NEWS, COMMENTARY, AND ARTS BY PSYCHIATRIC SURVIVORS, MENTAL HEALTH PEERS, AND OUR FAMILIES
VOL. XXXII NO. 3
FROM THE HILLS OF VERMONT
Peer Support Program Begins In Vermont Prisons By ANNE DONAHUE Counterpoint
SWANTON – A new peer support program has been rolled out in three of Vermont’s prisons, and Annie Ramniceanu, the mental health systems director for the Department of Corrections, said the administration hopes to expand it to the three other men’s prisons in the state and to the women’s facility as well. The program was established by the department, but is now being coordinated by inmates recruited by DOC. In a half-day meeting in October, five inmates, Ramniceanu and the staff liaison at Northwest State Correctional Facility worked out final details for launching the program there. Each facility will adopt protocols specific to its own institution, she said. The peer coaches identified potential lastminute glitches, reworked policy language and proposed ways to encourage other inmates to access the program, which they have named Open Ears. They discussed issues as mundane as notebook supplies and as serious as ensuring confidentiality. They also discussed the nature of peer support within the program, identifying it as listening and trying to be supportive in how to address stresses their peers are identifying, without taking on a counseling or clinical role. All 15 of the new coaches participated in an
eight-day intensive training on peer support in the summer and then began working on implementation, Ramniceanu said. The training was led by a former Pennsylvania inmate who works with Peerstar, a company that specializes in forensic peer support in that state. The peer support roles will be the highest-paid inmate jobs, at $7 per day. They will work 20 hours per week over five days. TELLING HIS STORY – Tim Dowd shares his reaTim Dowd, the inmate sons for taking on peer support leadership in an Open Ears coordinator, interview with Counterpoint. (Photo courtesy of said in an interview that Robert Sheehan, Department of Corrections) he had experienced abuse and trauma but had learned to cope and turn across every plane.” negatives into positives. He said he thinks he is Like every peer an approachable person, which makes him well support coach, Dowd Peer support workers suited for the role. has completed his own will wear badges with Being nonjudgmental will be key, Dowd said. WRAP plan “to get the name and logo “You look at a person for who they are” and me through what I’ve they designed for the not what they’ve done. There are “a lot of people been through” and to program. here who have good hearts.” stay well while helping “Their sense of self-worth is in the toilet. Their others. WRAP stands for Wellness Recovery sense of being is minimalized.” It’s important Action Plan. for people to understand that “mental illness is “Me being a positive role model makes me feel not incurable,” he said. That “should be known (Continued on page 3)
ED Wait Times Soar
WATERBURY – Wait times skyrocketed this fall for people in psychiatric distress being held involuntarily in emergency rooms as the deadline neared for a report on recommendations by the Agency of Human Services on addressing shortcomings in access to mental health care. Data has shown a doubling of average emergency room waits in some categories in the last quarter. At least two people were reported to have spent a month in the Brattleboro Memorial Hospital emergency room. Between July and September of this year, 102 people were held involuntarily waiting for an inpatient bed, after a low of 58 in JanuaryMarch 2016. Those numbers do not include numbers for people who come voluntarily for help, or how long they wait, because DMH only collects data for involuntary patients. Voluntary patients represent about 70 percent of the total, but the state’s hospitals have not yet implemented a means to monitor voluntary patient waits. The commissioner of the Department of Mental Health, Melissa Bailey, (Continued on page 4)
50 FYQ2 2016
Number of times that an involuntary inpatient placement was unavailable, and an adult was held in the emergency department.
5 The Arts12
Survivors Testify About Overcoming Trauma
COUNTERPO!NT • FALL 2017
Peer Leadership and Advocacy
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 firstname.lastname@example.org.
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ALYSSUM Peer crisis respite. To serve on board, contact Gloria at 802-767-6000 or firstname.lastname@example.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 at the Department of Mental Health, 280 State Drive NOB 2 North, Waterbury, noon-3 p.m. To apply for membership, contact Melinda Murtaugh (melinda.murtaugh@vermont. gov), Clare Munat(email@example.com), or Marla Simpson, M.A.(firstname.lastname@example.org) for further information.
Advisory Steering Committee at the new hospital in Berlin, last Monday of month, 1:30 - 3:30 p.m.
RUTLAND REGIONAL MEDICAL CENTER
How to Reach The Department of Mental Health:
BRATTLEBORO RETREAT Consumer Advisory Council,
For DMH meetings go to web site and choose “more” at the bottom of the “Upcoming Events” column.
Program Quality Committee, third Tuesdays, 9 -11 a.m., McClure bldg, Rm 601A.
Facebook and Web Sites WELLNESS WORKFORCE COALITION
www.vcil.org/services/wellness-workforce-coalition Trainings, events and meetings of the Wellness Workforce Coalition.
MAD IN VERMONT
www.facebook.com/groups/madinvermont Venue for peer support, news, and advocacy/activism organizing in Vermont. “Psychiatric survivors, ex-patients/inmates, consumers, human rights activists and non-pathologizing allies are welcome.”
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.
MENTAL HEALTH LAW PROJECT
Representation for rights when facing commitment to a psychiatric hospital. 802-241-3222.
FOUNDING EDITOR Robert Crosby Loomis (1943-1994)
EDITOR AND PUBLISHER Wilda L. White, Vermont Psychiatric Survivors, Inc. The publisher has supervisory authority over all aspects of Counterpoint editing and publishing.
UNIVERSITY OF VERMONT MEDICAL CENTER
Copyright 2017, All Rights Reserved
Advisory groups required for every community mental health center. Contact your local agency for information about meetings and membership
LOCAL PROGRAM STANDING COMMITTEES
Community Advisory Committee, fourth Mondays, noon, conference room A. fourth Tuesdays, 12 - 1:30 p.m., contact Gwynn Yandow, Director of Patient Advocacy and Consumer Affairs at 802-258-6118 for meeting location.
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.
EDITORIAL BOARD Joanne Desany, Calvin Moen, Melinda Murtaugh, Sara Neller, Eleanor Newton 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.
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NEWS EDITOR Anne B. Donahue News articles without a byline were written by the news editor. Opinions expressed by columnists and writers reflect the opinion of their authors and should not be taken as the position of Counterpoint.
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VERMONT CLIENT ASSISTANCE PROGRAM
Rights when dealing with service organizations such as Vocational Rehabilitation. Box 1367, Burlington VT 05402; 800-747-5022.
HEALTH CARE ADVOCATE To report problems with any
health insurance or Medicaid/Medicare issues in Vermont 800-917-7787 or 802-241-1102.
VERMONT FEDERATION OF FAMILIES FOR CHILDREN’S MENTAL HEALTH
Statewide support for families of children, youth or young adults in transition who are experiencing or at risk of experiencing emotional, behavioral or mental health challenges. 800-639-6071, 802-876-7021.
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COUNTERPO!NT • FALL 2017
DOC • Continued from page 1 good,” he said. The message of Open Ears is that “there’s hope.” “This is a step,” Dowd said. “Hopefully it will go on beyond these bars.” The concept of bringing peer support to ex-inmates got active discussion during the planning meeting. Ted Carron, another inmate, said, “It’s going to be hard for me after 13 years” in prison. “I have no one to talk to. I don’t want to go to my PO [probation officer] to say I’m having problems.” There would be value in having a “little support group for people just getting out” so those who have succeeded can share “how [they] dealt with it,” he said. Geoff Poirier wanted to know how they would find out whether the program is working. “I just want to make sure I’m making a difference and that I’m helping this person.” Ramniceanu said that the department has identified benchmarks based on a similar program in Pennsylvania, including reduction in the use of mental health services and reduction in disciplinary incidents and segregation. The peer coaches were unsure about a reduction in requests for mental health services. “They’re going to talk about things they’ve never talked about before,” David Miller said. That might lead to more recognition of the need for mental health treatment, and that is not the role for peer support, he noted. “The only thing we’re doing for them is relating to them.” Ramniceanu agreed that the role is not a clinical one – “You’re not doing anything for them, [but] you’re inspiring hope” – but, rather, providing the message that “no matter how dark it gets, there’s always light.” However, she said that Pennsylvania has seen reductions in indicators like a reduction in disciplinary reports. She said the department will also “put the stories together” that peer workers share about their successes as a way of showing what the program is achieving. However, she said that Pennsylvania has seen reductions in those indicators, and the department will also “put the stories together” that peer workers share about successes. The program will be voluntary and not part of any inmate’s treatment plan, Ramniceanu reminded the participants as they reviewed the policy guide. It will also be completely confidential. At one point, Poirier suggested that a checklist be maintained for each inmate as a reminder of what was covered. Dowd reminded him, “We can’t keep any record or documentation” in order to ensure privacy. Only the fact of an appointment will be recorded. The only exception to confidentiality, which inmates will be informed of from the start, is a threat to harm themselves or others, a plan to escape from custody, or use of weapons. The group reviewed the requirements for becoming peer coaches, and Ramniceanu agreed that any educational requirements should be removed. “There are a lot of people who are really smart who don’t have GEDs,” Carron said. “It’s their life experiences, not their education” that should count. They supported a criterion that a prospect should have no disciplinary infractions in the prior three months, but one inmate said he was already getting comments from correctional officers about his own actions, telling him, “That’s not how a peer support should be.” Ramniceanu said that although the peer
TEAM PHOTO – The peer recovery staff at Northwest State Correctional Facility in Swanton gathered for a group shot after a planning meeting attended by Counterpoint. From left: Annie Ramniceanu from the Department of Corrections, Tim Colby, Tim Dowd, David Miller, Ted Carron, Geoffrey Poirier and News Editor Anne Donahue. (Photo courtesy of Robert Sheehan, Department of Corrections) coaches should be modeling behavior, there shouldn’t be a different standard for them. “You’re human, you’re not perfect.” She said officers would be educated about the expectations. “The results are going to change their minds,” Carron added. Dowd asked what they should be calling people who participated in receiving support, and the group agreed on using the term “peers” for both the support workers and those who come for support. It communicates that one person is “not above or below” the other, Poirier said. Adequate supplies of pens and notebooks for the support coaches will come from each facility’s budget, Ramniceanu assured them. “It will be one of the most important tools,” Dowd said, because unless inmates who are receiving support can take notes and keep them, “it won’t stick.” Only coaches will receive notebooks, but they can tear off sheets of paper to give participants. In the prison environment, if a person received a notebook automatically, they would “make appointments just to get a notebook,” Dowd commented. In contrast to the program underway at the Southern State and Northern State Correctional Facilities, peer staff at Northwest will also be providing orientation to new inmates. Having an orientation to the facility from a peer is something the facility has wanted for a long time, according to Robert Sheehan, the recreation coordinator and staff liaison for peer support, who said that entry was “the biggest stress point” for people. The newly trained support staff will be ideal for the role, and there was a trial run the previous weekend, Poirier said, when he was called in to help with a newly admitted inmate. “It was as natural as it could be,” Poirier said. Ramniceanu said that the process of developing the program was peer-run. “They actually developed this,” she said of the policy manual and procedures. It was not “the department coming down” and saying “you will do it this way.” “The men have taken it on as a tremendous honor and responsibility,” she said. “It’s been very meaningful.” She will provide individual supervision to the support coaches in all three facilities to make sure that they are keeping themselves healthy in the process of helping others. Although the Peerstar model is specific to mental illness and substance use disorders, Ramniceanu said it is not being narrowly defined in Vermont; the program is open to addressing “any stressors” being experienced.
She looks on the criteria as including “lived experience of being in a correctional facility” along with mental health and substance use, though “some of the peers fall more into one of the categories” than another. Vermont was introduced to the concept of peer support in corrections during a visit to Pennsylvania as a part of its efforts to address mental health needs. Pennsylvania had been under a Department of Justice settlement based on violation of inmate rights, and the legislature’s Joint Justice Oversight Committee had heard testimony from the commissioner there. The peer support program was not part of the overview, but during the tour Vermont staff saw what was occurring, and Ramniceanu said they decided to try to develop something similar. “The field of expertise in this was incredibly thin,” she found. “There’s nobody doing this.” Failures in mental health services in corrections have subjected the department to criticism in the legislature and to lawsuits over the past several years. Ramniceanu said the department believes the program will be helpful but doesn’t expect that it will transform everything about the environment. “To create systems change and cultural change is much bigger than any of this,” she said.
Street Outreach Funding Offered WATERBURY – Five Chittenden County towns have offered to fund half the cost of four street outreach staff to help support individuals who are struggling with mental health issues, the commissioner of the Department of Mental Health, Melissa Bailey, announced in November. Bailey said it’s an agreement that demonstrates understanding that the need to provide support to homeless individuals in crisis is everyone’s responsibility, not just the state’s, and it cannot be resolved by putting people into prison or involuntary hospitalization. DMH is “working really hard to come up with the money” to make the program happen, she said. The towns involved are Burlington, South Burlington, Shelburne, Winooski and Essex. The solution to people in crisis is “not just, add more beds,” Bailey said. “I’m not sold on that” despite the pressure from many sources to do so, she said. Bailey said she will be meeting with town officials in other areas of the state with the highest rates of homelessness – Rutland, Brattleboro and the Barre/Montpelier area – “as a start” for suggesting a similar partnership.
COUNTERPO!NT • FALL 2017
ED WAIT TIMES SOAR • Continued from page 1 said she expects the department will make “some pretty clear recommendations that would alleviate some of the tensions” of emergency room backups in the AHS December 15 report. The larger question that faces the state, she said, is “Are we going to be able to do more with less?” referencing a budget shortfall that will be a barrier to building more community supports. “That’s a resource issue,” she said. On a daily basis, just the number of people being held involuntarily in an emergency room in September averaged 11, compared to five in June. September data was the most recent available from DMH before Counterpoint went to press. Between June and September, the length of waits almost doubled for involuntary patients who did not get admitted within their first two days in the emergency room, increasing from an average of 114 hours (4.7 days) in June to 218 hours (nine days) in September. The average wait for those admitted within the first two days has remained at about 13 hours. Involuntary holds, called emergency examinations, also increased to a new high in the July-September quarter: Paperwork was filed to mandate admission to a hospital for 177 people. Vermont Psychiatric Survivors is researching the reasons people are showing up in emergency rooms, and according to executive director Wilda White, the early evidence is confirming that many of the reasons listed in medical records are not why they actually came. “Their case manager is telling them to go to the ED” with very few attempts to talk them through a momentary crisis before calling an ambulance and police. “This happens over and over and over again,” she said.
Deadline Criticized The legislature called for an analysis and action plan “in order to address the present crisis that emergency departments are experiencing in treating an individual who presents with symptoms of a mental health crisis, and in recognition that this crisis is a symptom of larger systemic shortcomings in the provision of mental health services statewide.” White said that research VPS is doing to identify the issues and needs will not be completed in time for the report under the deadline the legislature set. “I resent that the legislature passed an arbitrary, unreasonable deadline,” she said. “I prefer quality research that actually responds to the problem.” “If it [the legislature] gets crap, it’s because it passed crap” by giving inadequate time and no money for a real analysis, 200 White said. Bailey disagrees. She said that while there is 180 always room for more data, a response to the 160 crisis cannot wait for completion of research or data collection that is still 140 underway. Deputy Commissioner 120 Mourning Fox said that “having an artificial 100 deadline imposed” by the legislature was a positive 80 FYQ1 2015 FYQ2 2015 thing, because otherwise “analysis paralysis” can
block taking essential action. Bailey said DMH invited a broad mix of people to provide input, and sits in the middle between voices of “peers and families and advocates” and very different voices from places like law enforcement and the courts, which often express frustration when individuals are not admitted to a hospital. Input from providers has focused on claiming needs in three main areas: more inpatient beds for patients with the highest potential for violence; a reduction in the length of inpatient stays by speeding up the use of court orders for forced drugging; and increased resources in the community, especially in supportive housing. The report will respond to a specific question raised by the legislature about whether the legal process needs to be changed to allow petitions for forced medication orders to move more quickly, Bailey said. While not offering details, Bailey said in terms of scope, “We’re talking about the tippy top of the triangle” among individuals with mental health needs. “There are these really intense cases where the delay is not helpful,” she said. “It’s about getting to the right treatment” in those cases where medication is what is appropriate. White said that VPS has committed to several projects that will help to develop better understanding of underlying issues. Focus groups will be underway shortly to assess individual perspectives on using the ED. That will supplement in-depth interviews and chart reviews that White has been conducting. She said these have already demonstrated two things: that clinical records do not match what people say are their real reasons for going to the ED, and that often, orders of non-hospitalization are what actually cause a person to go into crisis. An ONH is a court order that sets out conditions for a person’s release from a hospital and can be renewed annually. “The trauma of the ONH is causing [the] problems,” she said. “They get so upset about the ONH.” If actual problems are not being identified, “the problem is not solved when they are released,” White said. She has heard patients identify problems that range from having had a fight, to not feeling safe in a home situation, to needing a shower or wanting a hug. VPS is also working on an audit of the designated agencies to identify whether they are using best practices in their service delivery. That review is being conducted by a doctoral student, White said. Research is underway on two data pieces sought from hospitals by both advocates and
legislators, but these data will not be in place by December either, according to Devon Green from the Vermont Association for Hospitals and Health Care Systems. Emergency room data on the numbers of people waiting, and how long they wait, includes only those individuals who are being held involuntarily. There are also no data about how frequently people are subjected to restraint because of a crisis while waiting for an inpatient bed. Green said “there is progress” in meeting the commitment by the hospitals to gather data. In both categories, providers needed to work out definitions, such as “What constitutes a patient with a mental illness waiting in an ED?” Now that there is agreement on language – for the wait times, the data will reflect people “ready to be admitted or transferred, but that’s not happening” – capturing the information in both categories will be underway shortly, Green said.
Admissions Question White presented initial national background research on characteristics of people most likely to experience long waits at meetings last summer. Her report led to a question at one public hearing about whether hospitals could refuse to admit some types of patients, contributing to those waits. DMH data shows that there are often inpatient psychiatric units with vacant beds while some patients wait in emergency rooms. According to White, officials at DMH “said very authoritatively that there are no restrictions” on hospitals refusing an admission. She said she contested the statement and wrote a follow-up letter outlining the admission requirements under federal law. White said that in a meeting last month with DMH and hospital representatives in response to her letter, no one disagreed that there must be a clinical justification to refuse admission. She said she doesn’t think highlighting the federal law will make a significant difference in access. “I do think that if they [are] aware that people are keeping a close eye,” it will help, she said. Hospitals cannot refuse admissions based on the fact that a person “is here all the time,” has criminal justice system involvement or has a particular diagnosis. Identifying the justification is crucial for reasons other than a specific admission, she said. “The most critical information we need,” she said, is to document the clinical reason for refused admissions to identify solutions that “serve people with complex needs” who aren’t (Continued on page 5
Number of people held for an involuntary admission to a hospital.
COUNTERPO!NT • FALL 2017
Survivors Testify About Overcoming Trauma MONTPELIER – Three survivors of childhood trauma shared how they were able to overcome obstacles to a healthy life before a legislative work group this fall. The Adverse Childhood Experiences Working Group was created by the legislature to meet six times over the summer and fall to “analyze existing resources related to building resilience in early childhood and propose appropriate structures for advancing the most evidence-based or evidenceinformed and cost-effective approaches to serve children experiencing trauma.” Testimony opened with Jim Masland, of Thetford, himself a state representative, who told the others, “I don’t have any doubt that I’m one of the lucky ones” despite the fact that “I lost at least several whole decades of [my life], of being ineffective, unproductive.” “By the time I was 10 years old, I didn’t trust a soul on earth,” he said. He added that he did not form any friendships from elementary school until midway through college. The work group chair, Rep. Mike Mrowicki (D-Putney), told Masland, “I see you as someone who has risen above some difficult situations and is successful and someone I admire greatly.” “Is there one thing you can say helped?” he asked. “Are there a list of things that helped?” “People helped,” Masland replied. He said there were “buffers – people who mediate along the way” who made a difference. “There were some in my case who had no idea how much they were helping me or why.” He said he found talk therapy helpful as well. “I would affirm what was learned when the VA began working with Vietnam vets with PTSD, that one of the best things is to talk it out.” He said, “When you talk out something that occurred, it becomes history instead of something that’s occurring before you every day, and being able to deal with something as history is profoundly helpful.” Ericka Reil of Barre continued that theme when she told the legislators that what helped her most was “talking about my experience and being able to tell my story, and let people know they’re not alone.” Reil is now the coordinator of the Wellness Workforce Coalition. Of her childhood, she said, “I thought that what happened at my house happened at every house. I didn’t know what feeling hugged felt like.” “I did try traditional means of healing, but it did not work for me,” Reil told the work group.
In the hospital, she experienced physical restraint and seclusion, and “my PTSD in the hospital skyrocketed.” For her, “talk therapy didn’t work because I had a lot of trust issues,” she said. However, the more she was able to share her own story, “the more I felt like a real person – and I am a real person – and that I can help others and let them know they’re not alone.” Reil said, “Everyone that goes through trauma is different and has different needs.” Peer support was what worked for her, she said, while for some, therapy works, and for some, medication works. The most important thing, she said, is to ask, “What happened to you?” not “What is wrong with you?” Ryan Lane was a mental health practitioner for 17 years before he began to experience recurring memories of early trauma: “My father in a rage, physically abusing me. In my memory, I am perhaps 3 or 4 years old.” Lane said he was suicidal at times in sixth and seventh grade, but “no one knew as I had no one to tell, nor was I led to believe that, for the most part, I would be worth saving.” When his traumatic memories began to resurface three years ago, Lane said he began to experience nearly daily panic attacks and “crippling depression and dissociation” that led him to inpatient treatment six months ago. However, he has found telling his story to be healing, using his “experience as a survivor and a clinician.” He has formed his own “community of care” by reaching out to make new friends “who understand my journey.” Lane, who is a program manager with the Department of Health’s Division of Alcohol and Drug Abuse Programs, said he sees a trauma therapist weekly and has learned how to address his needs to build his recovery. “I know that I need to remain physically active for my brain chemistry, as well as my ability to remain in the present. I know meditation supports my brain as well. I know the types of therapy and therapeutic relationships that are conducive to trauma recovery,” he told the legislators. “You bring what we’re dealing with to life,” said Sen. David Soucy (R-Rutland) as he expressed appreciation to one of the witnesses who had shared deeply personal memories to help educate the members of the Adverse Childhood Experiences Working Group. Individual legislators in the group said they will be working on bills for proposal when the legislature comes back into session in January.
ED WAIT TIMES SOAR • Continued from page 4 being served in the inpatient settings currently available. White said the hospital association pushed back on providing such documentation because it feels the hospitals are already overburdened with paperwork. That contradicts the association’s own statement about the urgency of the crisis for its emergency rooms, she said. Green, from the hospital association, said she does not object to providing the documentation but needs to go back to her member hospitals to respond. The hospitals have been “really coming together on inpatient data collection” but are “feeling a crunch” in time and resources. She also believes that admissions currently being refused are clinically appropriate, although improving documentation has the potential to identify problems. “If something does come up, I give providers a lot of credit; they usually work to correct it,” she said. Bailey said DMH is developing a list of parameters to help identify when a refusal to admit is clinically appropriate. A requirement to document
Rep. Jim Masland
“ By the time I was 10 years old, I didn’t trust a soul on earth.”
“ I did try traditional means of healing, but it did not work for me.”
“ I know the types of therapy and therapeutic relationships that are conducive to trauma recovery.”
reasons will become a part of contracts with the two hospitals – Rutland Regional Medical Center and the Brattleboro Retreat – that provide highintensity Level 1 units, which are supposed to function on a no-refusal basis. Green emphasized that hospital capacity is “not just about filling a bed” but is about “providing quality care in a safe environment.” To look only at numbers like vacant beds and persons waiting in emergency departments is to ignore the issues “that go to the very heart of this,” she said. An occupancy rate of 100 percent “tends not to be safe or appropriate,” she said, because it ignores the needs of patients on the unit at the time. There may be patients who “need more space” at a given time, or some patients whose care would be impaired if someone with different needs was admitted. She said the standard for appropriate care – and to maintain access for emergency admissions – is considered to be 85 percent. According to DMH data, the last time Vermont’s hospital psychiatric units averaged occupancy below 85 percent was in the middle of 2014.
COUNTERPO!NT • FALL 2017
Consent To Research Challenged By ANNE DONAHUE Counterpoint
The University of Vermont and the state’s Agency of Human Services are reconsidering their research policies regarding people who do not have the capacity to give consent in light of questions raised by Counterpoint about compliance with federal rules and Vermont laws. The federal rules were revised earlier this year – over the objection of some disability rights organizations – to change who can give replacement consent to research when there are no state laws that address it. Under the federal rules, informed consent to research must be provided by the individual or by a “legally authorized representative” if the person lacks capacity for consent. The new federal rules directly state that if there is “no applicable [state] law,” the research institution’s policy can be based on its institutional policy for surrogate consent for non-research procedures. “It is certainly dangerous to widen the possible permission for such research to occur,” said Tina Minkowitz, an attorney with the Center for the Human Rights of Users and Survivors of Psychiatry. “I think it is more human rights protective in a legal context … to say that if consent capacity is deemed to not exist, no research can be done on the person.” According to UVM leadership, a draft policy was being rewritten to comply with the federal rule by adopting the requirements of the University of Vermont Medical Center’s policy for consent to medical procedures. It would tighten up previous practices by placing more focus on what the person’s own choice might be, but it would to allow consent by family members. That kind of consent still has “hooks and tentacles” that make it “light years” from a person’s own consent, said Chris Hansen of Burlington, a psychiatric survivor who has been involved internationally on consent issues. “Thinking about it for myself,” she said, “the people most likely to be asked … would not represent my views.” Counterpoint questioned whether even UVM’s draft policy change would bring it into compliance, since Vermont has an advance directive law that addresses consent to “experimental treatment” that could have the effect of blocking any other surrogate consent. Donna Silver, the director of UVM’s Research Protections Office, expressed concern. “This would be a huge change for us. I will bring this to both legal counsels for consideration before I do any further work on the policy.” Although current AHS policy permits substitute consent to research is, it is “silent” on who can give it, said Shawn Skafflestad, the chair of the AHS Institutional Review Board. An IRB is the entity that approves proposed research at an institution. Federal rules define research in detail. It can include surveys of program participants, pilots of new programs, or medical studies. “This just hasn’t come up” in proposals that the AHS IRB has reviewed, said Martha Csala, an IRB member. She said AHS was happy that Counterpoint had identified the policy gap because, “When it does come up it’s great to be ready for it.” The IRB will consider whether to state directly that research at AHS will not be permitted
to include people who cannot give informed consent, or to outline the standards that would apply if that kind of research were proposed, she said. At UVM, research currently occurs with people who cannot consent for themselves, according to Silver, but there are few such studies. She said that such research has always involved a category called “no more than minimal risk,” and not for any higher level of risk. Silver also said that studies with people who lack consent capacity are never permitted at UVM under a process of expedited review, which is permitted by federal rules for minimal risk studies. The federal definition of minimal risk is that “the probability and magnitude of harm or discomfort anticipated in the research are not greater in and of themselves than those ordinarily encountered in daily life or during the performance of routine physical or psychological examinations or tests.” Silver acknowledged, however, that current UVM policy does not state that higher- risk research would never be approved, and she agreed that policies should either state that or specify the conditions that would be placed by the UVM IRB on any such proposals. “It will [come up] someday,” she noted.
Debate over Consent The subject of research on people with impaired capacity to consent has been debated for years, but there are few federal rules for oversight. One disability rights organization – not identified in the federal register summary of public comment – said last year that the existing problem with surrogate consent would not be solved by the new language because it still does not recognize that a “representative’s consent is not equivalent to an autonomous decision by the subject.” Hansen, who is the director of Intentional Peer Support, said that she recognized it was “a really difficult dilemma” because “in order to be able to advance treatment at all, we need to do research.” She said that society needs to put much more emphasis on the importance of every person having an advance directive. Minkowitz said that surrogate consent to research is particularly dangerous for particular types of treatment, such as “new neuroleptics or new forms of administration such as skin patches or time-release deposits under the skin that the person cannot stop on their own.” “The conditions that are considered to produce lack of such capacity are the very ones where the treatments are done against a person’s will and against their interests, and there is a lack of respect for the person’s humanity at a basic level in depriving them of the right to control what happens to their own mind and body,” Minkowitz said. “I have written about forced psychiatry as torture, and the right to make decisions about treatment and not be deprived of capacity to make one’s own decisions has been accepted by the predominant UN human rights mechanisms dealing with this issue.” Disability Rights Vermont was one of the organizations that made public comments on the federal rule objecting to using the same standard
as substitute consent for medical treatment. Executive Director Ed Paquin wrote, “Consent for treatment by [a substitute decision-maker] represents a different ethical threshold than consent for research … it should be understood that [another person’s] ability to represent an individual’s judgment is in fact a matter of judgment, and an imperfect one.” He suggested that if surrogate consent is permitted, there should be added requirements to protect the research subjects “to compensate for the inherent risks that are added by virtue of the use of consent by a surrogate,” and urged that the definition of surrogates not be changed “unless and until appropriate standards are adopted that will bring ethical guidance” to their use. “The current status quo is not acceptable,” he wrote. “However, the problem is not solved by creating what amounts to a minefield of different standards by leaving broad discretion among different jurisdictions, while at the same time leaving in place unanswered questions about balancing subject protections and rights.” [See sidebar.] The comments by survivors and advocates echo recommendations for new guidance adopted in 2008 and 2009 by the Secretary’s Advisory Committee on Human Research Protections of the federal Office of Human Research Protections. This guidance said a representative “stands in for but is not fully equivalent to” and “may not be ethically equivalent” to a person’s own consent. SACHRP said it recognized a “pressing need” for research that improved understanding and treatment of conditions that create impaired capacity, which requires the inclusion of such persons in research, but that it also required development of “the highest ethical standards.” The SACHRP recommendations were never adopted by OHRP.
UVM Changes Suspended The UVM IRB was already reviewing a new policy on substitute consent that Silver had prepared, which was intended to reflect the new federal rule, and its decision was “imminent,” according to Silver. Vermont has no laws that specify who can give consent to either research or medical procedures when there is no agent under an advance directive or court-appointed guardian. Vermont law says that the Department of Health must establish rules that include “at least one optional form of an advance directive” that includes “the use of experimental treatments.” That form is on the department’s website and includes an option to consent to “participate in treatment studies or drug trials,” or give authority to an agent to provide such consent. Counterpoint asked both UVM and AHS whether that statute qualified as “applicable law” for a means of surrogate consent, therefore barring any other method of surrogate consent. Silver responded, “I am not sure what to think about this” and said she would not proceed with work on the new policy without consulting legal staff. Csala replied with her own question: “Are you saying that there is no one else that can be considered a[n] LAR, even if AHS has a policy in (Continued on page 7)
COUNTERPO!NT • FALL 2017
Are Vermont Subjects Protected? Both the previous federal rules and those adopted in 2017 say that there should be “additional safeguards” when research involves “vulnerable populations” but provide no guidance on what those safeguards should be. Vulnerable populations are identified as people who might be subject to coercion or undue influence in the process of making an informed decision. The vulnerable group identified as “mentally disabled” in the old rule was referred to in the new rule as “individuals with impaired decision-making ability.” Other groups include prisoners and children. Donna Silver, the director of the University of Vermont’s Research Protections Office, said UVM has not spelled out specific additional protections in the past for studies that include the use of substitute decision-makers for people unable to consent for themselves. She said that as policies are developed, examples of safeguards that can be required by the Institutional Review Board will be added. An IRB is the internal body that must approve all research at an institution. Chris Hansen of Burlington participated in the United Nations Convention for the Rights of People with Disabilities, where the issue of capacity to consent was “a pretty hot topic.” She said that “one of the biggest victories” in that debate was gaining recognition that the ability to consent is not an “all-or-nothing concept,” and that supported consent can be used when a person can still make their own decision, with help. That example could be applied to
research, she said; it is one of the safeguards could extend throughout the course of the study recommended by experts on research ethics as instead of just at the time of consent, when a way to maximize autonomy while protecting necessary to protect the participant’s ongoing a person from undue influence. informed decision-making – something that Disability Rights Vermont cited some Hansen also strongly endorsed. examples of added protections in the comments She pointed out that capacity can fluctuate, it submitted as part of the federal rulemaking and someone who regains capacity during the process. Executive Director Ed Paquin said course of a study should have the opportunity that such protections were important because for their own informed consent process, of the risks of using substitute consent for while someone who loses capacity after the research. study has begun may need a surrogate who “Any substituted judgement is a step away can participate in the ongoing decision about from the ideal of informed consent,” he said, continuing in the study. and “even when research or experimental “It cuts both ways,” and supported consent treatment may offer great promise” the ethical can help address the spectrum of a person’s difference in surrogate consent needs to be ability to consent at different times. considered. Counterpoint provided to both UVM and the “The farther away from autonomous, Agency of Human Services links to some of the informed consent, the greater the risk,” he extensive literature on the types of safeguards wrote. that should be considered, including citations He suggested requiring a lower threshold to recommendations made in 2008 and 2009 for allowable risk and a more favorable risk/ by the Secretary’s Advisory Committee on benefit ratio as a requirement for approval in Human Research Protections of the federal such studies, as well as allowing only certain Office of Human Research Protections. categories of surrogates to provide consent if the The SACHRP-recommended protections research involved higher risk – “for example, include ones adopted last year by the University those specified by advanced directives, those of Minnesota after an external review and with closer kinship, or those more familiar critique of its program that resulted after a with the participants.” patient died by suicide while in a study of a Paquin said requirements could be included psychiatric drug. PAGE 7 / VERMONT ADVANCE DIRECTIVE FOR HEALTH CARE that investigators and/or independent The external review team identified the monitors assess the ability of the surrogate to university’s policy on the use of surrogate perform necessary duties, ormedications that they receive consent asmore one of its violations of federal rules. 7. I prefer the following or treatments: Use space or additional sheets for this section, needed. education as toif their roles and responsibilities. It was similar to the longstanding policy in _____________________________________________________________________________________________ He also suggested the role of the surrogate effect at UVM. Avoid use of the following medications or treatments: (List medications/treatments)
CONSENT • Continued from page 6 which it recognizes other types of relationships, in the absence of an advance directive?”
UVM, Hospital Disconnect UVM’s draft policy on surrogate consent listed a guardian first, an agent under an advance directive second, and then a specific list of family members who can consent under a required order of priority, starting with a spouse and then an adult child, parent [of an adult], grandparent, adult sibling, or adult grandchild. She said the draft policy was reviewed by the hospital lawyers to ensure it matched the medical consent policy. UVMMC told Counterpoint, however, that it did not match. “No one had really checked into our process,” according to Meg O’Donnell, director of Government and Community Relations and assistant general counsel at the hospital. Because Vermont law is silent on other ways of getting consent for treatment, UVMMC policy states that if there is no agent or guardian, a decision can be made by a family member or friend, and that “providers should exercise their professional judgment when determining which family member(s) should be consulted as the patient’s surrogate decisionmaker.” “In general, when determining who should serve as the surrogate decision-maker, providers should assess which individual best knows what the patient would want in a given circumstance,” the policy states. It does not create a set order of individuals,
8. Consent for Student Education, Treatment Studies or Drug Trials
_____ I do / do not (circle one) wish to participate in student medical education.
_____ I do / do not (circle one) wish to participate in treatment studies or drug trials.
_____ I authorize my agent to consent to any of the above.
Health Treatment 9. Mentalwith In accordance Vermont law, the Department of Health online advance directive includes this option for A. Emergency Involuntary Treatment. If it is determined that an emergency involuntary consent to research. treatment must be provided for me, I prefer these interventions in the following order: (List by number as many as you choose. For example, 1 = ﬁrst choice; 2 = second choice, etc. or limitYou them, research through regulatory change,” the summary of maythe alsoway notethe the UVM type ofdraft medication and maximum dosage.) policy did. The UVM draft also contained public comment said. _____ Medication in policy pill form no assessment of medication whether a listed family However, the federal agencies setting out _____ Liquid member would know what the person would the new rule agreed that the existing definition _____ Medication by injection have wanted. It is thatrestraints draft that Silver said she of a legally authorized representative “may _____ Physical would rewrite. be inappropriately hindering the conduct of _____ Seclusion At the Agency of Human Services, the policy research with subjects who lack capacity to _____ Seclusion and physical restraints combined _____ Other: _______________________________________________________________________ said that a legally authorized representative consent” because of the lack of state laws.
could give consent, but it provided no definition It said that the new language was more Reason for preferences above (optional): ________________________________________________ of an LAR. protective of the ethical right of equal access for B. Electro-convulsive Therapy (ECT) or “Electro-Shock Treatment”: If my doctor thinks that Skafflestad said the IRB had not addressed individuals to choose to be involved research I should receive ECT and I am not legally capable of consenting to or refusing ECT, myin preference details isinindicated its policy for “something that doesn’t because “research that an IRB has approved below: come up [and is] not likely to,” but he now asof any ethical conduct with the participation _____ I do NOT consent to the administration formto of ECT. recognizes that it needs/todoaddress “getting some subjectsECT with impaired decision-making not consent (circle one) of to unilateral _____ I consent kind of_____ language in.” capacity ought I consent / do not consent (circle one) to bifrontal ECTnot be prohibited” in those states haveECT no laws for surrogate consent “while to bilateral _____ I consent / do not consent (circle one) which Feds Opted for Leeway being allowed proceed … [in states] that have consent (or authorize my agent to consent) to ECT asto follows: _____ I consent The leeway____ thatI the new federal rule laws authorizing consent by a legally agree to the number of allows treatments the specifically attending Psychiatrist considers appropriate.
for surrogate ____ consent when there is no state law authorized representative in the clinical or I agree to the number of treatments Dr. ___________________considers appropriate.
created controversy during public comment research context.” ____ I agree to the the number of treatments my agent considers appropriate.
process, according theto record in the ambiguity in the interpretation ____ Ito agree no more thanFederal the following“Reduced number of treatments_____.
Register. Other instructions regarding the administrationofof the ECT:regulatory requirements will facilitate “About one-third of the commenters research that may offer the promise of _____________________________________________________________________________________________ responding this question, including improved medical treatment for this subject that I and mydisability agent have been apprised of and will follow the uniform _____toI acknowledge rights organizations, advocacy organizations, [and] will serve to facilitate the informed consent procedures and the usepopulation of standard… forms to indicate consent to ECT per and academic 18institutions, V.S.A 7408. did not agree with responsible inclusion of subjects who cannot the direction of the contemplated modification consent on their own behalf to research or whether this issue should be addressed participation.”
COUNTERPO!NT • FALL 2017
VOSHA, DMH Still in Negotiation WATERBURY – The Department of Mental Health and the Department of Labor remain in negotiation over workplace safety citations issued by the Vermont Occupational Safety and Health Administration over the summer in response to staff injuries from patient assaults at the Vermont Psychiatric Care Hospital. DMH Commissioner Melissa Bailey said in mid-November that the department has already begun to implement the improvements it agrees are appropriate to address staff concerns. Its position has not changed, she said, on the citation for failure to provide “personal protective equipment” such as shin guards or chest guards.
“We’re not in agreement with that one at all,” Bailey said. Research by Counterpoint last summer found that such a requirement for a hospital was unprecedented. DMH has established a safety committee and is getting input from staff about how to address safety, she said, while attempts at a settlement with the Vermont Occupational Safety and Health Administration continue. VOSHA responded to DMH’s proposed improvements in midNovember. Stephen Monahan, director of the Workers’ Compensation and Safety Division at the Vermont Department of Labor, responded to Counterpoint’s request for an estimated timeline for the negotiations by stating, “We do not discuss cases in litigation until resolved.”
Psych Survivors Elect Board Members RUTLAND – Members of Vermont Psychiatric Survivors elected two new board members at its annual meeting in September. The membership also voted to amend the bylaws to require that candidates for the board “must identify with having lived experience” and to require board candidates to attend at least two board meetings and an orientation before seeking office. VPS is a statewide mutual support and civil rights advocacy organization open to Vermonters with past or current mental health challenges, consumers of mental health services and those who accept and uphold VPSʼs mission. Shery Mead and Chris Hansen were elected to three year terms. Mead is the founder of Intentional Peer Support. She started her first peer organization to focus on “unlearning the mental patient role” after being threatened with loss of custody of her children based on a psychiatric diagnosis. She later created New Hampshire’s first peer-run crisis respite program and started training mental health
Federation for Families Names New Director WILLISTON – The Board of Directors of the Vermont Federation of Families for Children’s Mental Health’s has announced that Cindy Tabor has been named as its new executive director. The agency’s press release said that as the assistant director for 11 years, “Tabor played an instrumental role on the cross-trained leadership team, creating a smooth, stable transition for families, staff and partners alike” It identified the mission of VFFCMH as providing support and advocacy for families of Cindy Tabor children and youth (ages 0-22) who are experiencing or are at risk of experiencing emotional, behavioral or mental health challenges. It is a statewide, family-run organization. “Tabor brings with her a depth of knowledge, diverse skill set, system of care involvement and strength-based enthusiasm to this position,” the press release said.
professionals and peer support workers locally, nationally and internationally. Hansen is the Director of Intentional Peer Support. She has been an advisor to mental health services in New Zealand and has served in numerous capacities there. She served on the board of the World Network of Users and Survivors of Psychiatry, assisted Shery Mead in the development of peer respite programs in several countries, and has been promoting, developing and providing training in Intentional Peer Support for most of the past decade. Board members elected Zachary Hughes as president and re-elected Whitney Nichols as vice president and Robert Dyer as secretary. The sixth board member is outgoing president Martha (Marty) Roberts.
VPS Adds Peer Advocates RUTLAND – Vermont Psychiatric Survivors has announced that two new peer advocates have joined the staff, filling positions in Brattleboro and Rutland. Conor Cash is a recent transplant to the Brattleboro area. He reports that he has worked in the nonprofit sector, the legal field, and in academia as an instructor in human geography. Cash is interested in “the intersections of mental health phenomena and broader societal and environmental crises, as well as the interplay between what we refer to as addiction with the formal market economy.” In addition to his work with Vermont Psychiatric Survivors, he grows oyster mushrooms for sale at farmers’ markets in the region, he said, and enjoys “hiking and running when it is warm and hibernating in the fictional worlds of print and film when it is cold.” Cash received a bachelor’s degree in geography in 2008 and a master’s in geography in 2011, both from the University of Arizona. Catherine Pither is the new peer advocate in Rutland. She recently relocated to Vermont from the New York City area. Most recently, she was employed as a mental health counselor at Head Start, and has provided respite services to families and worked as a resident service provider at a low-income housing unit. Pither has a bachelor’s degree in psychology from Montclair State University in New Jersey and a master’s in counseling from Mercy College in New York, from which she graduated with distinction.
She enjoys spending time with her three children and doing crafts, particularly crocheting, and loves animals and has helped to rescue many cats and dogs and the occasional bird. Peer advocates use their lived experience and training, via a peer support approach, to advocate on behalf of and with individuals who have been marginalized by psychiatric labels so that they may lead full and satisfying lives of their own design. Some peer advocates also fill the role of patient representative at hospital psychiatric units. The patient representative assists with finding resources necessary for understanding and navigating the system. For questions about what a patient representative does or how to reach one, contact VPS at 802-775-6834. VPS also announced that Calvin Moen has been named to the position of director of training. He joined VPS in 2014 as the peer advocate in the Brattleboro office.
COUNTERPO!NT • FALL 2017
Drug Tracks When It Is Swallowed SILVER SPRING, Md – The federal Food and Drug Administration has announced approval of new version of the drug Abilify that includes an embedded sensor that records when the medication was taken and can transmit the information to others. Public response in national media reports raised concerns about protection of privacy and the potential for coerced use. According to the FDA’s November news release, the new drug is called Abilify MyCite. The FDA said it is approved for the treatment of schizophrenia, acute treatment of manic and mixed episodes associated with bipolar I disorder, and for use as an add-on treatment for depression in adults. It said the system works by sending a message from the pill’s sensor to a wearable patch. According to a New York Times article, the sensor generates an electrical signal when splashed by stomach fluid. After several minutes, the signal is detected by a patch similar to a Band-Aid that must be worn on the left rib cage and replaced after seven days, the article said. The patch sends the date and time of pill ingestion and the patient’s activity level via Bluetooth to a cellphone app. According to the FDA, patients can permit their caregivers and physician to access the information through a web-based portal. The app lets them block recipients anytime they change their mind, the Times article said. Although sharing of the information would require consent, the Times article said “another controversial use might be requiring digital medicine as a condition for parole or releasing patients committed to psychiatric facilities.” “Many patients with these conditions do not take medication regularly, often with severe consequences,” the Times article stated. “But symptoms of schizophrenia and related disorders can include paranoia and delusions, so some doctors and patients wonder how widely digital Abilify will be accepted,” it added. “The problem it aims to address is a real (and expensive) one: nonadherence, which is the
term for patients not following through with prescribed treatment,” a National Public Radio report stated. “Nonadherence is a problem for people with many kinds of health conditions, such as hypertension and high cholesterol.” The Times quoted Dr. Peter Kramer, a psychiatrist and the author of “Listening to Prozac,” as raising concerns about “packaging a medication with a tattletale.” While ethical for “a fully competent patient
With this drug, Gellad says, “you will actually know if a person has taken the pill, put in in their mouth, and it’s in their stomach.” … [a] ‘digital drug’ sounds like a potentially coercive tool,” he was quoted as saying. Dr. Paul Appelbaum, director of law, ethics and psychiatry at Columbia University’s psychiatry department was quoted in the article as saying, “Many of those patients don’t take meds because they don’t like side effects, or don’t think they have an illness, or because they become paranoid about the doctor or the doctor’s intentions.” “A system that will monitor their behavior and send signals out of their body and notify their doctor?” he added. “You would think that, whether in psychiatry or general medicine, drugs for almost any other condition would be a better place to start than a drug for schizophrenia.” In the FDA news release, Mitchell Mathis, M.D., director of the Division of Psychiatry Products in the FDA’s Center for Drug Evaluation and Research, said, “Being able to track ingestion of medications prescribed for mental illness may be useful for some patients. “The FDA supports the development and
use of new technology in prescription drugs and is committed to working with companies to understand how technology might benefit patients and prescribers.” The Times said that “experts estimate that so-called nonadherence or noncompliance to medication costs about $100 billion a year, much of it because patients get sicker and need additional treatment or hospitalization.” The FDA’s announcement included a warning: “It is important to note that Abilify MyCite’s prescribing information (labeling) notes that the ability of the product to improve patient compliance with their treatment regimen has not been shown.” The NPR report quoted Dr. Walid Gellad, codirector of the Center for Pharmaceutical Policy and Prescribing at the University of Pittsburgh, as saying that while Abilify MyCite might not be attractive to patients, it may appeal to caregivers and family members who worry about whether a person has taken their medication. With this drug, Gellad says, “you will actually know if a person has taken the pill, put in in their mouth, and it’s in their stomach.” But he also said that other possible solutions to the nonadherence problem already exist. Gellard pointed to the injectable version of Abilify, a monthly shot administered by a health care professional, NPR said.
The fall Counterpoint poll question was:
Are there ever times when 20% a person “YES” should be forced to 80% “NO” take drugs by a court order?
Counterpoint Telephone Poll QUESTION: A psych med has been approved that has a sensor to track when you swallowed it and makes a record that you or someone else with permission can look up. Do you think this is a good idea? For more details on the new drug, see article above.
VOTE by calling:
(Toll Free call)
>> To vote “YES” Dial Extension 12
>> To Vote “NO” Dial Extension 13
Results of the poll will be published in the next issue of Counterpoint.
COUNTERPO!NT • FALL 2017
Work Obstacles Remain Significant MONTPELIER – A state report released in October says the number of Vermonters with mental health disabilities receiving Social Security Disability benefits (SSDI) continues to increase faster than national rates, and those receiving benefits rarely return to employment. The report offered no explanations for the increase. Survivors said such statements worsen discrimination against them and do not reflect the reality of the obstacles they encounter, sometimes within the Division of Vocational Rehabilitation itself. “You know in your heart” that people who read news media reports are making judgments like “‘they’re faking’” and it “makes [us] feel worse” for needing disability supports, said Sarah Launderville, executive director of the Vermont Center for Independent Living. Those who rely on Voc Rehab complain that the staff who are supposed to help them find employment are sometimes demeaning, discourage their efforts or lack the necessary knowledge to help them overcome barriers to employment. “They try to talk you out of the things you really want to do,” said Kate, who gave up and moved to New York after she said she repeatedly encountered “an attitude that you should be so grateful to us” because “you’re not even worthy” of help by Voc Rehab staff. Kate asked for her last name to be withheld in case her comments would be used against her if she returned to Vermont. “There were a few people in Voc Rehab who really cared about me,” she said, but as a whole “there is a problem with doing the least you can do for someone, with the least amount of money.” Christina Colombe said, “What comes out of the benefits counselor’s mouth is inconsistent,” recounting a discouraging series of emails with information that would have blocked a job training opportunity. It turned out to be wrong, “which was a relief,” but she said it took her more than a month to track down the correct information. Colombe, of Barre, has neurological and psychiatric diagnoses and said she has been fighting to get off Social Security disability benefits for almost 20 years. The new report, an issue brief from the legislative Joint Fiscal Office, said that among the 25,738 Vermonters on the SSDI program last December, 46 percent had first become eligible on the basis of mental health disorders, up from 40 percent in 2001. That is a larger share than the country as a whole, which is about 35 percent, down from 37 percent in 2001, according to the report. This has a negative impact on Vermont workforce development because “beneficiaries with mental health diagnoses are likely to stay on the program for many years,” it said. Launderville and Sam Liss, a disability advocate, both said they believe the state is making progress in attempting to address employment for people with mental health disabilities. “I think that Voc Rehab is starting to put more emphasis on working with people with disabilities,” Launderville said. The Division of Vocational Rehabilitation, in the Department of Disabilities, Aging and Independent Living, said that the state’s data shows strong results and that it does not hear complaints like Kate’s or Colombe’s. The state is paid for the federal Ticket to Work program based partly on the number of people who get off disability benefits, said Division Director Diane Dalmasse. Last year, the state received $2.5 million under the program – “a significant level” for a small state like Vermont, Dalmasse said.
New Medicaid Rules Liss has advocated for employment for people with all disabilities for years. Among his roles are membership in the Statewide Independent Living Council, specializing in employment advocacy, and membership in the national council. He was celebrating in November when final rules were approved by a legislative committee that will make it easier for people with disabilities to work and also keep their Medicaid coverage – the exact barrier that Colombe had been encountering. There was a “blanket approval of all rule changes,” he said in email announcement to other advocates and peers. The new rules will increase access to the Medicaid for Working People with Disabilities program available through a buy-in to a federal program, Liss said. He testified in the legislature last year that Vermont’s existing program had the most restrictive eligibility criteria among the 35 states that offer it. Colombe said that at one point her only option appeared to be to “flee to Massachusetts or Connecticut, which have no income limits” for keeping Medicaid benefits. Launderville said that many of her peers worry about whether they will
have enough income as well as fear the loss of health care coverage if they discontinue their disability benefits. “I think [for] people with disabilities, it’s harder to make that leap,” she said. The state needs to keep working to identify “what are the supports that people need to be successful in work,” Launderville said.
One Person’s Experience For Kate, the barriers were far more personal. Kate, 39, says that she “always loved Vermont” and moved here five years ago, hoping to rebuild her education and a career after a diagnosis of schizoaffective disorder in her 20s that led to numerous hospitalizations and the postponement of college plans. “[My family was] all freaked out and abandoned me,” she said. However, her father instilled in her the belief that she should still have a career and “my illness should not confine me.” A job is “a form of belonging and acceptance into the community” that is crucial to well-being, Kate said. She started culinary school when she got to Vermont, but when she disclosed her diagnosis, “all of a sudden people were scared of me.” Kate said she did get some help from the St. Johnsbury Voc Rehab office, but they were pushing her to disclose her illness, which she has always found to be counter-productive. “As soon as I tell someone, I get stereotyped,” she said. Later, after going to the Springfield office for help, she encountered a staff person who, upon hearing her psychiatric diagnosis, got a “terrified look on her face.” Kate said “the next words out of her mouth” were to ask, “Do you hear command hallucinations that tell you to kill people?” She hoped to find a friendlier environment by moving to Brattleboro, but when she applied to an internship program with Strolling of the Heifers, which organizes the annual parade downtown, she was immediately asked, “What’s your disability?” Kate said she felt she needed support – she “felt kind of violated” by the encounter – but received none from her Voc Rehab-assigned worker. “I was so utterly disgusted. I gave up,” she said. She felt like she was always being treated like a “mooching, fraudulent dirtbag who just wants to use the system.” Since moving to New York, Kate found a national employment support network and learned that she could go to college online through that program, and she has enrolled in courses.
Pattern or Exception? Launderville said VCIL, an advocacy agency, hasn’t heard complaints like Kate’s. The complaints it most frequently hears are about financial obstacles like not receiving approval for assistive technology. However, she said that Voc Rehab has “recognized that as an issue” in the past and has worked to address it. Change can take time, she said, and she urged that people “make sure those things get [reported] to the management of Voc Rehab.” Launderville has served in the past on the Statewide Rehabilitation Council, an advisory group. Dalmasse reiterated that message. “If we know about it, we can address it. If we don’t, we can’t,” she said. It is not a complaint her office hears, she said, whether about disrespectful attitudes or the misinformation Colombe reported. “I don’t think that’s a norm,” Dalmasse said. VocRehab conducts a consumer satisfaction survey every two years and get “very high ratings,” she said. Liss, however, said he has heard complaints like Colombe’s. “I have been told that, on more than one occasion, benefits counselors have given incorrect information regarding the [Medicaid] program to beneficiaries or potential beneficiaries,” he said, giving an example of a peer who was told that a person is no longer eligible to reapply if there is a break in employment after age 65. “That is false,” Liss said. “There is no age limit.” He said that the Department of Disabilities, Aging and Independent Living confirmed that the information given was incorrect.
Status of Efforts People in the Community Rehabilitation and Treatment program who are labeled with a “severe and persistent” mental illness are served in a supported employment program run by the designated agencies, according to Melissa Bailey, commissioner of the Department of Mental Health. She said she didn’t have data on the overlap between those receiving services at designated agencies and those working with Voc Rehab. Deputy Commissioner Mourning Fox said that DMH has two adminis(Continued on page 11)
COUNTERPO!NT • FALL 2017
Work Obstacles • Continued from page 10 trative staff working exclusively on employment issues with the agencies. “It’s a huge priority for us,” he said. “It’s such a huge recovery piece.” A spokesman for the designated agencies’ employment programs, Dan Gifford of Rutland Mental Health Services, said they are underfunded to allow for enough “assertive efforts to get people back to work.” There is “just not enough of it [program support] to help people stay off benefits, or graduate from benefits when they are working,” he said. “One of the results is the increase in the number of consumers being on benefits the [Joint Fiscal Office] has reported on.” Liss offered a number of perspectives on the Joint Fiscal Office report and the current status of employment challenges – and opportunities – in the state. Liss said that he thought the high rates of people on disability cited in the report “may be related to a strong advocacy network for people with
mental health diagnoses in Vermont and a progressive awareness and response toward offering a safety net.” The real issue, he said, is how to eliminate barriers to employment for those individuals and to recognize disability benefits as a partial but critical solution to worker shortages in an aging state – as well as the benefits to the person. One key issue is affordable health care, and the new rules that go into effect in January are a good example of strengthening employment support, Liss said. It will allow higher assets and increased earnings before a person would risk losing Medicaid coverage. Liss said he believes the employment supports in the CRT program need to be strengthened, “stressing abilities” rather than reliance on disability income, “which destine most toward a life of poverty conditions.”
Crisis Response Commission To Review Grenon Shooting MONTPELIER – The new Mental Health Crisis Response Commission has chosen the police shooting death of Ralph “Phil” Grenon as its first case for review. It elected Wilda White, executive director of Vermont Psychiatric Survivors, as the commission chair at its first meeting this fall. The commission was created by the legislature this year to review “law enforcement interactions with persons acting in a manner that created reason to believe a mental health crisis was occurring and resulted in a fatality or serious bodily injury” and to make recommendations based on the reviews. Grenon’s killing was the impetus for the legislation. Police shot the 76-year-old man after a five-hour standoff in Burlington. He was hiding with two knives in a shower in his apartment. He was later reported to have a diagnosis of bipolar disorder. Last year Jim Leddy, a friend of Grenon’s and a retired state senator, convened a group of concerned persons to discuss how future deaths could be avoided. Vermont Psychiatric Survivors participated in the informal coalition, which named itself the “Grenon Response Advocacy Group.” The legislation identified categories of people to make up the commission. White represents the “individual who has a personal experience of living with a mental illness or psychiatric disability, appointed by Vermont Psychiatric Survivors.” The commission was established within the attorney general’s office,
for which Assistant Attorney General David Scherr is the representative. Other members of the commission include Deputy Commissioner Mourning Fox, representing the Department of Mental Health; Vermont State Police Lieutenant Maurice Lamothe as the appointee of the Commissioner of Public Safety; Hinesburg Police Chief Frank Koss, representing frontline local law enforcement and appointed by the Vermont Association of Chiefs of Police; Training Director Cindy TaylorPatch, of the Vermont Criminal Justice Training Council; Disability Rights Vermont Executive Director Ed Paquin; NAMI Executive Director Laurie Emerson, as the “family member of an individual who experienced or is experiencing a mental condition or psychiatric disability, appointed by the Vermont chapter of the National Alliance on Mental Illness”; and Sandy Steingard, MD, as the representative of the designated agencies appointed by Vermont Care Partners. In addition, the statute requires two persons to be named by the governor as “regionally diverse at-large members … such as an emergency dispatcher, specialist in interactions between law enforcement and individuals with a perceived mental condition, or a representative of the Vermont Human Rights Commission or Vermont Legal Aid.” The governor appointed John Campbell, the executive director of the Department of State’s Attorneys and Sheriffs, and Kristen Chandler, Team Two Coordinator.
15 Peer-Operated Projects Funded by VPS RUTLAND – Vermont Psychiatric Survivors funded 15 peer-operated projects this year through the Peer-Operated Projects grants it administers with funds from the Department of Mental Health. There were 21 applicants for funding. The POP grants support independent peer-run initiatives designed and operated by individuals with lived experience of mental health challenges. Hive Mutual Support Network, to continue rental of its studio that is the hub for its activities in downtown Brattleboro. The Hive’s activities include various support groups, meetings of the members of the collective that keeps the Hive running, and open hours to provide support to those who cannot or choose not to access more formal groups. Peer Access Connections of Chittenden County, to continue its peer-run warm line, which operates three nights a week to provide an opportunity for callers struggling with isolation to feel connected with a peer worker. Northeast Kingdom Peer Services (North), to continue its existing programs (a speakers’ bureau and the crisis response cadre) and to add a family support peer team, work with staff and residents of the Care Bed crisis program to develop wellness plans, and to provide training on its model to other areas of the state. Northeast Kingdom Peer Services (South), to continue those same peer services in the southern area of the Northeast Kingdom. Hot Topix Discussion Group, to continue its survivor-to-survivor education group in Bennington, with topics determined by attendees, to empower participants with knowledge so they can better handle individual issues and needs. Sunshine Social Club, for its weekly group that focuses on bringing survivors together for socialization, educational fun and a home-cooked meal in Bennington.
Westview House’s Wellness Initiative in Burlington, for a lending program of items that promote wellness (such as bicycles, snowshoes and a guitar) and for outings for social or physical activities. Paper Crafting: A Paper Arts Workshop, for a weekly workshop in Rutland to teach participants the art of paper crafting, including homemade gifts, greeting cards and decorations, providing an environment to foster self-awareness, develop social skills, reduce anxiety and increase self-esteem. Washington County Street Outreach group, for providing outreach at community meal sites in Barre and Montpelier to create social connection and emotional support for people in crisis or dealing with the daily challenges of trauma and homeless issues, including providing access to emergency food and warm clothing and referrals to resources. Another Way Woodworking, for a six-month project in Montpelier to develop woodworking skills, including basic furniture, gifts, arts and games, and improving the sense of connection among participants. 2018 Vermont Mad Pride March, for the organization and support of the third annual march and rally in Montpelier. Brattleboro Retreat Boutique, to expand outreach, donations and peer volunteer participation in the patient clothing space, which makes donated clothes available to patients who need them. Northeast Kingdom Elders for outreach to elders who are not aware of peer services and for teaching recovery principles and wellness planning to staff who work with elders as well as to peers. The First Step to Computing to purchase a laptop and other technology supplies for a computer skills education program in Burlington. HCRS Peer Support Community Training Program to develop community peer support training in Windham and Windsor Counties.
COUNTERPO!NT • WINTER 2017
The Arts Pain Shared in Mother-Daughter Poems
CABOT – Susan Sanders found her daughter’s poetry when she went to clean out her room, about a week after she died. “I had to take them slow. I was surprised, shocked how sad they were, how dark – how much they were a cry for help.” Jessica Sicely was only 15 when MOTHER-DAUGHTER — Susan Sanders and daughter Jessica Sicely she died by suicide in 1996. (Left, Counterpoint Photo: Anne Donahue) In 2011 Sanders had the idea to publish the poems and to combine them with the be doing well,” excited about starting at a new, poetry that she herself wrote in the “aftermath of small alternative school and about a day care job the grieving process.” at Smugglers’ Notch resort. In an interview with Counterpoint, she said, A crisis occurred with friends with whom she gesturing toward the book, “I did this to honor was peripherally involved in an incident involvher.” ing stolen money, and she wrote to one of them, “It was really painful” to put the book togeth- “Please don’t tell my family or I’ll kill myself.” er because it was “reliving it again – what she Although no one had been told, the next day was going through” in the months before her she went into the woods and shot herself. death. Sanders knew Jessica was writing poetry Sanders said that “the first year was kind of a but didn’t want to share it with her mother, and shock year,” but for three or four years after that, Sanders respected that. she went through the “should haves and could Many years later, she decided to “share her haves.” story to help others – especially teenagers – who “I would just go over in my mind, ‘I shouldn’t are feeling depressed.” have sent her back. I should have found a way She said she wants them to know that they ar- to keep her. I shouldn’t have put her in lockup. en’t alone. “They aren’t the only ones to feel this I should have moved back to Vermont. I should way. They don’t have to do this,” she said. have been more of a presence in her academic Sanders said that she also felt the need to life.’” bring public attention to suicide. Therapy helped her get past that self-blame. “I’m tired of keeping it a secret,” she said, and “I finally just had to stop,” Sanders said, and she feels it’s important to talk about it to help in above all, “I just knew she [Jessica] wouldn’t prevention. In recent months two young people want me to.” died by suicide in her county. Sanders said she spent 12 years working on “It’s going to keep happening, but maybe it can the book, writing and rewriting her own poetry happen less.” and then putting the two voices together: hers She also hopes to reach out to “parents who and her daughter’s. have gone through this” to let them know that She said she didn’t edit Jessica’s poetry other they, too, are not alone. than for spelling and line breaks. The collection of poetry – “Behind These The book is available at amazon.com by enterHills” – is broken into six chapters, alternately ing its title and the authors’ names. titled “Mother” and “Daughter.” Sanders has her master’s degree in poetry and Bye has written poetry for more than 40 years but by Jessica Sicely says, “For a whole year I couldn’t write anything.” After that, it became an outlet for her grief. Sometimes when your world Jessica had been struggling with depression is motionless you crave and an eating disorder while living with her the movement of something, mother in Arizona, where Sanders was working of anything. on her master’s. At one point, a school guidance counselor found entries in a notebook that led to When my life is on the run, Jessica being placed in “lockdown” at a hospital I want to run more. for several days. All the time I just want She wrote about that experience in one of her to leave and be gone forever, poems, opening by saying, “Since you left – there just leave all the memories is no way out. No up or down – just scream and and everything behind. shout.” After her discharge, she started therapy, Sanders said. I tell myself hold on, get a grip, you’ll be fine in just a day But the former National Junior Honor Society student was skipping school and continuing to or two but it always gets worse. struggle. So, finally I am taking Jessica didn’t know what to do and felt she that big step. I am going needed to be back in Vermont with her father on my own all alone, whom she “really missed,” according to her it may be worse in some ways, mother. Jessica had a close relationship with her but I know it will be better. dad, Sanders said, and spent her summers in Vermont; her older brother also lived with him. During the two months there, she “seemed to
by Jessica Sicely Speaking these words hurts my ears. Seeing my own face blinds my eyes. People tell me I am just a thing, a small thing that has no wings. When I try to reach high, try to fly, I find there are things I cannot accomplish. There are so many smiles hidden by my tears, and pain that never leaves my heart. I ask it to leave, but it does not hear me. I beg it to leave, and it informs me that I am a lesser being than what I think or seem to be inside. Then I think I am nothing, an immortal nothing, that will live forever because pain will never be eased by my death.
Infinite Fragments by Susan Sanders
In this house on Sunday night there is no way to ask how you left the world in one dark flash. That good nailed to the wood Jesus leaves his shroud in the cave to save the dead in another town. My mother prays I will hold on but infinite fragments of what I was once are no longer strong. My eyes scan every corner for a way out but there are no skeleton keys to help unlock this doubt. What is lost consumes this house and everything that was isn’t now. The world moves its thick weight and turns back against this Sunday night house and into the place that hides what love left out. When friends ask why she died I cannot say I know how much pain can weigh one down until you give up and leave the ghost of yourself.
COUNTERPO!NT • WINTER 2017
An engaged creative movement to dismantle social marginalization through the arts.
SURROUNDED BY ART – Participant Mike Alter sits beside the work of some of his peers at the opening reception of the show. (Counterpoint Photos: Anne Donahue)
The Drawing Water Project
TEMPLE by Lino Fontanello
BURLINGTON – The Drawing Water Project and the Forty-Seven Main Street Artists presented an art show at Union Station Galleries on Main Street in August. The Drawing Water Project is an “engaged creative movement to dismantle social marginalization through the arts,” according to Tom Merwin, a Rutland artist who leads the project. It was a recipient of a 2017 Vermont Psychiatric Survivors grant. “We work together to challenge the convenient labels of disability, mental illness and poverty to transform these barriers into opportunities for mutual beauty and growth,” the press release for the show said. It was sponsored by the South End Arts and Business Association. The painters of Forty-Seven Main Street Artists are based at the residential treatment center of the same name in Castleton and “join together and travel beyond the social construct that separates and marginalizes our creative voice.” For the past three years, its work has been shown at SEABA, Vermont Community Television, Compass Music and Arts, and Merwin Gallery in Castleton. “The larger plan is to take painting to where it is needed throughout Vermont for communion and healing, bringing art supplies to communities and residences where sisters and brothers can join us in our expression and exhibitions,” Merwin said.
SURFACE AND DEPTH by Mike Alter
LEAPING TROUT by Phil Hilts
UNTITLED by Jes Sinclair
UNTITLED by Tom Merwin
COUNTERPO!NT • WINTER 2017
My Humble Home
Two-storied cube of wood and glass, Survivor of the March lion’s lusty roar, The machine gun fire of woodpeckers crass, The gnawing mice at the ancient door, You are my humble home Which I adore. Needing paint which I can’t afford, You are my nest of dreams, The womb of my creative word, The source of all that seems. Imprisoned in winter’s ice, Crowned white with Arctic snow, Your ancient woodstove’s paid the price Of many a woodstick’s warming glow. But you are my love Despite my marital woe, My Grace from Above That only God can bestow: You are my warmth in cold, My coolness in summer’s heat, My light that dreams unfold, My living works replete. I do not know if I shall die Within your wooden womb, But I think you’ll capture my final sigh And be my spiritual tomb. My soul will walk within your walls If you still stand a century hence; For between the stately halls Of time and eternity there’s no fence To restrain roaming souls and dreams
From venting from hell or paradise Their deepest, immortal screams That from the spirit rise. At night I hear within your rooms Spirit-whispers, nostalgic creaks; The sense of a ghostly prayer forever looms In those sounds your ancient wood thus speaks. I am your soul and you are mine, Ancient architecture so well related; You are in every artful line My pen and mind in you created. And you have borne my angry pain Of a marriage so badly turned; Of my wife’s most cruel disdain For my love so poisonously spurned. A heathen life I live alone In a house so often filled By those who wouldn’t care a bone About a life whose heart is stilled. The world’s as cruel as the rain and wind That batter your paint-shredded face; Perhaps we have both mortally sinned To merit Nature’s cold disgrace. I do not know; I cannot comprehend; No more how you put up with flogging winds That shudder your walls as if to rend Your heart with atmospheric sins. Oh, time will move and time will pass Until the day you stand forgotten; Your lights forever out, your lawn’s
unmowed grass, Your doors and windows rotten. No more the squeals of infants, The many voices singing; No more the heart’s fleeting instants Of joy and pain so stinging To the soul and mortal mind; No more, no more, for fading thought Will have left them all behind And the Grim Reaper your deed bought. And now demolished in your ruins, My spirit will ask why In these devastated dunes Did life have to live and die? What means this pilgrimage Of birth and death in an old house, What purpose the mortal image Of a man no more than a tiny mouse? We are born, we build, we breed, we die, And are so soon forgotten. From fresh embryo it seems we fly To the grave so rotten. Old house, you are such as I, A mystery trapped in time; We both were born and thus must die As must my word and rhyme.
by Patrick W. Bradley St. Albans
To Secret Places Go When the world is at its darkest not because of nightfall When the fires of rage are burning and we are feeling ever so small When the Pain of merely living becomes too great to bear To Secret places go and I will meet you there When the tears of sorrow have turned your heart to desert dust Leaving nothing behind but a withered shallow crust When the world takes on a monochrome hue And checking out is all that there is left to do Please, if you will, to secret places go It is the safest of places that I know Gardens rich a wild growing Elves, dwarves, and gnomes knowing An innocence of a time long since past A safe haven for a moment to last Human frailties have we Temporary admittance to the land faerie Existing there are realms other than here Believe; hold close your belief in them most dear There are beautiful worlds of light I know When it’s darkest here, to secret places go
by Laura Lee Saorsa Smith Marshfield
Share Your Art! Express Yourself in Drawing, Prose and Poetry... Counterpoint is About Peers Sharing With Peers
Email to email@example.com or mail to Counterpoint, The Service Building, 128 Merchants Row, Suite 606, Rutland, VT 05701 Please include name and town
COUNTERPO!NT • WINTER 2017
Small Town In Vermont
Tears fall from hazel eyes onto a cold, stone floor. Nowhere to go. Nowhere to run. No more can she hide.
Young men limp by in soiled jackets and old painter’s pants.
She’s alone, tired and broken. A tortured soul she bears.
Others sport torn camouflage. Young women just removed from childhood walk
Life just doesn’t seem to get better. She just cannot seem to conquer all her fears. Where are the people who said they would always be by her side? Just as broken as her heart are those promises tossed aside. Even in her dreams she cannot escape her pain. She cannot escape her long-awaited fate. Of a life full of emptiness. A heart full of hate.
the other side of the road. Crying babies or groceries weigh them down. Poor backpacks. The Methodist church, old and stretching out its life, calls for boys to come in
She was only a mistake.
and join the Boy Scouts.
How do you take such pain and tragedy and make it all ok? How do you shake the nagging feeling that you are an unfinished masterpiece?
Cumberland Farms and the gas pumps in high
Hurried thoughts of suicide flutter through her mind and the Angels sing of glories and hallelujahs that she will never find. Tears are shed inside, never to be shown. These are the demons that she must fight with on her own.
like old men, old soldiers. Their wounds are
demand. Beyond that, big old houses sigh
Yesterday’s news. Their rents unfair. Unreasonable.
by Dennis Rivard
White River Junction
by Anna Bernier Newport
Enter the 2018
Louise Wahl Memorial Writing Contest Total Prizes Up to
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.
Contest Deadline: March 15, 2018 Send submissions to: Counterpoint The Service Building 128 Merchants Row, Suite 606 Rutland, VT 05701
or email to:
Include name and address.
16 EDITORIAL PAGE Editorial
Voices Do psychiatric survivors and mental health peers in Vermont have active voices in the policy issues that affect us? These days, despite progress, our place in the discussion is questionable. There may not be deliberate exclusion, but there is a lot of forgetfulness. The positives: • Many of the community mental health agencies have local standing committees that provide robust input into local policies. • Four of the six hospitals with psych units have advisory committees. • The state legislature heard from survivors and consumers last winter on new bills and initiatives that affected them. • The Agency of Human Services invited survivor input on the development of its response to the service access crisis. • But each of these has a not-so-positive flip side. • Despite decades of effort, community agencies’ commitment to a peer role and peer input varies widely across the state. Even those with a historically supportive position have gaps. When Washington County Mental Health held a series of forums for community input, it included peers as members of the panels, but it didn’t reference them in the publicity for the events. When the Agency of Human Services helped host a discussion on the crisis in access to services in Washington County, it invited a token survivor voice. Neither of the agency executive directors – both with decades of leadership in their agencies – questioned this tokenization. The meeting moderator said the focus of the planning was to identify strategies “from the patient out … using the expertise of those [non-patients] in this room.” Although the agency boards of directors are required by law to include consumers and their family members as 51 percent of their membership, the names are confidential so this does not model inclusion to the public – and the agencies are still legal if all of the 51 percent is made up of family members. • Two of the hospitals with psych units have no consumer advisory group. (Three of the four that do are mandated by state law to have them.) • In most cases, survivors had to self-advocate to be heard in the legislature. They were rarely put on a witness list through the pre-planning of legislative committees – the way other stakeholders are. • AHS and its Department of Human Services have invited psych survivor input, but it remains to be seen how much credibility those voices are being given. Its report on the access crisis is due out in December, which will reveal how much weight it gives to the input of “professionals” – state staff, community agency staff, and hospital staff – versus those of us affected by that crisis. The bottom line is that our voice is still not assumed to be critical to the conversation. We (Continued on page 17)
COUNTERPO!NT • FALL 2017
Innovation in Coercion
By Wilda L. White
I had never heard of Tyrese until I happened upon a news feed in which he reportedly blamed a psychiatric drug for causing him to do “some really stupid things publicly and privately that will take [him] a while to recover from.” The story initially caught my attention because I seldom, if ever, see accounts in the mainstream media about the actual harm caused to real people by psychiatric medications. I have since learned that the mononymous Tyrese is, among many things, an actor with recurring roles in The Fast and the Furious and The Transformers movie franchises. Over several weeks he posted emotional and detailed missives on social media about a child custody battle with his ex-wife. Critics called the posts bizarre and inappropriate and accused him of having a “meltdown.” Tyrese eventually apologized to his nine million Instagram followers and attributed his behavior to Rexulti. Rexulti is approved in the U.S. as a treatment for adults diagnosed with schizophrenia and as an add-on treatment to antidepressant medications for major depressive disorder. However, psychiatrists frequently prescribe psychiatric medications for uses that are not FDA-approved so we cannot assume that Tyrese was taking the medication for either condition. After Tyrese attributed his behavior to Rexulti, the drug’s creator, Otsuka and Lundbeck Pharmaceutical, issued a statement, saying that the company was “committed to delivering innovative medicines … for psychiatric disorders” and “supportive of all people who may be facing challenges with their mental health, and take seriously all reported adverse events potentially involving our medications.” The drug company’s statement reflected a tactic that I’ve seen psychiatrists use in medical malpractice actions: deflect blame by exploiting negative attitudes about people with mental health challenges by reminding the jury, or here, the public, that the aggrieved person is a person with a mental health challenge or psychiatric disorder. The tactic was effective. In on-line comments, sympathy seemed to shift away from Tyrese and towards the drug company. One headline proclaimed: “Drug Company Tyrese Blamed for his Meltdown Claps Back.” At no time did the company acknowledge that Rexulti comes with a long list of warnings and known adverse reactions including altered mental state and impaired judgment and thinking. While a relatively new drug, Rexulti is hardly innovative. It is little more than a successor drug to Abilify, and arguably just another example of pharmaceutical evergreening. Evergreening is a tactic used by drug companies to continue to profit from a drug after the patent has expired. The company modifies the original drug ever so slightly and then patents the new version. Abilify lost its patent in 2013; Rexulti was FDA-approved in 2015. Abilify and Rexulti are both atypical antipsychotics. The drugs have nearly identical side effects, including altered mental state, impaired judgment and thinking, tardive dyskinesia, diabetes, heart disease, weight gain, decline in white blood count, seizures, falls, body temperature dysregulation, suicide in younger patients, and increased risk of death in elderly patients with dementia-related psychosis. The drug company responsible for Abilify and Rexulti is also responsible for Abilify MyCite, which is no more than Abilify embedded with a sensor that tracks when the pill’s been taken. Much has been written about Abilify MyCite’s threat to privacy, concerns that I share. Less has been said about the fact that Abilify MyCite is the same drug as Abilify, with the same side-effect profile and no proof whatsoever that the drug’s compliance-monitoring capabilities will actually help anyone other than the company’s shareholders. It concerns me that consumers of psychiatric drugs have no power to influence drug companies to improve the safety and efficacy of their products. Typically, when consumers balk at using a product, companies adapt their products to meet consumer demands. However, when it comes to pharmaceuticals, companies blame patients and tout data that purports to show the costs of medication non-compliance. We never see data about the costs of harm from adverse effects of medication, costs that include damage to reputations, lost income from disability, and medical expenses to treat medication side effects. Just as Otsuka and Lundbeck Pharmaceutical exploited negative perceptions of people with mental illness when it responded to Tyrese’s claim about Rexulti, the company is similarly exploiting the second-class status of people with mental illnesses when it sought and received approval for a compliance-monitoring drug with a side-effect profile that alone explains why people don’t want to take it. It is only because people with psychiatric diagnoses can be forced drugged that a drug with a compliance-monitoring device is even feasible. While some suggest that the compliance-monitoring device is useful for those who forget to take their medication, it’s hard to believe that a person who forgets to take their medication on a daily basis would remember once a week to change the bandage that is necessary to complete the circuit that records whether the pill has been taken. Psychiatrists have proven very susceptible to pharmaceutical marketing. I suspect we will soon see prescribers choosing Abilify MyCite for people under court-ordered, forced-drugging or making acceptance of the drug a condition of hospital release. This isn’t innovation in medicine. It’s innovation in coercion.
COUNTERPO!NT • FALL 2017
OP-ED PAGE . Commentary (in Verse)
Principles Before Personalities in Politics
Harassment in Senior Housing
To the Editor: I believe we should keep “principles before personalities in politics.” First of all, we all want a fair and democratic democracy. Secondly, we want to feel as if our vote counts. One vote, one person, equals each vote counts. Now, we all know about voter suppression. What we may not all know is that our democracy has been stolen during elections many times. As you know, many countries have interests in the most powerful nation on earth: the United States of America. We are in debt in the trillions, and we owe many. So, how to pay back those votes? In politics, in land, in trade deals. And sometimes even in privatized prisons. We all want a healthier America, we all want a fair share, a fair deal. I happen to believe that health care and housing are basic human rights. I do not want to see anyone starve or be homeless. Maslow’s Basic Hierarchy of Needs is all I’m asking for: shelter, food, safety. However, some feel protected in society, some feel at risk. The hot topic in my conversation tonight was the 2016 presidential election. I happen to think, like some, that our election was Stolen – capital S, Stolen. I do not think that all of the votes were counted fairly. To be fully honest and transparent, I have been a Senator Bernie Sanders supporter since the mid-1980s, ever since he was the mayor of Burlington. He was the only presidential candidate to look out for basic human intelligent rights and the vulnerable in society. Since the elections, I have been living somewhat in fear. Not just because of terrorism or mass shootings, but because I believe our original American Democracy is at risk. I do believe the Russians, as well as other countries, stole our election process. I vote. I vote with regularity and am more outspoken than some, not all. I serve as an advocate for mental health and overall health in Vermont. In the past, I was a Vermont Ambassador for the US, Hugh O’Brian International Leadership Ambassador, 1989, and on Governor Peter Shumlin’s Council on Pathways from Poverty, 2015-16. We, 99 percent of us, want peace. However you deem to call it, or register as a voter. But I am saying things are not fair. They have not been fair since Al Gore won the election yet lost to George Bush. Life is often not fair. But what I count on as an American, as a voter, is that my vote is counted, that my voice is heard. Many are afraid to speak out for fear of retribution or fear of retaliation. For the record, I support the police, firefighters and the military. What I also support are basic human rights like health care and social security, which people have been paying into the system for their entire lives. There is so much more I could say, so much more that I feel, deeply. But I will conclude with this: Take back your rights, America! Make your votes count and your voices heard. Peace on earth and goodwill towards men. Or else we are headed towards WWIII and our own demise. MARLA S. SIMPSON, M.A. Randolph
by Eleanor Newton They say “he has lost his filter” and so Whatever pops into his head pops out his mouth and so he cannot be held accountable for anything he says or does. And so I am not allowed to hit him or dump hot water on him or Else I will be arrested for Assault and Battery! And He has just as much right as I do to be down on the first floor or on either porch at any time of day or night. And I should not let his presence keep me away But I have no rights to be there, too, and be left alone So maybe you don’t want to hear about victims But You will! I promise you that! Eleanor Newton is from Burlington and is on the Counterpoint editorial advisory board.
The Power of ‘Off’ by Susan Panaro Egan
(Voices • Continued from page 16) have to fight for it, remind people and put ourselves on the agenda. After so many years, it shouldn’t have to be that way. Sometimes we still have to educate newcomers. There is constant turnover in state leadership and among elected officials. That education shouldn’t have to be our job. It should be engrained in public policy. Consider this guidance from the federal Substance Abuse and Mental Health Services Administration, which notes that recovery is the single most important goal for the mental health system and includes empowerment as one of the 10 consensus principles for recovery: “Consumers have the authority … to participate in all decisions – including the allocation of resources – that will affect their lives, and are educated and supported in so doing” [emphasis added]. That places a clear responsibility on the system itself to foster inclusion. The people who are directly affected by decisions must be participants in the actual decision-making. In that regard, we still have a long way to go.
As a child, one learned to turn “off” the lights when leaving a room to save electricity. When driving a car, one knows when to turn “off” the highway or street to reach a destination. (Yes, a GPS can help, but I don’t use one.) The word “off” in any language is fairly easy to understand, unlike many of the descriptive words used by parts of society, often in the media. The ones I dislike the most are “crazy,” “unruly,” “out of control,” “uncooperative (due to diagnosis),” “combative” and “psycho” – among many others. When a person doesn’t feel well, physically or mentally, it can mean several things. For example, when my stomach is “off,” I may have indigestion, a bellyache, or maybe even a feeling of being bloated or full. Sometimes I may feel mentally or emotionally “off” – especially when a negative or depressing thought comes to mind. My point: Some days are better than others, and I’ve learned, therefore, to be more kind to myself and to take it slower and more gently on the “off” days. Susan Panero Egan is from Londonderry.
COUNTERPO!NT • FALL 2017
Black hole thermodynamics and psychiatric hospitals By KATE DEWOLFE
I’ve been told by therapists, psychiatrists, and friends and family members that I talk about thermodynamics too much. I’m not a religious person. I usually don’t believe in God. I believe in science. I have faith in science. I turn to science to make sense of my world and all of life’s stressors. My faith in science is what initially made psychiatry seem appealing. Psychiatry presents itself as a framework of objective science to understand extreme human emotions and experiences. After a couple years of mostly terrible experiences with psychiatry, and after looking into the research behind psychiatry’s treatments, I’ve come to the conclusion that it’s just not as pure and beautiful a science as, say, physics, thermodynamics or even chemistry. Instead, psychiatry is messy. It is full of subjectivity, full of motives, full of assumptions. I will consent to psychiatric medication if I know the drug has a desired effect, with side effects I can tolerate. But I do not turn to psychiatry for answers about life, my experiences, or for help navigating life’s biggest challenges. For life’s big questions, some might turn to God and their faith. I turn to the laws of thermodynamics. Thermodynamics is the physics of systems that contain heat or other forms of energy. The laws of thermodynamics are universal. They apply to everything, everywhere, that interacts with energy in any way. If you’re not familiar with the laws of thermodynamics, they can be easily summarized with a gambling metaphor. Gambler’s Laws of Thermodynamics • 0th: You must play the game. If two systems are in thermal equilibrium with a third system, then they are in thermal equilibrium with each other. This law gives us a notion of temperature. • 1st: You can’t win. Energy cannot be created or destroyed but can change from one form to another. • 2nd: You can’t break even (except for on a very cold day). The entropy, or disorder, of a system in isolation always increases over time. Entropy reaches a minimum as the temperature approaches absolute zero. • 3rd: You can’t quit the game (it never gets that cold). It is fundamentally impossible to reach absolute zero. If these laws seem familiar to you, but you’ve never studied thermodynamics before, it might
be because Michael Jackson sang a song about them in the musical “The Wiz” as the Scarecrow. The Scarecrow, like myself, made sense of his plight and struggle by turning to these fundamental laws of the universe: You can’t win You can’t break even And you can’t get out of the game People keep sayin’ Things are gonna change But they look just like they’re staying the same You get in Way over your head And you’ve only got yourself to blame You can’t win, child You can’t break even And you can’t get out of the game Maybe some of you see where I’m going with this, and what this has to do with psychiatric hospitals. I think many people who have been hospitalized involuntarily have had the experience of feeling like they must play a game that they cannot win, cannot break even, and can’t get out of. Yes, absolutely, of course. This is one way in which we can make sense of the experience of being hospitalized by considering the laws of thermodynamics. When I was hospitalized, I felt compelled to write out these gambler’s laws on a whiteboard in the unit, for all to see. So we get that, right? We need to now revisit the second law of thermodynamics. The entropy of a system in isolation always increases over time. Entropy is a measure of disorder. You can’t break even, because some energy will always go into making the system messy, rather than operate at perfect efficiency. This law states that the natural progression of the universe is from order to disorder. Highly ordered systems can always easily dissolve into chaos, but chaos will never easily become ordered. Except, apparently, in one situation. A black hole forms when a gigantic star dies and collapses in on itself. The mass of the star gets condensed into a single point, a singularity. Its gravity is so strong that not even light can escape. For many years, scientists believed that black holes violated the second law of thermodynamics. The singularity of a black hole is a highly ordered state. You can throw an entire chaotic nebula into it, and as it crosses the event horizon, it becomes part of that infinitesimal ordered point. Black holes were perceived as something of a paradox for years, the only things in all of time and space that seem to violate the natural progression from order to disorder. Consider now the claims of psychiatry and the rhetoric surrounding psychiatric hospitalization as a necessary treatment for madness. You take a mad person, whose mind is chaotic, whose existence is high in entropy, and have them cross the event horizon that is those locked psych unit doors. There they’re convinced or
forced to take antipsychotic medication. I’ve heard psychiatrists describe the effects of these drugs as treating “disordered thought.” The doctors see the patients “clear up.” Their thoughts get more “organized.” In theory, these hospitals operate much like a black hole. They take something chaotic and create something ordered, organized. Understand, though, physicists were wrong when they thought that black holes violated the second law of thermodynamics. Stephen Hawking later discovered that black holes radiate that entropy in the form of Hawking radiation. The second law of thermodynamics is not violated, because black holes still increase the entropy of the universe beyond the event horizon. Likewise, psychiatric hospitals do not violate the second law of thermodynamics beyond the confines of those locked doors. The metaphorical Hawking radiation takes many forms. Consider the damage done to our bodies, our health, as we take multiple powerful drugs long term. Consider that suicides are most likely to occur shortly after hospitalization. Consider the loss to our communities when our people are removed and placed in locked units over and over again. Consider the children in DCF custody, taken away from parents with psychiatric diagnoses. Consider the trauma of being forced-drugged, and the nightmares that follow such terrifying experiences. Consider the injuries caused by restraint procedures, to both patient and staff alike. Psychiatric hospitals are in many ways exactly like black holes. What I mean by it is that they appear, to the casual observer, to create order out of chaos. But the entropy of a system always increases over time. Psychiatric hospitals do not remove that entropy that is madness. They transform it into other forms of entropy, some of which have devastating consequences for patients, their families and their communities. Black holes broadcast entropy out into the universe in the form of Hawking radiation. Inside the black hole is order, and outside the universe has been gaining entropy since the very first moment of the big bang. Likewise, our mental health system, and particularly locked psychiatric units, broadcast toxic disorder out into the universe. Entropy, in and of itself, is neither good nor bad. It is only within a highly entropic, chaotic nebula, the remains of exploded stars, that rocky planets such as our Earth can form. Life cannot exist within a highly ordered black hole. I do not think it serves us well, speaking strictly from a thermodynamics standpoint, to pour our time and energy and money into a system designed to decrease entropy within its walls. The premise is false and naive. In this world, we have no choice but to obey the laws of thermodynamics. Kate DeWolfe is the southern Vermont patient representative for Vermont Psychiatric Survivors and lives in Brattleboro.
COUNTERPO!NT • FALL 2017
Headaches, Heartaches, and Pharmaceutical Roulette By CALVIN MOEN
he first time I was given a psychiatric diagnosis, it was clear to me that the diagnostic process itself was deeply flawed. “How can you tell me I have a medical condition for which the test is a short list of questions?” I wondered. “How can you tell me my brain chemistry is off if you don’t have a means of measuring it?” Ten years later, I went through that whole process again, this time with a different kind of medical diagnosis: migraine. As with psychiatry, migraine medicine is mostly theory. Migraines may be caused by changes in the brain’s nerves. Serotonin might be involved. You could be sensitive to certain foods or noises or lights or smells, and there’s no cure but there are medications that can ease or prevent some amount of the pain sometimes. If you can live with the side effects. Being diagnosed with migraine was helpful in some ways. I had a name for why I couldn’t get out of bed some mornings, needed to take a break in a dark room while at work, didn’t get around to washing the dishes at home. I had a name for it, but I didn’t have an explanation or a solution. I imagined food allergy tests that would isolate the ingredients I was reacting to so I could avoid them. I imagined blood tests for vitamin deficiencies that could be corrected with supplements. Perhaps I would get a lab result showing hormone imbalances that could be remedied. What I got was a prescription for Imitrex. This is one of a class of drugs called triptans, serotonin receptor agonists, that are believed to constrict blood vessels in the brain and relieve other migraine symptoms, but nobody really knows how. One of the side effects is more migraines. WebMD says about these drugs, “It is hard to know which triptan is the most effective. A
Have an Issue to Discuss with Other Survivors?
triptan that works well for someone else may not work well for you. You may have to try more than one triptan to find the one that works best for you.” Ah, the old pharmaceutical roulette. For a while, I could take Imitrex when I felt the first sign of a migraine and it would be alleviated, even if it did make me too drowsy to sit up. But eventually the headaches were rolling right over the meds, and another doctor prescribed a preventative drug called Topamax, to be taken daily. Topamax is an anticonvulsant prescribed off label as a mood stabilizer and weight loss aid, by the way. Shortly after I started this new drug, I drove my car into a snowbank. It was like I forgot how to steer. There were other neurological effects. Food started tasting different. I had diarrhea every day. My hands and feet would tingle. I stayed on it for a year, even though it wasn’t making a noticeable difference in the frequency or duration of headaches. In retrospect, my motivation for staying on the Topamax was desperation. The pain was real. It was making my life difficult, putting a strain on my relationships, and inhibiting my ability to earn a paycheck. I needed to do something, and drugs were all that was being offered. Finally I stopped taking Topamax and started trying everything else I heard about. I kept a log of what I ate and the hours I slept and when my head hurt and how much and for how long. I was trying to identify “triggers” so I could manage my symptoms. I took magnesium and feverfew and riboflavin. I tried ice packs, massage, aromatherapy, acupuncture, yoga, and homeopathy. I read an article suggesting that I simply accept this debilitating pain as my body’s way of slowing me down and making me rest. And I kept missing work, and I kept skipping chores and social engagements, and I kept hurting. Finally, on a hunch, I stopped eating anything made from milk. The results were dramatic. My headaches were reduced drastically. I could depend on my body in a way I hadn’t been able to for years. Later, I found an outdated book about mi-
graines, written by someone who had figured out how to manage his own, which confirmed that many people have sensitivities or allergies to casein, the protein in milk, that result in migraine symptoms. In short, with little guidance from medical practitioners and holistic providers who offered only “treatment,” I bumbled around for several years before stumbling on one major contributing factor and reducing my suffering significantly. The similarities and parallels between being treated for migraine and my experiences with psychiatry are staggering and frustrating. Just thinking about it gives me a headache and makes me feel overwhelmed and hopeless. The unproven theories about serotonin, overreliance on drugs that provide hit-or-miss relief with debilitating side effects, dearth of objective testing as part of the diagnosis, focus on managing symptoms as opposed to investigating causes and contributors – it’s like a recurring nightmare (also a side effect of Topamax). I’m happy to say, for the moment, I’ve cashed in my chips and walked away from the roulette table. I still get migraines, because I can’t avoid some triggers, like weather, but at least I am living a life that’s working for me. And I still get really depressed sometimes, because I am sensitive to my environment, and this world is not always easy to live in. But I have learned to take care of myself in ways doctors never could. When I go to doctors, they are happy to supply answers, but maybe they are answering the wrong questions. When it comes to headaches and heartaches, I’ve found more relief by listening to my own body and mind, identifying root causes and systemic factors, questioning the expertise of experts, and looking to my community to model resiliency and self-healing. And sometimes I just have a hunch and the willingness to follow it, and it changes my life. Calvin Moen is the training director for Vermont Psychiatric Survivors and does grassroots organizing for mutual support in Brattleboro.
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COUNTERPO!NT • FALL 2017
A Compassionate Proposal By PAMELA SPIRO WAGNER
lthough I am no longer in the system and the Department of Mental Health has no more power over me, I was part of the system in two states for most of my adult life, now spanning some six decades. From the perspective of someone who has spent a great deal of her life in psychiatric wards and hospitals, ER stays and subsequent hospital “treatment” do not work, especially the stripped-down, medication-oriented “stabilization” that passes for a hospitalization these days. In fact, most honest hospital staff admit that they do not even try to “treat” patients who are admitted, that the goal is purely and only stabilization, and that longer-term patients are mostly kept there because of a lack of other resources, like housing and safe alternatives. I maintain, moreover, that the vast majority of inpatients who seem “unsafe” are made more unsafe by the poor treatment they are given by the hospitals in Vermont to which they are often involuntarily admitted. Let’s face it, someone who wants to be in a hospital can make the best of an imperfect situation since they want the “care” given there, but someone who is forcibly detained and more or less forced to take meds in order to get out (and don’t kid yourselves because that is the name of the game) will not be so amenable to anything in that involuntary situation. But let’s talk about the ER admissions that lead to an inpatient stay. Why are people even being taught that an emergency department is the proper place to go in a crisis? Most mental health crises can be resolved easily and safely off the hospital grounds without the use of threats and coercion, and without
immediately depriving you of the simple right to wear your own clothing or even to leave the emergency department! Can any of you reading this imagine being detained against your will in a hospital where, if you object to your treatment, you most likely will be summarily shut up in a locked seclusion room, if only because your raised voice disturbs the other patients? Because the inexperienced emergency department doctors do not understand or want to deal with nonphysical crises, they are apt to forceinject Haldol into any person who objects to a sedating medication. That invariably escalates the situation. What might have been resolved with a little problem-solving or even one decent night’s sleep has resulted in the designation “dangerous to self and others.” The patient is now on the road to being involuntarily committed to a psychiatric facility, whether it was necessary or not. The idea that a person can languish for many days in an ER – and now that has become weeks – is disgusting. No crisis lasts that long unless the situation is irritating it! When will you learn that force does not work? When will you learn that mere shows of force, which intend to frighten a patient into submission, fulfill the criteria for assault? To deliberately frighten another person in order to make them comply with your will, and then to lay hands on them to do so, is one of the definitions of assault and battery. Just because you do it under the guise of medicine does not make it less assaultive. I have been in places where the security guards covered my face and mouth with a towel, supposedly to avoid being bitten (though I never did such a thing). Then they sat on me, face down, compressing my face and neck under the towel until I could neither object nor breathe, so the nurse could inject me with drugs that were never supposed to be used in my care (Continued on page 21)
Pantheism and Madness By MATTI SALMINEN
et’s not make all mental health radicals the same – otherwise we undermine our own contribution to diversity. I’ve been trying to find the words to describe my frustration with the radical scene in mental health. They’ve been too defensive. But, for a long time, I’ve felt that the trademark argument in radical mental health did not fit my stance, and I almost felt that I needed to apologize for this. I am a pantheist. That means I believe nature is god – and believing that nature is god means a lot of things. To me it means that extreme states and difficult emotions can be a source of divine inspiration and originate in the brain. I do not think that it is deconstructive to associate extreme states with chemical balances in our brains. I would argue that much of what affects the chemical balances in the brain is related to stress, drug use, alienation, and the like. I’d like to go farther into my belief system of pantheism to better show that the sciences and spirituality have a point of convergence. One of the primary questions in regard to creating a system of spiritual belief is “Where did we all come from?” I believe that mankind created mankind. Our universe, in much the same way, created itself – the whole process of life emerging from darkness was organic. But somewhere down the line, as the universe was building itself, there came to be love. All animals exhibit love, and maybe plants do, too. The creation of lovingness in the universe is the reason that mankind has put so much behind believing in god. I believe that love is organic to nature, that it is entwined in the DNA of all plants and animals. You could almost call me an atheist for believing that love is genetic … but I’m not. I do not think nature is blind. Nature created love with intentions similar to why we create love with and for each other. Love is wild, much the way nature is. Nature and all things of nature are of a divine origin, and they are all necessary for the existence of love and life. Nature created life and love not as an idea of self-gratification – there
was not one singular source to all things divine. God exists in all things, and all things are thus divine. This includes the experience of madness. There are many life experiences that open pathways to spiritual insight and creativity. The experience of madness is one of them. Many mental health advocates have decided that there can be no understanding of the brain that embraces the diversity of madness. Many want to promote a system of belief that madness is the construct of spiritual experiences that it cannot be associated with disease. Anything that strengthens a person emotionally is constructive of a richer and more profound understanding of being human. I look at people who’ve experienced terminal illness and believe that their experience does help them to gain much wisdom. The extreme states associated with what may be mental illness also can be constructive of a richer consciousness. I have made myself stronger by learning to live with the adversity and discrimination that goes along with having schizophrenia. I’ve fought many battles to be where I am – and I am proud to have fought hard. I am also sad to have lost years of my life to my struggle for sanity. For 10 years of my life, I thought I had a rat in my brain and I thought that people might torture me. I was afraid, angry and hurt. There was, however, a light at the end of this long, dark night. Stepping into the light, I found creative inspiration and will have a book of poetry published by the time this essay is printed. We do have unique gifts as mad people, and I do not want to devalue that by making an aspersion to the mind as being the source of madness. Venturing off into spiritual dimensions has a unique quality that can arouse amazing insights – and creativity. We have to fight to make certain this is not demeaned by society, let alone by our psychiatrists. Allowing for radical views on madness is necessary to our fight for justice and liberation. Our ability to strengthen the statement of mad pride is tied to our ability to accept many different forms of mad pride. There are many of us in the psychiatric survivor community, and we must all allow for just as many different views. Matti Salminen is from Brattleboro and an organizer of the annual Mad Pride march and rally.
COUNTERPO!NT • FALL 2017 A COMPASSIONATE PROPOSAL • Continued from page 20 at all. Take a minute and think not about that nurse’s safety but about me and how I might have felt under such “medical ministrations.” Do you think I felt cared about or well-treated? How do you imagine under such circumstances that you yourselves might react to such “care”? In Vermont, in 2015, without my having done anything except express my intense dislike for the fact that an ER was sending me against my will to the very hospital named on my advance directive as the one I did not want to go to, I was handcuffed and put in a waist chain and leg irons. Then a hood was pulled over my entire head and face before I was involuntarily transported. Once there, the sheriffs took me by the armpits and dragged me across the parking lot and down into the basement before again dragging me, my heels on the ground, to the second floor and down two long corridors to the adult low-stimulation area. I suppose you would simply have accepted this sort of “treatment” as standard operating procedure in Vermont because, after all, mental patients are dangerous criminals and deserve to be treated like Hannibal Lecter. But I was outraged and expressed this to the doctor who saw me some 10 minutes later, after the chains and handcuffs had been removed. Of course, to him, I had no reason to be so angry, and he promptly (and inappropriately, as it turned out, since he was forced to remove it from the record) diagnosed me with borderline personality disorder in addition to the Axis I diagnosis I had come in with. Emergency departments are no places to “treat” a person in crisis, not even someone with a so-called Axis I diagnosis. Your hospitals never helped me. They stabilized me and tortured me, but they never helped me. The only people who ever helped me were nonmedical, nonlicensed people. I think there should be more people hired to help people in crisis who are nonjudgmental, caring, compassionate and well-trained in nonviolent communication of the sort taught by Marshall Rosenberg. These would not be peers – other mental health consumers – who have been contaminated by a trauma-inducing system, but simply caring, patient, compassionate listeners who know how to help: mental health doulas. They would not be the sort to give advice and orders and would not be empowered to take records and keep notes that DMH can demand in order to monitor a person, even impersonally without names. I personally believe that if there were a lot of peer-run respites like Alyssum or family-type situations that could “adopt” a troubled person in an emergency for a few hours, days or however long they could, without being told the lie that drugs are necessary or even helpful, many people in distress would get better a lot faster and never get trapped in the abysmal mental illness system at all. I only got better once I was out of DMH’s clutches, and that meant not having any doctor in Vermont who could reinstate an order of nonhospitalization once mine expired. I now see someone in another state via Skype and Facetime, and she prescribes for me what I want to take. But no one can control me inside Vermont because I won’t go anywhere near a Vermont psychiatric practitioner, given my experience with their power and the uses they put it to. I won’t go near any ER for psychiatric or crisis reasons, either. No, thank you! Mental health doulas, like one person here in Brattleboro who has so helped me, could help anyone when they need it – outside of the emergency department and not using coercion, only the power of their warmth and nonviolent communication training. Why can’t there be a separate place outside of an ER for people in crisis to go initially? I mean, why start in an ER at all?
Yes, some need medical clearance, to be sure, because there are some in whom the crisis might just be a urinary tract infection, etc., and not a true mental health issue at all. But for many, these issues are, if not chronic, at least recognizably nonphysical, and they know what they need is not the physical medicine of the ER. So why cannot there be a real crisis center off site with a much more laid-back and relaxed atmosphere that is not so conducive to control and coercion as an ER and does not start from those premises? Sure, there may be some people who cannot handle this from the start, but I venture to guess the badly intoxicated and medically “uncleared” would need a regular ER to start with anyway. Others who are not intoxicated or in need of medical attention could find their way to the mental health crisis center – outside any ER – where they could truly get helped by nonemergency personnel with training to
By Pamela Spriro Wagner provide what is needed in a mental health crisis, not the coercion and control measures needed to provide quiet in a medical ER. I believe many mental health crises can be resolved with practical support and good listening, and very often with a good night’s sleep, avoiding the inpatient stay that so often eventuates from an ER visit. We need a place like Alyssum in Brattleboro. Alyssum saved me when a hospital would have sent me down the tubes, likely would have induced more despair, and ended with my going to Brussels for assisted suicide. Instead, Alyssum, where I have stayed twice, gave me back my life using compassion to help me find my own strengths, not using any sort of compulsion or coercion, even when I burned my face with cigars. Though it happened on their grounds, they did not overreact or use punitive tactics as retaliation. Instead, they doubled down on compassion to help me and, as a result, saved my life and sanity. But it is a two-hour drive to Rochester, Vermont, and the limited availability of this one resource makes it essentially unavailable to anyone who has been there more than once. This is tragic as I believe that many would benefit from multiple stays (longer than two or three days), and they may end up hospitalized when barred from Alyssum, even though they would have preferred it and undoubtedly done better there. Pamela Spiro Wagner is an artist, poet, co-author of “Divided Minds: Twin Sisters and their Journey through Schizophrenia” (St. Martin’s Press, 2005) and author of “We Mad Climb Shaky Ladders” (CavanKerry Press, 2009). Her third book, “Learning to See in Three Dimensions,” poems and art, was published in June by Green Writers Press and Sundog Poetry Center of Vermont.
COUNTERPO!NT • FALL 2017
DISABILITY RIGHTS VERMONT ANNOUNCES FY 2018 PRIORITIES Disability Rights Vermont (DRVT) is a private non-profit agency dedicated to defending and advancing the rights of people with mental health and disability issues. We are empowered (and funded!) by the federal government to investigate abuse, neglect and serious rights violations. Our fourteen member staff teams with the six member staff of the Disability Law Project of Vermont Legal Aid (DLP) to create the cross-disability legal protection and advocacy system for Vermont. This past year DRVT and the DLP were busy defending the rights of people with disabilities both in individual case work and in systemic change. Of course we can’t list everything here that we have done this year but following are a few of our important activities. DRVT has continued our work to create a more robust community-based system that will both provide needed supports for people experiencing mental health crises and avoid involuntary treatment, incarceration or other major life disruptions that occur now because of a lack of adequate community capacity. DRVT, on behalf of people with disabilities, has brought cases before the Federal Court and the Vermont Human Rights Commissions highlighting the harm that people suffer when held in inappropriately segregated and institutional settings solely due to their disabilities. Many of these cases have resulted in important systemic changes to improve conditions for people held this way, while we continue working to fix the overall system. DRVT staff has continued to promote self-advocacy by offering training in preparing Advance Directives for health care, by assisting individuals to understand institutions’ grievance processes policies and by offering assistance to peerrun services. We have also trained staff at several psychiatric units and designated agencies in recognizing and respecting patients’ rights. We have continued our work monitoring the treatment and education of youth detained at the Woodside Rehabilitation Facility, with a focus on the use of force and segregation of youth as well as with obtaining compliance with special education laws. DRVT maintained its main focus on detecting, remedying and preventing the inadequate provision of mental health care and the unnecessary use of force and isolation against people with disabilities in hospitals and correctional facilities throughout Vermont. This work is accomplished by DRVT staff monitoring facilities, meeting with patients and prisoners, investigating claims of abuse or neglect and assisting in filing formal grievances, complaints and litigation when necessary to vindicate people’s rights. We continue to monitor treatment environments in Vermont, including designated psychiatric hospitals, Emergency Departments, residential and community care homes. We also reach out to homeless shelters and to refugee, immigrant and other at-risk communities in Vermont. DRVT staff continued to support the right of people with disabilities to vote by conducting extensive voter registration efforts and providing polling place accessibility surveys to town officials. We have continued to grow our work assisting beneficiaries of Social Security who face barriers to employment throughout Vermont. DRVT has helped to resolve employment and educational discrimination claims, landlord tenant concerns, access to vocational services concerns, and inappropriate overpayment demands for dozens of Vermonters. Over time, DRVT has greatly expanded our work to assist
victims of crimes who have disabilities throughout Vermont, including having provided training to law enforcement officers in Rutland County on how best to interact with victims of sexual assault who have disabilities, providing representation for victims as they navigate the criminal justice system, and by helping victims with access to safety and to social services they might need. DLP and DRVT staff has made real and positive differences in the lives of the many individuals who have contacted us and for whom we have provided information, referrals, short-term assistance, investigations, and litigation. DRVT is publishing our formal Fiscal Year 2018 (10/1/17 - 9/30/18) priorities for the Protection & Advocacy for Individuals with Mental Illness (PAIMI) program on the adjoining pages. These priorities serve to focus the work of the agency and are developed by our Board and our advisory council, who get input from the community and staff. Your input is appreciated! We strive to do as much as we can with the resources we have and we can do that best when folks in the community let us know their greatest advocacy needs! We need volunteers, too! Disability Rights Vermont (DRVT) is looking for volunteers to serve on our PAIMI (Protection & Advocacy for Individuals with a Mental Illness) Advisory Council (PAC). We are looking for members with connections to the broader community who will assist DRVT in developing annual priorities and assess our performance. Each applicant must identify with one of the following categories: • You are a psychiatric survivor • You are or have been a recipient of mental health services •Y ou are a mental health professional • You are a mental health service provider • You are the parent of a minor child who has received or is receiving mental health services. • You are a family member of an individual who is or has been a recipient of mental health services •Y ou are a lawyer If any of the above categories apply to you and you are interested in having an impact on our community we want to hear from you! Please call 1-800-834-7890 x 101 for an application to join our PAIMI council.
Send us your comments to help us stay connected to the community we serve!
COUNTERPO!NT • FALL 2017
DISABILITY RIGHTS VERMONT – FY’18 PAIMI PRIORITIES (PAIMI is Protection & Advocacy for Individuals with Mental Illness)
Priority 1: Investigate individual cases of abuse, neglect, and serious rights violations in inpatient facilities (designated hospitals, any state run facilities, designated agencies, emergency departments, facilities for minors), prisons/ jails, and community settings, including peer services and designated agencies. Measure of Success: A. Work on a minimum of 100 cases of abuse, neglect, or serious rights violations of people with mental health issues. Among closed cases, at least 75% of those not withdrawn by client or found to be without merit by DRVT staff should be resolved favorably. B. In at least 2 opened cases, DRVT will advocate for adequate discharge of involuntary patients in the spirit of the community integration mandate of the Americans with Disabilities Act. C. DRVT will assist at least five clients to assure they receive appropriate medication, with informed consent and without coercion, and/or alternative treatment if that is their preference. D. DRVT will assist at least two clients to overcome employment discrimination. Priority 2: Reduce the use of seclusion, restraint, coercion and involuntary procedures through systemic efforts. Continue systemic work to create culturally competent, traumainformed, violence free and coercion free mental health treatment environments. Measures of Success: A. Work with at least two institutions to create respectful, trauma-informed, violence free and coercion free mental health treatment environments. B. Conduct systemic advocacy in the legislature, and with the administration, to preserve or enhance the right of Vermonters to be free from coercion in their mental health treatment and to receive appropriate community-based services. C. Work in at least one community to improve the systemwide response to mental health-related emergencies to prevent unnecessary use of force, involuntary treatment and incarceration. D. Monitor the quarterly statistics of the use of Tasers (Act 180 of 2014); periodic statistics on segregation in state prisons; and Certificates of Need (CONs) for Emergency Involuntary Procedures (EIPs) in inpatient settings. E. Continue to participate in the Adult Protective Services (APS) Subcommittee of the Department of Disabilities, Aging and Independent Living (DAIL) Advisory Board and actively participate on the Vulnerable Adult Fatality Review Team (VAFRT) and the Mental Health Crisis Response Commission (MHCRC). F. DRVT will create materials to educate news media outlets how to be respectful in reportage that concerns people with psychiatric and other disabilities. In addition, DRVT does not ignore evolving situations and other cases, or treatment facilities, which require attention.
residential childcare facilities. Outreach visits, including distribution of DRVT literature & self-advocacy materials, are conducted at a minimum of 10 CCHs. B. Outreach is conducted, at a minimum, to the four state prisons housing the most PAIMI eligible prisoners. C. Outreach is conducted at all designated facilities, including any state run facility. D. DRVT literature is distributed to all of the community mental health agencies, prisons, and designated hospitals, including their emergency departments, to intensive rehabilitation residences, and to specific homeless shelters, “club houses” and peer-run services. E. Outreach is conducted at least once at each Emergency Department of non-designated hospitals. F. Outreach will be conducted to individuals labeled with a disability who are victims of crime or domestic abuse. G. DRVT PAIMI Staff will receive training on cultural sensitivity to trauma and poverty. Priority 4: Advocate for self-determination and access to alternative treatment options and community integration. Use legal advocacy to enforce and expand rights across the State of Vermont. Measure of Success: A. Four self-advocacy and/or advance directive trainings for 40 individuals. B. Assist at least 5 individuals across the State of Vermont with their preparation of Advanced Directives. C. Work with the administration, other advocacy groups and individuals to monitor the implementation of Act 79. D. Encourage the development and expansion of peer run and alternative services in Vermont’s mental health system reform and educate peers on access to these services. E. DRVT will participate in systemic efforts to improve state services for individuals in or at risk of incarceration to speed successful reintegration. F. Participate in efforts to insure that state and local emergency planning efforts include the needs of people with mental health issues. G. Participate in coalition efforts to address transportation infrastructure needs of low-income people with mental health issues. H. Support the Vermont Communications Support Project in order to ensure that people with communications disorders related to their mental health can participate in the judicial and administrative systems. I. DRVT Staff will receive training in awareness of alternative treatment modalities available for individuals with psychiatric disabilities. Case acceptance is based on these PAIMI priorities; whether a client meets the federal definition of an individual with a mental illness; whether the case can be shown to have merit; whether the client does not have other representation; and whether there are sufficient staff resources to take on the case.
Priority 3: Reach out to community settings, designated How can you make your voice heard? facilities, emergency rooms, prisons/jails, residential and therapeutic care homes. Monitor conditions and educate Contact DRVT at: 141 Main Street, Suite 7, residents about rights and self-advocacy. Engage in systems Montpelier, VT 05602 work to improve conditions. Or by phone: 1-800-834-7890 or, locally, at Measures of Success: (802) 229-1355 A. Monitoring is conducted at a minimum of 5 community By email at: email@example.com care homes (CCH), including but not limited to residential Please visit our website at care homes, therapeutic community residences or licensed www.disabilityrightsvt.org
COUNTERPO!NT • FALL 2017
SURVIVOR PEER SERVICES Vermont Psychiatric Survivors Peer Support Groups BRATTLEBORO: Changing Tides, Brattleboro Mem.
Hosp, 17 Belmont Ave., Brattleboro; every Wednesday, 7-8:30 p.m. Call Sandra at 802-579-5937 BENNINGTON/UCS: United Counseling Service, 316 Dewey St., Bennington; Mondays and Wednesdays, noon-1 p.m. Call UCS at 802-442-5491 NORTHWESTERN: St. Paul’s United Methodist Church, 11 Church Street, St. Albans; 1st and 3rd Tues, 4:306:30 p.m. Leave message for Keith at 802-782-1387 RUTLAND: Wellness Group, VPS Office, 128 Merchants Row, Suite 606; every Wednesday, 5-7 p.m. Call Beth at 802-353-4365 SPRINGFIELD: First Congregational Church, 77 Main St., every Thursday from 2-3:30 p.m. Call Diana at 802-2891982
VPS is a membership organization providing peer support, outreach, advocacy and education 128 Merchants Row, Suite 606, Rutland, VT 05701 802-775-6834
www.vermontpsychiatricsurvivors.org Peer Support WARM LINES
VERMONT SUPPORT LINE (STATEWIDE): 888-604-6412; every day, 3-11 p.m
PEER ACCESS CONNECTIONS: 802.662.1280 Friday, Saturday and Sunday 7:00 p.m. to 9:00 p.m.;
Counterpoint publishes this resource list 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. Vermont Federation of Families for Children’s Mental Health 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
1-800-273-TALK (8255) 24/7 confidential support
Women’s Holistic Outreach Learning Environment
Public Community Mental Health
(W.H.O.L.E.) peer support groups in Springfield for “women who struggle with mental, emotional, and behavioral health issues.” Tuesdays from 7 to 8:30 p.m. at the Calvary Baptist Church, 156 Main St. Entrance at back on right side of building. More info at www.wholevpweb.com
Pride Center of Vermont
LGBTQ Individuals with Disabilities Social and Support Groups: Connections and support around coming out, socializing, employment challenges, safe sex, self-advocacy, and anything else! Burlington, Wednesdays, 4:30 p.m. at Pride Center, 255 S. Champlain St.
Brain Injury Association
VERMONT PSYCHIATRIC SURVIVORS OUTREACH AND PATIENT REPRESENTATIVES 802-775-6834 F: (802) 775-6823 firstname.lastname@example.org
The Trans Lifeline (dedicated to the trans population) can be reached at 1-877-565-8860.
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.
NAMI Connections Support Groups
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
BENNINGTON: Every Tuesday 12-1:30 pm; United Counsel-
Peer Centers & Employment Support
MONTPELIER: Every Friday 2-3:30 pm; Another Way,
ANOTHER WAY, 125 Barre St, Montpelier, 802-2290920; email@example.com; www.anotherwayvt. org; see website for events calendar. PATHWAYS VERMONT COMMUNITY CENTER (formerly The Wellness Co-Op), 279 North Winooski Avenue, Burlington, 888-492-8218 ext 300; www.pathwaysvermont.org/what-we-do/our-programs/pvcc; www.facebook.com/PathwaysVTCommunityCenter
Vermont Recovery Centers WWW.VTRECOVERYNETWORK.ORG BARRE, Turning Point Center of Central Vermont, 489 N. Main St.; 479-7373; firstname.lastname@example.org
BENNINGTON, Turning Point Center, 465 Main St; 802442-9700; email@example.com
BRATTLEBORO, Turning Point Center of Windham County, 39 Elm St.; 802-257-5600; firstname.lastname@example.org
BURLINGTON, Turning Point Center of Chittenden
County, 191 Bank St, 2nd floor; 802-861-3150; GaryD@ turningpointcentervt.org or www.turningpointcentervt.org
MIDDLEBURY, Turning Point Center of Addison Coun-
ty, 228 Maple St, Space 31B; 802-388-4249; tcacvt@ yahoo.com
MORRISVILLE, North Central Vermont Recovery Center, 275 Brooklyn St., 802-851-8120; email@example.com
RUTLAND, Turning Point Center, 141 State St; 802-7736010 firstname.lastname@example.org
SPRINGFIELD, Turning Point Recovery Center of Springfield, 7 Morgan St., 802-885-4668; spfldturningpoint@ gmail.com
ST. ALBANS, Turning Point of Franklin County, 182 Lake St; 802-782-8454; email@example.com
ST. JOHNSBURY, Kingdom Recovery Center, 297 Sum-
mer St; 802-751-8520; firstname.lastname@example.org; j.keough@ stjkrc.org; www.kingdomrecoverycenter.com
WHITE RIVER JUNCTION, Upper Valley Turning Point, 200 Olcott Dr; 802-295-5206; email@example.com; secondwindfound.org
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
ORANGE COUNTY: CLARA MARTIN CENTER, 11 Main St.,
Trans Crisis Hotline
Alyssum, 802-767-6000; www.alyssum.org; firstname.lastname@example.org
UNITED COUNSELING SERVICE OF BENNINGTON COUNTY;
DBT Peer Group
MUTUAL SUPPORT NETWORK www.hivemutualsupport.net 802-43-BUZZ-3 (802-432-8993)
Middlebury, 05753; 802-388-6751
NORTHEAST KINGDOM HUMAN SERVICES, 181 Crawford
WASHINGTON COUNTY MENTAL HEALTH PEER LINE:
THE HIVE: email@example.com
COUNSELING SERVICE OF ADDISON COUNTY, 89 Main St.,
Support Group locations on web: www.biavt.org; or email: firstname.lastname@example.org; Toll Free Line: 877-856-1772
Peer-run skills group. Sundays, 4 p.m.; 1 Mineral St, Springfield (The Whitcomb Building). tinyurl.com/PeerDBTVT
802-229-8015; 7 days/wk, 6-11 p.m.
NATIONAL SUICIDE PREVENTION LIFELINE
ing Service, 316 Dewey Street, CRT Center
BURLINGTON: Every Thursday 3-4:30 pm; St. Paul’s Episcopal Cathedral, 2 Cherry Street (enter from parking lot)
Road, Derby; 802-334-6744; 800-696-4979, 2225 Portland St., St. Johnsbury; 802-748-3181; 800-649-0118 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 (adults) 802-4886400; First Call: (child/adolescents) 802-488-7777
FRANKLIN AND GRAND ISLE COUNTIES: Northwestern Coun-
pal Church, 44 Second St.
seling and Support Services, 802-524-6554; 800-834-7793 LAMOILLE COUNTY: Lamoille County Mental Health, Weekdays 8 a.m.-4 p.m. 802-888-4914; Nights and weekends 802-888-4231
RUTLAND: Every Sunday 4:30-6 pm; Wellness Center
ESSEX, CALEDONIA AND ORLEANS: Northeast Kingdom
125 Barre St.
NEWPORT: Every Wednesday 6-7:30 pm; St. Mark’s Episco(Rutland Mental Health) 78 South Main St. (enter from Engrem St.)
ST. JOHNSBURY: Thursdays 6:30-8 pm; Universalist Unitarian Church, 47 Cherry St.
NATIONAL ALLIANCE ON MENTAL ILLNESS-VT (NAMI-VT)
802-876-7949 x101, 600 Blair Park Road, Suite 301, Williston, VT 05495; www.namivt.org; email@example.com
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: firstname.lastname@example.org Veterans’ Services WWW.VERMONTVETERANSSERVICES.ORG HOMELESS PROGRAM COORDINATOR: 802-742-3291 BRATTLEBORO: Morningside 802-257-0066 RUTLAND: Open Door Mission 802-775-5661; Transi-
tional Residence: Dodge House, 802-775-6772 BURLINGTON: Waystation/Wilson 802-864-7402 FREE TRANSPORTATION: Disabled American Veterans: Toll Free: 1-866-687-8387 X5394
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
Vermont Vet-to-Vet peer support groups: contact www.vtvettovet.org