NEWS, COMMENTARY, AND ARTS BY PSYCHIATRIC SURVIVORS, MENTAL HEALTH PEERS, AND OUR FAMILIES
VOL. XXXIV NO. 3
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FROM THE HILLS OF VERMONT
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SINCE 1985
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WINTER 2019
Court Upholds Psych Advance Directive
BALLOONS GALORE — Volunteers construct an archway of balloons for the 2019 MINDWalk fundraiser in Burlington this fall. The annual walk, sponsored by NAMI Vermont, drew about 150 participants and raised more than $40,000. Awards were presented to Sara Moran for highest individual fundraiser, Families Together for highest fundraising team and Northwestern Counseling and Support Services for largest team. (Counterpoint Photo: Neal Muse)
MONTPELIER — In a unanimous ruling, “The advance-directive statute’s definition of Vermont’s Supreme Court has upheld an ad- capacity focuses on the patient’s decision-makvance directive that rejected all psychiatric ing capabilities at the time of execution rather medication. It said disagreeing with a psychia- than the existence of a mental illness or the actrist about a diagnosis does not mean a person ceptance of the psychiatrist’s advice,” Reiber lacks capacity to said. “If patient’s make a health care diagnosis alone decision. meant that patient He “recognized in his The court found lacked capacity, advance directive that without that the advance there would be litdirective was valtle purpose to havmedication, he may remain id, and it therefore ing a statute that vacated the Family hospitalized against his will.” permitted him to Division’s involexecute an advance untary medication directive for psyorder. It said the state had failed to meet its chiatric treatment,” the court wrote. “And paburden of proof that the patient did not have tient’s disagreements with his diagnosis and capacity to make the decision at the time of with the recommended medication do not necsigning the advance directive. essarily indicate that he did not understand the “We disagree with the court’s suggestion diagnosis or the pros and cons of medication.” that patient lacked capacity merely because he The Mental Health Law Project represented the continued to have a mental illness,” said Chief patient, identified only as G.G. “This is a big deal,” (Continued on page 7) Justice Paul Reiber, who wrote the opinion.
Advisory Input Varies Across Agencies
By ANNE DONAHUE Counterpoint
Local program advisory committees exist as required at community mental health centers across Vermont but often function very differently, both in terms of how active they are in charting their own course and how closely they follow rules set by the state. That was Counterpoint’s assessment after interviewing committee members and administrators at almost all of the 10 agencies designated to provide the services for their geographic area. At some agencies, consumer members of the local adult program standing committees were enthusiastic about the way their input is received and applied to improve services, and some set their own agendas and conduct their own meetings. “We do have a definite impact,” said Mike Gavin, a consumer member and chair at Rutland Mental Health. Eric Kelley, a consumer member at Lamoille County Mental Health, gave a concrete example of a change in how assessments occur. Instead of clients being “hand fed” their plans by case
Emergency Room Plan Delayed By Advocates
managers, the clients now identify their own best treatment options, he said. “People are actually changing their outcomes on plans.” It is “something we’ve been talking about for years, and it’s actually happening now.” “It’s a really necessary and important part” of the agency, said Nancy Balbonconis, who is a consumer member of United Counseling Service’s committee in Bennington. It is “valued and appreciated by staff,” she said. At other agencies, however, the administration referred Counterpoint to a family member, who was the committee chair, for the interview about consumer input. At one, a former member was identified by the agency as the best person to speak for the committee. “I don’t think they understand a lot of the things they go over,” said Linda Rhodea, a family member who chairs the committee at Northeast Kingdom Human Services, but “I think they like being heard … (that) their thoughts and ideas are valued and heard.” The state rules require a program standing committee for each of the groups the agency
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serves, which usually include adults receiving mental health services, children and people with developmental disabilities. Committees must have at least five members, with a majority consumers or their family members. A consumer is defined as “an individual who is or was eligible to receive services from an agency because of his or her disability.” However, only the developmental disability program committee is required to have a specific minimum consumer representation — 25% — and while Counterpoint found that all the agencies met the baseline criteria for adult mental health committee membership, some were made up almost completely of consumers, while one had only two consumers on it. The rules also require that “at least one member of each local program standing committee shall serve as a voting member of the agency board of directors.” Not all of them have a board member, and the degree to which they interact with their agency boards appears very mixed. The rules also identify topics the committees are required to review. Most committees meet spe(Continued on page 4)
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Retreat Patients Speak