henkel said. “They should be offered other good treatments,” she said, which would involve “Vermont mental health organizations learning and implementing some of these modalities. “We’re way beyond the point where just having tiny experimental pilot programs is sufficient. This stuff should be in the mainstream, and should be implemented well enough and broadly enough to make forced drugging a rarity,” Henkel said. “Forced drugging only exists due to lack of effort to offer better care.”
Canada OKs Assisted Dying for Psych
“Intolerably suffering” Canadians who are not near the natural end of their lives now have the right to seek medical assistance in dying, and it “will eventually include people suffering solely from grievous and irremediable mental illnesses,” according to an article in the Canadian Press reporting on passage of a new law in March. The article said the expansion of Canada’s assisted dying law went into effect just over a week ahead of a final March 26 deadline imposed by the court to bring the law into compliance with a 2019 Quebec Superior Court ruling. “People suffering solely from mental illnesses will have to wait two years to gain the same right,” the article said. The article, written by Joan Bryden, continued: The government had initially intended to impose a blanket ban on assisted dying for people suffering solely from mental illnesses. But, under pressure from senators who believed that exclusion was unconstitutional, it subsequently put a two-year time limit on it. In the meantime, the government committed to setting up an expert panel to advise on the safeguards and protocols that should apply to people with mental illnesses. The government rejected a Senate amendment to allow people who fear losing mental competence to make advance requests for an assisted death. But it committed to launching within 30 days a joint parliamentary committee to review that issue and other unresolved matters, including whether mature minors should have access to the procedure.
“This is an important milestone, but there is more work to do.” The bill was triggered by two Quebecois with severe disabilities who went to court to successfully fight for their right to choose an assisted death even though their natural deaths were not “reasonably foreseeable.” But disability rights groups have strenuously opposed the bill, arguing it devalues the lives of people with disabilities, particularly those who are Black, racialized, Indigenous or otherwise already marginalized and face discrimination in the health system. They fear such vulnerable people will be pressured — either directly or indirectly through societal attitudes and lack of support services — to end their lives prematurely. Many mental health advocates have also weighed in against the eventual inclusion of people suffering solely from mental illnesses. They argue that it’s harder to predict the outcomes of mental illnesses, many of which can be treated, and point out that a wish to die is often a symptom of these illnesses. But Sen. Stan Kutcher, a psychiatrist and member of the Independent Senators Group who first proposed a time limit on the mental illness exclusion, argued that all competent Canadians suffering from irremediable and grievous illnesses, physical or mental, deserve the right to make their own choice. “It is not for us to decide if a person’s suffering is intolerable to them,” he told the Senate shortly before the vote. Dying with Dignity Canada welcomed the Senate’s sign-off on the bill, calling it “a momentous day for end-of-life rights in Canada.”
All 20 Conservative senators voted against the bill, several because they believed it didn’t go far enough, but most were fundamentally opposed to expanding the assisted dying regime, particularly to those with mental illnesses. In an emotional speech just before the vote, Conservative Senate leader Don Plett pleaded with his colleagues to reject the bill. “If there was ever a time to exercise sober second thought, it is now,” he told the Senate. “It is not often that we can truly say that with this vote we have the opportunity to save lives, to prevent the unnecessary premature death of the vulnerable, to offer hope to those who have lost it. But today we do.” For people who are near the natural end of life, the bill relaxes some of the rules for getting an assisted death. It drops the requirement that a person must be able to give final consent immediately before the procedure is performed. That’s intended to ensure that someone who has been approved for the procedure won’t be denied if they lose mental capacity before it can be carried out. It also drops the requirement that a person must wait 10 days after being approved for an assisted death before receiving the procedure. And it reduces the number of witnesses required to one, down from two. People not near death will face higher hurdles. Among other things, they’ll face a minimum 90-day period for assessments of their requests for an assisted death. They’ll have to be made aware of all alternatives, including counseling and they’ll have to be able to give final consent immediately before receiving the procedure.
24 Resources Directory SURVIVOR PEER SERVICES Vermont Psychiatric Survivors Peer Support Groups VPS Peer Support Groups are temporarily suspended during the COVID-19 crisis.
Summer 2021
NATIONAL SUICIDE PREVENTION LIFELINE 800-273-TALK (8255) 24/7 confidential support
VPS is a membership organization providing peer support, outreach, advocacy and education 128 Merchants Row, Suite 606, Rutland, VT 05701 802-775-6834
877-870-HOPE (4673)
Peer Support
Vermont Federation of Families for Children’s Mental Health
www.vermontpsychiatricsurvivors.org WARM LINES VERMONT SUPPORT LINE (STATEWIDE): 833-888-2557; 24 hours, 365 days [833-VT-TALKS] By call or text
PEER PLUS (STATEWIDE):
802-595-0588; 7 days/wk, 6-9 p.m.
MUTUAL SUPPORT NETWORK THE HIVE: info@hivemutualsupport.org www.hivemutualsupport.org 802-43-BUZZ-3 (802-432-8993)
CRISIS RESPITE
Alyssum, 802-767-6000; www.alyssum.org; information@alyssum.org
VERMONT PSYCHIATRIC SURVIVORS OUTREACH AND PATIENT REPRESENTATIVES (800) 475-4907 info@vermontpsychiatricsurvivors.org
HOSPITALIZATION ALTERNATIVE
Soteria House, information and online application at www.pathwaysvermont.org/what-we-do/ our-programs/soteria/ or call Pathways Vermont Intake Line, 888-492-8212, ext. 140
Some Peer Centers and Recovery Centers may be suspended during the COVID-19 crisis. Call to check on reopening schedules.
Peer Centers & Employment Support ANOTHER WAY, 125 Barre St, Montpelier, 802-229-
0920; info@anotherwayvt.org; www.anotherwayvt. org; see website for events calendar.
PATHWAYS VERMONT COMMUNITY CENTER, 279 North
Winooski Avenue, Burlington, 888-492-8218 ext 300; www.facebook.com/PathwaysVTCommunityCenter; www.pathwaysvermont.org/what-we-do/ our-programs/pvcc
Vermont Recovery Centers WWW.VTRECOVERYNETWORK.ORG BARRE, Turning Point Center of Central Vermont, 489
N. Main St.; 479-7373; tpccvbarre@gmail.com BENNINGTON, Turning Point Center, 465 Main St; 802442-9700; turningpointbennington@comcast.net
Samaritans Hotline
Statewide support for families of children, youth or young adults in transition who are experiencing or at risk to experience emotional, behavioral or mental health challenges. 800-639-6071, 802-876-7021
Pride Center of Vermont
LGBTQ Individuals with Disabilities Social and Support: Connections and support around coming out, socializing, employment challenges, safe sex, self-advocacy. During COVID restrictions, call (802) 860-7812
Brain Injury Association
Support Group locations on web: www.biavt.org; or email: support1@biavt.org; Toll Free Line: 877-856-1772
DBT Peer Group
Peer-run skills group. Sundays, 4 p.m.; 1 Mineral St, Springfield (The Whitcomb Building). tinyurl.com/PeerDBTVT
Trans Crisis Hotline
The Trans Lifeline (dedicated to the trans population) can be reached at 877-565-8860.
Crisis Text Line
Around-the-clock help via text: 741741 for a reply explaining the ground rules; message routed to a trained counselor.
LGBTQ Youth Crisis Hotline:
The Trevor Lifeline now at 866-488-7386. TrevorText Available on Fridays (4-8 p.m.). Text the word “Trevor” to 1-202-304-1200. Standard text messaging rates.
NATIONAL ALLIANCE ON MENTAL ILLNESS-VT (NAMI-VT): 802-876-7949 x101, or 800-639-6480; 600 Blair Park Road, Suite 301, Williston, 05495; www.namivt.org; info@ namivt.org
Connections Peer Support Groups
NAMI is providing its support groups by various alternative means during the pandemic. All meetings are facilitated by trained NAMI peers — individuals with mental health conditions who are at a good place in their recovery journey and want to help other peers get to a good place in their recovery. For more specific information, including on a new Central Vermont group, go to namivt.org/support/peersupport-groups/
Counterpoint publishes this resource directory to allow readers to seek out choices for support. Counterpoint has not reviewed or evaluated the quality or biases of these resources, and makes no representation about their value for any individual. Public Community Mental Health COUNSELING SERVICE OF ADDISON COUNTY, 89 Main St.,
Middlebury, 05753; 802-388-6751
UNITED COUNSELING SERVICE OF BENNINGTON COUNTY,
PO Box 588, Ledge Hill Dr., Bennington, 05201; 802-4425491
CHITTENDEN COUNTY: HOWARD CENTER, 300 Flynn Ave., Burlington, 05401; 802-488-6200
FRANKLIN & GRAND ISLE: NORTHWESTERN COUNSELING AND SUPPORT SERVICES, 107 Fisher Pond Road, St. Albans, 05478; 802-524-6554
LAMOILLE COUNTY MENTAL HEALTH SERVICES, 72 Harrel
Street, Morrisville, 05661; 802-888-5026
NORTHEAST KINGDOM HUMAN SERVICES, 181 Crawford
Road, Derby; 802-334-6744; 800-696-4979, 2225 Portland St., St. Johnsbury; 802-748-3181; 800-649-0118
ORANGE COUNTY: CLARA MARTIN CENTER, 11 Main St.,
Randolph, 05060-0167; 802-728-4466
RUTLAND MENTAL HEALTH SERVICES, 78 So. Main St., Rutland, 05701; 802-775-2381
WASHINGTON COUNTY MENTAL HEALTH SERVICES, 9 Heaton
St., Montpelier, 05601; 802-229-6328
WINDHAM AND WINDSOR COUNTIES: HEALTH CARE AND REHABILITATION SERVICES OF SOUTHEASTERN VERMONT,
390 River Street, Springfield, 05156; 886-4500; 51 Fairview St., Brattleboro, 05301, 802-254-6028; 49 School St., Hartford, 05047, 802-295-3031
24-Hour Crisis Lines: Involuntary Custody Screening
ADDISON COUNTY: Counseling Services of Addison County 802-388-7641
BENNINGTON COUNTY: United Counseling Service, 802-
442-5491; (Manchester) 802-362-3950
CHITTENDEN COUNTY: Howard Center 802-488-7777 FRANKLIN AND GRAND ISLE COUNTIES: Northwestern Coun-
seling and Support Services, 802-524-6554; 800-834-7793
LAMOILLE COUNTY: Lamoille County Mental Health, Week-
days 8 a.m.-4 p.m. 802-888-4914; Nights and weekends 802-888-4231
ESSEX, CALEDONIA AND ORLEANS: Northeast Kingdom
Human Services 800-696-4979
ORANGE COUNTY: Clara Martin, 800-639-6360 RUTLAND: Mental Health Services, 802-775-1000 WASHINGTON COUNTY: Mental Health Services, 802-229-0591 WINDHAM,WINDSOR COUNTIES: Health Care and Rehabili-
tation Services, 800-622-4235
Please contact us if your organization’s information changes: counterpoint@vermontpsychiatricsurvivors.org
BRATTLEBORO, Turning Point Center of Windham County, 39 Elm St.; 802-257-5600; tpwc.1@hotmail.com BURLINGTON, Turning Point Center of Chittenden County, 191 Bank St, 2nd floor; 802-861-3150; www. turningpointcentervt.org or GaryD@turningpointcentervt.org
MIDDLEBURY, Turning Point Center of Addison County, 228 Maple St, Space 31B; 802-388-4249; tcacvt@ yahoo.com MORRISVILLE, North Central Vermont Recovery Center, 275 Brooklyn St., 802-851-8120; recovery@ncvrc. com
Veterans’ Services HOMELESS PROGRAM COORDINATOR: 802-742-3291 BRATTLEBORO: Morningside 802-257-0066 RUTLAND: Open Door Mission 802-775-5661; Transitional Residence: Dodge House, 802-775-6772
BURLINGTON: Waystation/Wilson 802-864-7402 FREE TRANSPORTATION: Disabled American Veterans:
Toll Free: 1-866-687-8387 X5394
RUTLAND, Turning Point Center, 141 State St; 802-7736010; turningpointcenterrutland@yahoo.com
SPRINGFIELD, Turning Point Recovery Center of Springfield, 7 Morgan St., 802-885-4668; spfldturningpoint@ gmail.com
ST. ALBANS, Turning Point of Franklin County, 182 Lake St; 802-782-8454; tpfcdirection@gmail.com
ST. JOHNSBURY, Kingdom Recovery Center, 297 Sum-
mer St; 802-751-8520; c.boyd@stjkrc.org; j.keough@ stjkrc.org; www.kingdomrecoverycenter.com
WHITE RIVER JUNCTION, Upper Valley Turning Point, 200 Olcott Dr; 802-295-5206; secondwindfound.org; mhelijas@secondwindfound.org
Homeless?
Vermont Veterans Services (VVS) program for homeless veterans with very low income, call 802-656-3232.
www.MakeTheConnection.net Web site sponsored by The Department of Veterans Affairs with testimonials by veterans to help connect with the experiences of other veterans, and with information and resources to help transition from service, face health issues, or navigate daily life as a civilian.
Vermont Veterans Outreach BENNINGTON AREA: 802-442-2980; cell: 802-310-5391 BERLIN AREA: 802-224-7108; cell: 802-399-6135 BRADFORD AREA: 802-222-4824; cell: 802-734-2282 COLCHESTER AREA: 802-338-3078; cell: 802-310-5743 ENOSBURG AREA: 802-933-2166; cell: 802-399-6068 JERICHO AREA: 802-899-5291; cell: 802-310-0631 NEWPORT AREA: 802-338-4162; cell: 802-399-6250 RUTLAND AREA: 802-775-0195; cell: 802-310-5334 VERGENNES AREA: 802-877-2356; cell: 802-881-6680 WHITE RIVER AREA: 802-295-7921; cell: 802-881-6232 WILLISTON AREA: 802-879-1385; cell: 802-734-2123 OUTREACH TEAM LEADER: 802-338-3022; cell: 802-881-5057 TOLL-FREE HOTLINE (24/7) 1-888-607-8773
VA Mental Health Services
VA HOSPITAL: Toll Free 1-866-687-8387 MENTAL HEALTH CLINIC: Toll Free 1-866-687-8387 Ext 6132 OUTPATIENT CLINICS: Bennington: 802-447-6913; Brattleboro: 802-251-2200; Burlington Lakeside Clinic: 802-6577000; Newport: 802-334-9777; Rutland: 802-772-2300 VET CENTERS: (Burlington) 802-862-1806; (White River Jnct) 802-295-2908