Counterpoint Summer 2022

NEWS, COMMENTARY, AND ARTS BY PSYCHIATRIC SURVIVORS, MENTAL HEALTH PEERS, AND OUR FAMILIES

VOL. XXXVI NO. 4

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FROM THE HILLS OF VERMONT

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SINCE 1985

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SUMMER 2022

Legislature Nixes Peer Respite and Certification Bills

BY BRETT YATES

This spring, the Vermont General Assembly rejected an ambitious bid to expand and improve peer-based mental health services throughout the state. Neither of the two complementary bills drafted by Vermont’s five peer-led mental health organizations – Alyssum, Another Way, MadFreedom, Pathways Vermont, and Vermont Psychiatric Survivors – passed in any form during the legislative session.

Introduced by Sen. Cheryl Hooker of Rutland, S. 194 and S. 195 aimed to establish, respectively, a new network of seven peer respite centers and a statewide certification program for peer support specialists. The respites would have replicated the model developed by 11-year-old, Rochester-based Alyssum, a peer-operated overnight program in a homelike environment, to provide “person-centered crisis support,” as the legislation put it, in locations stretching from Bennington to the Northeast Kingdom. At the same time, the Vermont Department of Mental Health (DMH) would have contracted peer-led organizations to set official standards for peer support and to train, test, and roster peers.

Journeying between four committees in the

Senate and House, the legislation drew support from peers, psychiatric survivors, mental health consumers, executive branch officials, and legislators themselves, in addition to facing

various doubts and criticisms. Ultimately, a group of senators balked at the price tag: $2.525 million in total, reduced from $4.275 million originally.

The Senate Committee on Health and Welfare received the first testimony in late January, with advocates joining Commissioner of Mental Health Emily Dawes to endorse the bills. Stumbling blocks began to appear soon thereafter.

In February, the Office of Professional Regulation (OPR), which licenses Vermont’s psychoanalysts and psychologists, declared its availability to “assist with credentialing peer support specialists.” OPR’s process begins with a “Sunrise Review,” which, in the words of Director Lauren Hibbert, assesses “whether it’s necessary for the government to intrude into the marketplace.” Staff Attorney Lauren Layman told senators that OPR could submit a report

by Dec. 15, putting the legislature in a position to craft a peer certification law in 2023, rather than in the current legislative session.

“This is a new concept to us,” Layman said.

“When reading this bill, initially it was unclear to us whether there would be some form of psychotherapy being used by peers in support of other peers.”

MadFreedom founder Wilda White argued (Continued on page 4)

Budget Gives 8% Rate Increase to DAs

By BRETT YATES

The Vermont General Assembly concluded the legislative session on May 12 by passing an $8.3 billion state budget for fiscal year 2023 (FY23), which begins on July 1. $294,407,829 will go to the Department of Mental Health (DMH), $10 million more than it received in the FY22 appropriations bill.

The additional funds will shore up Vermont’s 10 Designated Agencies (DAs), the nonprofit mental health centers that, as DMH’s proxies, deliver community-based care across the state.

In order to receive reimbursement for services, the DAs bill Medicaid through DMH, whose expanded budget will allow the DAs to increase their rates by 8%. Under the new budget for the Department of Disabilities, Aging, and Independent Living, the five Specialized Services Agencies (SSAs) serving Vermonters with developmental disabilities will do the same.

The governor’s recommended budget had sought just a 3% boost in the Medicaid reimbursement rate for the DAs within a total appropriation of $287,273,887 for DMH. The legislature deemed this figure insufficient to address the DAs’ labor shortage.

“We’re asking our community-based provider system to continue to function with a 3% increase while state government is negotiating and asking for over a 10% for salary and benefits for state employees,” Sen. Jane Kirchel, chair of the Senate Committee on Appropriations, complained. “It just seems really inadequate.”

House Committee on Appropriations Chair Mary Hooper agreed: “The community-based partners are our front line of mental health care providers. And if they are essentially destabilized because their staff is making wise economic decisions or burnout decisions, I’m really worried about what’s happening in the

7 The Arts12

GUN SAFETY LAW

community and our ability to provide these services.”

Secretary of Human Services Jenney Samuelson pointed, however, to the state’s fear of spending beyond the limit set by the Centers for Medicare and Medicaid Services (CMS) for (Continued on page 5)

18

Eleven Years of Being Peers

2 Peer Leadership and Advocacy

Summer 2022

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 NAPS:

“The Value and Values of Peer Support” will be the theme of the 2022 hybrid conference of the National Association of Peer Supporters on Oct. 20 to 21. In-person events will take place at the Sheraton DFW in Texas. For more information, contact conference@peersupportwork.org.

NARPA: The National Association for Rights Protection and Advocacy will hold its 2022 Annual Rights Conference at the Doubletree Newark Airport in New Jersey from Oct. 26 to 29. For more information, visit narpa.org.

ISPS-US: The US chapter of the International Society for Psychological and Social Approaches to Psychosis will host a conference with the theme “Opportunity Through Experience: Psychosis, Extreme States, and Possibilities for Transformation” from Nov. 4 to 6. “People with lived experience, family members, clinicians and researchers” will offer presentations both online and in person in Sacramento, CA. For more information, visit isps-us.org.

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 2022, All Rights Reserved FOUNDING EDITOR Robert Crosby Loomis (1943-1994) EDITORIAL BOARD Kara Greenblott, Zach Hughes, 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 Brett Yates 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

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NEWS .

Summer 2022

3

Register Now

2022

Vermont

Date: Saturday, July 16th Time: 12:00pm

Location: Burlington, VT

Route:

Meet at Church St. and Main St. and march to Battery Park

Vermont Mad Pride is a march and celebration organized by psychiatric survivors, consumers, mad people and folks the world has labeled "mentally ill." Mad Pride is about challenging discrimination, advocating for rights, affirming mad identities, remembering and participating in mad history, and having fun. Our lives and contributions are valuable and need celebration!

ASL interpreters will be provided, other accommodations available on request.

Sponsors To Date:

For more information, please email: ericka@anotherwayvt.org

4 NEWS

Summer 2022

PEER RESPITE PROPOSAL • Continued from page 1 against giving OPR a primary role in the certification process: “This is something that is happening in 48 states, plus the District of Columbia.

Most of the states do not have their office of professional regulation involved in this, for the very reason that, for peer support to work, it needs to look very different – because it is – from the medical profession.”

On the other hand, Agency of Human Services (AHS) Policy Advisor Shayla Livingston advocated for OPR’s participation in the development of the certification, and for “considering a framework for respite beds” after the establishment of the certification program. She also floated a potential alternative route that would, instead, look at a set of six programming proposals for “unlocked community residences” received last year by DMH and conceived largely by the Designated Agencies.

Finally, Livingston suggested that funding, even for the certification program alone, could present a problem. “I do just need to say it’s not in the governor’s budget right now, so I’m not clear where that money would come from. At least in the department’s budget, there is not room for that,” she warned.

Sen. Ginny Lyons, chair of the Committee on Health and Welfare, encouraged OPR’s involvement but expressed a desire to move forward on both the certification and the peer respites without delay.

“Every time we take a step forward, we somehow take two steps back with a working group or a report or something,” she complained.

In March, Hooker presented the committee with a new draft that combined S. 194 and S. 195 into a single bill. The updated version of S. 195 codified a collaborative role for OPR in the development of the peer certification, but its timeline did not leave room for a Sunrise Review. It also reduced the immediate cost of the legislation by lowering the number of new respites to four in the near term. The other three would appear in 2025 and wouldn’t require an appropriation until then.

Unanimously, the committee approved the legislation and passed it on to the Senate Committee on Finance, which forwarded it without complaint to the Senate Committee on Appropriations. Here the bill – or the substance of it – ran into a wall.

Unanimously, the committee approved the legislation and passed it on to the Senate Committee on Finance, which forwarded it without complaint to the Senate Committee on Appropriations. Here the bill – or the substance of it – ran into a wall.

Unlike the Committee on Health and Welfare, the Committee on Appropriations took no testimony from advocates. Instead, it used a single 30-minute hearing almost exclusively to articulate its resistance. One member of the committee, the powerful Senate President Pro Tempore Becca Balint, who gave the keynote address at Mental Health Advocacy Day this year, was not in attendance.

Sen. Philip Baruth wondered what would happen “if somebody has a break and becomes violent” at a peer respite. “What does the security look like?” he asked.

Hooker, the bill’s lone representative, explained that peer respites operate as voluntary programs. Sen. Jane Kirchel, the committee chair, indicated a preference for prioritizing funding for locked capacity in the mental health system, bringing up the 1980 and 1991 murders allegedly committed by Vermonters Louis Hines and Elizabeth Teague prior to their involuntary commitments.

Sen. Dick Sears shared similar sentiments, lamenting the loss of the Vermont State Hospital in 2011. “We haven’t solved our bed situation for the mentally ill since the Irene closure, and even before that it was a crisis,” he said.

“I understand the value of peer support,” Kirchel professed. “We just haven’t figured out how much money we have. And we might have less, depending on what the committee next door decides relative to some

of their tax reduction proposals, because the House actually reduced revenues by about $50 million.”

Hooker sought to persuade the committee that a peer respite “pays for itself” by diverting patients from expensive emergency rooms, and that it is likelier than inpatient care to help its guests avoid costly hospitalizations in the future. But the question of money persisted.

Part of the rationale for S. 195 had emerged from the Centers for Medicare and Medicaid Services (CMS) policy to permit states access to federal dollars for peer support as long as they’ve implemented certification programs for practitioners. This benefit – which, following an agreement between CMS and AHS, would allow peer supporters in Vermont to bill Medicaid insurance for services provided to their clients – represented a potential problem in Kirchel’s eyes.

The “Global Commitment waiver” that structures Vermont’s Medicaid program also imposes a financial cap on federal contributions. “It’s very close to being hit,” Kirchel cautioned.

Amid the perceived squeeze, Sears pointed to what he saw as a competing imperative to raise Medicaid reimbursement rates for cash-strapped Designated Agencies. “I certainly agree with Senator Hooker that we have a crisis in mental health, but that is partly exasperated by the fact that we can’t hire workers in our Designated Agencies,” he opined.

At a subsequent hearing, the Committee on Appropriations – again, without Sen. Balint – recommended a version of S. 195 that eliminated the new peer respites completely and stripped all of the funding for peer certification. Even so, the text of bill still mandated the certification program.

Upon receiving this S. 195, the House Committee on Health Care discovered that, thanks to the previous change, DMH had no means to pay for the three contracts with peer-led organizations that the legislation would compel it to enter for curriculum development, peer training, and the issuance of certifications. On April 21, the committee proposed a strike-all amendment.

In the annual budget adjustment, DMH had secured funding for a $30,000 grant that would convene stakeholders to “draft a recommended work plan” for the future implementation of a peer certification program.

Out of a concern that dropping the defunded legislation altogether would send an unintended message of opposition to the notion of peer certification, the Committee on Health Care instead crafted a largely symbolic bill endorsing DMH’s preexisting intention to issue the grant.

On April 5, Vermont’s five peer-led mental health organizations had written a letter to the committee, urging it to restore S. 195 to the Senate Committee on Health and Welfare’s version. Once it had become clear

In the annual budget adjustment, DMH had secured funding for a $30,000 grant that would convene stakeholders to “draft a recommended work plan” for the future implementation of a peer certification program. that the funding in that draft would not return, however, they sent another letter asking the legislature to abandon the bill and to allow them to “work cooperatively with DMH to develop and implement a statewide peer certification program outside of the legislative process.”

When S. 195 circled back to the Senate Committee on Health and Welfare, its members heeded this request. The bill died in May. DMH’s interest in implementing a peer certification program had preceded S. 195. Before the House Committee on Health Care on March 31, Deputy Commission Alison Krompf mentioned that DMH and AHS had previously discussed a shared aim of petitioning CMS for a Medicaid state plan amendment to add peer support among Vermont’s covered services.

“That’s something we were planning on working towards anyway,” she said.

Summer 2022

NEWS .

5

BUDGET • Continued from page 1 federal matching dollars under Vermont’s Global Commitment to Health Waiver, which expires at the end of June. Governor Scott submitted an application for its renewal last year.

“It’s particularly important to recognize that this comes at a time when we’re also in the middle of negotiating the waiver. And as a reminder, the waiver gives us the flexibility to make investments in our home- and communitybased services providers,” Samuelson said, “but it keeps us within a capitated budget. There’s very little room in the current proposed cap from CMS, which they say is their best and final offer, to both increase rates and to do additional innovation while optimizing our federal funds.”

Even so, Vermont Care Partners, the umbrella organization that represents the DAs and SSAs, petitioned the legislature for a 10% rate increase.

The request cited staff vacancies at 20% and annual turnover at 31%.

“Staff are leaving for better pay and less risk at fast food and retail establishments,” Executive Director Julie Tessler related. “Some residential and crisis beds programs have had to reduce hours or even close.”

On March 25, the House passed a 7% rate increase for the DAs. The Senate upped the increase to 8% with its own version of the budget on April 20. The two chambers appointed

The additional funds will shore up Vermont’s 10 Designated Agencies (DAs), the nonprofit mental health centers that, as DMH’s proxies, deliver communitybased care across the state. a Committee of Conference to hash out the differences between their bills, and the Senate’s increase stuck.

The budget also lays out terms for DMH’s proposed expansion of mobile crisis outreach, following a pilot program that began last year in Rutland with the intention of keeping children and adolescents out of hospital beds by sending clinicians to meet them in their homes and schools during mental health emergencies. In the fall, CMS awarded a total of $15 million in planning grants to help 20 states, including Vermont, design mobile crisis services.

The legislature stipulated that Vermont’s

program “shall be based on evidence-based and trauma-informed practices, including using peer support staff.” DMH will deliver a status report on its development by Jan. 15, 2023.

In DMH’s budget request, a plan to roll out four additional mobile crisis response teams (to join Rutland’s) bore an anticipated cost of $5,946,997. Most of DMH’s annual funding comes from Medicaid, but the department also asked for a General Fund appropriation of $12,576,387 – raised to $12,966,387 in the final budget – to bring its Zero Suicide initiative to all 10 DAs and to hire a statewide suicide prevention coordinator, among other expenditures.

By DMH’s projection, its most expensive program in FY23 will be Success Beyond Six (estimated at $72,250,289), which puts clinicians employed by the DAs into schools. By contrast, in January DMH expected to spend $3,737,163 on peer services in FY23.

The “big bill,” as it’s called, passed two months after the annual budget adjustment, which modified FY22 appropriations in the waning months of that fiscal calendar. The budget adjustment added $367 million in statewide spending, including retention bonuses and shift differential pay for DMH workers and $440,000 for additional staffing at National Suicide Lifeline in-state crisis centers.

‘Anti-Oppressive Practice’ Added to Mental Health Relicensure Curriculum A new law aims to improve “cultural competency, cultural humility, and antiracism” among Vermont’s mental health professionals. It also intends to find ways to expand the mental health workforce by identifying barriers for job condidates in underrepresented groups.

H. 661 amends the criteria for the biennial licensure renewal for psychologists, social workers, alcohol and drug abuse counselors, clinical mental health counselors, marriage and family therapists, psychoanalysts, and behavior analysts. Notably, it adds a requirement for “one or more continuing education units in the area of systematic oppression and antioppressive practice.”

Rep. Tanya Vyhovsky, who introduced the legislation, is a school social worker who previously served as the program director for the Pathways Vermont Support Line. “It’s not that we think mental health practitioners are necessarily more biased than another healthcare profession, but due to the nature of the work that we’re doing, it’s really important to think about how we sit with people when they’re really struggling,” she said.

The law does not increase the total number of continuing education units that mental health professionals must complete in order to continue to practice. On the contrary, it seeks in two ways to ease their burden of relicensure: by sanctioning synchronous virtual training (in addition to in-person classes) and by eliminating the necessity for dual licensees to undertake continuing education twice. Instead, one set of completed courses can count toward two or more licenses.

As introduced in January, H. 661 sought to compel mental health professionals to study “diversity, equity, and inclusion” within this process.

By late March, three such units of continuing education had become “one or more.” With the encouragement of the Vermont Center for Independent Living (VCIL), the focus of these units also had shifted to “systematic oppression.”

“Making sure the educational opportunities are there that are not going to cause additional harm is really important,” VCIL Executive Director Sarah Launderville testified. “There are training modules that have been used in the past that cause additional oppression to marginalized communities.”

With H. 661 referred to the House Committee on Government Operations, members of the House Committee on Health Care nevertheless proposed a revision to accommodate work already in process as a result of their own Act 33 (2021), whose Health Equity Advisory Commission will submit a report on training and licensure in October. In order to allow for the use of the commission’s recommendations, the final version of H. 661 postponed the effective date for the new continuing education requirements to

July 1, 2023.

The rest of the law will go into effect this summer, including a mandate for the Office of Professional Regulation (OPR) to conduct a study that will locate obstacles to entry into the mental health field for “individuals who are Black, Indigenous, or Persons of Color (BIPOC), refugees and new Americans, individuals with low income, and those with lived mental health and substance use experience.”

Xusana Davis, Vermont’s Executive Director of Racial Equity, spoke to legislators about prejudices in hiring: “If you’ve ever heard discussions, particularly in a human resources context, about things like ‘culture fit,’ I would strongly encourage us to think about ‘culture add,’ not ‘culture fit,’ because, oftentimes, what we’re saying when we say ‘culture fit’ is, ‘Do you fit in? Can you replicate the practices and behaviors and interpersonal styles that we already have?’”

“What that means,” she continued, “is that candidates who are from cultures that may be different than ours end up getting shut out, because we see them as other or different and therefore somehow less able to interact with people in the way that we’re accustomed to. But we have to step back and ask ourselves, ‘Is the way that we’re accustomed to interacting with people the only way?’”

VCIL, along with the Vermont Commission on Native American Affairs, the LGBTQ nonprofit Outright Vermont, and the refugee organization AALV, will assist OPR in this endeavor. Amid a widely reported labor shortage in the mental health field, OPR will also create a “registry of mental health professionals who are available to serve as supervisors for mental health professionals in training,” and it will look at ways of potentially “streamlining the licensure of mental health professionals.”

“We have a licensure issue in the state, in terms of how long it takes us to get mental health providers licensed,” OPR Director Lauren Hibbert commented. “The statutes are very complicated – well-intentioned but very complicated – and our rules are circuitous and very confusing.

They’re very hard for an external applicant to navigate.”

As a result, the “one staff person for all mental health licensing in this state” receives, by Hibbert’s account, 700 emails in an average week. H. 661 adds one more Licensing Board Administrator to OPR’s staff to help with the workload.”

NEWS 6 NEWS

Summer 2022

Howard Center Union Signs New Contract

By BRETT YATES

A new collective bargaining agreement between Local 1674 of the American Federation of State, County and Municipal Employees (AFSCME) and the Howard Center, Chittenden County’s designated agency for mental health, went into effect on March 20, according to a union official.

Negotiations had begun nearly a year earlier to replace a contract that expired in June 2021.

The Howard Center Union, as it calls itself, represents more than 600 workers, of which more than 200 are dues-paying members.

The Howard Center employs a workforce of approximately 1,600 in total.

“We had a lot of demands,” said Amanda Calder, a direct support professional at the Howard Center who also serves as a union steward and treasurer. “The biggest thing was pay.”

Before the three-year contract renewal, the Howard Center’s lowest-paid employees (such as life skills educators and peer community recovery specialists) earned $15.81 per hour, by Calder’s account. At the highest pay grade, she noted, registered nurses made $29 per hour.

“As you can see, that’s better than some jobs,” acknowledged Calder, who had earned $19.13 per hour.

“It’s more than minimum wage. But basically, there’s an extreme minority that are getting paid a livable wage. I’m making a livable wage if you’re single, have roommates, and have no kids.”

During negotiations, the union discovered that the vacancy rate for jobs in the lowest pay grade had reached 25%.

“Understaffing is a huge problem, and it’s been a huge problem forever, but then especially during COVID,” Calder observed. “All of these clients have no staff, or one or two days a week instead of five days a week. It puts huge stress on the clients and the people they live with – their shared living providers or their families or their friends, whoever else is helping them.”

Even so, Howard Center management’s priority “was to raise pay for the masters-level clinicians and the nurses, and to heck with everyone else,” Calder complained. “Our priority was raises for everybody, but especially to bring up the bottom.”

By the union’s account, management initially proposed 1% annual raises for lower-level employees on a five-year deal. The Local 1674

“We had a lot of demands,” said Amanda Calder, a direct support professional at the Howard Center who also serves as a union steward and treasurer. “The biggest thing was pay.”

bargaining team – comprised of Calder and two colleagues – held out.

“They’d say, ‘We really don’t have any more money,’ and then they kept coming back with more money,” Calder recalled. “When we were getting closer to the end of bargaining, they said that what they were committing to do was that they’d be operating at a deficit.”

As negotiations stretched into winter, the Vermont General Assembly entered the 2022 legislative session with the hope of ameliorating worker shortages throughout the state. The question of how much to raise Medicaid reimbursement rates for community mental health centers became a sticking point as legislators hashed out the annual budget.

“To me, the most important thing is that the state isn’t funding things properly. I feel like Howard Center management is a secondary problem,” Calder opined. “Basically, their job at the agency is to keep things running smoothly while everyone’s lives are falling apart. They lobby the government to do stuff, but the government doesn’t really listen to them. The

state is their boss, so there’s only so much they can advocate.”

“They’re kind of the middleman. Us putting pressure on them can put pressure on the state,” she continued. “As a union, we have the ability to say whatever the hell we want to the state. We’re voters, and we’re workers, and we don’t really answer to them.”

In the end, the union won a minimum wage of $18, which represented a 13.9% increase, with subsequent raises of 2% and 2.5% in the second and third years of the contract for workers at the bottom. “I think, because of the staffing crisis, we actually had more bargaining power this time,” Calder reflected.

The union reached a tentative agreement with the Howard Center on Jan. 24, and the membership’s ratification vote took place on Feb. 17. “It passed unanimously, which never happens, but everyone was wanting to get this done,” Calder remembered.

Still, the work of the bargaining team hadn’t ended. “Going from the tentative agreement to the contract took much longer than it’s ever taken,” Calder said.

By her account, when the Howard Center sent over the document for signatures, the union discovered major unannounced revisions to the

As negotiations stretched into winter, the Vermont General Assembly entered the 2022 legislative session with the hope of ameliorating worker shortages throughout the state. tentative agreement, including a modification to the dental coverage.

“I was so mad that I couldn’t deal with it for a few days,” Calder recollected. “We made this long list of what the things were that they’d changed and what we thought about them and if they were OK or not or if they could be OK if we changed them, so it ended up being bargaining after bargaining.”

“They wrote back and said, ‘We’ve made all the changes you said.’ But of course they didn’t, so we had to through it again, and it was a smaller list, but it took time,” she continued.

“The last time, they still hadn’t fixed a couple things, but we were like, ‘OK, we’re just going to sign this because we want to get people their raises.’”

The union called it a victory. “It’s actually a pretty good agreement.

There’s almost nothing bad in it,” Calder said.

By this, she meant not just that Local 1674 had negotiated retroactive raises, better 401ks, expanded bereavement leave, and bigger shift differentials, but, equally, that it had managed to resist a number of proposals put forth by management, such as a stipulation that the agency could reassign staffers to different programs or locations within the Howard Center without their consent. The union also celebrated the defeat of a provision that would have excluded probationary employees from the bargaining unit.

At the same time, the union didn’t win all it had fought for. Calder had wanted more time off, lower health insurance premiums, retention bonuses, and an end to involuntary schedule changes, among other thwarted demands. The union also failed to secure the right to collect agency fees, the required payments that nonmembers make to cover their “fair share” of the cost of a union’s work on their behalf.

Finally, under the terms of the new deal, the pay for most Howard Center workers is “still pretty bad,” Calder admitted. “I did the math – I basically got zero raise because the inflation is 8%.”

Even so, in her view, the contract represents an improvement. And, as she sees it, it will benefit not only the Howard Center’s employees but also, indirectly, its clients.

“It makes it possible for people to stay in these (Continued on page 7)

Summer 2022

NEWS .

NEWS

7

Gun Safety Law Permits Healthcare Provider Disclosures

By BRETT YATES

The Vermont General Assembly’s effort to boost firearm safety this spring generated significant debate and a gubernatorial veto before the legislation’s passage into law. While most of the discussion focused on background check requirements for gun buyers, a less noticed provision codified a new exemption to medical confidentiality when a patient’s purchase or possession of a “dangerous weapon” appears to pose an “extreme risk.”

Introduced in 2021, S.30 started out as a ban on guns inside hospitals, childcare facilities, and some government buildings, and the version passed by the Senate that March narrowed the ban to hospitals only. The House Committee on Judiciary took up the bill in this year’s legislative session, proposing a strike-all amendment by Rep. William Notte that significantly expanded its scope to limit privacy protections in healthcare settings for potentially violent gun owners and to take on what gun control advocates call “the Charleston loophole,” in reference to the 2015 massacre at the Emanuel African Methodist Episcopal Church in South Carolina.

Under federal law, before a firearm sale, licensed dealers must contact the FBI’s National Instant Criminal Background Check System (NICBCS), which holds a list of individuals prohibited from owning a firearm. Most background checks take place instantly, but confusion owing to common names and other challenges can cause delays. When these last longer than three days, the buyer may purchase the weapon without a “green light.”

Lawmakers aimed to remove the three-day limit on this waiting period in Vermont, requiring a completed background check for all purchases, but Gov. Phil Scott refused, based on the contention that the legislation could trap law-abiding prospective buyers in a permanent bureaucratic limbo. A new, mostly identical bill, S.4, changed the maximum delay to seven business days and received the governor’s signature.

Previously, in 2018, Scott had signed a suite of gun safety legislation that included S.221, which gave the Vermont Attorney General and the state’s attorneys the right to petition the Superior Court for an “extreme risk protection order” (ERPO) in response to an individual’s violent behavior or threats, forcing them to relinquish their firearms upon a judge’s command. S.4 seeks to enlist healthcare providers in this process, giving them license to share information about their patients with law enforcement to facilitate such petitions.

Vermont law has long contained exceptions to physician-patient privilege. 18 V.S.A. § 1882 establishes that a “mental health professional” has a duty to “exercise reasonable care” when a “patient poses a serious

risk of danger to an identifiable victim,” and the Vermont Superior Court has ruled that this duty may supersede the patient’s right to privacy as established by 12 V.S.A. § 1612, which otherwise prohibits the disclosure of “any information acquired in attending a patient in a professional capacity.”

While 18 V.S.A. § 1882 imposes an obligation upon the provider, S.4 extends only a permission. But the new law encompasses all healthcare providers, not just mental health professionals, and now they will no longer need to cite a specific individual as a likely victim when notifying law enforcement of danger. Instead, the patient may appear to pose a risk to the public at large or to themselves.

According to Erik FitzPatrick from the Office of Legislative Council, healthcare providers “arguably” already possess the immunity granted

by S.4 as a matter of federal law under HIPAA. He speculated that the state statute would perhaps merely provide an “extra level of comfort” to providers.

The Vermont chapter of Moms Demand Action, an anti-gun group, issued a statement following S.4’s passage, praising the law for providing “critical tools to help health care professionals, law enforcement, and judges reduce the threat of gun violence and make our state a safer place.”

The Vermont Traditions Coalition, a pro-gun group, opposed the legislation. Firearms Policy Analyst William R. Moore warned that it “would irreparably harm the confidentiality between all patients in most types of counseling.”

“Even the debate of these amendments will leak to people now considering seeking help and trigger fear that discussion about suicidal thoughts and ideations will trigger the automatic filing of ERPOs,” Moore predicted.

HOWARD CENTER UNION • Continued from page 6

At the same time, the union didn’t win all it had fought for. Calder had wanted more time off, lower health insurance premiums, retention bonuses, and an end to involuntary schedule changes, among other thwarted demands. jobs longer and to get better at their jobs,” Calder said. “I don’t actually know what the turnover rate is for the agency, but one number I’ve heard is like 25%. When you’re in a group home and a quarter of the people supporting you change every year, that’s a lot of change in who’s bathing you, who’s learning about your life story, and that kind of stuff. It takes a long time to really get to know someone to support them well.”

“With workers being organized and supporting each other, part of what we support each other

in is advocating for clients and pushing against cuts to things and what we see as unfair decisions or treatment of people,” she went on.

“I could give a lot of examples of management making really stupid and harmful decisions and workers advocating against that.”

Calder recognized that mental health and disability services workers cause problems, too, and allowed that, even with the best intentions and practices, they on some level occupy a “position of oppression” relative to their clients. “I’m someone who’s like, we should ultimately not need a mental health system because we just have a supportive society where people can have feelings and get support and heal from things and not hurt each other,” she said.

Such a society, in her imagination, would include “livable wages for everyone, and affordable housing, and free childcare, and shorter working times so that people have time to take care of themselves and each other and make art and have time with nature, all the things that are healthy.” She believes that organized labor will play a role in creating this world.

“I think we need to build worker power to be able to win the kinds of things that we need,” Calder said. “As a union, we can say things, and we can’t get fired for it, because we have

“I’m someone who’s like, we should ultimately not need a mental health system because we just have a supportive society where people can have feelings and get support and heal from things and not hurt each other.” a process, and there has to be just cause. So we have more freedom of speech, and we can advocate to the legislature, and we can ally ourselves with psychiatric survivors, with selfadvocates.”

“Lamoille County Mental Health is the only other agency that has a union,” she pointed out.

“It also is AFSCME. There’s a lot of the mental health field that’s not unionized, and I think that’s one of the things that’s necessary for improving services.”

8 NEWS

Summer 2022

Assisted Suicide Law Expanded to Include Telemedicine

By BRETT YATES

Nine years after Vermont legalized medical aid in dying through Act 39, the General Assembly updated the statute to permit physicians in virtual care settings to write prescriptions for life-ending medication for terminally ill patients.

“When we passed this law, telemedicine was an idea,” Sen. Dick McCormack, the bill’s lead sponsor, explained. “Telemedicine is now frequently used.”

S. 74 took effect immediately upon its passage this spring. In McCormack’s words, doctors “still have the option, upon an electronic communication, of saying, ‘I think I need to see you in person.’ But this makes the law under Act 39 consistent with usual medical practice, which is that the doctor would decide whether or not telemedicine is acceptable.”

The change does not eliminate the requirement for in-person verification of a terminal condition by way of a physical examination. But now, the

Finally, S.74 expands an immunity provision for doctors “acting in good faith compliance” with Act 39 to include all healthcare providers who may aid in an assisted suicide, such as nurses and pharmacists.

Pharmacist Steve Hochtenberg told legislators that liability concerns had dissuaded some of his peers from filling prescriptions for life-ending medication.

Data reported by the Department of Mental Health shows that 116 Vermonters received medical aid in dying between May 31, 2013, and June 30, 2021. Cancer patients accounted for 77% of the total.

Act 39 continues to kindle debate. For its many of its proponents, the legalization of assisted suicide represents a triumph for patient-led care at medicine’s most crucial juncture, while its critics fear that the patient’s power to choose death over continued suffering could instead – despite various safeguards in the legislation – fall into the hands of a third party.

This could be a family member or a doctor.

According to advocates, people with end-stage diseases often struggle to travel to medical appointments. They highlighted what they saw as an imperative to make end-of-life choice available to housebound patients.

doctor writing the prescription through an online consultation can rely on medical records attesting to such an examination having taken place previously, instead of having to administer one.

According to advocates, people with end-stage diseases often struggle to travel to medical appointments. They highlighted what they saw as an imperative to make end-of-life choice available to housebound patients.

“Most patients have very clear thoughts and wishes for how their life comes to an end, but they don’t have the energy or the emotional capacity to focus on that early. And so it’s often later in the illness, when people have a high symptom burden and their disease is quite advanced and their energy is quite low and time is quite short, that suddenly plans for the end of life are needed,” Dr. Diana Barnard, a palliative care physician at Porter Medical Center, described before the House Committee on Human Services.

Besides Vermont, nine states and Washington, D.C., have legalized assisted suicide. Testimony submitted by the Death with Dignity Political Fund in March asserted that, of these, Vermont was the only one that still did not permit the use of telemedicine for aid in dying.

S.74 makes two other significant revisions to Act 39. One is to eliminate a 48-hour delay before the issuance of a prescription, following a still extant process of 15 days or more during which the patient submits and confirms their wish for a physician-assisted suicide.

By the account of Kim Callinan, president of the advocacy group Compassion & Choices, Vermont’s 17-day waiting period was the secondlongest in the nation after Hawaii’s. At 15 days, Vermont “will still have one of the longer time frames in place, but it will be far more manageable for terminally ill people,” she said.

The Vermont Center for Independent Living’s executive director, Sarah Launderville, protested S.74’s expanded immunity clause for its “implicit trust” of the medical community. She alleged bias among providers who “advise against life-sustaining treatment for people with disabilities whose conditions would be treated were they not living with a disability.” Launderville advocated unsuccessfully for a provision requiring the collection of demographic data for Act 39 patients.

On April 13, Rep. Anne Donahue, who had opposed Act 39, proposed an amendment to S.74 intended to limit the risk of coercion in end-of-life choices. She argued that an exclusively virtual care environment would render manifestations of outside influence upon patients less visible to doctors.

“I believe it affects their ability to assess voluntariness – not being face to face; not being able to look in the eyes, because we can’t do that on Zoom; not being able to see who else might be in the room,” Donahue opined.

The amendment sought to mandate, during the assisted suicide request, one point of real-world contact with the patient by a healthcare provider, who could thereby attest to the patient’s independence. The provider wouldn’t have to be the doctor in charge of writing the prescription or a doctor at all. Donahue explained, by way of example, that the physical presence of a home health aide or a physical therapist, at any of five designated points within the patient’s 15-day application process for lifeending medication, would fulfill the requirement.

The House rejected the amendment on a vote of 41 to 98. Without it, the bill became law two weeks later.

Summer 2022

NEWS .

VPCH Gets New CEO

By BRETT YATES

In February, the Vermont Department of Mental Health hired Daryl Hall as the CEO of the Vermont Psychiatric Care Hospital (VPCH) in Berlin. VPCH’s prior CEO, Emily Hawes, became the Commissioner of Mental Health last year.

Hall previously served as the CEO of the 170bed Logansport State Hospital in Indiana. VPCH operates 25 beds exclusively for involuntary patients.

“I’ve really enjoyed the transition,” Hall told Counterpoint. “For me, it’s been pretty refreshing to be around open-minded people who have some great idealistic thinking about things, which to me spurs creativity and helps us find some new ways to do old things and sometimes to do new things.”

By his account, as CEO, Hall supports staff, sets internal policy (with the help of a six-person “brain trust”), and works to ensure regulatory compliance before the Centers for Medicare and Medicaid Services and the Joint Commission.

“Honestly, for me right now, there’s still a fair amount of a learning curve in just understanding the differences between Vermont state government and Indiana state government,” he admitted.

At his old job, Hall oversaw a forensic psychiatric hospital, serving patients who had entered the mental health system through a criminal court. No such dedicated facility exists in Vermont.

“In Indiana, the pathway into involuntary hospitalizations is really heavily influenced through the legal system. Whereas in Vermont there are a lot of folks who are in emergency

Before joining the Indiana Division of Mental Health and Addiction, Hall worked for the Indiana Department of Corrections as a director of programming. He stressed the differences between prisons and psychiatric facilities. departments and holding for beds, in Indiana that tends to be jails because of that forensic piece,” Hall explained. “Here, we don’t have that component, so I feel like it’s much more of a collaborative effort among providers to really take a look at the level of care.”

Before joining the Indiana Division of Mental

Health and Addiction, Hall worked for the Indiana Department of Corrections as a director of programming. He stressed the differences between prisons and psychiatric facilities.

“A lot of times folks want to, from the outside, look at them as similar, in that folks are locked up against their will,” he said. “Corrections is really designed to provide public safety, and safety is an element of us, but I think we’re looking more at long-term qualify of life both for our clientele and their families.”

VPCH seems to offer new possibilities to Hall.

“We talk about client-centered therapy in the field, and I’ve heard that terminology for 25

“For me, it’s been pretty refreshing to be around open-minded people who have some great idealistic thinking about things, which to me spurs creativity and helps us find some new ways to do old things and sometimes to do new things.” years. I’ve never seen it quite like I see it here, where folks have really bought into that idea,” he asserted. “A real strength is meeting clients where they are and understanding that this is really their life, and we’re a part of it at this point in time and trying to find ways to help them get back on a track and down a continuum with lesser services and into the community, where they’ll be living active lives.”

Hall believes that psychiatric hospitals have changed over the years in response to critiques by reformers, in part by raising their staff-topatient ratios to provide individualized care. The State of Vermont built VPCH in 2014, 180 years after the opening of the Brattleboro Retreat, its other active psychiatric-only hospital.

“I think it was built with a lot of input from survivor groups and advocacy groups, so as far as space, we have much smaller units. Our largest unit is eight, so folks have more personal space,” Hall noted. “It’s designed to look a little different than what a hospital looks.”

VPCH uses restraint, seclusion, and involuntary medication. But these techniques don’t appear to define its therapeutic approach for Hall, who described an effort to incorporate “mutual input” and to move away from “the

Read Counterpoint Online

9

traditional medical model of ‘you’re the patient; I’m the doctor; do what I say.’”

With a masters in clinical psychology, Hall started his career as a clinician before moving into managerial and administrative work.

“At first I thought I was going to go into doing individual therapy,” he recollected. “That’s kind of my first love, the clinical piece of it, so being in a hospital setting is comfortable to me and even more so, as far as my training goes, than corrections.”

In the first months of his tenure, the continued risk of COVID-19 has caused some frustration.

“For most folks, they’ve moved out and away from [coronavirus precautions]. For us, we still have a fair amount of rules and regulations with the safety of our staff and our patients,” he said.

“We’re trying to find ways to re-engage, trying to look pre-COVID a little bit, but it’s just kind of a slow road in getting there as we keep having these little blips on the screen as it relates to COVID.” Over the long term, Hall hopes to reduce the stigma of inpatient psychiatry locally by strengthening VPCH’s ties with its neighbors.

“One thing that I would like to do here is for us to become a very active community partner. A lot of times folks look at a psychiatric hospital as ‘that place off in the distance.’ We’ve historically built hospitals outside of towns,” he observed.

Today, as Hall sees it, psychiatric hospitals like VPCH will continue to evolve, including in ways that may lie outside of their control. “The entire healthcare field has really kind of risen up and started to change a little bit,” he remarked.

“We’re trying to find ways to re-engage, trying to look pre-COVID a little bit, but it’s just kind of a slow road in getting there as we keep having these little blips on the screen as it relates to COVID.” “So how that looks in terms of staffing – and, again, it’s not just at this hospital but across the whole medical field – we’re trying to work through some of that piece. And that piece has actually elevated to Washington, DC, to kind of look at our whole national healthcare model, how that needs to look in the future, and how we provide services more efficiently.”

vtps.help/ counterpoint Contact our toll-free office number

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10 NEWS

Summer 2022

DMH Gives Virtual Preview of River Valley Therapeutic Residence in Essex, Vt Kitchen Multipurpose Room

Art Room Bedroom

Sensory Room Living Room

Serenity Room Greenhouse Room

Summer 2022

NEWS .

11

Locked Residence in Essex

By BRETT YATES

Construction began last fall on the newly dubbed River Valley Therapeutic Residence in Essex, and in March, the Vermont Department of Mental Health (DMH) hoped to finalize its interior design. At a stakeholder meeting, DMH General Counsel Karen Barber, Middlesex Therapeutic Community Residence Director Troy Parah, and Department of Buildings and General Services Project Manager Tabrena Karish shared renderings prepared by Lavalle Brensinger Architects in order to gather one last round of feedback about finishes and furnishings.

The 16-bed “secure residential recovery facility” will replace, at more than double the capacity, a pair of nine-year-old FEMA trailers in Middlesex that, after Tropical Storm Irene flooded the Vermont State Hospital, began to house psychiatric patients who, according to DMH, “are no longer in need of inpatient care but who need intensive services in a secure setting.”

Psychiatric survivors protested the introduction of additional locked capacity to Vermont’s mental health system and particularly opposed plans to allow for the use of restraint and seclusion, which DMH dropped last year.

The virtual meeting in March represented the tail-end of an engagement process that, according to Barber, had included patients at Middlesex and at the Vermont Psychiatric Care Hospital (VPCH), staff at both facilities, and DMH employees. The presentation’s slides offered the first public glimpse inside the residence as imagined by its designers, with computer-generated images of nine mostly beige rooms featuring plastic laminate and “wood look” luxury vinyl tile (or, in some cases, rubber sheet flooring).

In the proposed design, still subject to potential revision, the facility’s bedrooms will come in three color schemes, with a uniform layout featuring a bed, a desk, a mirror, storage

shelves, and an upholstered bench beneath a window. The living room will contain five lounge chairs, three love seats, and, according to Parah, a TV “on the wall that you can’t see” in the images.

“One of the things we learned from the COVID pandemic is that infection control is an important part of thinking about upholstery,” Barber said. “Some of [the love seats] look a little less than a traditional couch you may have at your home, but we found that during COVID we really needed to wipe them down and keep them clean, so we’re trying to really balance making it a residence and making people feel comfortable but also making sure we’re taking safety in mind.”

A large multipurpose room, with chairs arranged in a circle, will host “morning and afternoon check-ins with all the residents,” Parah said. He also noted “a couple areas where residents would have access to computers” and unpictured storage space along the perimeter for folding tables for activities.

A dining room of four tables with four chairs apiece will lead into an open-concept kitchen for the residents’ use, with a wall separating it from the larger commercial kitchen where hired cooks will prepare meals. A ceiling beam imprinted with inspirational words such as “improvement,” “progress,” “freedom,” and “optimism” aroused negative comment at the meeting.

“I’ve heard that quite a bit. There’s been a lot of feedback that people don’t like that,” Parah acknowledged.

A “serenity room” will offer, in Parah’s words, a “space to be used for folks that are looking for a quiet space outside of their room to read a magazine or a book or just to sit quietly,” and a smaller “sensory room” will provide an even more private setting, with a rocking chair that,

by Parah’s account, has already proven popular at VPCH. A metaphorically named “greenhouse room” will give residents a chance to care for indoor plants. The facility’s architectural blueprint also shows an exercise room, and while the renderings don’t address it, Parah mentioned the likely purchase of a treadmill, a stationary bike, and a ping-pong table and the possibility of a rowing machine and a foosball table. Additionally, residents will have access to the old Woodside

Juvenile Rehabilitation Center’s freestanding basketball gym on the property, a holdover from the demolished facility that used to occupy the site.

An art room prompted criticism during the meeting for its bareness. “It’s very dull. It’s not very uplifting to the mind or to the soul or to the spirit. It doesn’t seem very inspired. Maybe a part of it has to do with cutting costs; I don’t know. But it seems important to have a space that will have a therapeutic effect on people,” Linda Cramer of Disability Rights Vermont observed.

Karish countered that, in real life, the art room will feature artwork by the facility’s residents on its walls. “One thing to keep in mind is that these are just architectural renderings. It’s like a staged home – there’s not a lot of life to it,” she said. “It’s lacking the personal element that residents would bring to the space.”

Through its Art in State Buildings program, the Vermont Arts Council also intends to commission a $43,000 art installation inside the facility. A public survey went out in February, spotlighting four preliminary design concepts

by Vermont artists.

Toward the end of the meeting, Barber solicited suggestions for a “flex space” with a tobe-determined purpose. One idea was to turn it into a music room.

The presentation didn’t include any renderings of a backyard, but Karish provided a description: “We have a walking path that goes around the yard. We have a covered porch area right outside the dining room for outside dining. We also have another patio area with a gazebo, and we have the raised beds [for gardening], and then we have a grass area that can be used for whatever.”

DMH plans to open the River Valley Therapeutic Residence in the first quarter of 2023. In March, the Green Mountain Care Board approved a $2.9 million budgetary increase for its construction, now expected to cost nearly $25 million.

“I think DMH has tried to be really clear that this is not a place where people are going to live for the rest of their lives. This is a transition,” Barber said. “This is a step down, but the goal is to get everyone back in the community. We want to help them as quickly as possible transition to the next level of care. We’re really hopeful that the new space and all the natural light and all the different things that have gone into the designing of it will kind of help with that.”

The Arts

12

By BRETT YATES

Summer 2022

Book Review

How Radical Psychiatrists Pursued ‘Disalienation’ in a French Hospital

A libertarian Marxist refugee from the fascist regime that won the Spanish Civil War, Dr. Francois Tosquelles, a Catalan, arrived in France less than a year before the German invasion. Following a months-long internment at the Septfonds concentration camp, his release sent him in 1940 to Saint-Alban, a small village in Occitanie, to practice psychiatry in an asylum administered by the collaborationist Vichy government.

Here, Tosquelles encountered an institution that had become a softer kind of Nazi death camp, where hunger and unsanitary conditions slowly killed off society’s outcasts and undesirables, as they did in psychiatric hospitals across occupied France during World War II. At disease-ridden Saint-Alban, for more than 800 inmates, haystacks served as both beds and toilets inside locked, dark, unheated cells.

The remarkable story of how Tosquelles and his peers, over the course of 22 years, transformed a psychiatric prison into a “healing collective” could have anchored a work of mainstream nonfiction in the narrative mode. In Disalienation: Politics, Philosophy, and Radical Psychiatry in Postwar France (University of Chicago Press, 2021)

by Camille Robcis, a professor at Columbia University, it underpins an intricate exploration of the political and theoretical dimensions of institutional psychotherapy, the reform movement that began at SaintAlban; and of the intellectual legacies of its adherents. These include several major 20th-century thinkers whose well-known philosophical works, Robcis argues, owe more to their backgrounds in psychiatry than many of their contemporary readers may realize.

The structure of Saint-Alban that developed under Tosquelles reflected, above all, the doctor’s commitment to anti-authoritarianism, a response as much to the politics of Franco, Hitler, and Stalin as to “the inhumanity of the psychiatric world.” What began as an effort to secure basic living conditions for patients, such as an adequate supply of food, gave way, after the war, to a new psychiatric model, the democratic “asylum-village.”

The walls separating the hospital from the surrounding town came down, as ordinary clothes replaced uniforms and medical blouses. Capitalizing on a newfound trust in their accountability, patients formed a cooperative with elections and committees that planned meals, performances, sporting events, work activities, field trips, and the publication of a weekly newsletter. Treatment took the form not only of one-on-one sessions with psychoanalysts but of a broader “psychotherapeutic dialogue,” amid open-ended “general meetings,” where even the gardeners, cooks, and secretaries took part.

Robcis stresses the distinction between institutional psychotherapy and “antipsychiatry,” a term that for her encompasses figures such as America’s Thomas Szasz and Italy’s Franco Basaglia, who advocated for deinstitutionalization and the demedicalization of mental health. Basaglia regarded the psychiatric hospital as a barrier to freedom, but Tosquelles believed that the institution “could be constantly rethought, reworked, and remapped” to promote human liberty, providing not only “the social

environment for the cure” but also a new template for communal life.

While critical of mainstream psychiatry’s “focus on brain localization” and “historical entanglement with structures of power,” institutional psychotherapists remained open to drugs and electroconvulsive therapy. They rejected antipsychiatry’s classification of psychosis as a “cultural construction” just as they did the earlier view of it as a “pure product of biology.”

Tosquelles’s multi-sided approach required an understanding of society, culture, neurology, politics, and family, which he derived principally from Marx and Freud. Robcis quotes him in an interview from 1984: “Marx talks about the problems of man as a social being and Freud talks about the psychopathology of man, why he is condemned to suffer.

Without them, we cannot understand anything about man, let alone about the mad.”

Before Tosquelles, neither Marx nor Freud had a strong presence in places like Saint-Alban. Freud himself had considered psychoanalysis a tool to treat neurotics, not psychotics.

Jacques Lacan disagreed, bringing Freud’s belief in “the importance of listening to the patients’ narration of their lives and ailments” and his technique of free association to Paris’s Sainte-Anne Hospital, where his work helped inspire Tosquelles.

Tosquelles, in turn, inspired others, such as his student Jean Oury, who modeled the Loire Valley’s La Borde clinic after Saint-Alban. La Borde’s medical staff included the semiotician Félix Guattari, who, through “institutional analysis,” sought to picture how institutional psychotherapy’s reconfiguration of the psychiatric hospital could apply to other, perhaps larger sites, like cities, schools, and political organizations.

Guattari co-wrote several books with the post-structuralist Gilles Deleuze, with whom he aimed to unearth hidden currents of authoritarianism throughout society. Tosquelles had employed Freud’s concept of the unconscious mind and its irrational desires to try to understand the popular appeal of fascism as a political movement in the 1940s, but Guattari and Deleuze believed that their own “schizoanalysis,” as an emancipatory alternative to Freudian psychoanalysis, could actively fight “the fascism in our heads.” Their anarchic process of joint authorship, described by Deleuze as “never a homogenization, but a proliferation, an accumulation of bifurcations, a rhizome,” recalled, according to Robcis, “the ‘explosion’ of roles that was so important to institutional psychotherapy.”

Winning a significant readership in France, the resulting texts arguably became famous to some degree for their partial inscrutability, and here still, their concepts resist a digestible summary. In a volume full of complex ideas, addressed from an academic but largely accessible perspective, the general reader may finally begin to experience some frustration, though perhaps by no fault of the author.

But Guattari wasn’t the only practitioner of institutional psychotherapy who became a world-renowned philosopher. Not long after finishing medical school, the Martinican postcolonialist Frantz Fanon worked for 15 months at Saint-Alban, where he wrote articles for the patient-run (Continued on page 12)

The Arts . 13

Summer 2022

Three Poems

By WIM ALDEN, Woodstock

What Is Mental Health?

By RAVEN CRISPINO, Rutland What is mental health?

e d spac

a my he m o r f ce distan ble t n a Iw e trou m s e g. caus orryin w For it o t ets me And s d, ns er han h t o tentio n e i h t d o n h go art, o es wit s l My he u p m and Is war

What is men-tal-hell-th Wat-iz-men-tall-hell-thhh Anyway, That is what my mind just told me to do.

So I did it.

I am feeling better today; more in control.

Better than a month ago; a week ago.

Yesterday was OK. OK in the way that means great, very good.

I don’t like to exhibit expectations Especially on 4 or 5 letter words Don’t lean on them too hard.

How much weight can a single word hold?

A person, a feeling, a noun, a song?

Open tho ugh the d oor may Passing t be hrough is not an op tion

How are you feeling today?

Group therapy was OK – that was yesterday.

Looking forward to one on one therapy tomorrow. lad I wrote this out so I could remember. (about G therapy) ometimes being depressed means forgetting S stuff about you that’s important or things you have to do.

Weary from the day I take to my room With nothing left to fight but demons

I t makes you feel like you can’t or don’t want to do anything. Not even get up to cook or wash your hands. You just wipe the dirt somewhere and forget about it. When you aren’t depressed you can actually get yourself up off the couch or out of bed and without a decision are able to voluntarily do nice things for yourself. Without looking at the clock, without fear that you might not be able to do it.

T hese are the moments that should not be taken for granted because they don’t always come. I was able to introduce myself today to people; people I never met before. I was able to ask for small, simple favors without feeling like a complete user or burden. I am just somebody that needs occasional help sometimes. And it is completely OK to ask.

I JUST WANTED TO LET YOU KNOW; IT’S OK And this is mental health.

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

14

The Arts

Summer 2022

DISALIENATION • Continued from page 12

newsletter, and subsequently set out to adapt Tosquelles’s strategies to a new context in North Africa.

To Fanon, Algeria’s Blida-Joinville hospital, premised on “enclosure and segregation,” operated as a colony within a colony. He succeeded in transforming the institution, but eventually he resigned in order to confront French colonialism directly – and, it seems, to imagine new “national cultures” for the Global South, rooted similarly in healing and disalienation.

The final intellectual figure examined by Robcis, Michel Foucault, didn’t practice at Saint-Alban, but he earned a degree in psychopathology from the University of Paris and “dabbled in experimental and clinical psychology” before settling into a career in academia and political activism. Robcis’s overview aims to trace his development as possibly the most prominent theoretician of antipsychiatry from a starting point of his engagement with psychiatry itself and particularly with institutional psychotherapy.

What began as an effort to secure basic living conditions for patients, such as an adequate supply of food, gave way, after the war, to a new psychiatric model, the democratic “asylum-village.”

In his twenties, Foucault saw a potential for both healing and revolution in, as he put it, “therapies that offered patients concrete means to overcome their situation of conflict, to modify their milieu, or to respond in a more adapted way to the contradictions of their conditions of existence.” But could psychiatric hospitals – or psychoanalysis in any setting, given what Foucault saw as its intentional remove from “socially integrated forms of inter-subjective relations” – really achieve any of these goals? Despite early professions of support for “certain doctors” and their psychiatric reforms, Foucault warned from the beginning of the impossibility of any psychiatric cure “when we undo the relationship between a patient and his milieu.”

By Robcis’s account, Foucault had “lost hope” in psychiatry – even radical psychiatry – by 1957, before the publication of any of his major works, in which his belief in the arbitrariness of all behavioral norms allowed him to examine institutions like hospitals and prisons purely as instruments of social control. The author points out that, by the mid-1960s, Foucault’s followers – at London’s Kingsley Hall clinic, for instance – had come to view madness as “a ‘voyage’ rather than a form of suffering” and “an act of rebellion against repressive normativity that needed to be applauded.”

Antipsychiatry remains an active (if often maligned) current in the contemporary discourse of mental health. But, institutional psychotherapy at best represents – likely to everyone’s detriment – a historical footnote, at least in the United States, where it never found a foothold in the first place. For Foucault, its innovations evidently weren’t good enough, but clearly the movement wrestled with the concerns that drove his work in ways that today’s incurious, depoliticized technocrats, whose psychiatry eschews both Marx and Freud, do not. In its radical self-consciousness, institutional psychotherapy imagined and implemented reforms that, if they’d become widespread, probably would have made Foucault’s critique

of psychiatry – which Oury cautioned would lead only to budget cuts for hospitals – a lot less convincing.

Even toward the end of his life, however, Foucault apparently claimed an affinity for the work of Dr. Franco Basaglia, who in 1979 succeeded in persuading the Italian Parliament to abolish the country’s psychiatric hospitals. Historians may regard deinstitutionalization in the United States – which began before the publication of Foucault’s Madness and Civilization – as an ultimately neoliberal project rather than a liberatory one, given the subsequent rise of mass incarceration and the coercive nature of much of the nation’s remaining psychiatric “safety net.” But in Italy (particularly in Trieste, where Basaglia practiced his “democratic psychiatry”), a robust system of community-based mental healthcare replaced the institutions. As the previous issue of Counterpoint detailed (“Trieste Still Stands – for Now,” page 18), a center-right regional government now threatens this achievement.

Although Robcis notes that several young psychiatrists in France recently have “returned” to institutional psychotherapy in some form, the future of the movement – or, more accurately, of its underlying principles – doesn’t appear, for the author, to lie primarily in the mental health sphere. Disalienation’s epilogue mentions social movements like Occupy Wall Street, Los Indignados, and Nuit Debout, whose spontaneous assemblies have sought to reinvigorate an idea of “the common” as an improvisatory site for democratic resistance to the authoritarianism of both the market and the state. Robcis proposes Tosquelles’s experiment at Saint-Alban as one guide for arranging the public square of a new politics in accordance with commitments to self-management and “nonhierarchical practices.”

The author points out that, by the mid-1960s, Foucault’s followers – at London’s Kingsley Hall clinic, for instance – had come to view madness as “a ‘voyage’ rather than a form of suffering” and “an act of rebellion against repressive normativity that needed to be applauded.”

It may be possible to imagine the spirit of Saint-Alban as a governing logic for anarchist activist spaces, but does one really want to? The supremely flexible, transitory “institutions” in question here are institutions in a metaphorical sense, and for their organizers, that may constitute much of their appeal.

What makes Tosquelles’s story astonishing, however, is that France gave him the reins of an actual institution, a structure that held real power – complete power, in fact – over the lives of those within it. And while Robcis takes pains to emphasize the doctor’s anti-Stalinist bona fides, Tosquelles evidently didn’t decline to use that power, granted to him by the state, to advance his own idea of democracy at Saint-Alban. An important question is whether anyone with similar political inclinations will come near any sort of power anywhere ever again.

Louise Wahl Memorial Annual

Writing Contest

Enter the 2022 Contest: Deadline July 23 $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, 2022 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.

COMMENTARY .

Summer 2022

15

Crazy or Not, Here I Come

By PHOEBE SPARROW WAGNER

I used to be “crazy.” Labeled CMI, chronically mentally ill, prone to psychosis, I was a revolvingdoor mental patient, one who spent almost as much time in her adult life in the hospital as out of it. Although I had various diagnoses, the main one was schizophrenia, or the variant of it, schizoaffective disorder, that some claim combines features of bipolar disorder and schizophrenia. Over time, as I bounced from hospital to home and back to the hospital, the doctors would tack on other labels as well, like PTSD and different personality disorders.

Although I occasionally was admitted “voluntarily,” most of these hospital stays started out involuntary, until nurses, brandishing paper and pen, advised me of my right to sign in as “voluntary.”

I would sign, but this did not mean I could leave because not even voluntary patients could leave at will, not in the state where I lived at the time.

If you wanted to leave before the doctor thought you should, you had to sign a paper stating this and then wait to see if the doctor challenged the paper. If she did so within three days, you could be taken to probate court for a judge to hear the case. This was never good.

We patients knew the judge virtually always sided with the doctors, since we were “crazy” and by definition could not know what was good for us.

But let me go back to the schizophrenia diagnosis. I heard voices, most of the time. Awful voices, voices that jeered and mocked and threatened me, voices that led me to burn myself dozens of times in an effort to rid myself of them. I heard and saw messages to me in everything, from the television and radio ads to newspaper headlines. I saw tiny scintillating red lights that swarmed about me like a cloud of gnats, and which I called the Red Strychnines. I saw Alan Arkin, the actor, and Senator Joe Lieberman dressed as Nazis supervising a conveyor belt sending bodies to the crematorium, and I heard music, people chanting in low voices, unintelligibly at first but later changing to threats. As is often the case, these voices and visions led me to distorted thinking, and to “paranoia,” based on what I heard and saw.

There were other voices. Brother Luke was the name I gave to the one good voice. He talked to me about time and space and humanity and love, and I felt safe with him. And there were the voices I called the Little People, to distinguish them from the main voices, the bad ones. The Little People occupied objects I used, like my comb or paint brushes, and they would talk to one another but would almost never speak directly to me. I could listen in on their lives and concerns, but mostly could not or did not want to interfere. They kept me company with their constant chatter, but they were never threatening or upsetting.

The bad voices did bother me, however, and I would often end up in the hospital because of them. But living in a hospital is as bad as it sounds, with horrible food, little to do, and really no help at all except the constant pressure to take medication, which could turn to threats if you didn’t comply. Worse, if you got out of line

(the Substance Abuse and Mental Health Services Administration) knew that restraints and seclusion were not helpful, as they stated in one of their pamphlets: “… there is a common misconception that seclusion and restraint are used only when absolutely necessary as crisis response techniques. In fact, seclusion and restraint are most commonly used to address loud, disruptive, noncompliant behavior and generally originate from a power struggle between consumer and staff. The decision to apply seclusion or restraint techniques is often arbitrary, idiosyncratic, and generally avoidable…”

In another SAMHSA publication: “Seclusion and restraint were once perceived as therapeutic practices in the treatment of people with mental and/or substance use disorders. Today, these methods are viewed as traumatizing practices and are only to be used as a last resort when less-restrictive measures have failed and safety is at severe risk.”

And this: “Restraints can be harmful and often re-traumatizing for people, especially those who have trauma histories. Beyond the physical risks of injury and death, it has been found that

I don’t believe mental illness is a real entity anymore. I don’t believe in schizophrenia or manic depression or depression or the notion that anyone’s personality can have a disorder.

– that is, if you got too loud or angry at being kept there or treated by force – they would do things like have a team of security guards strip you naked and lock you in a freezing seclusion cell alone, or shackle your wrists and ankles to a bed, leaving you like that for hours, even days at a time. Or both at the same time. I know this because everything I write about happened to me on multiple occasions.

Staff called seclusion and restraints measures of last resort and claimed they were employed only when necessary to maintain safety, but we patients knew they were used almost always as retribution and punishment. Even SAMHSA

people who experience seclusion and restraint remain in care longer and are more likely to be readmitted for care.”

But both seclusion and restraints are still used and increasingly so as staff-to-patient ratios are decreased in psych hospitals and units, with more patients per staff and many staff members poorly trained, if at all.

I don’t believe mental illness is a real entity anymore. I don’t believe in schizophrenia or manic depression or depression or the notion that anyone’s personality can have a disorder. I don’t believe that psychiatry is a valid science or even an art worthy of the name. And I do not believe that we are right on the verge of discovering the origins of “mental illness.”

We were told this many times before: for instance, when the “miracle of psychosurgery” maimed or killed thousands, “helping” them with ice picks and prefrontal lobotomies. We were told of the miracles of shock, when a variety of drugs as well as electrical current applied to the brain “helped” thousands more, even when bones were broken and people died. And we are still being fed the lie that neuroleptic drugs like Thorazine and Haldol and the new generation (Continued on page 16)

16 COMMENTARY

Summer 2022

CRAZY OR NOT • Continued from page 15 of similar drugs like Zyprexa and Risperdal 2008. I did not at the time understand what had are in fact “antipsychotic” and are an effective happened, but I woke up one morning with a treatment for, well, whatever ails you. voice inside my head (all the other voices seemed But it was not true that lobotomies helped to come from outside me) repeatedly telling me, anyone. Shock treatments, which induce grand “You have to build a human.” Well, I thought, mal seizures, are by definition brain-damaging, this voice is not telling me to harm myself, what’s and the drugs rarely help more than they hurt, the problem with obeying? So I set out to build a since it has been shown that long-term they human, and in three months, I created a life-size create more illness, chronic illness, than they papier-mâché woman, seated in a chair. ever alleviated.

We should have known this. Back in the ‘50s, when Thorazine was seriously referred to as a chemical lobotomy (seen as desirable), doctors noted that the drug was not in fact a treatment that helped the person who took it, reducing symptoms or restoring health. What they saw was that those given the drug were subdued, even immobilized into the infamous Thorazine shuffle, and more “compliant.”

This helped the nurses be nurses, as the formerly disruptive were now bludgeoned by Thorazine into mild, shuffling sufferers.

They were no longer madmen or madwomen – no, they had been disabled by the drug and could now be nursed as true patients, patients who were sick and needed nursing care.

I have been given high doses of Thorazine and know from experience that it is a horrible, deadening drug. I have been forcibly treated with soulkilling Haldol and the others, and when Clozaril came out, I was given that (I developed agranulocytosis, twice, so I was taken off it), and then Risperdal and Zyprexa and most of the others that later came onto the market. None of them helped me or reduced the voices or made me happier.

Two things did help: art, which became my life’s passion, and therapy – therapy not with a psychiatrist or an LCSW Phoebe Sparrow Wagner working with a psychiatrist (clinicians who saw only sowill be July’s featured artist called mental illness), but with at Harmony Collective Artist a woman who does not even Gallery in Brattleboro, where have a license to practice in sales of her work will benefit this country. She never saw schizophrenia or bipolar or Groundworks Collaborative, personality disorders in me a nonprofit homeless shelter when we talked; she saw me, and food pantry. the me beneath all the labels, and she saw a good person, not the “Satan’s spawn” that the voices derided. She saw me healthy and thriving, even before I did.

This seemed to unleash something in me and She did not want to control me. In fact, human I made art constantly from 2008 onward. It was freedom was and is her main concern. But she only in 2017, when I stopped all my psych drugs, accepted me as I was, and her unconditional that I realized I had also stopped doing art. I acceptance, her love (for what else was it?), gave went back on them, and within a week or two I me back a sense of self and the self-esteem to was doing art again. thrive and move forward into my life.

And a second slow withdrawal in 2020, which I want to say a word about my falling in love also resulted in my stopping my daily artwith art. I became an artist very suddenly in making, led me to the conclusion that without at

least one of these drugs, I could not do art. And art was now my raison d’être.

I finally determined that it was Abilify that enabled me to do art. Abilify, which I had started in 2008 as an antipsychotic, is also used to “boost” anti-depressants. Nowhere has anyone ever noted its use in stimulating creativity. But that’s what it does for me, and it does so reliably.

Off Abilify, I do no art. On it, I can access my creativity in a way that I can no longer live without.

But it does not act as an antipsychotic, or as an antidepressant, because I’m fine these days, and all my “symptoms” (a term I never use except in quotes), all the voices and visions, the distorted thinking and paranoia I used to experience, are gone, whether I take the drug or not.

I believe that the extreme mental states called “mental illness” all have their origin in trauma, and often these traumas are re-enacted and reinforced by what is absurdly called “psychiatric care.” Forced medication, forcible treatment, restraints, seclusion and involuntary commitments, all these are liberally employed, as if shackling a person to bed or chair for hours at a time, or holding someone down for forced injections, is an act of compassion. These measures are undertaken most often against poor people or minorities, and buttressed by the same lies about “antipsychotics” and “antidepressants” that are also foisted on the general public.

If psychiatry were a profession entirely dedicated to the truth about each individual and the truth about trauma, and weren’t tied to the mercenary interests of the pharmaceutical companies, maybe today it would be a healing profession and not the corrupt, pseudo-medical cabal it is.

The profession could change, become what it purports to be, but this would necessitate psychiatrists looking honestly at history.

I doubt that those who have arrogated so much power to themselves will ever relinquish it, much less acknowledge with remorse the immense harm psychiatry has inflicted on the world.

Phoebe Sparrow Wagner is a Brattleboro artist, poet, and author, and a survivor of the mental illness system. Her websites are https://www.artfolie365.com and https:// phoebesparrowwagner.com, where a version of this essay previously appeared.

Summer 2022

COMMENTARY .

17

EDITORIAL

Who Decides if the News Is ‘Bad’?

In April, the Burlington-based alt-weekly Seven Days published the following headline: “UVM Health Network Halts Badly Needed Psychiatric Bed Project.”

The article was a news story, not a commentary, about an announcement by the University of Vermont Health Network (UVMHN) that, due to financial challenges, it would shelve its plan to build a new psychiatric unit at the Central Vermont Medical Center (CVMC) in Berlin.

Most reporters strive to uphold an ideal of journalistic objectivity, but every news story, examined closely, nevertheless betrays countless unstated opinions that inform choices about where its primary focus should lie, which words best describe what has happened, which sources warrant consultation, and which facts demand inclusion. Biases also inevitably help determine what does or doesn’t qualify as a fact in the first place.

Is it a fact, for instance, that the long-anticipated psych ward at CVMC is “badly needed”? Presumably Seven Days, like any news organization, seeks to balance the civic (and commercial) imperative to persuade readers of the urgency of its reporting with the recognition that any particular declaration of urgency inherently constitutes a value judgment. The inadequacy of Vermont’s psychiatric inpatient capacity, however, must have registered to its editor as an unassailable truth.

After all, public officials have – again and again – declared a widespread mental health crisis, and hospital physicians have offered ample testimony about psychiatric patients enduring prolonged waits in emergency rooms due to logjammed psychiatric units. At some point, expert opinion calcifies into fact.

What would a journalism professor say? A particularly fusty one might tell a reporter that, under the rubric of “objectivity,” they can write about plans for a psychiatric unit, and they can cite relevant officials’ claims or public data about the unavailability of inpatient beds as a possible basis for those plans, but the readers must figure out for themselves whether those claims or data really prove that the new unit is “badly needed.”

The purpose of this editorial isn’t to chide Seven Days for connecting the dots directly, instead of merely setting up its readership to connect them. It amounts more or less to the same thing. But the article in question – which asserts that the (possibly temporary) demise of the “desperately needed project” at CVMC “couldn’t come at a worse time for Vermont’s longoverburdened mental health care system” – reveals deeper assumptions about how mental health systems should work, and these assumptions ground coverage of mental health more broadly in the press.

A reporter seeking to use hard evidence to demonstrate the necessity for the CVMC expansion would likely run into a problem: the available statewide data on emergency room waits for psychiatric patients is not as compelling as recent testimony from physicians has been. The most recently published figures, from an Act 200 report by the Vermont Department of Mental Health (DMH), span October 1, 2020, to September 30, 2021, and therefore can’t speak to new developments, but neither do they predate the reported increase in mental health emergencies since the start of COVID-19.

According to the Vermont Association of Hospitals and Health Systems Network Services Organization’s data, the average adult psychiatric patient spent one full day in the emergency room before inpatient placement during the abovementioned calendar. The prior year’s Act 200 report shows an average of 0.85 days in the ER before admission to a psychiatric unit. The oldest available report with such data indicates an average wait of 0.9 days between 2018 and 2019, casting some doubt on the narrative of a significant increase in waits during the pandemic.

Statewide data does show that children lately have endured longer waits than adults: two days on average before placement at the Brattleboro Retreat, Vermont’s only psychiatric hospital serving youth, or at an outof-state facility. This problem led DMH in January to issue a request for proposals for inpatient beds for children, but CVMC’s additional capacity would not serve these patients.

Wait times also are three times higher for involuntary adult psychiatric patients than for voluntary ones, but it is important to point out here that involuntary patients are not, in fact, waiting for inpatient placement.

The emergency department is waiting to transfer them, but the patient is waiting simply to be released from confinement.

Per Act 79, another DMH report from January documented, in fiscal year 2021, “the lowest level of adult inpatient bed utilization” over the last eight years in Vermont’s psychiatric units. Amid staffing shortages, hospitals closed many beds, but even so, the number of open beds rose.

Now, fiscal year 2022 has nearly ended, and once DMH has tabulated its numbers, we may see that psychiatric units had few, if any, vacancies during this time. If that proves to be the case, bed closures will likely represent a big part of the problem, suggesting, perhaps, that the training and hiring of more workers, rather than the creation of more physical space for inpatient psychiatry, might alleviate the jam. But for now, we don’t know where we are.

We do know, however, that transferral to an inpatient bed doesn’t have to be the only way for an emergency department to handle someone who shows up in an extreme mental state. Unfortunately, none of Vermont’s major media outlets found time this spring to mention legislation introduced by Sen. Cheryl Hooker, which would have provided alternative care settings for mental health patients by creating seven peer respites across the state.

Outlets like Seven Days and VTDigger dedicated numerous articles to ER waits and then to the Green Mountain Care Board’s stingy refusal to grant UVMHN the right to charge insurers (including Medicaid) rates high enough to fund the construction of a new building at CVMC. DMH supported Hooker’s bill’s assertion that new peer respites would relieve pressure on emergency rooms, but this potential solution never entered the mainstream conversation about where we ought to send patients now trapped in overcrowded ERs. Nor did we see a great deal of discussion about how ending homelessness, for instance, might lead to fewer ER visits in the first place.

This is a political problem. There are all sorts of reasons why our society chooses to inflict coercive, dehumanizing “treatment” upon mental health patients inside locked facilities, but most journalists probably just don’t know that other possibilities exist, and it’s the job of activists to change that.

In other words, psychiatric survivors must make their case. Notably, in 2018, when Seven Days published a piece on the beginnings of “Vermont’s psychiatric bed crisis,” the author included a countervailing quote by Wilda White, then the executive director of Vermont Psychiatric Survivors, who apparently advocated for “housing, therapy, and community centers” instead of new investments in inpatient care. “This is not a system that needs more capacity to deal with crisis. This is a system that needs more capacity to deal with prevention and early intervention,” she reportedly stated.

By 2022, though, only one story remained about what Vermont could do to mitigate the effects upon its hospital system of its residents’ apparently increasing psychological stress. This is the way every standard solution to a social problem maintains its power within our inert culture – not by winning the public’s support in a vibrant contest of ideas but by presenting itself, with the help of a politically captured press, as the only feasible course outside of total inaction and indifference.

The artificially narrow playing field in popular political discourse affects every kind of policy debate, so naturally it has significant implications as well when it comes to progressive advocacy around “mental health awareness,” which often takes aim exclusively at a conservative tendency to ignore or minimize mental health and to underfund its treatment.

When the argument does not address the character of mental health services, focusing instead only on their availability and destigmatization, well-meaning people may end up hurting those they want to help. They won’t change until the information they receive changes.

Does mainstream mental health journalism become more or less objective by incorporating the perspectives of survivors, consumers, and ex-patients? It’s the wrong question, because objectivity isn’t real and never was. But these perspectives must become powerful enough currents in mental health discourse that the point of view that journalists imagine as objectivity will always contain them.

Send your reactions to commentaries or an opinion piece of your own to: COUNTERPOINT 128 Merchants Row, Suite 606, Rutland, VT 05701, or to counterpoint@vermontpsychiatricsurvivors.org Include name, address and email.

18 COMMENTARY

Summer 2022

Eleven Years of Being Peers

By LINDA FUGLESTAD

This year, 2022, Alyssum quietly, but proudly, celebrates 11 years of being here in Vermont as the first peer-hosted alternative holistic crisis intervention and respite! In doing this work, we have been happy to celebrate our ongoing connection with our first ever guest from when we opened in 2011, a guest now known as Teddy Bear.

Teddy was our first guest when we were new and just finding our way as a pilot program, funded by the Vermont Department of Mental health, free to eligible Vermont residents in need. Since then, we have come a long way and learned a lot, and so, says Teddy, has he. Through ongoing supports, first during in-person shortterm stays at Alyssum, warm line support calls and, in the last two years, in-person home visits, we have been thankful and privileged to maintain our connection with Teddy for 11 years as peers.

Teddy first came to Alyssum to work on challenges like depression, feeling isolated, and having conflicts with service providers.

Through talking to peers here, and with space for self-reflection, over the years Teddy shares having regained some of his love of hobbies like crocheting, painting, photography and writing poetry.

Teddy strengthened skills to negotiate interpersonal conflicts and was a little better able to get his needs met in his community as well. We have some of Teddy’s photography on display, including an amazing portrait of our first emotional support dog, Lady, done by Teddy in an amazing likeness of her that we treasure.

In future visits Teddy worked on gender identity and managing health concerns like diet changes and living with chronic pain and asking for support while juggling various community and medical providers, not all of them supportive.

Teddy shares, “A lot of those times, including my first visit, you literally saved my life. My first visit, I was so ready to kill myself and was unable to get help. A friend Melanie contacted Gloria [Alyssum’s executive director], then asked me to call [your program]. I did. Then I tried crisis to see about a referral and was told a harsh no. My therapist then called [Alyssum].

It was late and snowing really bad. I was told to please wait, someone was on their way. Get stuff I need together. I did, then later that same night Carl came and got me. Loaded my stuff. Told me I was going to a really nice place where I’d get help I needed. He also told me not to worry about the weather. That his truck was very good

in bad weather and he was a very good driver.

We got there safely and I met Seth. Good person for me to talk to. It saved my life.”

Since that first night, and through various staff changes, Alyssum has been blessed to have Teddy here more than once for special holidays and support visits and enjoyed doing crafts together along with opportunities for one-onone time to talk through challenges as they have come up in his life. Our annual holiday tree is brighter with the beautifully crocheted ornaments Teddy made.

In the last two years, between the pandemic and decreased mobility, peer staff have been thankful to still be able to stay connected with Teddy via home visits to provide Teddy’s requested supports and much needed connection.

Alyssum provides a holistic, peer staffed mental health crisis respite.

This alternative to hospitalization will support individuals to emerge from crisis with wisdom and personal responsibility skills for living well.

We know Teddy misses our beautiful setting out in the country with birds chirping and blue skies, peaceful quiet, and the river nearby for a dip in hot weather, but Teddy confirms that this solution of home visits and Zoom calls being an option as a compromise has been so greatly needed and appreciated.

A multitude of changes have happened in the 11 years since Alyssum opened, with new ideas, updates, and the addition of our much beloved emotional support dog Prince. We have been blessed by many ongoing mental healthrelated trainings to keep us up to date with ways to offer more to guests. We treasure all of our past and present guests and are thankful for the long-term connections we make as peers, doing support calls on the phones or meeting new peers as they visit our program or having people come back to work on skills building, life challenges or feeling supported and safe in their

Alyssum Staff

body, their lives, their communities.

Teddy has been glad to be a part of our journey throughout all of these transitions, being here as needed to share his successes as well as process personal losses and grief over the years. Despite losing dear friends, or having to move to find a supportive community, we admire Teddy for staying loving, resilient, friendly and hopeful.

Even though times get tough for him sometimes, he says he never gives up looking for a better way.

Throughout everything over the years, it has been wonderful to watch Teddy blossom and grow, unfolding into a new version of himself that he has embraced with love and kindness, all the while treasuring his love of helping others and having a connection with us, building relationships, and being an ongoing part of the Alyssum family. Staff has especially enjoyed over the years that, during a stay here, Teddy has always been up for an impromptu trip to the park for a concert or a diet coke or for his favorite ice cream cone or coffee at the bookstore in town. Although Teddy would definitely say that nothing could top his fond memories of coming to this area to have creemies with his Dad at Tozier’s Restaurant in Bethel, Vermont, as a kid growing up, longtime staff person Linda hopes that the night they made crème brûlée together in the middle of the night in the kitchen or blueberry pancakes at 3 a.m. might at least come close!

Teddy has many cool things he is known for, including playing the dulcimer, and sporting fashionable hats like berets and fedoras or standing out with cool hairstyles, colored pink, purple, blue or green, depending on what they fancy at the time. Wherever Teddy has lived, it has always touched our hearts at Alyssum to hear how he goes above and beyond helping friends and neighbors, doing nice things for people, even if his body hurts from it later, and always joyfully sending special surprise gifts to family and friends.

When not visiting Alyssum, Teddy has two quirky kitties, Cheeky and Howard, who love to steal his chair or get under his feet or lay in wait to dash out into the hallway of his apartment, just to keep life interesting. Teddy says, “I still I think there should be two or three more Alyssums throughout Vermont, even though I am frustrated that my physical and mental health limit my ability to visit right now due to the risk of being too far from medical providers if needed. I still have the hope of better mental and physical health, thanks to Alyssum support.”

Two of us at Alyssum were just blessed to be able to go visit Teddy in April for a home visit to bring him a special requested home-cooked lunch and birthday cake to celebrate a milestone birthday. We are so very thankful as peers in the holistic alternative mental health world to have flexible ways we can stay connected with all of our guests, whenever possible, but in particular, right now, we celebrate and treasure the meaningful memories and connection built with our very first guest, Teddy, who began our peer journey with us since the beginning 11 years ago! It has been 11 years of support, mutual respect and connection. Thank you to Teddy for being our first ever guest! Happy 11 years and counting!

Interested in learning more about our program? Check out our website and Facebook page or ask if you’d like brochures. Alyssum Inc., Rochester, VT, (802)-767-6001, alyssum.org.

Summer 2022

COMMENTARY .

19

Mental Health and Cycling

By TANAWAT LUEKR-U-SUKE

Riding my bike and walking have always been a way for me to clear my thoughts and improve my attitude. Over time, long walks and bike rides became meditation sessions for me, allowing me to boost my mental health simply by making time to engage in something that brings me joy.

During my childhood in New York City, my family and I would walk around eight miles every Saturday. These walks would start at 96th Street in Manhattan, and we would walk at our own pace all the way to Times Square through Central Park. Sometimes we would go to see sights in the park, which would reroute us in all kinds of funky ways.

Whether we were visiting the statue of Balto or Belvedere Castle, we walked to watch people and experience the area. These fleeting moments, tied to unique locations, gave us a different perspective on the world around us.

This is where I first learned the value of walking to places and taking your time to absorb your surroundings.

Later, as a highly emotional teenager who had stopped walking with my family on weekends, I did not not have an outlet for my thoughts.

Instead there was a lot of pent-up rage and sadness, unseen until the event of an outburst, wherepon they would spill out onto unsuspecting victims.

In my junior year of high school, a new friend convinced me to bike around the city. At first it was merely a way for me to get around and liberate myself. I had been previously tied down with a school-provided MetroCard that provided just three free daily trips. Two were to be used to commute to and from school and the third to get to an afterschool activity. With no money in my pocket, my only way to see more of the world

was if someone took me. But now, with a bike, I was my only limiting factor.

Together, my friend and I explored the city by bike, and on foot too. The long journeys allowed me once again to reflect on myself and my surroundings. Typically, these reflections would then turn toward society, our city, the systems we interact with.

College was where I built the habit of commuting by bike, which I maintained as I transitioned into a working adult. Commuting by bike reduced my financial stress and still provided a way to see and experience the world with a greater sense of freedom than subway

Over time, long walks and bike rides became meditation sessions for me, allowing me to boost my mental health simply by making time to engage in something that brings me joy. cars or packed buses offered. Eventually my commutes would be 10 miles long, from Washington Heights down to the East Village.

At my job, where I worked sometimes 60hour weeks on a fixed salary, there were lots of expectations of what needed to get done, and the stress levels were high. My partner would note on

These rides provide me with some much needed time on the bike as well as exposure to the community that surrounds me. weeks when I was too tired to commute by bike that my attitude and anger management would worsen. Prolonged absence from commuting by bike would hinder my ability to keep my impulsive thought processes in check.

These days, I have a short walk and even shorter bike ride to work. These commutes are long enough to be pleasant but not long enough to help me very much in maintaining my mental health. When I start to feel overly agitated, I ride out to the “cut” on the Colchester Causeway.

These rides provide me with some much needed time on the bike as well as exposure to the community that surrounds me. It is always interesting to see families who embark on bike rides with kiddos on the Island Line Trail.

Instead of having a major park with loads of different sights and attractions, the bike path is the attraction. Sometimes people will tell me it is the only place they feel safe to have kids ride their bikes. At the end of the day, getting outdoors and onto the bike path along Lake Champlain seems to be the most common way for locals to unwind.

Tanawat Luekr-u-suke lives and cycles in Burlington, VT.

Have News To Share? Send it to Counterpoint!

Vermont Psychiatric Survivors, 128 Merchants Row, Suite 606, Rutland, VT 05701 or by email to: counterpoint@vermontpsychiatricsurvivors.org

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20 NEWS

Summer 2022

Segue House Cited for Violations

By BRETT YATES

internal records showing that two of five employees had not completed their 12 required hours of annual training.

The second recorded violation arose from a failure to observe a resident’s “right to have accommodations made to a disability,” based on the experience of a sleepwalker who, assigned to a shared third-floor bedroom near a “steep

which oozed a “black/brown tar-like” substance The Department of Disabilities, Aging and that had stained the adjacent wall. Another Independent Living’s Division of Licensing and bathroom contained a mingled collection of Protection (DLP) conducted an “unannounced “used disposable razors,” which the residents on-site re-licensure survey and complaint had been “reusing and sharing” despite the risk investigation” at Segue House in Montpelier of spreading bacteria and viruses. The state of in February. The state regulators identified the sinks and toilets led regulators to cast doubt compliance violations in nine categories. on the manager’s claim that “custodial services Washington County Mental Health come in weekly to clean.”

Services operates Segue House as a Meanwhile, the presence of “soiled “therapeutic community residence” DLP’s visit to Segue House revealed laundry, trash, [and] soiled dishes” in (TCR) at 7 St. Paul Street. According to “odorous” bedrooms betrayed a lack of “any shortcomings in sanitation, DLP, 39 such facilities across the state indication of assistance from TCR staff to house “people who are experiencing engage the residents in maintaining a safe fire safety, and resident care. problems in coping with such difficulties and sanitary environment.” One resident as substance abuse, psychiatric disabilities, spent two weeks without a proper bedroom traumatic brain injuries, cognitive and at all, instead sleeping inside the facility’s developmental disabilities, family dysfunctions staircase,” had suffered injuries. Because noise “art room,” whose double swinging doors left the and delinquency.” at night appeared to exacerbate the patient’s resident without appropriate privacy due to their These homes “tend to be small and somnambulism, a neurologist had issued an Plexiglas panels. characterized by the sharing of a common life.” unheeded recommendation for a private room On March 23, regulators accepted a plan of Official regulatory documents state that DLP “with a gate at the door as a safety measure.” correction submitted by Segue House’s manager. “shall inspect a residence prior to issuing a The rest of the citations addressed failures “We may follow-up to verify that substantial license and may inspect a residence any other of maintenance and cleaning. In the kitchens, compliance has been achieved and maintained. time it considers an inspection necessary to regulators found “food fragments and other If we find that your facility has failed to achieve determine if a residence is in compliance” with debris” on the counters, a dining table “soiled or maintain substantial compliance, remedies its rules, including the obligation to maintain a with scattered food remains,” mold inside may be imposed,” DLP’s form letter warned. “homelike and comfortable environment.” the microwave, and expired cold cuts in the DLP records indicate that the most recent DLP’s visit to Segue House revealed refrigerator. previous inspection of Segue House occurred in shortcomings in sanitation, fire safety, and One of the bathrooms had a dirty bathtub and 2014. The report from that visit noted several of resident care. The first citation pointed to an eight-by-four-inch hole in the ceiling, from the same violations.

A letter from Washington County Mental Health Services Dear Counterpoint, We appreciate the attention you are bringing to residential programs funded by the Department of Mental Health (DMH). We believe that these programs are an essential part of our system of care and for the residents, an important part of their journey in recovery. These residences serve people experiencing significant mental health and often co-occurring substance use conditions, many of whom are at risk for homelessness or inpatient care. The

importance of these programs cannot be understated, nor the effort it takes to maintain them. Operational challenges were highlighted in the context of the global pandemic which was acutely felt by the health and human services sector.

The health and safety of the people we serve and those who serve them is of the utmost importance to us and we are grateful for any feedback that helps us to improve the quality of our services and supports. All findings from the Vermont Division of Licensing and Protection’s site visit in

February 2022 have been addressed, the plan of correction accepted and implemented. We are currently making significant investments in our DMH funded residential programs including much needed facility upgrades for accessibility as well as increased wages for our staff.

Once again, thank you for spotlighting the importance of these residential settings.

Keith Grier, WCMHS Director, Community Support Program

In the News T he Vermont Department of Mental Health (DMH) began to solicit applications on Feb. 16 for grants that will pay for structural upgrades to supportive housing and community-based mental health facilities, with an aim of boosting safety and accessibility and improving service environments through projects such as ramp installations and HVAC renovations. At least one grant from the $400,000 pot of American Rescue Plan Act funds will go to a peerrun or peer-directed organization.

O n Feb. 22, Health Care and Rehabilitation Services (HCRS), the mental health agency for Windsor and Windham counties, announced that its youth outpatient services had moved to downtown White River Junction. The new location at 132 South Main Street includes a playroom for children.

Only the University of Vermont Medical Center (UVMMC) had responded to DMH’s Jan. 28 request for proposals for a new inpatient psychiatric unit for children and adolescents by its Feb. 22 due date.

According to a VTDigger report

in the spring, UVMMC subsequently backed away from its proposal, at least temporarily, citing a $44 million budgetary deficit at the University of Vermont Health Network.

Louis Josephson ended his six-year tenure as CEO of the Brattleboro Retreat in April after a winter of staffing challenges.

His interim replacement, Linda Rossi, previously an executive vice president, reportedly became the first woman to serve as the head of the psychiatric hospital in its 188-year history.

The University of Vermont Health Network (UVMHN) told the Green Mountain Care Board (GMCB) in late April that for now it could not afford to build a new psychiatric unit at Central Vermont Medical Center.

In the works since 2018, when regulators ordered an increase in UVMHN’s inpatient psychiatric inpatient capacity, the project would have added 25 beds at an estimated cost of $158 million. Weeks earlier, GMCB had denied a midyear application by UVMHN to raise the rates that its hospitals charge insurers by 10 percent.

T he Vermont Senate voted to confirm Jenney Samuelson as the Secretary of Human Services on May 2. A former deputy secretary, Samuelson had become interim secretary following the retirement, at the end of 2021, of Mike Smith, whose second stint leading the Agency of Human Services (AHS) began in 2019. AHS, the state’s largest agency, consists of DMH and five other departments.

On May 6, following last year’s formal apology for a 1931 state law endorsing eugenics, the Vermont General Assembly passed a bill codifying a process to create a Truth and Reconciliation Commission that will identify historical instances of state-sanctioned discrimination against various populations, including people perceived to have mental or psychiatric disabilities, and will examine possible ways to overturn the lasting effects of such policies. The bill appropriates $748,000 in Fiscal Year 2023 for the commission, which will cost the state an estimated $4.5 million in total before disbanding in 2026.

Summer 2022

NEWS .

21

New Grant Program Targets Youth Mental Health Starting in July, the Vermont Agency of Education (AOE) will administer a two-year program whereby, in consultation with the Department of Mental Health (DMH), it will disburse grants for youth programming in schools and community settings.

Legislation passed on April 27 specifies that grant applicants must employ “evidence-based strategies to address students’ social, emotional, mental health, and wellness needs” and collect data to demonstrate their effectiveness. Committees received testimony by representatives from Vermont Afterschool; MENTOR Vermont; Mental Health First Aid, whose model the law mentions by name; and Designated Agencies that employ school-based clinicians.

Introduced by Sen. Ginny Lyons, S. 197 initially set out to create a working group that would have endeavored to design “a coordinated system of response to mental health crises” among police departments, hospitals, and the Designated Agencies. At a Feb. 11 meeting of the Senate Committee on Health and Welfare, however, the senator announced that the bill would “take a turn toward youth.”

Since the onset of the COVID-19 pandemic, parents, educators, counselors, emergency room physicians, and others have expressed alarm at signs of escalating psychological stress among Vermont’s young people. Grants under S.197 will target organizations that provide “opportunities for children and youth to participate in activities that heal and prevent social isolation, such as outdoor activities, art therapy, recreation, and time in nature,” as well as those that can create “partnership[s] with classroom teachers and school guidance counselors to coordinate supports, communication, and strategies.”

Superintendent Lynn Cota of the Franklin Northeast Supervisory Union supported the bill. “I’m sure you all already understand the crisis that we’re feeling in our Vermont schools and the magnitude and the complexity of the mental health needs and the resulting behavior manifestations that we’re all seeing,” she told legislators. “It’s really taxing the capacity that we have and the level of expertise that we have within our schools in order to support those students.”

Sen. Ann Cummings wondered whether a two-year program could make a lasting difference in schools. “We have services there that we’re severely underfunding, and we’re setting up new temporary programs.

For a kid to start something and build a relationship and then have it end could do a lot of damage,” she cautioned Lyons.

The legislation suggests, however, that the grant program will aim to supply “a model for the integration of mental health and in-school and afterschool programming” that AOE could seek to sustain, in some fashion, beyond the mandated two years. The legislature will receive a report on the matter from AOE by early 2025.

Lyons first sought to tap unreserved ESSER III dollars to pay for the grants. ESSER (Elementary and Secondary School Emergency Relief), a federal program, aimed to help schools respond to the impacts of the coronavirus; its third tranche of funds, also known as ARP ESSER (in reference to President Biden’s American Rescue Plan), delivered $258 million to Vermont, but most of it went to local school districts, not to the state.

Last year’s appropriations bill, however, set aside a small portion on behalf of AOE for “regional capacity grants to address students’ social, emotional, and mental health needs.” This allocation ultimately served this spring to pay for Lyons’s bill.

“We came to her and reminded the Senate committees that we actually had $3 million from ARP ESSER that had been appropriated last year for broader work in terms of integrating systems of support for students,” Deputy Secretary of Education Heather Bouchey told the House Committee on Education. “It made a lot of sense for us to use this particular bill to lay out a shared plan with the General Assembly and the administration for what we would do with those $3 million.”

The lion’s share of this total, $2.5 million, will fund the grants for youth mental health programming. S. 197 reserves the other $500,000 for teachers.

“Many of them are still working through and handling their own personal experiences with respect to COVID, in terms of trauma, in terms of loss, and on top of that, really trying to hold it together and figure out how to keep themselves whole and well and ensuring that they take care of and teach our students,” Bouchey described.

The “statewide COVID-19 supports for educators and school staff” mentioned in the law may, according to Bouchey, take the form of free teletherapy, delivered by an in-state or out-of-state contractor. AOE has already spoken with some “potential bidders,” she noted.

“We really think this is a critical piece because, without our educators in a good space, we’re really going to have a hard time ensuring that our students are navigating successfully out of the pandemic,” Bouchey said.

22 NEWS

Summer 2022

Burlington Elects Support Group Facilitator to City Council

By BRETT YATES

asking athletes questions. It felt like a very On Town Meeting Day, control of the Burlington collaborative group. I really had a wonderful City Council hinged on an open contest in Ward experience with it.”

8 between two college students. Preserving the Studying to become a social worker, House Vermont Progressive Party’s six-seat plurality, started to work at Lund, a nonprofit focused on Ali House, a senior at the University of Vermont children and families. Here, she stepped into the (UVM), defeated Democrat Hannah King with role of facilitator for a “post-permanency” support 54% of the vote. group. According to House, post-permanency House’s campaign centered, among other refers to “the process or the journey that children issues, mental health. Her platform, as articulated and their families embark on” following an on her official website, criticized “the self-care adoption or a change in guardianship, which may movement” for placing “the onus of mental health entail “healing and narrative work and a sense of and well-being solely on individuals” instead of claiming that needs to take place.” on “the systems within which we operate.”

As a high schooler, House underwent her own “I envision a Burlington where everybody – not version of this journey when her older brother just those with means – are able to access a wide became her guardian. While noting the imperative array of decolonized collective care opportunities “to be very conscientious in my work not to and mental health resources,” House wrote. These generalize my experience to the people that I work would include not only professional counseling with,” she acknowledged that it had “shaped” and therapy but also “informal opportunities” to her practice and perspective. “Even if I can’t Ali House advance emotional wellness, such as community understand exactly what a child or a family is gardens, healing workshops, and support groups. going through, I have a window into that process,” she described.

“I think mental health services should be as diverse as the people Until recently, House had not envisioned entering politics. But UVM they claim to treat and as unique as the people they treat,” House told introduced her to a professor who also served as a state representative Counterpoint. “I think we should always be, as a City Council, looking for on the House Committee on Human Services, which led House to an new approaches to mental healthcare.” internship at the statehouse. She also began to testify at City Council At UVM, House co-founded a support group for injured athletes. “I meetings. played field hockey my freshman year and had a misdiagnosis, and As an elected official, House hopes that her openness about her own unfortunately it caused some permanent damage, so I’m not allowed to “mental health struggles” will set an example. “It’s more common than run anymore,” she related. we think. It exists for people in leadership too,” she observed. “We need Catamount Sports Psychology & Counseling, housed within UVM’s more people who’ve had mental health struggles in these positions Department of Athletics, facilitated the small group’s sessions, which where they can create policy around it. It needs to be a survivor-led House called “very athlete-driven and athlete-focused. Athletes were movement.”

DMH Seeks to Expand Family Peer Support Nonprofits had an opportunity this spring to bid on a contract with the Vermont Department of Mental Health (DMH) to provide peer support for parents of children within the mental health system. DMH’s request for proposals (RFP), issued on April 11, also asked for an assessment of existing parental peer supports and youth peer supports in Vermont.

The combined cost for both scopes of work cannot exceed $100,000, per DMH, which expects to make use of federal funds. The department intends to select a winning proposal in June.

According to the RFP, the contractor will train parents across the state to “provide support, education, and guidance for parents and guardians as they navigate the Coordinated Service Planning process.”

In Vermont, a determination of “severe emotional disturbance” renders a child eligible for a Coordinated Service Plan, which aims to integrate separate forms of assistance provided by DMH, the Department for Children and Families, and the Agency of Education into a unified program that, under 33 V.S.A. § 4301, “shall be designed to meet the needs of the child within his or her family or in an out-of-home placement, and in the school and the community.” Parents or guardians work together with community supports and with the state to develop the plan.

In addition to offering help with this process, the contractor will develop a “strategic action plan” to expand peer support for both parents and children throughout the state, based on an analysis of current services and on local and national recommendations. The plan will address the possibility of a statewide certification program specific to family peer support specialists.

During the recent legislative session, the Vermont General Assembly rejected a bill to implement a statewide certification program for mental health peers, which would have included opportunities for subspecialization. Under the legislation, a peer-led organization, as DMH’s contractor, would have solicited “feedback and recommendations” from Vermont’s “family organizations” in developing the curriculum, but testimony from the Vermont Federation of Families for Children’s Mental Health (VFFCMH) and NAMI-VT suggested that family organizations

should take the lead in designing and delivering certification for family peer support specialists.

VFFCMH, which by its account has offered family peer support for 32 years, warned that, without changes, the bill might have the effect of pulling family organizations “further away from their grassroot origins and their national networks of expertise.”

NAMI-VT emphasized the uniqueness of family peer support, whose specialists, in the words of Executive Director Laurie Emerson, “work to empower families by teaching skills that assist them in finding their own voice and to advocate. They have current knowledge of the mental health system and most importantly, recognize the life experience of raising a child with a mental health diagnosis or supporting an adult family member with mental health needs.”

Summer 2022

NEWS .

23

Mad Pride to Come to Burlington

By BRETT YATES

Vermont Mad Pride Day will take place on July 16, 2022, in Burlington. Attendees will gather at Church and Main streets for a march at noon to Battery Park, where festivities will continue – with speeches, music, and food and drink – until 3 p.m.

Cities around the world host Mad Pride events, timed often to coincide with Bastille Day, the holiday commemorating the Parisian uprising that freed seven prisoners (including two “lunatics” and one “deviant”) during the French Revolution. Before COVID-19, marchers gathered annually in central or southern Vermont, where Vermont Psychiatric Survivors organized the most recent Mad Pride in Brattleboro in 2019.

This time, Another Way Community Center has taken the lead. Organizer Ericka Reil, a peer specialist at Another Way, mentioned additional help from Pathways Vermont, MadFreedom, the Vermont Center for Independent Living, and Disability Rights Vermont.

In the hope of staging Vermont’s biggest Mad Pride Day yet, Another Way has shifted the location for the first time to the state’s largest population center. “We did have to secure permits,” Reil said, “and it was actually very, very easy. The City of Burlington was very kind to us, and they were very receptive to the whole thing.”

Reil has attended previous events. “I’m a psychiatric survivor. I’m proud of that fact,” she explained. “I want to be visible with that fact, and I want people to know that we’re out there.

We’re independent, we’re one of you, we’re your neighbors, we’re your coworkers, we’re your community, and we want to be seen for who we are.”

Mad Pride also offers family members and allies a chance to stand with psychiatric survivors against stigma and oppression. “I encourage people to show up in any way they feel fit and come out and join us,” Reil urged.

As of early May, organizers hadn’t yet finalized the programming, but Reil noted that the local a capella group Root 7 would perform. “Of course, we’re going to have speakers,” she said, “but we also want to have poets, and we want to have artists and musicians and anybody who wants to come out and show their artistic side or their mad side and work with us.”

The celebration could get a bit noisy. “For somebody who is not good with a situation that’s overstimulating, it could be overstimulating,” Reil cautioned. “Sometimes it can be a little chaotic. But we’re all there. We’re all very easy to talk to you. If somebody has questions about anything, we’re all available to help.”

Reil sees value in “just being together and being as one and being one voice” and looks forward to

seeing fellow activists and mental health peers from across the state in person. “Any time you can get together with people that know what it’s like to be hospitalized, institutionalized, just having shared experiences, is a good time in my opinion,” she said.

Prospective attendees can help organizers’ preparations by registering at https://www. eventbrite.com/e/vermont-mad-pride-2022tickets-320688847977. The event is free, with ASL interpretation provided.

White House Pledges Nationwide Peer Certification While President Joe Biden’s first State of the Union address on March 1 focused primarily on Ukraine, COVID-19, and inflation, the speech also touched briefly on the issue of mental health, which the White House has promised to address, in part, by promoting peer support.

“Let’s get all Americans the mental health services they need: more people they can turn to for help, and full parity between physical and mental healthcare,” Biden urged Congress.

On the day of the speech, the White House put forth an accompanying fact sheet detailing the Biden administration’s plans to “to transform how mental health is understood, perceived, accessed, treated, and integrated – in and out of health care settings.”

The fact sheet identified “a severe shortage of behavioral health providers” amid “an unprecedented mental health crisis among people of all ages.” One of seven proposals to beef up system capacity was to create a “national certification program for peer specialists.”

This initiative would “convene stakeholders, launch development, and support implementation of a national certified peer specialist certification program, which will accelerate universal adoption, recognition, and integration of the peer mental health workforce across all elements of the health care system.”

Through the Substance Abuse and Mental Health Services Administration, the executive branch of the federal government has previously recognized the efficacy of peer support on the basis of “emerging

research” pointing to benefits for participants such as an “increased sense of control and ability to bring about changes in their lives,” an “increased sense that treatment is responsive and inclusive of needs,” and “increased social support and social functioning.”

At least 46 states have already implemented certification programs for mental health peers. An effort to do the same in Vermont failed in the legislature this spring (see “Legislature Nixes Peer Respite and Certification Bills,” page 1).

Following the State of the Union address, the National Association of Peer Supporters released a statement: “Presidential Administrations have a played critical role in elevating the value that people with lived and living experiences of mental health and substance conditions and their families have in the design, delivery, and evaluation of services. We celebrate the inclusion of the Peer Support Workforce in the Administration’s strategy.

We stand ready to partner with the Biden administration on improving the health of all Americans including through policy related to the peer support profession.”

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

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 2022

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/ peer-support-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, 802442-5491; (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 Rehabilitation 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 Cen-

ter, 275 Brooklyn St., 802-851-8120; recovery@ncvrc. com

RUTLAND, Turning Point Center, 141 State St; 802-7736010; turningpointcenterrutland@yahoo.com SPRINGFIELD, Turning Point Recovery Center of Spring-

field, 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

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

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