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
2 Peer Leadership and Advocacy
Fall 2018
Meeting Dates and Membership Information for Boards, Committees and Conferences Peer Organizations VERMONT PSYCHIATRIC SURVIVORS BOARD
A membership organization providing peer support, outreach, advocacy and education. Must be able to attend meetings monthly. Experience with boards preferred, but not necessary. For information call 802-775-6834 or email info@vermontpsychiatricsurvivors.org.
COUNTERPOINT EDITORIAL BOARD
The advisory board for the Vermont Psychiatric Survivors newspaper. Assists with policy and editing. Contact counterpoint@vermontpsychiatricsurvivors.org.
ALYSSUM Peer crisis respite. To serve on board, contact Gloria at 802-767-6000 or info@alyssum.org. DISABILITY RIGHTS VERMONT PAIMI COUNCIL
Protection and advocacy for individuals with mental illness. Call 1-800-834-7890 x 101.
State Committees ADULT PROGRAM STANDING COMMITTEE
Advises the Commissioner of Mental Health on the adult mental health system. The committee is the official body for review of and recommendations for redesignation of community mental health programs (designated agencies) and monitors other aspects of the system. Members are persons with lived mental health experience, family members, and professionals. Meets monthly on 2nd Monday at the Department of Mental Health, 280 State Drive NOB 2 North, Waterbury, noon-3 p.m. For further information, contact Vicki Warfield (vicki@vermontpsychiatricsurvivors.org) or Daniel Towle (dantowle@comcast.net).
LOCAL PROGRAM STANDING COMMITTEES
Advisory groups required for every community mental health center. Contact your local agency for information about meetings and membership.
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.
Hospital Advisory VERMONT PSYCHIATRIC CARE HOSPITAL
ADULT PROTECTIVE SERVICES
Reporting of abuse, neglect or exploitation of vulnerable adults, 800-564-1612; also to report violations at hospitals/nursing homes.
VERMONT CENTER FOR INDEPENDENT LIVING
Peer services and advocacy for persons with disabilities. 800-639-1522.
VERMONT FAMILY NETWORK
Support for families with child or youth with mental health challenges. 800-800-4005; 802-876-5315.
VERMONT CLIENT ASSISTANCE PROGRAM
Advisory Steering Committee, Berlin, check DMH website for dates at mentalhealth.vermont.com.
Rights when dealing with service organizations such as Vocational Rehabilitation. Box 1367, Burlington VT 05402; 800-747-5022.
BRATTLEBORO RETREAT
HEALTH CARE ADVOCATE To report problems with any
Consumer Advisory Council, fourth Tuesdays, 12 - 1:30 p.m., contact Gwynn Yandow, Director of Patient Advocacy and Consumer Affairs at 802-258-6118 for meeting location.
RUTLAND REGIONAL MEDICAL CENTER
Community Advisory Committee, fourth Mondays, noon, conference room A.
UNIVERSITY OF VERMONT MEDICAL CENTER
Program Quality Committee, third Tuesdays, 9-10 a.m., McClure bldg, Rm 601A.
Have News To Share? Send it to Counterpoint! The Service Building, 128 Merchants Row Suite 606, Rutland, VT 05701 Email: counterpoint@ vermontpsychiatricsurvivors.org
COUNTERPOINT DEADLINES
FALL (September delivery; submission deadline July 29) WINTER (December delivery; submission deadline October 7) SUMMER (June delivery; submission deadline April 7)
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.
How to Reach The Department of Mental Health:
802-241-0090
mentalhealth.vermont.gov For DMH meetings go to web site and choose “more” at the bottom of the “Upcoming Events” column. ADDRESS: 280 State Drive NOB 2 North Waterbury, VT 05671-2010
The Service Building, 128 Merchants Row Suite 606, Rutland, VT 05701 Phone: (802) 775-6834 email: counterpoint@ vermontpsychiatricsurvivors.org MISSION STATEMENT:
Counterpoint is a voice for news and the arts by psychiatric survivors, ex-patients, and consumers of mental health services, and our families and friends. Copyright 2019, All Rights Reserved FOUNDING EDITOR Robert Crosby Loomis (1943-1994) EDITORIAL BOARD Joanne Desany, Emma Harrigan, Calvin Moen, Sara Neller, Eleanor Newton, Sarah Simoneau The Editorial Board reviews editorial policy and all materials in each issue of Counterpoint. Review does not necessarily imply support or agreement with any positions or opinions. PUBLISHER Vermont Psychiatric Survivors, Inc. The publisher has supervisory authority over all aspects of Counterpoint editing and publishing. EDITOR Anne B. Donahue News articles without a byline written by the editor. Opinions expressed by columnists and writers reflect the opinion of their authors and should not be taken as the position of Counterpoint.
Counterpoint is funded by the freedom-loving people of Vermont through their Department of Mental Health. Financial support does not imply support, agreement or endorsement of any of the positions or opinions in this newspaper; DMH does not interfere with editorial content.
Counterpoint is published by Vermont Psychiatric Survivors three times a year, distributed free of charge throughout Vermont, and also available by mail subscription. Vermont Psychiatric Survivors is an independent, statewide mutual support and civil rights advocacy organization run by and for psychiatric survivors. The mission of Vermont Psychiatric Survivors is to provide advocacy and mutual support that seeks to end psychiatric coercion, oppression and discrimination. Counterpoint does not use pseudonyms in its reporting without stating that a pseudonym is being used and without an explanation for why the person’s identity is not being disclosed. Counterpoint does not use anonymous sources under any circumstances. NAMI-Vermont, the Vermont Association for Mental Health and Addictions Recovery and Vermont Care Partners present:
Mental Health Advocacy Day
V
Wednesday, Jan. 29, 8 a.m. - 2 p.m. Capitol Building, Montpelier
Mental health advocates, community members and organizations will be urging lawmakers about the importance to “Support Your Community — Invest in Mental Health.” The agenda includes advocacy training, opportunities to interact with legislators, providing testimony and listening to personal stories of lived experience.
Don’t Miss Out on a Counterpoint! Mail delivery straight to your home — be the first to get it, never miss an issue. c Enclosed is $10 for 3 issues (1 year). c I can’t afford it right now, but please sign me up (VT only). c Please use this extra donation to help in your work. (Our thanks!) Checks or money orders should be made payable to “Vermont Psychiatric Survivors.” Send to: Counterpoint, The Service Building, 128 Merchants Row, Suite 606, Rutland, VT 05701
Access Counterpoint online at www.vermontpsychiatricsurvivors.org
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NEWS .
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ROUND UP In the News Advance Directive Upheld
A unanimous Vermont Supreme Court upheld the advance directive of a patient who said he wanted no medications. The court said the fact that he had a mental illness and disagreed with his psychiatrist about the diagnosis and treatment did not mean he did not have capacity to create an advance directive. See page 1.
Advisory Input Varies
Despite challenges at many community mental health centers with keeping enough members on local program standing committees, those who participate say they feel their voices are heard. The degree to which they follow state rules vary among the agencies. See page 1.
Locked ERs Are Challenged
Several advocates questioned the use of locked sections of an emergency room to prevent voluntary patients from leaving during a psychiatric crisis. The objections came in formal comments made to the Green Mountain Care Board questioning the plans for an ER renova-
tion at Northwestern Medical Center in St. Albans. See page 7. The Counterpoint poll question for this issue asks, “Should psych areas in emergency departments be locked to prevent high-risk patients from leaving?” See bottom of this page.
sis. A group of peer-run organizations presented a proposal for community centers and respite beds to lessen emergency room use. Representatives from several community mental health agencies presented programs they have begun. See pages 8-9.
Acupuncture Access
State Promises Full Funding
A change in law is enabling practitioners of acupuncture to make it more accessible to those who find it gives relief from mental distress. See page 6.
The Agency of Human Services committed to investments in community services, including peer services, in the draft plan with an application to the federal government. See page 9.
Peer Staff Are Honored
VPS Annual Meeting
The Department of Mental Health recognized staff in mental health programs in the state at its annual conference, and two of the four honored were staff at peer-led agencies. The conference keynote speakers discussed stigma and personal wellness, respectively. See page 8.
Responses Differ on ER Use
Panelists at two workshops at the DMH conference discussed how to help reduce delays at emergency rooms for people in a psychiatric cri-
Vermont Psychiatric Survivors heard farewell comments from outgoing board President Marty Roberts and advocacy advice from Chris Hansen of Intentional Peer Support. See page 10.
Remembering 25 Years
Marty Roberts retired after lengthy service to Vermont Psychiatric Survivors, including many years as its board chair. She shared with Counterpoint some of her memories of her advocacy work in the state. See page 11.
In Commentary Peer Support a No-Brainer
Institutional Black Holes
Counterpoint’s winter editorial argues that with such broad recognition of the value of peer support, it should be an obvious step to expand those supports. See page 16.
A Vermont Psychiatric Survivors staff member argues that one of the best ways to prevent abuses of power in institutions is to have camera monitoring. See page 17.
Readers Oppose Minimums
Learning from Madness
In the Counterpoint fall poll, those responding opposed the idea that there should be a minimum amount of hospital time — similar to a minimum sentence — for people found not guilty of a crime by reason of insanity. See page 16.
Peer Support in Rutland
A patient at Rutland Regional Medical Center describes the support she feels from the peer support workers on staff there. See page 16.
Two survivors share some reflections from a new book they co-edited, “Much Madness: A Survivor’s Guide to Extreme States and Self-Advocacy for Young Adults.” The book is “a collection of personal stories from eight individuals who experienced psychosis or other extreme states as adolescents or young adults.” See pages 18-19.
Hip-Hop and Coaching
A VPS board member who attended the sum-
mer Alternatives conference describes a workshop on a life coaching program from Belgium which is an alternative to medical model approaches to healing. A VPS staff member who attended shares what he learned about hip-hop and its role in social change. See page 19.
Disability Rights Vermont
The annual priorities for Disability Rights Vermont are on pages 20 and 21. The agency encouraged feedback.
Sharing Retreat Experiences
Two different writers share the disappointment they felt with the treatment and physical environment during stays this summer at the Brattleboro Retreat. They each offer suggestions for how to improve the hospital. See pages 2223.
Counterpoint Telephone Poll QUESTION: Should psych areas in emergency rooms be locked to prevent patients from leaving?
(See news article on page 7)
VOTE by calling:
888-507-0721
(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.
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ADVISORY INPUT VARIES ACROSS AGENCIES • Continued from page 1 cific core responsibilities, but members often told Counterpoint that they do not give input on general agency policies, as also required by the rules. Counterpoint conducted interviews at each of the designated agencies.
Clara Martin Center
(Orange County) Committee member Marla Simpson, who said she “wears all three hats” as a service provider, service recipient and family member, said that a staff member sets the agenda there. Many of the topics that Marla Simpson Department of Mental Health rules require them to cover can be boring or dry, she said, but there are also very positive opportunities to contribute. The “most exciting meetings” are when the committee is deciding on the community awards that are given to “unsung heroes” by the center, she said. Simpson serves on the statewide adult standing committee as well, and she said she thought the best way to enhance local committees would be to have them visit several state meetings. She feels that Clara Martin members do feel heard and empowered by participating, but it isn’t as dynamic, nor does it “have the same magnitude as far as influencing opinion” as at the state level. Staff member Melanie Gidney said that the standing committee functions as a committee of the agency’s board of trustees and includes board members. There are currently four consumer members on the adult committee, but recruitment is always a concern, she said.
Counseling Service of Addison County
Mary Price, a CSAC peer support specialist, used to be in the Community Rehabilitation Services program and on the committee but now serves as staff support to it. All of the seven to 10 active members are CRT clients, she said, but none of them serves on the agency’s board. Price said that as an adult outpatient service recipient, she did not know that she was still eligible to be a member of what CSAC calls the “CRT Advisory Board.” Staff bring an agenda but then ask members if they have anything they want to add. A prominent recent discussion issue has been staff shortages that are leaving minimal coverage for emergency services, she said. “They actually do listen to us,” Price said. Member input is brought to the next staff CRT meeting, and then there is an update at the next committee meeting and members “do see [the] progress, or lack thereof” and react in terms of needed follow-up. Rachel Cummings, the new executive director of six months, said the agency has been “purposeful” about keeping it consumer driven, but in addition, “my board and I [have] been having this conversation, how to improve that loop back to the board.”
Health Care and Rehabilitation Services (Windham, Windsor Coun-
ties) Malaika Puffer, the peer support manager at HCRS, said the agenda historically has been set by the agency but there have been recent efforts to “shift the ownership more into the hands of
the members,” working on “supporting folks to be able to facilitate the meeting themselves and people from the agency be able to step back.” Puffer said she’s seen an increase in agency recognition of the importance of the input, hearing staff say more often, “Let’s bring that to the standing committee.” It has six to eight members and is currently looking for more; they have been mostly, “if not exclusively,” people who receive services at HCRS, she said. It is the norm that one member is also on the agency board, although there is a temporary gap at the moment, she added. Puffer said she believes it is “really, really important to make [the committees] meaningful” in order for an agency to get as much input as possible. Even an active standing committee “can’t be the entirety of the voice” when it comes to how clients should be involved, she said. (Puffer spoke as an agency representative. HCRS sent contact information for committee members, but it arrived too late for the article deadline.)
Howard Center (Chittenden County)
At the Howard Center the committee is known as the Community Advisory Network, which predates the state-required program standing committee. According to Connie Stabler, a family member, the CAN helps set the agenda, looking at “what do we want to hear about” as well as the agency bringing “ideas that they want feedback on.” Stabler fills the role of the liaison member of the agency board and is co-chair with a consumer member. “I think Howard has a pretty robust system” for input, she said. Other than herself, one other family member and one community member, “the rest are peers” on the CAN, with an average core group of six to 10 participants. All clients are invited to participate, and the Westview House staff brings over clients for meetings. “Everybody gets their say,” Stabler said. When there have been ideas on how to improve something, it comes back as a topic later in the year to ask, “What was done?” The fact that there is no consumer member of the CAN on the agency board is not for lack of trying, Stabler said. “It’s an ongoing difficulty,” and she is “always trying to think of people” who would be willing to serve. Elaine Soto, the community support program director at Howard, explained that the CAN does not have a set membership. “It’s open to anybody to come any time,” but there is “a committed group of regulars.” She said that the Howard board currently has no consumer members and that it was “not something we have focused on” to address. Agency boards are required to have a majority of family and consumer members, but as with the standing committees, there is no minimum for how many of them are consumers.
Lamoille County Mental Health Services
Eric Kelley’s frustration with the Lamoille County adult committee is not about active input — it’s about the difficulty keeping people involved. The committee is “kind of struggling for enrollment right now,” not “sparking interest.” People join but then drop off and as a result, “it’s hard to get a theme going … Eric Kelley keeping it steady.”
“I wish more people would take up the cause,” he said. “It really affects what’s going on with recovery.” Kelley said they currently meet the minimum for five members: two from the community and three as consumers. None are on the agency’s board. There is no formal chair, and staff set the agenda, he said. However, in terms of whether the committee has a strong voice, he responded, “Absolutely.” “It goes way beyond surveys” or other types of input because members “get to talk to the heads” and weigh in on topics like staff hiring.
Northeast Kingdom Human Services (Caledonia, Essex Counties)
Linda Rhodes, a community and family member, chairs the committee and sets the agenda “with input from the members” and said, “I lean heavily” on longtime active consumer member Renee Rose. “She’s been great” and does good recruiting for membership, she said. Most of the eight to 10 members are consumers, Rhodes said. She said the committee tries to have staff come “when we can” for program updates but that NKHS staff shortages are sometimes an obstacle. Rhodes said she believes the committee has an impact. “I think they [members] feel like they’re part of something bigger than themselves,” she said, although policy input is not a direct part of the work. As far as interviewing key staff, “that does not seem to be happening,” Rhodes said, and the committee knows it needs to be doing this.
Northwestern Counseling & Support Services (Franklin, Grand
Isle Counties) Todd Bauman, the executive director at NCSS, said he was excited by “some really cool things going on” in trying to develop a culture of “a health care lens” that often brings its three standing committees together to discuss common issues. The agency encourages thinking outside of the subgroups, believing “services should be integrated across all those realms,” including all of health care, Bauman said. A recent example of adult committee input was review of the design of the renovations at Northwestern Medical Center’s emergency room that includes a new psychiatric space. Bauman said he told hospital leadership, “You really cannot develop this in isolation” of the people who would be using it. CRT Director Steve Broer said there was a standing agenda with the state-required topics and then a “more fluid” discussion component, often with issues NCSS wants feedback on. There are eight to 10 members, and “pretty much all of them [are] people who receive services,” mostly CRT, Broer said. The agency is looking to expand that to include more adult outpatient and people served in its integrated health settings, he said. Mobile outreach staff give rides as needed to individuals who have difficulties attending. Managers and other key hires meet with the committee before an offer for employment is made, he added. Broer said the adult standing committee provided leadership in the push for its original crisis bed program and gave feedback on its recent move to a new location. (NCSS provided timely contact information for the chair of the committee, a consumer who is also on the agency’s board. Through an oversight, Counterpoint failed to reach out to her in time for this article.) (Continued on page 5)
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ADVISORY INPUT VARIES ACROSS AGENCIES • Continued from page 4 Rutland Mental Health Services support role for the committee, credited Gavin Mike Gavin, a consumer and chair of the adult standing committee, gave credit to the agency’s executive director Dick Courselle for the “excellent” flow of information that gives the committee such a clear voice. One agency board member is on the committee but is not one of the consumer members. Gavin said the committee is updating its member list because, although “we definitely have consumer members,” participants aren’t always labeled in their roles. The committee is “looking for more people who are receiving services” because “they’re the ones who need to express the opinions.” Pamphlets are being put out at program sites, and Gavin asked Counterpoint to promote it as well. He said the agency brings the information the committee needs in order to fulfill its duties and asks whether it wants to add something to the agenda. Committee members need to bring a lot of follow-up work home in order to then ask questions and make recommendations at subsequent meetings, Gavin said. “We have a lot of responsibilities,” he said. By seeing complaint records — one of the required roles — the committee can recommend resolutions to problems, he said. In client surveys, “comments are especially helpful because we can deal with those.” “Usually whatever we say is well received,” Gavin said, although results may take some time. The committee “advocated for years” about housing, which it identified as the greatest need, “which we now have” through the intensive residential program for “people who don’t need to be in the ER.” Claire Waterman, the agency’s risk and compliance manager who fills the administrative
with pushing for more structure for the committee to ensure it was meeting its role under the state rules. “He’s a great asset” and “not shy to share that he’s a recipient” of services and “how he feels going into the building” as a consumer, she said.
United Counseling Service of Bennington County
The five or six current members at UCS are all clients, said Nancy Balbonconis, except for the agency board liaison member who is a family member. “We generally set [the agenda] and staff follows what we put,” she said. The committee rotates members to chair the meetings. The committee addresses required issues such as reviewing hiring, grievance data, and the system of care plan and gives input to staff on other issues. Staff then bring suggestions for addressing those concerns back to the committee, she said. “I think that the members do feel that we’re listened to,” Balbonconis said, but getting members “can be a challenge.” The committee recently sent out a “catchy kind of a letter,” but it didn’t get a response. It is now planning a peer-run forum to share why the committee has value. “I really like being a part,” Balbonconis added. “I like to advocate for my peers,” she said, noting that not all of them are able to advocate for themselves.
Washington County Mental Health Services
Zack Hughes, a consumer and co-chair of the WCMHS committee, told Counterpoint, “I call us an oversight committee” rather than an advisory committee because of its role, which goes
well beyond the state-required topics. He cited recent “serious discussions,” including with Montpelier’s police chief, about the police killing of a client. Community issues “affect people coming in for services,” Hughes said. “We look at global polZack Hughes icy” at the agency, he said. When the agency is considering new initiatives, “they tend to run it by us first.” Both he and co-chair Denise Lewis are also staff of WCMHS in peer support positions but don’t see it as creating a conflict because they remove themselves if the issue relates to their job, they said. Lewis gave an example of a recent committee interview for a staff management position for which her supervisor was one of the applicants, and she removed herself. The co-chairs set the agenda for the committee, which currently has five or six active members, four of them clients who receive services. Hughes used to be the committee member who also sat on the agency board until it was recognized that it was an impermissible conflict, and “we are actively seeking” a replacement, he said. One committee member sits in on the agency’s management committee meetings. The committee’s goal is to improve visibility in order to recruit more members. “We believe that we [need to] put out our stuff to the community to try to do it,” Hughes said. When “people see we’re actually doing something” they are more likely to decide to participate, he said. “We have a key role,” Hughes said. “It’s a very serious responsibility.”
COURT UPHOLDS PSYCH ADVANCE DIRECTIVE • Continued from page 1 said Jack McCullough, director of MHLP. “If the court had gone the other way, it would have made it very difficult for a psych patient to ever execute a valid, binding advance directive.” The court noted that G.G. had been diagnosed with schizophrenia and had been under an involuntary drug order in the past but said the fact that he “has been found incompetent in the past this does not mean that he was incompetent in August 2017, when the advance directive was executed.” Reiber said in the opinion that the advance directive “was signed by two witnesses who affirmed that patient appeared to understand the nature of the directive and that he signed it without undue influence or duress,” which is the statutory requirement. He wrote
that one of the witnesses was a nurse who administered medication to the patient as part of his outpatient program. The court decision said that the nurse testified that G.G. “felt his providers had not been listening to his concerns and complaints about the treatment and were downplaying his reported adverse effects.” “Before he executed the advance directive, she discussed with him the meaning of an advance directive and how to complete and file it. She stated that when she met with patient to execute the advance directive, he understood that he had been diagnosed with schizophrenia, but he disagreed with the diagnosis,” Reiber wrote. He noted that G.G. had “recognized in his advance directive that without medication, he may
remain hospitalized against his will.” According to state law, capacity for signing an advance directive is “an individual’s ability to make and communicate a decision regarding the issue that needs to be decided.” It says that “an individual shall be deemed to have capacity to make a health care decision if the individual has a basic understanding of the diagnosed condition and the benefits, risks, and alternatives to the proposed health care.” State law also requires that hospitals provide information to all involuntary patients, prior to discharge, regarding advance directives. Disability Rights Vermont and other patient representation agencies provide guidance on how to create one.
own rights, for example, rights to a decent wage and … to participate in the health system. We must also acknowledge that people enter health education with their own biases; a rights-based health education helps health-care workers recognize and address their inherent discriminatory behaviors and attitudes.” The blog post, which includes a link to the UN report, can be found at www.hhrjournal.org/2019/10/rights-based-education-could-help-resolve-global-health-inequities/ Courtesy of Keris Myrick
Medical Nihilism, published in 2018 by Oxford University Press and authored by Jacob Stegenga. According to a blog by John Horgan, who directs the Center for Science Writings at the Stevens Institute of Technology, the book’s author says that many “widely consumed” medications are “barely effective and have many harmful side effects.” Examples include drugs for high cholesterol, hypertension and depression. “Although Stegenga makes some exceptions … in general he believes that ‘[m]ost treatments … do not work very well, and many do more harm than good …’” Stegenga warns readers not to stop taking prescribed medications without medical supervision. For the blog, see blogs. scientificamerican.com/cross-check/is-medicine-overrated/
NOTES FROM THE KEY UPDATE Articles from The Key Update, published by The National Mental Health Consumers’ Self-Help Clearinghouse. Minor edits made for length.
Rights-Based Education
“Many of the problems in global health stem from power imbalances in the health workforce, and these can be traced back to medical education systems,” the UN Special Rapporteur, Dainius Pūras, wrote in a Health and Human Rights Journal blog about his recent report to the UN. “In the report, I recommend that all health workforce education is reframed around human rights imperatives ... We should ensure that health-care workers have … skills not only to stop violations of human rights in the care of patients but also to promote and protect their
Medicine Overrated?
“Given medicine’s poor record, physicians should prescribe and patients consume far fewer medications, a new book argues.” This is the teaser on a recent Scientific American review of
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Ear Acupuncture Access Expands ple can just be who they are.” Despite potential benefits, the law stipulates that individuals who practice cannot “purport to treat any disease, disorder, infirmity, or affliction.”
By TRACY BRANNSTROM Counterpoint
MONTPELIER — The legislature voted this year to allow individuals to practice ear acupuncture (auriculotherapy) in their communities without the special license that was previously required, and providers say it will make it more accessible to those with mental health and substance use disorders. Ear acupuncture involves the shallow placement of thin, sterilized disposable needles into specific sites on the surface of the outer ear. Waitsfield resident Chris Bordonaro said that ear acupuncture was one of the more helpful interventions he has experienced during more than three decades of problems with alcohol. He said that he was only recently evaluated by mental health clinicians and began to see that he was using alcohol as a means to cope with his severe anxiety. Bordonaro said that the co-occurrence of substance use disorder and psychiatric diagnosis, or dual diagnosis, is important to recognize when designing interventions.
Origins in 1970s Ear acupuncture has targeted substance use and mental health issues in the United States since the early 1970s when community members and activists created a drug detoxification program in a Bronx hospital at the height of a heroin epidemic. They offered ear acupuncture in combination with methadone, a medication-assisted treatment, in the psychiatric unit of Lincoln Memorial Hospital, according to Laura Cooley, a licensed acupuncturist, trainer of auriculotherapy and legislative advocate. It was “developed by community members to save their communities,” said Cooley. Community health workers, nurses, counselors and other community members in Vermont have sought to provide the service in drug and alcohol recovery centers, community centers and clinical settings, offering it at low or no cost to make it accessible for those who would not ordinarily be able to afford acupuncture, according to Katie Whitaker, RN. However, the previous licensing criteria under state law created obstacles for those who wanted to practice ear acupuncture in their communities, said Gabe Gilman, general counsel to the Vermont Office of Professional Regulation. “There was a great deal of red tape and cost,” Gilman said. The state law amendment that took effect in July removed ear acupuncture from the oversight and licensing required for other forms of acupuncture. As a result, it eliminated the requirement that a licensed acupuncturist be available to talk in person, by phone or electronically when a
More Are Trained
Ear acupuncture involves placement of thin needles into specific sites on the surface of the outer ear. (Counterpoint Photo: Tracy Brannstrom) person is providing the service. It also eliminated the license application fee of $100, with $200 due at each biennial renewal. “The state is in the business of regulating marketplace activities, and this is a community-level practice,” Gilman explained. “Very few people derive primary income from ear acupuncture. It’s more of a part-time activity. It exists on the level of popular folk therapy and peer assistance.” The amendment also removed the requirement that individuals practice only in state or federally funded addiction programs. Previously, the law referred to those approved for a license as an acupuncture detox specialist.
Feeling Better
Whitaker, who works in a rural, federally qualified health care center in northeastern Vermont, offers free ear acupuncture to patients as an add-on to their primary care appointments. Previously, when it was legally permitted only for substance use treatment, she said her patients reported reduced cravings, and some told her that they felt good for the first time without the aid of a substance. Since the law’s amendment, Whittaker has provided the intervention for those working through a variety of health and mental health issues. “I see this as a nervous system reset,” she said. “It can drop you into a place of rest, relaxation and safety. And what comes out of that is, people can manage stress better, they sleep better and they feel better in their bodies.” Whittaker added that while clinical interventions focus on urine screenings, medication adherence and other monitoring techniques, ear acupuncture creates a space in which “peo-
Although just 12 individuals have been licensed through the state, the National Acupuncture Detoxification Association said that 67 individuals in Vermont have filed a certificate that shows they underwent the organization’s 70-hour training, according to Sara Bursac, the executive director of NADA. The amendment to the statute still requires “appropriate training” for those who practice ear acupuncture. The NADA training teaches participants to place needles in five points on each ear. These target the liver, kidney, lungs, parasympathetic nervous system and shen, or spirit. The fivepoint protocol can provide relief for addiction, stress and trauma, according to the organization’s website. In his 1975 book “The Ear: Gateway to Balancing the Body,” acupuncturist Mario Wexu wrote that research in China and Europe has shown “a close physiological relationship between specific areas of the ear to specific areas of the body.” “When stimulated,” he wrote, “they send a signal to the brain, which in turn sends a signal to the corresponding areas or functions of the body.” Health outcomes for mental health issues are also possible, according to Victoria Taylor, who provides ear acupuncture at an inpatient recovery program in rural Virginia, because the premise underlying acupuncture is that “mind and body are in the same place.”
Dual Diagnosis
Those diagnosed with substance use disorder show elevated risk for almost all psychiatric diagnoses, with the correlations for depression and bipolar disorder ranking highest, according to a 1990 study by Darrel Regier and colleagues published in the Journal of the American Medical Association. Kurt White, who oversees outpatient programs at the Brattleboro Retreat, said that as a society, “we’ve made such a weird separation of these problems, when the norm is probably that people are dealing with both at the same time.” Cooley said that one of the largest obstacles for those who wanted to provide the intervention was its restriction to drug and alcohol treatment and recovery programs. Using the term “detox,” she said, can give the impression that benefits are limited to those undergoing substance withdrawal. “It’s not just detox,” she said. “It gets people back in shape for facing life.”
PSYCHIATRIC STUDY BRIEFS Symptoms Hidden Due to Stigma
A study published online in August reported finding that nearly half of all patients withhold critical information about their mental health out of embarrassment and fear both of stigmatization and the possible long-term implications of sharing such information. “These findings suggest that concerns about potential negative repercussions may lead many patients who experience imminent threats to avoid disclosing this information to their clinician,” the study concluded. Assessment of
Patient Nondisclosures to Clinicians of Experiencing Imminent Threats, JAMA Netw Open. 2019;2(8):e199277.
Depression as Adverse Effect
More than a third of all the prescription medications Americans use have depression as a potential side effect, and there is an increase in rate of diagnoses of depression among those individuals, according to a new study. A cross-sectional study of adults showed that 37% of Americans take at least one medication
that has depression as a listed potential adverse effect, according to the study, which was reported in the Journal of the American Medical Society in 2018. Those using three or more of such prescriptions were three times more likely to experience depression than people who did not use any, it said — 15% versus 5%. The original investigation was titled “Prevalence of Prescription Medications With Depression as a Potential Adverse Effect Among Adults in the United States.”
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Locked Psych ER Plan Challenged By CALVIN MOEN Counterpoint
Voluntary: 91%
Voluntary: 81%
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Admissions to inpatient psychiatry
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Days waiting in the emergency room
voluntary patients and those being held at the ED against their will. “There is no legal basis for involuntary detention of anyone who is not in the custody of the state,” they wrote, maintaining that restricting patients to a locked area is discrimination based on psychiatric status. The advocates also spoke to the fear and stigma against psychiatric patients that is reinforced by placing them in a separate locked area, creating “a perception of being punished for having a mental health crisis.” It is also a deterrent to those who may want to seek help at the ED but might avoid it because of the risk of being “held involuntarily with potentially fatal consequences,” and it violates the principles of trauma-informed care, they wrote. As to the presumed risk of patients attempting suicide in the ED, Donahue and her colleagues cited data from a Joint Commission report that showed “vastly lower” numbers of inpatient suicides per year than had been speculated. Suicides that do occur can be prevented by making environments safer, said the report. Donahue, Nial and Towle had been part of a work group to provide input to the design of Central Vermont Medical Center’s planned new emergency department, Donahue told Counterpoint. There they learned that the University of Vermont Medical Center was also finalizing an ED renovation plan, she said. The three advocates were collaborating with those hospitals on the details of their designs, said Donahue, when she learned about the plan to renovate NMC’s emergency department. She and her colleagues assembled their comments and circulated their letter among advocacy and peer-run groups in time to submit it before the CON was approved. Co-signers include virtually every such group in the state, Donahue said, and several individuals. In addition to voicing its agreement with the letter, DMH posed several detailed questions to NMC regarding which patients would be assigned to the locked rooms, whether patients who are legally voluntary may choose where they wait, and whether children and adolescents would be kept in this area as well as adults. The GMCB has asked the hospital to respond to the written comments and questions from the community advocates and from DMH.
A majority of the days — 81% — that people waited in emergency rooms in the state were spent by patients seeking voluntary care between October 2017 and September 2018. There were 1,681 combined days of waiting by patients being held involuntarily and an estimated 7,960 days of waiting by patients seeking voluntary care.
Psychiatric section in new ER draft plan
intake/ exam
intake/ exam
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lounge patient room
Involuntary: 19%
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MONTPELIER — Plans to renovate the emergency department at Northwestern Medical Center in St. Albans have come under scrutiny as the hospital awaits approval by the Green Mountain Care Board. An application for a certificate of need filed by NMC on June 27 outlined proposed renovations to its ED that include creating a separate locked area for psychiatric patients. A CON is required for any new health care projects in the state. On November 11, three individuals identifying themselves as having “direct lived experience with psychiatric hospitalization” submitted written comments to the GMCB expressing serious concerns about the plans. The former patients’ concerns centered on lack of patient space outside of individual rooms and the “detention of persons with a mental health disability” in locked areas as “clearly discrimination under the Americans with Disabilities Act.” A November 14 memo from Sarah Squirrell, commissioner of the Department of Mental Health, expressed agreement with the comments and suggested that renovations should focus on providing care “in the least restrictive setting possible,” per state statute. Squirrell’s memo included DMH data showing that 95% of psychiatric patients discharged from Vermont emergency departments during FY19 were there voluntarily and that “NMC had only 16 involuntary patients wait in their emergency department for all of FY19.” Voluntary patients, she said, “do not need, and should not be, locked in a room or separate area simply because they are presenting with a mental health concern.” In its request for approval of the proposed $7.6 million renovation project, NMC referred to a 2018 survey by the Centers for Medicare and Medicaid as evidence of the “dramatic need” for improvements, and asked for expedited review by GMCB. In that survey, CMS found that NMC’s emergency department failed to meet standards of care by using police officers to watch or detain psychiatric patients. According to the application, the hospital created a “temporary safe room” to avoid entering a decertification process and communicated to the survey team its intentions to conduct a comprehensive renovation. The plan specifies the construction of a locked “safe holding area” separate from the rest of the ED, “for the care, treatment, and holding of patients who are suffering from severe mental health needs with or without suicidal ideation.”
The reasons given in the CON application for a segregated and locked area for psychiatric patients were to prevent them from escaping and to reduce “disruptions” to other patients. According to the application, this area would have its own bathroom, shower, and nurses’ station and be designed to be free of ligature points to minimize risk of suicide by hanging. It would contain two patient rooms, with two more adjoining rooms that could “flex” to become part of the locked area or remain unlocked “to accommodate patients with other emergent medical concerns.” When the GMCB asked whether NMC had involved psychiatric patients, their families or advocates in the design of the new suite, the hospital’s CEO, Jill Berry Bowen, replied that individuals receiving mental health services as well as “key clinicians” from Northwestern Counseling & Support Services participated in the design process. Bowen went on to say that the proposed design was based on renovations at Rutland Regional Medical Center which “the Centers for Medicare and Medicaid (CMS) repeatedly advised was best practice.” Patient advocates disagreed. The individuals who submitted public comment on the CON application — Anne Donahue, Ward Nial and Dan Towle — questioned NMC’s response, saying that CMS does not identify best practices in design. It establishes standards and determines whether hospitals are in compliance, which simply denotes absence of violation, their letter to the GMCB said. They further noted that RRMC’s emergency room was designed and built before the addition of a new criterion for a CON: “The project will support equal access to appropriate mental health care that meets standards of quality, access, and affordability equivalent to other components of health care as part of an integrated, holistic system of care, as appropriate.” Donahue and her colleagues said they believed the proposed design does not meet this criterion. They agreed that a specialized area may be appropriate but that an area designated for those experiencing psychiatric crisis should be calming and allow for visits by support people as mandated by state statute. It should also be accessible to other patients, they said. The advocates pointed out that the design allows for little space outside patient rooms other than a hallway and suggested a small lounge area for meeting with peers, advocates or family members. Regarding the locking of patient areas, they expressed concern that the NMC plans do not distinguish between
team station inpatient psych elevator
bathroom/ shower
Involuntary: 9% Voluntary admissions to inpatient psychiatric units in Vermont made up 91% of all admissions from October 2017 to September 2018. There were 461 people admitted against their will and an estimated 4,603 voluntary admissions. (Both graphs are data from a Department of Mental Health report, March 2019)
patient room patient room
patient patient room room
patient room
In contrast to the design for Northwestern Medical Center’s emergency room section for psychiatric patients, the draft plan at Central Vermont Medical Center includes two lounges and the ability to have between two and all eight of its rooms unlocked.
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HONOREES — Two peer support workers were honored at the Department of Mental Health conference this fall. Left photo: Jenniflower Laker beams as Commissioner Sarah Squirrell reads a description of her peer work with guests at Alyssum in Rochester. Alyssum is the state’s only peer-run crisis respite center. Right photo: The honoree for employment services, Abby Levinsohn, receives her award from Deputy Commissioner Mourning Fox. Levinsohn works at the Pathways Community Center in Burlington. (Counterpoint Photo: Anne Donahue)
‘Better Together,’ Conference Asserts
KILLINGTON — Mental health system representatives, psychiatric survivors and peer support workers from throughout the state gathered for a conference this fall to explore topics ranging from emergency room diversion to family intervention to suicide. An estimated 350 attended. Five people were honored for their work, one of them for peer services. The employment support specialist honor also went to a peer support worker. Chosen for her peer support work with guests at Alyssum, the state’s only peer-run crisis respite center, was Jenniflower Laker. The honoree for employment services was Abby Levinsohn, who works at the Pathways Community Center. Other awards went to Jessica Coleman of the Howard Center and Northeastern Family Institute for her work at a designated agency/ specialized service agency, to Kathleen Berk of the Vermont Housing Authority for housing support, and to Shawn Burke of the South Burlington Police Department for supportive law enforcement intervention. The conference, sponsored by the Department of Mental Health, was titled “Better Together: Alliances in Mental Health and Wellness.” The first keynote speaker was John Broderick, the former chief justice of the New Hamp-
shire Supreme Court, who discussed how he had learned about the importance of fighting stigma through the experiences of his son. Broderick, who is now the director for external affairs for Dartmouth Hitchcock Medical Center, was in a coma for several days after being beaten by his son, who then served more than four years in prison. Although he had struggled with alcohol for many years, it was there his son was first diagnosed with mental illness and treated, he said. Broderick’s son has now lived 15 years sober and supports his father’s efforts to educate the public about the need to raise awareness about the symptoms of illness and the importance of “changing the culture” that creates shame and stigma, Broderick said. “There are a lot of travelers in the valley of mental illness, we just don’t see it,” he said. “People don’t talk about it.” Ignorance and fear are the excuses, and not a good reason for stigma and discrimination, he said. “Why do we tolerate for one more day that which cannot be justified?” Broderick pointed to other major changes in social attitudes, from smoking culture (every room once had an ashtray, and now smokers go outdoors) to progress in racial justice. “If we can eliminate ashtrays and elect Barack
Obama,” we can do this, he said. Much of his public speaking is in high schools, and Broderick shared a story about a boy who came to him after a presentation, asking to hug him and sharing his own struggles with mental health. He told Broderick he was the “first person he could tell” whom he felt would “not blame or judge for his challenges,” Broderick said. The second keynote speaker, Steven Taubman, MD, identified as a peer and told anecdotes about his support dog — who mingled with the audience — while addressing the topic of self-care and stress. Taubman’s address was titled “Mindfulness, Magic and Mental Health: Tips for Caring for Yourself and Others.” The professional chiropractor and hypnotist kept the audience laughing as he shared magic tricks, led a meditation exercise, and stressed the ability to make choices about being happy. In his final demonstration, he illustrated how nonverbal cues and vocal tones can convey information. He had six members of the audience draw pictures, which were collected and scrambled. After telling the participants to each deny out loud being the artist, he correctly guessed who drew each picture, gaining rousing applause. The conference included 24 breakout sessions.
Responses Differ on ER Solutions
KILLINGTON — Several workshops at the Department of Mental Health conference focused on unnecessary emergency room use, but psychiatric survivors had different ideas about how to address it than did community mental health centers and hospitals. Three community agencies presented the work they have been doing with visitors to emergency rooms who might not use them as frequently if they received better follow-up support in the community. For the most part, peer supports were not included in those projects. Four peer-led agencies presented an alternative that would prevent people from feeling the need to go to the emergency room at all. Those agencies — Vermont Psychiatric Survivors, Another Way, Alyssum and Pathways Vermont — have collaborated on a proposal to develop a network of peer-run community centers across the state that would be linked to two-bed peer respites.
Peer Proposal Wilda White, former executive director of VPS, spoke on behalf of those agencies in the workshop “Narrowing the Gap in Recovery-Oriented Services.” She gave an overview of state data and research she has conducted. It shows an increase in emergency room visits related to a psychiatric diagnosis from under 8,000 in 2010 to almost 14,500 in 2017 and an increase in average waiting time from 1.28 days to 2.57 days. Much of the data about those visits remained the same, she said: More than half the patients are under age 40, with the largest group being 18-24, and more than three-quarters are discharged to home. White said the biggest change was in the diagnoses, both in the ED and for inpatient admissions. The primary ED diagnosis in 2010 was a mood disorder (26%), while in 2017 it was alcohol-related (28%). Among inpatient admissions, the top five di-
agnoses in 2010 were mood disorders (38%), alcohol-related (22%), schizophrenia and other psychotic disorders (11%), substance abuse (9%) and anxiety (4%). In 2017, those top five had changed. Mood disorders remained highest but dropped to 27%, and alcohol-related increased to 27%. The third — which was not in the top five in 2010 — was suicide or self-harm attempts, at 19%. Meanwhile, schizophrenia or psychoses dropped to 9%, and substance abuse dropped to 5%. White said the data goes contrary to a perception that there has been an increase in the acuity, or severity, of conditions. Her own interviews found that among the primary reasons people go to the emergency room are homelessness and loneliness. White said her findings, now supported by new data from community agencies and hospitals, show that housing could address 75% of issues that lead to ED use, followed by having con(Continued on page 9)
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RESPONSES DIFFER ON ER SOLUTIONS • Continued from page 8 nections (friends, family support, physical affection and having someone to talk to) and having known alternatives to the emergency room.
Benefit of Network Those factors demonstrate the difference that peer-run community centers and respite could make, she said. Two such centers already exist — Pathways in Burlington and Another Way in Barre — and provide basic needs, such as showers and kitchen access, as well as peer support for employment and housing, according to panel member Santi Leporati of Another Way. They also help address isolation through group activities and community meals, Leporati said. White said such centers create the social connectedness that people need and offer opportunities to develop new social and interpersonal networks. Gloria van den Berg, who directs Vermont’s single existing peer respite, Alyssum, said a peer respite “offers something the mental health system cannot offer” and allows people to reach out and get support rather than being labeled as ill. White said there was strong research support for peer-run respites, showing a 70% decrease in likelihood of using emergency or inpatient services, significant improvement in healing and feelings of empowerment, and a significant cost savings. Average psychiatric care costs for respite users were $1,057 versus $3,187 for those who did not use a respite, she said. White said that the proposal by the four peerrun agencies calls for a six-year rollout to open the six centers, with a start-up cost for the network of about $600,000. Developing the proposal would mean the investments for mental health would align with the system goal of being recovery-oriented, keep pace with the new expansion of inpatient beds and “mitigate against” the negative aspects of inpatient care, she said. The peer-run model recognizes that “your healing is not complete until you can be who you are, completely yourself” and “not suffering shame,” by being with others who were “in the same place” of distress, White said.
Agency Projects The mental health system presentation was titled “Reducing High Emergency Department Utilization: A Designated Agency/Medical Center Partnership.” It focused primarily on a proj-
ect between Northwest Counseling and Support Services and Northwestern Medical Center in St. Albans and included descriptions of projects by Washington County Mental Health Services and Northeast Kingdom Human Services. The presenters from NCSS said that it focused on “high utilizers” of the emergency department who were also clients of the agency. The agency handout defined a high utilizer as a person who makes three or more ED visits in three months. The first set of data showed that between January and September 2017, 48 clients were identified as high ED utilizers and connected to extra supports. By placing a mental health clinician in the ED and doing follow-up with those patients, the project resulted in a 61% reduction in ED use in the first nine months of the pilot and then maintained that reduction after the pilot period, NCSS said. Care coordination focused on personal adjustments, finances, employment, food, clothing and mental health symptoms, the agency said. Among the clients who were seen, the largest group, 40%, were served by the NCSS outpatient mental health program. The other three groups were almost evenly split: 22% were receiving developmental services, 20% were in the CRT program for longterm mental health support and 18% were receiving children’s services. The agency said it found that 64% had chronic medical conditions, and integrated health teams in primary care practices worked with them on addressing those medical issues. Seizure disorders were most prevalent, followed by chronic pain. According to Todd Bauman, the executive director of NCSS, investments made in home- and community-based supports improved health outcomes and decreased health care expense. “We estimate that we invested about $120,000 in home- and community-based services and saved about $750,000 in ED-related expense,” he said. It demonstrated that “the solution can’t just be more hospital beds,” he said. Bauman said that the pilot will be expanding through a grant from OneCare Vermont, which is the state’s accountable care organization. OneCare is an organization owned by hospitals and other medical providers which receives money from insurers to provide all of a person’s health care, aimed at health care reform through moving money into preventive care services.
Wilda White Bauman said that the quality indicator typically used for psychiatric emergency room visits doesn’t help to identify “whether anyone is better off” as a result of the care. It measures whether patients receive a follow-up contact within 30 days of an ED visit. That could be done by just making a phone call to each person and achieving 100%, he said. NCSS will report that measure as required, Bauman said, but its focus will be on whether it is successful in reducing the number of ED visits. Mary Moulton, executive director of WCMHS, said later that she agreed that the quality indicator of a 30-day follow-up was completely inadequate. The project her agency has developed is also receiving a grant from OneCare, but she said the quality measure for its clinician contact will be a 24-hour follow-up for people who go to the ED, not 30 days. In its pilot project, WCMHS clients with three or more ED visits within 90 days received enhanced services, and there was a 50% to 75% reduction in ED use. WCMHS staff said the services focused not only on health care and wellness but also on community connections and enhanced social networks to address isolation. Support for housing and safe living environments was a “really, really big” factor, they said.
State Tells Feds It Plans To Fully Fund Community Services
WATERBURY — The Agency of Human Services committed to investments in community services, including peer services, in a draft implementation plan for an application filed with the federal government in September that is seeking to keep Medicaid money coming for freestanding inpatient hospitals. According to Sarah Squirrell, commissioner of the Department of Mental Health, it would be premature to assume that would mean additional funds in next year’s state budget. “We can’t get ahead of the governor’s budget,” which will not be submitted to the legislature until January, she said. The Centers for Medicaid and Medicare Services recently began to offer waivers to states to allow funding for inpatient psychiatric care that is separate from a general hospital, which would not usually be covered, as long as the states commit to ongoing community services.
Vermont has a current waiver for funding for its two hospitals in that category, the Brattleboro Retreat and Vermont Psychiatric Care Hospital in Vermont, but it is expiring. The state said it would assure, as required, “that resources would not be disproportionately drawn into increasing access to treatment in inpatient and residential settings at the expense of community-based services” and that it would maintain all current community services funding. Vermont’s draft plan said it has already “initiated programs or met many of the milestones identified by CMS” for community supports. That included a statement that Vermont Psychiatric Survivors “provide[s] peers to EDs to provide support and advocacy for any individual in an ED who have presented in a psychiatric emergency.” Squirrell acknowledged that the state does not currently provide funding for VPS to pro-
vide emergency room support anywhere except in Rutland. The document is still a draft and will have corrections made, she said. She said the draft represents “aspirational” planning. Where it says, for example, that “Vermont is looking to expand peer run crisis and stabilization units,” she said it reflects the growing recognition that “peer services are essential to the continuum of care” and “need to be expanded in a meaningful way.” Squirrell said this theme became evident during a statewide listening tour and a series of think tank discussions this past summer and fall that contributed to a 10-year plan for “an integrated, holistic system of care” that the department will be finalizing in December. The waiver application also seeks to allow Vermont to receive funding for patients who stay longer than 30 days, which is the current federal funding limit even under a waiver.
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VPS Hears Peer Advocacy Speaker QUECHEE — The Vermont Psychiatric Survivors annual meeting featured farewell comments from its outgoing longtime president, Marty Roberts, as well as a presentation by Chris Hansen with tips on peer mutual support and advocacy. Participants also identified advocacy goals that were later circulated to the full membership for input. Hansen is director of Intentional Peer Support, an international organization which developed and trains in its model for peer support and community building. Hansen described the seeds of her activism growing from both anger and solidarity, through “my own history of pain and being locked up.” “None of that needed to happen,” she said, and she made a commitment to “both human rights and to the power of connection.” There are so many ways of understanding our experiences that are not as traumatic and invasive as hospitalization, she said, and she learned that connection and belonging were the best kind of therapy. The over-medicalized versions of our stories induce dependency and tell us we must be poor, needy recipients of the expertise of others, and those stories ignore our losses, Hansen said: losses of income, housing, children, careers, sense of self and status as respected citizens. Our connection as psychiatric survivors is our common experience of distress and of negative treatment, she said. The spirit of IPS is acknowledging the connections among us and understanding the social model of disability that recognizes that it is the structures of society that disable us, Hansen said. “We have the right to tell our own stories,” she said. “I have the right to choose who I am in my distress.” The energy of anger over our treatment can be a valuable advocacy tool — “Sometimes we’ve got to
Training Head Hired
RUTLAND — Vermont Psychiatric Survivors has announced a new staff member, Vicki Warfield, who has joined as the director of training and outreach. Before joining VPS, Warfield served as coordinator for the Wellness Workforce Coalition — a collaboration by organizations focused on training and advocacy for peer support services in Vermont. Her previous professional background includes advocacy for the needs of individuals with dementia and end-of-life issues. Warfield serves on the Adult Standing Committee of the Department of Mental Health and with Montpelier Community Justice. She graduated from the University of Colorado with a Bachelor’s in Psychology and from Selkirk College with a Social Service Worker certification. Warfield said that with the help of the survivor community, she is now unlearning much of her formal education, while gaining a better awareness of issues around social justice, intersectionality, community organizing and self-determination of care. She said she is “passionate about dismantling institutionalized systems of oppression, building strong communities, individualizing healthcare within a broad social perspective and advocating for greater acceptance of and respect for neurodiVicki Warfield versity.”
THE GANG’S ALL HERE — Some of the Vermont Psychiatric Survivors staff, board and organization members gathered for a group picture during its annual membership meeting.
fight pretty hard finding ways to challenge systems” — but we also need to look at what we do and what approaches to use “when people are listening,” she observed. It means knowing “when to put your chainsaw away,” she said, adding, “Where do we go from here?” Hansen said that survivors can look at where we stand today in two different ways. Trauma leads to the desire to “do what’s been done to us,” and sometimes we look at the change we are trying to achieve and “it is still as far away as when we started,” making it “tempting to give up or to stay angry,” she said.
It can be useful to lean back, though, and “look how far we’ve come,” as long as it doesn’t make it too easy to pat ourselves on the back, Hansen said. We are “holding multiple truths — both are true,” she said. Advocacy can mean “finding ways to connect with them in ways that they can hear,” Hansen said. The deepest connection is when we can communicate that “your liberation is bound up in mine,” Hansen concluded. The VPS membership also elected the board, including new members Walter Wade and Karim Chapman, both of Rutland.
Charting a Path: Members help to develop the plans for advocacy and partnerships for the coming year As the new executive director of Vermont Psychiatric Survivors, it has been a goal for me to reach out to our membership and get a bead on what people think should be the focus of our work. At the annual meeting, I took the opportunity to get that information by getting members, staff and board members to answer three questions: 1. What do you think our advocacy goals should focus on? 2. With whom should we work? 3. How should we be approaching those goals — what tools should we use? After collecting all of the responses, the list was sent out to the general membership for ranking. They were asked to rate the importance of 21 advocacy goals; to name the most important organizations to work with from a list of 48; and the likelihood that they would participate in any of 39 different advocacy initiatives. The results listed here reflect the highest-rated advocacy goals, the organizations rated as most important, and initiatives that members were most likely to want to get involved with.
Advocacy Goals
“Support larger development of peer services” was rated as the most important advocacy goal (8.73 out of 10) followed by “more peer respites” (8.27) and “parity in Medicare coverage for physical and mental health services” (8.27). The next highest priorities were “expand the VT Choices program to mental health so the money follows the person” (8.18) and “challenge coercive practices; freedom to choose” (8.1).
With whom should we be partnering?
Participants unanimously named the Statewide Independent Living Council, our own members and recruiting new members, and Disability Rights Vermont as the most important organizations to be working with. Pathways Vermont and Intentional Peer Support were named by more than 90% and seven organizations or groups were rated as most important by more than 80% of the participants: Alyssum, VCIL, VT Digger and other media outlets, first responder trainings, Vermont Coalition for Disability Rights, Vermont Recovery Centers, and traumatic brain injury networks.
How likely are you to want to participate in these advocacy initiatives?
People appear to be ready and willing to get the word out and speak up about issues. Initiatives most likely to be well supported with participation are: participate in public comments on all Department of Mental Health initiatives; peer gatherings; periodic events that focus on advocacy and activism or specific issues; leadership and advocacy training; encourage media contact; and panel discussions at conferences. The themes emerging from the results appear to be focused on peer support and services, advocacy at the state level, and media coverage.
So where do we go from here?
We welcome any and all comments about the survey and the results. Send comments to: info@vermontpsychiatricsurvivors.org
Remember: We are a member organization and want to represent your interests, and we want to help you build the skills to advocate for yourself and others. We are truly better together.
Christophre Woods, Executive Director
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Reflections on 25 Years of Advocacy By ANNE DONAHUE MONTPELIER — In the early 1990s, when Marty Roberts was a patient at Central Vermont Medical Center, she connected for the first time with a true community of support. Reflecting on 25 years of peer advocacy, the recently retired chair of the Vermont Psychiatric Survivors board of directors said that she received from other patients what wasn’t available in mental health treatment or mental health agencies. “We found we had these things in common,” Roberts said, “and that itself was community.” It marked the beginning of a discovery of her own place in the survivor movement, where, in contrast to structured agency programs, supports develop naturally, she said. She went on to become one of the most long-standing voices in Vermont’s survivor network, including 12 years co-chairing the state’s Adult Program Standing Committee and so many years on the VPS board that she has lost count. Roberts has been involved in the system long enough to see how some issues just cycle around and around, re-debated but never solved, and long enough to see some of the eras of great change. In 1972, she was a patient at the Vermont State Hospital in Waterbury. She was on an unlocked ward with about 30 others. In those days, patients often showed up to visit staff working in the state office complex. “I used to hitchhike to Montpelier,” Roberts recalled, by just walking over to the nearby interstate. There may have been practices like restraint and seclusion on other wards, but not where she was, Roberts said. “It was a refuge for some people” who were “not accepted elsewhere” in their communities, she said. There were “people who had been there forever,” for decades, she said. Although the hospital did not close until after the flooding from Tropical Storm Irene in 2007, by then it was much smaller and served only involuntary patients. Roberts sees the late 1980s and early ‘90s as a time when it “seemed like things were wakening.” The then-commissioner for mental health, Rod Copeland, held committee meetings with a cross section of people involved in the system, and there, “I was emboldened to talk” because of “his value of what we had to say.” Community services were expanding, with agencies like Washington County Mental Health, the county where she lives, trying new things. In 1997, Roberts completed her first training for teaching others to develop a Wellness Recovery Action Plan and has conducted trainings ever since. The homegrown program, started by Mary Ellen Copeland in Brattleboro and now recognized as an evidence-based practice across the globe, helps people identify their own triggers and responses in order to stay well. WRAP was part of the widespread focus on “people deciding their own destiny,” she said. There was a growing sense that it was important that “people had a lot of choice.” Roberts credits a lot of the change during that time and into the 2000s to Linda Corey, the former longtime executive director of VPS, who died in 2014. It was she who “really worked to get people heard,” Roberts said, “insisting that people have input.”
Marty Roberts In 2000, the state’s administrative rules for redesignating community mental health agencies created the program standing committees for adults, children and those with developmental disabilities. The committees include providers and consumer members and have a formal role in making recommendations to the commissioner. Roberts was appointed to the first adult standing committee, which she said gained its own strong voice early on in large part because of the encouragement of Beth Tanzman, who was the adult program director. She “consistently pushed us,” saying, “Take it for yourselves,” Roberts recalled. Roberts said she was anxious at first in a role that involved sometimes confronting the Department of Mental Health but looks back now and wishes she had been able to do more about the committee’s role in the redesignation process. It needed to be more active in addressing how people are treated, instead of just reviewing agency reports, she said. At the same time, community agencies were required to form their own local standing committees, and Roberts was active for a while with the one in Washington County. One of its initiatives, she said, was an effort to address poor treatment in the emergency room at Central Vermont Medical Center. The group sought to engage nursing staff in better understanding the people coming in for mental health reasons. Staff resented the time taken away from their “real patients” to address those seeking mental health help, Roberts said. That effort failed when the staff refused to meet with them, she said. Sometimes she reflects on “how much time and effort has been spent and we haven’t gotten there” — having any requests of the mental
health system granted. She shook her head, reflecting on reports that the state program standing committee is no longer permitted to even create its own agenda, and over new struggles with treatment and attitudes in hospital emergency rooms. “In the long run, nothing has changed,” she said, and then paused. “I wouldn’t say nothing,” she corrected. But it is a history of “promises [that] are made and not kept” for achieving more independence, control and decision-making. It does happen, but “it happens in bits and small pieces.” It’s hard to get a broad sense of where things stand today, she said. “When people are looking for help, do they have options? Things that really help people?” Roberts believes it does happen in some parts of the state but not others. She said she does see progress in the recognition that “people can have pretty big challenges and still have pretty good lives” and be a part of their communities. “It’s a real life,” she said. “It’s not like waiting for a real life.” There are also more efforts at greater community awareness — that people can be different, and like with any marginalized group, it could be any one of us being excluded, she said. Roberts could name all 12 of the commissioners of the Department of Mental Health from the past 20 years and said that, even with their short stays, individuals make a real impact in that role. “The values that somebody has, the relationships, the initiatives they push, willingness to listen to us, to try new things … can really put a stamp” on the mental health system, Roberts said. She cited some who stood out in her mind: Susan Besio, Michael Hartman, Mary Moulton and — despite a tenure that lasted only several months — Patrick Flood, for his “ideals and commitment to the values of the peer community.” Being the chair of the VPS board was a major commitment of time and energy, Roberts said, and she knew for a while that it was time to retire, but she was waiting for a stable time for the peer-run agency. It has been a time of real challenge in recruiting leadership, she said, but with a new executive director and the strength of several new board members, she feels able to leave. “You have to leave everything some time,” she noted. She will be taking more time for her writing, which has always been a great help to her, she said. She has resolved at this point that “what I hoped my life would be, isn’t going to be,” but that “doesn’t mean it can’t be good.” And while it might be an end of one of her largest leadership roles, Roberts isn’t leaving everything behind. She will continue in less intensive roles as chair of the board of the Vermont Center for Independent Living and as a board member of Alyssum, the peer-run crisis respite residence in Rochester.
The Arts
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WINTER 2019
1,000 Cranes for Hope and Healing
SENBAZURU — The staff at Alyssum, Vermont’s peerrun crisis respite program, decided to create 1,000 origami cranes for hope and healing as part of its 10-year anniversary open house in September. Senbazuru, which means “a thousand cranes” in Japanese, is the art of folding origami cranes and tying them together. In Japanese folklore, the crane is a mystical animal that lives for a thousand years. It is a symbol of good luck and long life. A Japanese legend promises that the gods will grant a wish to anyone who folds a thousand origami cranes. Today, folding 1,000 origami cranes symbolizes hope, healing and recovery after a difficulty or catastrophe. Alyssum staff began folding cranes before the open house, and visitors then learned how to create an origami crane, adding to the collection and helping achieve the 1,000-crane goal. (Description of Senbazuru comes from excerpts from several web sources: www.japanesestyle.com/legend-thousand-origami-cranes, muza-chan.net/japan/index.php/blog/ one-thousand-origami-cranes and www.japanvisitor.com/japan-house-home/senbazuru-one-thousand-cranes.) (Counterpoint Photos: Anne Donahue)
The Arts
Fall 20182019 WINTER
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The Malingerer Goes to the Movies (A Dis-Ability Coming-Out poem, for Colin Kempner, and Judith Wright) 1. You’re sitting there, and it’s getting harder to breathe. It feels as if a little man, like a gnome, has crept up the back of your seat, and dropped a net into your head, over your brain… You glance at the woman sitting next to you, and she isn’t there… You look at the screen, and it seems unreal, like a bad film… Are you in a theater at all? Are you in a room filled with water? ARE THERE ANY PEOPLE HERE? 2. Show’s over, you’re out in the parking lot, wondering how to get home…
by Scott Norman Rosenthal Irasburg
Modern Psalms: The Final Virtue Artist’s Statement
I made this piece, Pietà de la Liberté, in one month, as an expression of my response to the ongoing and worsening crisis of asylum seekers and potential immigrants in this country. So many thousands of people are being forcibly held in detention camps for the simple “crime” of fleeing violence and murder in their home countries, and for believing the law of asylum and compassionate welcome, as exemplified by Emma Lazarus’s poem one the base of the Statue of Liberty, is still held true today in the United States of America. The position is that of the Pietà, or the grieving mother of Jesus with her dead or dying son, the work of Renaissance sculptor Michelangelo Buonarroti. I placed a dead or dying immigrant child in the lap of the Statue of Liberty in this Pietà-like pose to echo that extreme grief. The piece is made almost entirely of paper- and cloth-mâché. Phoebe Sparrow Wagner is an artist, poet and author from Brattleboro. She is co-author of “Divided Minds: Twin Sisters and their Journey through Schizophrenia” (St Martins Press, 2005) and author of “We Mad Climb Shaky Ladders” (CavanKerry Press, 2009). Her third book, poems and original art, “Learning to See in Three Dimensions” (Green Writers Press, 2017), is now also available from Amazon and other booksellers.
Share Your Art! Email to counterpoint @vermontpsychiatricsurvivors.org or mail to Counterpoint, The Service Building, 128 Merchants Row, Suite 606, Rutland, VT 05701 Please include name and town
Among all the virtues needed by humankind, The rarest one will find And is most kind Is gentle, understanding tolerance Of other cultures and their true spiritual substance! Other languages and ideas The evolutionary soul will please And geocidal tensions ease, For tolerance is the rarest and final virtue For our race to reach a universal peace that is true! If I am willing to truly understand, and thus respect you, Then this great love will every hate undo And every war will be through! We will need no more our grisly blood libations And finally peace will saturate all nations! Let every human tribe this mutual love and understanding imbibe From the Holiest of Grails And no more will be heard the cruelty of battlefields’ dying wails! When we reject the demon god of Mars, Then we will finally reach the stars!
by Patrick William Bradley, Jr. St. Albans
Snow
the snow is confetti from the sky coming down being thrown by people at a wedding in heaven
by Carmen Beauregard Underhill
14
The Arts
Fall 2018 2019 WINTER
Writing Some Wrongs — a series of skits from true facts Cast: requires a minimum of four people who can play various roles. Each actor’s role is known because they carry signs stating who they are. Stage: begins dimly lit. A large heart with some sparkles and small mirrors covering its surface dangles from the ceiling, near side center back of stage. Act 1 Scene 1 Dad and Mom facing each other. Dad: Welcome home from the hospital … I expect you to be good as new and return to all your duties now. Scene 2 Dad: You are not complying! You must leave within three days! The kids stay here. Mom: I’ll do whatever you say … but … but … where will I go? Dad: Just leave! (points angrily) Mom turns, walks off dejectedly. Scene 3 Scene changes to Mom walking through psych hospital doors. Narrator Voice: She never dreamed he would discard her this way. She never dreamed he would want custody. She was shocked that he wanted to sever her relationship with their children. Little did she know they would be embroiled in an ongoing custody dispute for the next 10 years. Heart dangling from ceiling drops — noisily — a few inches. Act 2 Dad: The children are invited to a birthday party so they won’t be with you on Saturday. Mom: No — that’s my day with them, I can bring them. Dad: No! Mom: Then let’s trade for the next Saturday. Dad: No! Mom: So the children won’t see me at all for over a month? They are only 5 and 7! Dad: Quit arguing or I won’t let them come next month either.
A loud crack is heard as the heart drops a few inches again. Act 3 Scene 1 Mom (on psychiatrist’s couch): I feel I am being followed. People are watching me. Psychiatrist (writing notes on clipboard): Hmm … hmm. Scene 2, another location Dad’s Friend: I visited my cousin in the hospital — she’s there, too. He says she did — (cut off) Dad (turns, yells): Emergency injunction! Scene 3, courtroom Judge (bangs gavel): Suspend all visitation to Mom! Suddenly, a very loud crack, and heart drops with more force, a few more inches, as a few sparkles and mirrors flutter to the floor. Act 4 Scene 1 (at child’s friend’s house) Child: Can my friend come stay overnight at my Mom’s house? Friend’s Mom (in aside to audience): No. He tells me what kind of person she is — I’ll never let my children be at her house. Act 5 Scene 1 Dad: I am moving with the kids to the West Coast. Mom: No! Dad: You can’t stop me. Scene 2, courtroom Judge: The kids can come visit Mom for the summers. Dad: NO, I will not let them visit her. Judge: Then the kids stay here with Mom, and you can move West. Dad: No. I won’t let them live with their Mom, so I won’t move. Scene 3, a week later, at Mom’s Kids: Dad says you won’t let us move! It’s all your fault! Act 6, at Mom’s
Child: You can’t make me do chores! You are lazy and selfish — you don’t do your dishes all week then make us do your work! Child 2: Dad says if I don’t want to be here I can call him anytime and he’ll come get me away from you! The dangling heart falls another few inches, drops more sparkles and mirrors. Act 7, with Mom Child 1: You don’t love us because you won’t give Dad money. Child 2: You never buy us things. Dad says every time we come here it costs him money. The heart slowly drops a foot, a few sparkles and mirrors flutter to the floor. Act 8, at Mom’s Child 1: If Dad dies, we go live with — (interrupted) Child 2: Yeah, he put it in his will! Aside to Audience by Mom: But what about me? I’m their mom, their next of kin! Narrator Voice: He’s figured out a way to keep the children from you even after he’s dead. Another sudden loud crack but this time with splintering noises. Heart finally stops about 5 feet from the floor. Stage becomes dark, with a dim spotlight on the heart. Stage slowly brightens as several people rush onstage to catch the loose pieces falling from the heart. Each person holds a sign designating who they represent: Women’s Information Services, Wellness Recovery Action Plan, LISTEN, Vermont Psychiatric Survivors, The Haven, church family. As they pick up mirrors and other parts, they attach them back onto the heart, all gathering in a circle to support the heart from falling all the way to the floor. The End
by NF
Windsor
Louise Wahl Memorial Writing Contest Enter the 2020 Contest: Deadline March 15, 2020 Named for a former Vermont activist to encourage creative writing by psychiatric survivors, mental health consumers and peers. One entry per category (prose or poetry); 3,000 word preferred maximum. Repeat entrants limited to two First Place awards. Entries are judged by an independent panel. Winners will be published in the summer 2020 Counterpoint.
$250 in Total Prizes Awarded! Send submissions to:
Counterpoint, The Service Building, 128 Merchants Row, Suite 606, Rutland, VT 05701 or by email to: counterpoint@vermontpsychiatricsurvivors.org
Include name and address.
The Arts . 15
WINTER 2019
Dreamer/Believer
Graphic art pieces by Linda A. Walsh
Feet slip away from you Run, run to nowhere. Paralyzed with fear. Stuck in one spot forever. Time stands still, A killer at your back. Indescribable evil is a looming in cornerstones. Your mind tells you lies, Lips move, No one can hear you. Screaming into the void … Lost in a sea of chaos. Transcendence gone wild. Lost in the vast, Lost in life, Levitate and see everything. Dive beneath the ice. Crash through your fear, Float on pink clouds forever if you have to. Cascading vibes flow through you, And spill upon reality. Thoughts become enemies. Late night, early morning troops of scar tissue that form invisible bandages on your soul. Bind your breaking, Cushion the madness within. Don’t bruise yourself this night, Don’t let trauma win again. Be you, Not what others forced upon you. No pressure building, No desperate measures, will be documented In your heart tonight. Rest on the cool side of the bed. I’ll visit you soon. I’ll be the black, You will be the moon. You don’t illuminate my darkness. You make me see it’s just covered light. And my fear melts like frozen lies. Demons all danced out, finally become friends with my angels. Rest is on the horizon. The nuns will bring the salvation necessary to survive. They formed a gang, They’re on the way … Be on the watch, Walk in the way of shadows, They be all you need. Put yourself in the way of beauty, However ugly it’s disguised to seem. Befriend the perfect monster, Because your life just a dream.
St. Johnsbury
Rays of Hope Love Balance Harmony Abundance Contentment Inner Peacefulness Untroubled Spirit Time to Dream Spiritual Growth
Road Map The Pot Of Gold Is Definitely a Life Worth Living!
by Cheryl George Rutland
United States Broken Rx Heart of America
The intention of love creates hope in humanity. The humanitarian crisis represents intolerance to the weakened humans suffering from economic and social insecurities. The collective broken heart is affecting every human being on earth. The dulling love and darkness of depression reflect the excessive differences between poverty and wealth. Focus on the collective heart beating as one, breathing and feeling the indigenous pain of our global lungs. Seek the balance in all relations to mend our heart and return to the peace of mind. The balanced heart chakra gives love unconditionally. Reflect on this inner ability of natural empathic compassion.
by Tahnee Rifaiy Brattleboro
16E EDITORIAL PAGE Editorial
No-Brainer
Peer support works. Peer-run programs are smaller and less expensive — more flexible — than large agencies. They are based on the lived experiences of the directors of those programs. Peer support helps people form relationships and a natural community. It prevents crises. In a crisis, it helps avoid escalation. All these things are known, and this fall, as a think tank organized by the Department of Mental Health brainstormed over a long-term vision for integrated, holistic health care, building peer support programs became one of the most dominant themes. The think tank was made up of people from all sectors: survivors, consumer advocates, community mental health agencies, hospital representatives and more. It becomes a no-brainer, then, to unify behind increases in support for peer services in Vermont. There are a lot of subtopics to sort out. Should peers be certified, or at least have formal standards — or does that defeat the principal of mutuality? Do peer supports need to be provided through a peer-run agency — or is it acceptable if they are embedded as part of a hospital or designated agency’s staff? Those are follow-up questions. The most immediate priority is to communicate the consensus to expand the base of peer support as the next essential step towards holistic — mind, body, spirit — health care.
WINTER Fall 2018 2019
Opinions Readers Speak Out
Hospital Minimums Opposed
RUTLAND — The fall when a treatment team beThe fall Counterpoint poll question lieves that the psychiatric Counterpoint poll had a lower response rate than pri- was: Should a minimum sentence problem (that caused the or polls but more in-depth in a hospital be required if not person to lack the judgment guilty by reason of insanity? comments on a complicated to know they were commitissue. The poll asked about ting a crime) has been rea proposal for mandatory solved,” the comment addYes time in a hospital after being ed. 21% found not guilty of a crime by Another person added, reason of insanity. “Hospitals are theoreticalThere were 19 “no” votes ly places of healing, so they No (79%) and five “yes” votes on should not be part of the 70% the Vermont Psychiatric Surcriminal ‘justice’ system at vivors Facebook page. all. The fact that people get The question was based remanded to hospitals is an on discussion in a legislaindication of a huge probtive committee about whether a person in lem in our healthcare system: that healthcare that circumstance should have a minimum of is being conflated with criminal ‘justice.’ three years of psychiatric hospitalization if the “I know that in reality hospitals aren’t alcharge was murder or attempted murder. ways places of healing, but using them as prisSeveral comments pointed out that a person ons only encourages more prison practices who is found not guilty by reason of insanity in general, not just for patients who came in has never been convicted of a crime. through the criminal justice system,” the com“So to even think about this track … is a vio- ment said. lation of the Constitution of the United States,” Several of the comments said that the opone wrote. posite was needed: There should actually be a “I think the fact that we all reflexively think maximum amount of time a person can be inof it as a ‘sentence’ shows the central problem voluntarily hospitalized after a criminal charge to begin with,” another said. “Any sentence is is dropped. totally inappropriate if a person is found not to “I know people who have been locked up for be guilty of a crime.” years beyond what they would have served in Hospitalization orders should be “ending jail or prison if found guilty,” one said.
Letters to the Editor
Hospital Peer Support Staff Make a Huge Difference The following letter was written by a patient at Rutland Regional Medical Center based on her stay there in December, 2018 and currently, beginning on November 8. In it, she describes her encounters with the two peer support specialists on staff there. Some edits were made for clarity. Ed.
To the Editor: I first met Kitty [Gallagher] when she entered my room and introduced herself to me as a peer support person. This was exciting to me that she had been through similar circumstances in her life that I had. As she listed what I will call her extensive resume, I was impressed and intrigued. She had been advocating and fighting for the rights of psychiatric survivors. This woman had also come through her own personal and traumatic life experiences. Listening to her made my extreme tiredness disappear. I saw life, action and hope for the first time in 12 months. The fact that the hospital embraced peer workers was a revelation to me. Over my two-week stay in 2018 and my five days in so far for 2019, she proved a powerful ally and encouraged “speaking up” if there was something I did not like. This went from food, to medications, to staff concerns. Kitty insisted I ask for what I wanted and encouraged me when I did ask. For her, there is always room for improvement for patients as well as for staff.
I felt she walked side-by-side with me as I navigated the psychiatric system to help me get my life on track. Kitty assures people that she has been through battles of her own. She stresses the importance of continuing to look for what works for us. It begins with us. She talks with people, not at people. It seems ingrained in this unassuming woman to reach out and relate to others. She embodies empowerment. Kitty’s smile lights up my world, as does her husky voice. Around her, I relax and share my deep struggles. She provides observations and praise. This woman lives what she talks about. She is the kind of peer support person needed in so many other facilities. Kitty is humble, honest and will meet and has met me where I am while showing me where I can go — not minimizing the struggle that is inevitable in the journey. She has made an incredible difference in my life. The other peer worker at RRMC is Akbar [Abidi], who introduced himself to me the first day or two I was there last year. What I noticed first was how easily he smiled. The other was his quiet confidence as we talked. I found myself feeling reassured, cared for, and safe when Akbar worked the unit. We had numerous opportunities to talk. His deep concern showed as he listened, nodded and smiled. Curious about his name, I asked what it
meant; it was something about royalty. Wow! That fit him. I began calling him King Akbar. He laughed and smiled which made me feel good. Akbar is unflappable no matter what I ask of him. His calm bearing makes me calm. I seek him out to soak in his gentle presence. He has shared many of his life journey with me. We agree that people need to use more humor to get through difficult situations. He knows the pain of parental disapproval, using shame that stings when the parents’ expectations for their offspring do not come to fruition. What I mean is the parents’ disappointment is shown through negative and emotionally abusive comments that do not change even if their child is successful and happy on another path after they have made it through difficult times. When other patients are facing difficult situations, I steer them to Akbar to advocate for them. This gentle man is the type needed in other facilities. I only half-joked that he should be running the unit. This peer worker shows the willingness to engage without forcing his presence. He may ask if they like to walk and talk, and with some, he lets them know he is available and waits for them to come to him. Akbar is humble and honest. What a difference he has made in my life! Knowing there are people like this in the world reassures me about goodness. MICHELE ROYCE
OP-ED
Fall 2018 2019 WINTER
17
An Evidentiary Black Hole The case for video surveillance BY ISAAC JOSE LEZCANO
M
uckamore Abbey is a large psychiatric hospital in Northern Ireland. Recently, there have been a number of allegations from patients of abuse and neglect. The news media’s description of the allegations reminds me a lot of Disability Rights Vermont’s and Vermont Psychiatric Survivors’ efforts at the Brattleboro Retreat. A young man reported to his father that he was punched in the stomach by a staff member (presumably during a restraint incident). The incident was investigated internally by the hospital, and the father was assured that it was a “one-off” event. For the last two years, other incidents of this type were reported by patients, patients’ families and a local watchdog group. Everything changed just two months ago, when the Department of Health asked for a serious investigation of the claims. Unlike the Brattleboro Retreat, Muckamore Abbey is equipped with CCTV cameras in every area accessible to patients (excluding seclusion rooms, patient beds and bathrooms). The Police Service of Northern Ireland created a team to review the last three years’ worth of footage, with explosive results far exceeding what anyone (including the watchdog groups) expected. According to an August 27 article on the BBC News website (“Muckamore Abbey: CCTV reveals 1,500 crimes at hospital”), 1,500 individual incidents of criminality by staff were discovered on just one of the units (a six-bed adult intensive care unit). Detective Chief Inspector Jill Juffie described what she had seen so far as “very traumatic events” and elaborated on the value of video evidence: “These patients would not normally have been able to tell anyone what was happening to them and that is why it is so crucial in this case that we have the CCTV evidence.” Currently slightly more than 20 staff members have been suspended as a result of the investigation. This is by far the strongest response the hospital has ever had to a report of an abuse incident. It is not a coincidence that this large expulsion of staff involved in wrongdoing coincides with a sudden increase in public knowledge regarding the abuses. In fact, it is a reflection of a very consistent pattern. People with careers in hierarchical organizations that exert extraordinary control over the lives of others (e.g., police, military, prisons and hospitals) experience many pressures that prevent them from fully executing their duties in good faith and in accordance with their stated rules and ethics. When a police officer witnesses his partner plant evidence on a suspect or wield inappropriate force, professional ethics and the law demand that he report the incident. In reality, what we often see is a group effort to cover up and lie about the incident.
The witnessing officer knows that he will be seen as disloyal if he reports on his partner. He knows that scrutiny on the department as a whole will make his job harder. He knows that making waves makes it less likely for him to be promoted. All of this assumes that he is even tempted to report on his partner. More likely he is so deeply entrenched in the work culture of his profession that he sees the rule-breaking as “how we get the job done,” violating people’s rights as acceptable “when they deserve it” and rules on his conduct as unfortunate and foolish “red tape.”
If we are serious about protecting the most vulnerable members of our society, we need to realize that privacy is an absurd excuse for failing to have an objective record of what happens to patients who have been locked away from the public eye. This is why it is so common for police, prisons and the military to investigate and fire bad actors only after the incident has become publicly known (often through video evidence). Even the higher-ups care more about the survival of the organization itself than their employees following the law, and they will often resort to extraordinary measures to restrain and punish unlawful abuses only when doing so functions as a form of damage control for the organization’s reputation. The police chief, general, warden or hospital director acts shocked, says that the behavior was against the organization’s core ethics and punishes the one offender in a hundred who gets caught. As video becomes more and more accessible, the number of bad actors getting caught is rising. Besides a toxic culture of violence (which is a partisan and subjective matter so I won’t get into it here), there are many obvious factors for why abuses occur in these professions. Police, prison guards and modern soldiers (those engaged in occupations against insurgencies) work long hours, have an inherently oppositional role and a stressful job and work against populations that are dehumanized as being “subhuman,” “animals,” “human waste” and so forth. They are in a position of power over these people and know that there are very few functioning systems to audit their behavior. Psych hospitals are similarly a perfect storm of factors to create abuse and cover-ups. Much of the staff are low-paid and work long hours. The job is not an immense source of social capital, and these staff have an inherently oppositional role to the patients, many of whom are imprisoned against their will. Staff frustration with patients is a common event. The patients have paperwork declaring them
mentally ill and often fulfill other criteria that our society also dehumanizes: homelessness, drug use, poverty — all factors that if you go on certain Brattleboro Facebook pages you will see associated with being considered “subhuman,” “animals” and “human waste.” Worse, the staff at psych hospitals work in an environment with no objective record of what occurs. Police and soldiers often record video of events, while on psych units this is strictly forbidden. Not only do the staff outnumber the patients/ victims in any investigation resulting from an accusation of wrongdoing, but people declared mentally ill are not considered to be objective reporters of reality, and are aware that their testimony as a victim will not be taken seriously. If we are serious about protecting the most vulnerable members of our society, we need to realize that privacy is an absurd excuse for failing to have an objective record of what happens to patients who have been locked away from the public eye. Through my work as a patient representative, I am personally aware of several incidents that have occurred at the Brattleboro Retreat that would have had very different outcomes had there been video recordings. Not allowing places where agents of the state have total control over people’s lives to be taped in the name of “privacy” is like not allowing the regulation of pollution in the name of “freedom.” The beneficiaries of these policies are far fewer than those who are harmed. A successful modern society is built on making decisions based on objective facts. In the absence of facts, we resort to trusting testimony based on the speaker’s identity. Social capital should not grant absolute credibility, and a lack of it should not frighten vulnerable people into silence. For the first time in human history we live in an age where the absolute truth of an event can be recorded and distributed cheaply. Turning away from modern surveillance technology and relying on the socially assumed honesty of policemen, valor of soldiers or beneficence of medical personnel is as backwards and stupid as using a dowsing rod to figure out where to drill a well. Isaac Jose Lezcano is the Brattleboro-area patient representative for Vermont Psychiatric Survivors.
Do You Have Thoughts or Reactions to Our Commentaries? Please Share Them! Send comments to: Counterpoint, The Service Building, 128 Merchants Row, Suite 606, Rutland, VT 05701, or to counterpoint@ vermontpsychiatricsurvivors.org.
18 COMMENTARY
Fall 2018 2019 WINTER
Learning from Madness By KAZ DEWOLFE and CALVIN MOEN
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uch of the discrimination against mad and neurodivergent people happens and is allowed to happen because we are not seen as credible witnesses to our own experience. We are written off as psychotic, our thinking as distorted and our communication as manipulative, and therefore our narratives are discounted. It is crucial, therefore, that our perspectives be elevated to the level of expertise and our stories be given legitimate platforms where they can influence culture and scholarship. Earlier this year, an opportunity to do just that came in the form of a federal mental health block grant, a portion of which was set aside for initiatives dealing with “early episode psychosis.” The Hive Mutual Support Network in Brattleboro received funding for a two-part project. In September, the Hive hosted a webinar that featured a panel of individuals who had experienced psychosis or other extreme states as young people, talking about their experiences in and outside of the psychiatric system, what their barriers had been and how they successfully advocated for themselves. In November, the Hive launched its first book, “Much Madness: A Survivor’s Guide to Extreme States and Self-Advocacy for Young Adults.” “Much Madness” is a collection of personal stories from eight individuals who experienced psychosis or other extreme states as adolescents or young adults. Contributors shared what helped them navigate their extreme states, as well as what supports were unhelpful or harmful. “Much Madness” also contains a list of resources that can be helpful to young people experiencing psychosis or extreme states. The following is reprinted from the introduction to the book by editors Kaz DeWolfe and Calvin Moen.
***
This isn’t the kind of guide that gives step-bystep instructions. No one else can tell you how to survive. All we can do is make space for sharing stories. We can talk about how we survived, with the hope that it will spark survival strategies in someone else. It may be through telling our stories and hearing others’ that we achieve survival. That doesn’t mean this book isn’t instructive. Even from this very small collection of personal stories, themes and patterns emerge. These themes might inform radical change if we connect the dots and form conclusions.
Overcoming Isolation
Our authors described learning to hide their differences. We sometimes call this “passing as sane,” or “masking.” In some of these stories, masking resulted in isolation, when the authors had no one to talk to about their pain. Other times, masking resulted in liberation, when they successfully escaped harmful situations. In her essay, Jess Stohlmann-Rainey writes, “Passing is a privilege not all of us mad people are able to achieve, especially if we are otherwise marginalized. It is also a privilege that reinforces the abuses of the mental health system and creates the expectation that mad people should assimilate.” However, in her case, she found that it was the only way she knew to escape institutionalization. Some of these stories are about seeking out supportive communities and relationships. A few of our contributors describe a need for safety to talk about extreme states. They identify peer relationships as one resource. Some contributors found spiritual or activism communities where they could connect with others. Jolie Mahan writes about being in and out of institutions where other patients were their greatest source of emotional support. These places had rules prohibiting patients from contacting each other outside of the program, but Jolie and their friends from the hospital broke the rules and stayed in touch.
“Much Madness” is a collection of personal stories from eight individuals who experienced psychosis or other extreme states as adolescents or young adults. “It ended up being one of the wisest choices we ever made because, as we soon found out, the struggles of living with mental illness don’t end in the hospital. They were only just beginning,” writes Jolie. In her essay, Jodi Girouard writes about regaining a sense of hope while staying at a peerrun respite: “There I found peace in the valley by the river. I learned to throw river rocks into the water and release my pain and hurt from the men who took part of my life.”
Navigating Paternalism
When we navigate the psychiatric system, we often run up against what’s called “medical paternalism,” which is when healthcare providers make decisions on our behalf, supposedly acting for our own good. This can shut us out of that decision-making process, and losing our ability to make our own decisions can be traumatic. Several of these stories describe a power imbalance between patient and provider. Some providers in these stories dismiss patients’ concerns; some withhold needed information about treatments.
Some of our contributors had similar experiences of being prescribed medications with intolerable effects. The anonymous author of “Brain Blender” describes meetings with doctors who didn’t listen when told the medications were not working. “Every conversation I had about medication during this period could be summed up as: doctors trying to convince me the side effects were a necessary evil, or that I was lying about them,” says this writer. Some writers mentioned withdrawal when coming off of their meds. We also had contributors who finally, after trial and error, found drugs that helped them. Others found life without medication to be their best option. Two of the authors wrote about how adults in their lives taught them about risk. They were told their bodies and behaviors needed to be controlled or something bad would happen. The Borderline Academic describes being called to the headmaster’s office at school. There, she was scolded for trying to find a special connection with a teacher. She was told this teacher needed to be protected from her. “We don’t know what could happen if we don’t put a stop to this behavior,” the headmaster told her. Malaika Puffer writes about being shamed, and even restrained, for harming herself. As a result, she came to believe that she was both sick and a moral failure. “I was victim and perpetrator, a closed system,” she writes.
Finding Meaning
Many of these stories are about finding the meaning behind our extreme states. The psychiatric system often tells us that our states are symptoms of illness. But many of us have needed answers beyond mere pathology. Our contributors found that meaning through various channels: poetry, filmmaking, activism, academia, and friendship. Kaz DeWolfe writes of finding a spiritual community of people who had visions and heard voices — and who found meaning in them. Instead of their visions and voices being symptoms of brokenness, they were gifts of magick. “We interpreted each other’s dreams and visions. We created spells to help navigate life’s stressors and survive oppressive forces in our world. We worked through trauma together. We raised healing energy to fill painful emotional voids left by sexual assault, child abuse, and neglect.” Calvin Rey Moen concludes his essay with the recognition that his feelings of detachment and misplaced anger had their roots in abuse and trauma. He also attributes this understanding to being part of a community of peers. “We recognize abusive dynamics and the effects of trauma. We connect our big feelings and responses to bigger systems we are forced to survive: classism and heterosexism and patriarchy and so much more. And I wonder, what if I had a community like this when I was young and trying to make sense of my demons?” Contributors wrote from Vermont and beyond. They responded to our call for submissions in spite of its very short deadline. They quickly worked with us on revisions to finish this project within the time frame. We knew and had worked with some of the contributors. Others were people we’d never (Continued on page 19)
COMMENTARY. . COMMENTARY
Fall 2018 2019 WINTER
19
More from the Alternatives Conference
Consensus Reality, Hip-Hop and Mental Health By BERT DYER
O
ne of the Alternatives conference workshops I attended this summer focused on an organization for life skills coaching from Belgium that presented its alternative to the medical model of care for mental health. This organization, Life Projects, focuses on the awakening of the true, naturally present potential of the individual (or group) to guide participants in everyday themes or specific life projects in management, leadership and organizational matters. The organization guides participants in being full of life according to the principles of the five elements and nature. Using this method makes the essence of ancient Eastern and Western wisdoms practical and useful for the modern person. I enjoyed this workshop and agreed with the values and ethics put forth. I believe that honoring traditional indigenous ways of connecting to ourselves, to each other and to nature are wholesome and effective methods for inspiring success in Life Projects. I have experienced this in my own life through my connections with nature during groups and outings with Westview Clubhouse at the Howard Center. My lived experience and mental health challenges are a personal testimony to the ineffectiveness of mental asylums.
Therefore, I firmly believe that compassion and connection through peer work are essential to holistic healthcare plans which are person-centered and effective long-term. I personally have engaged in art therapy which allowed for me to co-create meaningful forms of expression without feeling overanalyzed. I think that this workshop was an excellent representation of effective alternatives to the conventional medical model.
By NATE LULEK
A
n eye-opening and fun workshop presented at the Alternatives conference this past summer featured Celia Brown, Liz Breier, Noah Gokul aka Bindiram and Gerald Jenkins aka DJ Kareem. This group was on point with the history and rise of hip-hop starting with its roots tied to the Bronx borough of New York City during the late 1960s into the 1980s. The presenters tied their experiences with hip-hop to social change and the impacts on public exposure to mental health issues. Gokul was likely the youngest person in the room. He goes by the name of Bindiram when performing. He brought a more contemporary take on some new artists that don’t shy away from making their mental health struggles known on their tracks or on social media. Gokul’s premise was that these artists are
actually allowing their fans to see their mental health struggles through their music and their use of social media. I enjoyed his take on how it is a great thing that these entertainers are bringing mental health into the popular collective consciousness illustrating problems, but that they are not focusing on solutions. This part of the workshop resonated with me strongly. Listening to the messages can be very evocative, but many times the artists are broaching the topic of their mental health, or mental health as a global issue, without casting any light on what they are doing to recover, maintain or advocate for wellness. I can understand that addressing mental health can be stigmatizing, alienating or at the very worst a career-ending pursuit, and the efforts to express their struggles can be a saving grace for many people struggling with life, mustering the strength to seek assistance with whatever life is throwing at them. If we could pull this underlying message into all genres of music, film, performance and visual media, then ushering forth solution-based alternatives might be possible. Perhaps mental health would not be such a polarizing global problem that gets swept out of the mainstream collective consciousness if it was not based solely on the horrific incidents that make it only a politicized temporary blip on the radar.
Bert Dyer is a member of the Vermont Psychiatric Survivors board of directors. He lives in Burlington. Nate Lulek is a peer advocate and patient representative on the staff of Vermont Psychiatric Survivors.
LEARNING FROM MADNESS • Continued from page 22 met, who saw a Facebook post or got an email from the Vermont Psychiatric Survivors mailing list. Many of them told us how challenging it was to write these stories. A few declined to use their names, or used pseudonyms, in order to preserve careers or relationships. All of them were incredibly vulnerable and brave experts on their own experiences. In addition to personal essays, this book also includes a resource guide. We have listed a few groups, articles, and other media we have found useful. We believe that first-hand experience is its own expertise. Still, it sometimes helps to have academic studies to back up what we know to be true. And, as many writers express over and over in these pages, finding a community that won’t
judge us can be a key to our survival. Making meaning of our experiences can be crucial to advocating for ourselves. In addition to creating a resource we hope will help someone feel less alone, editing this book was also an opportunity for us. We were able to make new connections. We got to know each other and ourselves more intimately. We deepened conversations about what it means to pass as sane, to what extent our extreme states could be gifts or curses, and what it is about them that really scares people. Reading this guide might bring up strong feelings in psychiatric survivors, parents, friends and partners, and providers. We hope you have, or can find, support to express those feelings and process whatever comes up. Strong feelings can be a catalyst for change,
and a crisis can be a vehicle for transformation. As Emily Dickinson wrote, “Much Madness is divinest Sense — / To a discerning Eye — ” Learning to discern what Madness is telling us is a lifelong task. Links to download a free PDF of “Much Madness” or to purchase a hard copy are available at hivemutualsupport.org/muchmadness. There is also a link to a closed-captioned recording of the webinar. Kaz DeWolfe is the communications coordinator for Vermont Psychiatric Survivors and the co-editor of Radical Abolitionist, a cognitive liberty blogspace. Calvin Moen is the former training director for Vermont Psychiatric Survivors and does grassroots organizing for mutual support in Brattleboro.
Have an Issue to Discuss with Other Survivors? COUNTERPOINT IS THE PLACE FOR YOUR VOICE. SHARE YOUR THOUGHTS HERE!
If you’d like, we’ll even help you with editing to express your ideas clearly. Names may be withheld on request but must be included with letter or commentary. Please identify your town. Letters or commentaries do not represent the opinion of the publisher and may be edited for length or content. Send comments to: Counterpoint, The Service Building, 128 Merchants Row, Suite 606, Rutland, VT 05701, or to counterpoint@vermontpsychiatricsurvivors.org.
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WINTER 2019
DISABILITY RIGHTS VERMONT ANNOUNCES FY 2020 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 fifteen 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 Commission highlighting the harm that people suffer when held in inappropriately segregated and institutional settings solely due to their disabilities. Some of these cases have resulted in important systemic changes to improve conditions for people held this way, while we continue working to improve the overall system. Recently, DRVT won a federal court order requiring the Woodside Rehabilitation Facility to modify their policies relating to the use-of-force, seclusion and isolation, and overall treatment policies. We continue to monitor the facility and to work with the Department of Children & Families to insure children with disabilities get the support they need. 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 and by offering assistance to peer-run services. We have also trained staff at several psychiatric units and designated agencies in recognizing and respecting patients’ rights. DRVT maintains a 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. Unfortunately, a lack of community options cause many to spend more time than is appropriate in institutional settings and so, in this year, DRVT is seeking to identify the scope of the problem and find solutions so that people receiving services can do so in the most appropriate integrated settings as required by the ADA. We continue to monitor treatment environments in Vermont, meeting with patients and prisoners. These include psychiatric units, Emergency Departments, prisons, residential and community care homes, homeless shelters and 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 continue to assist 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. We also review representative payees of people with disabilities at the direction of the Social Security Administration. 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 2020 (10/1/19 - 9/30/20) 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 • You 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 • You 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!
COMMENTARY.
WINTER 2019
DISABILITY RIGHTS VERMONT
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FY 20 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 (hospitals, any state run facilities, 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 75 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 10 opened cases, DRVT will advocate for timely discharge of patients identified by their medical providers as being unnecessarily institutionalized, or release of prisoners who have served their “minimums” 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, trauma-informed, 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. Conduct systemic advocacy in the legislature, and with the administration, to preserve or enhance community-based services for people with mental health needs. 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). In addition, DRVT does not ignore evolving situations and other cases, or treatment facilities, which require attention. riority 3: Reach out to community settings, designated facilities and hospitals, emergency rooms, prisons/jails, residential and therapeutic care homes. Monitor conditions and educate residents, patients and providers about rights, self-advocacy, and DRVT services, with emphasis on the integration mandate of the ADA. Measure of Success: A. Outreach is conducted at a minimum of 5 community care homes (CCH), including but not limited to residential care homes, therapeutic community residences or licensed residential childcare facilities. These visits include distribution of DRVT literature & self-advocacy materials. 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 hospitals, including any state run facility. D. DRVT literature is distributed to all of the community mental health agencies, prisons, to intensive rehabilitation residences, and to specific homeless shelters, “club houses” and peer-run services. E. Outreach is conducted at least once at each hospital Emergency Department or other inpatient unit where patients who have been admitted based on a psychiatric diagnosis are held. F. Outreach will be conducted to individuals labeled with a disability who are victims of crime or domestic abuse. G. DRVT PAIMI Staff will maintain and improve their cultural and linguistic competence and their trauma-informed skills and sensitivity. Priority 4: Advocate for self-determination, access to alternative treatment options and community integration. DRVT will advocate for designated agencies to establish relationships with individuals in inpatient settings during discharge planning in order to support people to seek their full potential in the community. Measure of Success: A. Conduct 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. Respond to opportunities to 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. D. DRVT will participate in systemic efforts to improve state services for inpatient or incarcerated individuals to speed successful reintegration. E. Participate in coalition efforts to address transportation infrastructure needs of low-income people with mental health issues. F. Support the Vermont Communications Support Project (VCSP) in order to ensure that people with communications disorders related to their mental health can participate in the judicial and administrative systems. G. 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. How can you make your voice heard? Contact DRVT at: 141 Main Street, Suite 7, Montpelier, VT 05602 Or by phone: 1-800-834-7890 or, locally, at (802) 229-1355 By email at: info@disabilityrightsvt.org
22 COMMENTARY
WINTER2019 2019 WINTER
Sharing Experiences from By JODI GIROUARD
I
voluntarily spent a week trying to get help at the Brattleboro Retreat in August. I have a severe mental illness, and at times I need to go to an inpatient treatment facility to get acute care and to stabilize. I had concerns about the environment and the care that I received that I believe need to be voiced and somehow addressed. Patients still there need to be treated with more dignity and the basic human rights of cleanliness, interaction and therapy. I believe I can be a voice for those that are not in a position to raise awareness over these concerns on Tyler 2 at the Retreat. An improved environment and care could be essential in helping them recover. I want it known that it is not my intention to close the Brattleboro Retreat or bring negative publicity. I believe it is an essential place that could have better treatment options and conditions for patients. And I believe most of the staff want to help, they just don’t have enough supervision and tend to spend much of their time behind the computers at the nurse’s station. I do, however, believe there are three areas that need change that could be done with the current staff for the improvement of patient care. It is essential so that better care and perhaps greater stability could happen in the healing of the patients still there and still being transferred from other facilities like I was. Sanitary conditions, the type of treatment and/or the lack of it, and staff interactions are the main issues. I believe these basic needs should be looked at and considered for better alternatives to the current ways they are implemented.
Sanitary Conditions
There are four bathrooms on Tyler 2: one men’s, one women’s, and two all-gender. The women’s and one all-gender are the ones that I showered in. The other all-gender was just for toilet use. I think it is important to note that staff has a private bathroom beside these and at no time would any of them deem it appropriate to use the patient bathroom, nor step foot in to check the environment. I wonder what changes might occur if they were to use the inpatient bathrooms. I am deeply concerned about the unsanitary conditions there. The walls, especially in the shower, were tiled and lined with pink mold and bits of black. The floors were slimy and the drains in the shower had hair stuck in them, often for days at a time. I knew the drains weren’t being cleaned because one patient had purple hair and she left days before me, and her purple hair was still in the drains after she was gone for many days. With more than 22 patients able to use the showers daily, they need to be cleaned better. Also, on the floor, I met a kind man who had hepatitis C. His bare legs and bare feet were covered in open sores. He often had Band-Aids on the sores, but they would come off. One day I counted six bloody Band-Aids left on the floors of the two public rooms we used. This is unacceptable. He also used the same showers, and at times I saw blood on the floor in the all-gender bathroom. Staff should have kept his sores covered better and not had him walking about without shoes. At one point near the end of my stay, I complained to the charge nurse and saw a bit of im-
provement after I mentioned knowing Anne Do- with each. I shared my symptoms and what I nahue at Counterpoint and having a friend in the wanted to work on. No treatment was started or legislature. planned. The windows had beautiful views of a mounThe following day, when I had not yet received tain, a pond, and the courtyard that we were al- any treatment, the social worker called my huslowed to go out in once we were deemed cleared. band. She told him that they were looking at the Such an asset to help patients see the beauty in following Friday for discharge. the world. He called, excited, but I was concerned that I Unfortunately, I don’t believe the windows had yet to talk of options for treatment or had were cleaned yearly. There were black stains and any changes before she called. How did she know layers of dirt on the outside, so when I sat in the that I would be all set if nothing was done yet? seats that had the views, or in the bedrooms, it was hard to see the beautiful surroundings. It could be a point of pride. The tables and chairs were removed from the gathering place in front of the nurse’s station. New, safer chairs and tables were placed in the two common rooms. We were to eat and have groups at the tables. Unfortunately, the tables and the counter in the day Photo from Brattleboro Retreat web site. room were never sanitized. I sat at one during a rare group, and there were I was concerned that the Retreat was more of a thick stains of some kind of sauce on it. I was try- holding cell than a treatment hospital. Before going to the Retreat, I looked on their ing to write on a paper by it. This is unacceptable. Also, because the tables and chairs were placed website. It stated there would be a board-certionly in the two public rooms, they were not ac- fied psychiatrist in the treatment plan. There was cessible during part of the second shift. When I one psychiatrist on teletherapy, a live chat on a awoke from the nightmares that were my main computer for some patients. There was no talk therapy, no ways to help struggle due to PTSD, I would leave my room to avoid disturbing my roommate. I needed to me reduce my nightmares other than drugs. The only people on my team were a nurse pracground and calm myself. Unfortunately, the two rooms that had the titioner I saw for five-ish minutes a day and a chairs were locked at 10 p.m. and not opened social worker who said I only needed to see her again until 7 a.m. I had to stand or lean against every other day. Groups on the floor were posted on a whitethe walls during those hours. Many patients struggle with disturbances board. Most groups were erased or just never implemented. Most were canceled, due to underduring the night. There should be a place to sit. staffing, I was told. There was one group, David’s guitar group, “I believe the Brattleboro that was always packed and popular. I could see Retreat has good staff that the response in the patients as we opened up and everyone was given lyrics and everyone sang. It does care. I think perhaps showed that personal connection was helpful. There was one “therapeutic group” called acthey don’t realize the ceptance and commitment therapy, or ACT. It met most days and went over the same thing: We potential for healing that had behaviors that we used to try to overcome they could have with more our hardships, our illnesses, but they weren’t helping. We should look at what we value, what personal connections.” would be helpful, and do that. Unfortunately, there was no in-between talk of how to get from A to the positive result of Z. On the floor, the kitchen was always locked. There were a lot of coloring worksheets on the Every time someone needed a drink, even wafloor. No other type of artistic expression was imter, a staff member had to be found to unlock the plemented or offered. Also, patients’ computers door and to go in and pour a drink or get a snack. and phones were taken. I am a writer and needed Mental health workers spent most of the time paper and a pen to write without my computer. being guards to this room instead of being able to Paper was stringently given out, a few sheets at a spend time listening and helping patients recovtime. I wrote based on my experiences there: one er from acute symptoms they were having. 75-page handwritten story and 26 poems. ImagIt seems that having cold water available withine having to constantly find a staff member and out having to ask for it could somehow happen. have them look for paper, and then have them Often it took asking more than two workers to give you two to four pages at a time. find someone to help. Nurses were efficient and effective at getting Also, the bathrooms were always locked. Findmedications to patients and taking vital signs. ing a staff member available was difficult someThere were three shifts, each with a nurse astimes. signed to patients. I was asked by only one nurse on one shift during my week’s stay about how my Staff Interactions day had been, how I felt, and if I wanted to talk. Initially, I had time with a nurse practitioner Mostly I was treated by being given my meds, and then with a social worker, about 15 minutes
COMMENTARY.
WINTER 2019
the Brattleboro Retreat asked if I was suicidal, and having my vitals taken. On every shift, there was a mental health worker assigned a certain number of patients. I never knew who was mine. Yes, it was written on a whiteboard, as was who my nurse was to be that shift. But not once did any ever introduce themselves, even at the beginning of the shift. None asked what I might need help with or to focus on for the day. They were mostly door openers for the bathroom and the locked kitchen. This saddens me. I spent a lot of my time writing poetry for other patients. Old men cried. Women tried to hug me. Young adults asked me to write more for them. In return, some gave me flowers picked from the garden beds in the locked courtyard as a thank-you. I had six Styrofoam cups filled with flowers on the shelf in my room. Patients came to life when seen. When heard. When valued as people with dignity and worth. Patients were starting to see goodness in themselves. Upon leaving, I gave the flowers to other patients. One elderly lady stayed in bed most of the week, coming out only for meals. I went to her doorway holding two cups of flowers I offered her to choose from. She got out of bed and walked to me. She said no one had ever given her flowers. She was close to 80. I said she could have both cups. She said she wanted only the one with the yellow and white flowers. She took it from my hand and placed it
on her empty desk. She wore paper clothes all week. She had a beard and a rubber band around one side of her glasses holding them together. She smiled at the flowers. This makes me think that perhaps the staff needs to spend less time hiding behind the nurse’s station. Perhaps less time on the computers. Perhaps meeting face to face for talks, or listening. Perhaps making a connection with patients might improve both roles. Patients would feel heard and seen. Staff might feel valued and appreciated in their job. Some patients spent most of their days, while I was there, in bed. When I walked by their open doors, they would be staring at the ceiling. Some were in paper gowns because they had no clothes. Downstairs was a free boutique of thrifted clothing. I would think encouraging patients to get up and dress might help bring normalcy to their daily lives. I also think going around and encouraging attendance to groups would get more motivated to go.
My Voice
I am one of the lucky ones. I have a good support system to fall back on and help advocate for my well-being both while I am at an inpatient facility and at home. I have family and doctors, a therapist and a case manager. All work together to help keep me stable. I found most of the patients at the Brattleboro Retreat have no one to support them. They are
23
then lost in the system or without a voice for many of these conditions. I have decided to be their voice because most of these concerns I have addressed seem to be basic human rights. Cleanliness. Interactive treatment teams and staff. Being seen and heard seem like basic needs in order to feel valued. These are necessary and seem easy to implement. Because of my severe illness, I have been hospitalized more than 40 times in my life, mostly at UVMMC in Burlington and Shepherd Pratt in Baltimore. There were some of these issues back in the late 1980s and early 1990s at UVMMC. Almost all have been drastically improved and continue to be looked at and modified. I believe the Brattleboro Retreat has good staff that does care. I think perhaps they don’t realize the potential for healing that they could have with more personal connections. Introducing oneself to patients each shift, encouraging patients to dress and leave their rooms, and asking patients to attend groups and being willing to sit and listen so patients are heard seem fundamental to the job description. What wondrous, powerful healing could happen, just like it did when I uplifted other patients with a poem about the goodness I found in each one. Being treated with dignity is the first step. Cleanliness and treating all with dignity is a basic right for all no matter the illness. Jodi Girouard is a contributor to Counterpoint who lives in South Burlington.
Retreat Would Cause Great Pain to Anna Marsh Today By MICHELLE NEVILLE I am a former patient of the Brattleboro Retreat, as recently as this past summer. I am a 41-year-old pharmaceutical research specialist, a brain surgery survivor, transgendered, and suffer from severe depression and anxiety. Over my lifetime I have been in many hospitals due to my depression, due to bad experiences at hospitals, and also my living in different parts of the country. I found the Brattleboro Retreat during my struggle with depression in 2012. As a transgender individual, I was very intrigued by having an inpatient program for the LGBT+ community and I was happy to try it. I found so much support and peace when I first went to this hospital and in subsequent admissions. I have been multiple times and, due to the help of the hospital, I experienced a period of no depression for more than two years. One of my favorite parts of the Retreat was the story of the founding of the hospital. In the 1800s the treatment of people with mental health issues was very troubling and painful. Anna Marsh, the founder, had been witness to some of this treatment and wanted something better. The hospital, as stated on its website, was founded on moral treatment: “The basis of Moral treatment was founded on treating patients with dignity and respect in a caring, family-like environment that included meaningful work, cultural pursuits, wholesome nutrition and daily exercise.” I remember when I first went there, we had groups outside, sat in the rainbow chairs, and experienced a lot of different types of groups. I had art therapy from a real art therapist, music therapy, and really meaningful group discussions.
It really helped me and filled my heart with great experience and put me at some temporary ease while I was trying to get my depression under control. I remember we could visit a gift shop and buy things, such as a sweet snack or a special book. The Osgood 2 unit was so wonderful when I went there, very new, very clean, with a beautiful view of the pond. It had music, snacks, beverages, books and art supplies, and was really state-of-the art. The most important component to the floor was the mental health workers, nurses, doctors and staff who were all so caring and compassionate. They truly wanted to help, and you could feel that. Fast-forward to 2019 and I returned to the Retreat. My depression returned, and I was struggling terribly. Apparently, during my two years away, a lot had changed. When I returned, the place felt so cold. All the pictures and drawings from patients were taken off the walls, the bathroom doors were locked, there never seemed to be enough staff, and many things were taken away. No pool, no outside groups, no sitting in the rainbow chairs, little to no art therapy, no supplies, no cafeteria, and no physical psychiatrist presence on the unit. There was a television screen where you would go in and talk to the doctor or be given a nurse practitioner. I was appalled by the fact that a patient struggling with a mental illness has no physical presence from a psychiatrist when they are inpatient. I found the place was very run down, the windows had writing on them, and the beautiful view of the pond was so distorted due to the amount of filth on the outside windows. The staff had also changed, and it very much felt like the
Retreat had stopped caring. I was not feeling comfortable at all as there was always someone locked up in the confined unit and, as a result, there were less staff to interact with. I also had a particular incident as a result of a new practitioner who really didn’t know or care about my history. I left due to the incident with the new practitioner, but eventually came back requesting a different practitioner. The first time they honored the request, and I did not see the practitioner I had a bad experience with. However, when I came back again due to my continued struggle, they did not honor my request and forced me to see the practitioner I was not comfortable with. I left almost immediately after receiving word they would force me to see the practitioner I was not comfortable with regardless of my request. I continued to struggle but felt a sense of grief knowing the Retreat did not care or care to understand the struggle I was having. I also have noticed that, over time, the Retreat has really institutionalized in such a way that it does not feel comfortable for those struggling and seems to be more like a prison than a place of healing. Until the Retreat goes back to its original intent of moral care, I cannot return. It’s a sad day for me to acknowledge and accept that, but I pray that it will return to its original intent or a new hospital will appear in its absence that will honor and care for those with mental health issues with dignity and respect. Michelle Neville lives in a neighboring state to Vermont. She asked that her town of residence not be listed to protect her privacy. This commentary was also published as a letter to the editor in the Brattleboro Reformer.
24 Resources Directory 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 John at 802-258-0782 BENNINGTON/UCS: United Counseling Service, 316 Dewey St., Bennington; Mondays and Wednesdays, noon-1 p.m. Call Barbara at 802-442-5491 RUTLAND: Wellness Group, VPS Office, 128 Merchants Row, Suite 606; every Wednesday, 5-7 p.m. Call Beth at 802-353-4365
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):
833-888-2557; every day, 3 p.m.- 6 a.m. [833-VT-TALKS] By call or text
PEER PLUS (STATEWIDE):
802-595-0588; 7 days/wk, 6-9 p.m.
MUTUAL SUPPORT NETWORK THE HIVE: info@hivemutualsupport.org www.hivemutualsupport.org 802-43-BUZZ-3 (802-432-8993)
WINTER 2019
NATIONAL SUICIDE PREVENTION LIFELINE 800-273-TALK (8255) 24/7 confidential support
Samaritans Hotline
877-870-HOPE (4673)
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
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
Support Group locations on web: www.biavt.org; or email: support1@biavt.org; Toll Free Line: 877-856-1772
DBT Peer Group
Peer-run skills group. Sundays, 4 p.m.; 1 Mineral St, Springfield (The Whitcomb Building). tinyurl.com/PeerDBTVT
Trans Crisis Hotline
Counterpoint publishes this resource directory to allow readers to seek out choices for support. Counterpoint has not reviewed or evaluated the quality or biases of these resources, and makes no representation about their value for any individual. Public Community Mental Health COUNSELING SERVICE OF ADDISON COUNTY, 89 Main St.,
Middlebury, 05753; 802-388-6751
UNITED COUNSELING SERVICE OF BENNINGTON COUNTY,
PO Box 588, Ledge Hill Dr., Bennington, 05201; 802-4425491
CHITTENDEN COUNTY: HOWARD CENTER, 300 Flynn Ave., Burlington, 05401; 802-488-6200
FRANKLIN & GRAND ISLE: NORTHWESTERN COUNSELING AND SUPPORT SERVICES, 107 Fisher Pond Road, St. Albans, 05478; 802-524-6554
LAMOILLE COUNTY MENTAL HEALTH SERVICES, 72 Harrel
Street, Morrisville, 05661; 802-888-5026
NORTHEAST KINGDOM HUMAN SERVICES, 181 Crawford
Road, Derby; 802-334-6744; 800-696-4979, 2225 Portland St., St. Johnsbury; 802-748-3181; 800-649-0118
ORANGE COUNTY: CLARA MARTIN CENTER, 11 Main St.,
Randolph, 05060-0167; 802-728-4466
RUTLAND MENTAL HEALTH SERVICES, 78 So. Main St., Rutland, 05701; 802-775-2381
WASHINGTON COUNTY MENTAL HEALTH SERVICES, 9 Heaton
St., Montpelier, 05601; 802-229-6328
CRISIS RESPITE
The Trans Lifeline (dedicated to the trans population) can be reached at 877-565-8860.
VERMONT PSYCHIATRIC SURVIVORS OUTREACH AND PATIENT REPRESENTATIVES
Crisis Text Line
390 River Street, Springfield, 05156; 886-4500; 51 Fairview St., Brattleboro, 05301, 802-254-6028; 49 School St., Hartford, 05047, 802-295-3031
LGBTQ Youth Crisis Hotline:
24-Hour Crisis Lines: Involuntary Custody Screening
Alyssum, 802-767-6000; www.alyssum.org; information@alyssum.org
802-775-6834 F: 802-775-6823 info@vermontpsychiatricsurvivors.org
HOSPITALIZATION ALTERNATIVE
Soteria House, information and online application at www.pathwaysvermont.org/what-we-do/ our-programs/soteria/ or call Pathways Vermont Intake Line, 888-492-8212, ext. 140
Around-the-clock help via text: 741741 for a reply explaining the ground rules; message routed to a trained counselor.
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
BENNINGTON: Every Tuesday 12-1:30 pm; United Counsel-
Peer Centers & Employment Support ANOTHER WAY, 125 Barre St, Montpelier, 802-2290920; info@anotherwayvt.org; www.anotherwayvt. org; see website for events calendar.
PATHWAYS VERMONT COMMUNITY CENTER, 279 North
Winooski Avenue, Burlington, 888-492-8218 ext 300; www.facebook.com/PathwaysVTCommunityCenter; www.pathwaysvermont.org/what-we-do/ our-programs/pvcc
Vermont Recovery Centers WWW.VTRECOVERYNETWORK.ORG BARRE, Turning Point Center of Central Vermont, 489
N. Main St.; 479-7373; tpccvbarre@gmail.com BENNINGTON, Turning Point Center, 465 Main St; 802442-9700; turningpointbennington@comcast.net
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 into lower level)
WINDHAM AND WINDSOR COUNTIES: HEALTH CARE AND REHABILITATION SERVICES OF SOUTHEASTERN VERMONT,
ADDISON COUNTY: Counseling Services of Addison County 802-388-7641
BENNINGTON COUNTY: United Counseling Service, 802-
442-5491; (Manchester) 802-362-3950
CHITTENDEN COUNTY: Howard Center 802-488-7777 FRANKLIN AND GRAND ISLE COUNTIES: Northwestern Coun-
seling and Support Services, 802-524-6554; 800-834-7793
LAMOILLE COUNTY: Lamoille County Mental Health, Week-
BERLIN: Second Thursdays each month, 4-5:30 pm; Central
days 8 a.m.-4 p.m. 802-888-4914; Nights and weekends 802-888-4231
RUTLAND: First and third Sundays 4:30-6:30 pm; Well-
Human Services 800-696-4979
NATIONAL ALLIANCE ON MENTAL ILLNESS-VT (NAMI-VT)
ORANGE COUNTY: Clara Martin, 800-639-6360 RUTLAND: Mental Health Services, 802-775-1000 WASHINGTON COUNTY: Mental Health Services, 802-229-0591 WINDHAM,WINDSOR COUNTIES: Health Care and Rehabili-
Vermont Medical Center Board Room, 130 Fisher Road.
ness Center (Rutland Mental Health) 78 South Main Street (parking/entrance off Engrem Avenue)
802-876-7949 x101, or 800-639-6480; 600 Blair Park Road, Suite 301, Williston, 05495; www.namivt.org; info@ namivt.org
ESSEX, CALEDONIA AND ORLEANS: Northeast Kingdom
tation Services, 800-622-4235
Please contact us if your organization’s information changes: counterpoint@vermontpsychiatricsurvivors.org
BRATTLEBORO, Turning Point Center of Windham County, 39 Elm St.; 802-257-5600; tpwc.1@hotmail.com
BURLINGTON, Turning Point Center of Chittenden Coun-
ty, 191 Bank St, 2nd floor; 802-861-3150; www.turning pointcentervt.org or GaryD@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; recovery@ncvrc.com
RUTLAND, Turning Point Center, 141 State St; 802-7736010; turningpointcenterrutland@yahoo.com
SPRINGFIELD, Turning Point Recovery Center of Springfield, 7 Morgan St., 802-885-4668; spfldturningpoint@ gmail.com
ST. ALBANS, Turning Point of Franklin County, 182 Lake St; 802-782-8454; tpfcdirection@gmail.com ST. JOHNSBURY, Kingdom Recovery Center, 297 Fall St;
802-751-8520; c.boyd@stjkrc.org; j.keough@stjkrc. org; www.kingdomrecoverycenter.com
WHITE RIVER JUNCTION, Upper Valley Turning Point, 200 Olcott Dr; 802-295-5206; secondwindfound.org; mhelijas@secondwindfound.org
Veterans’ Services
Vermont Veterans Outreach
WWW.VERMONTVETERANSSERVICES.ORG
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
HOMELESS PROGRAM COORDINATOR: 802-742-3291 BRATTLEBORO: Morningside 802-257-0066 RUTLAND: Open Door Mission 802-775-5661; Transitional Residence: Dodge House, 802-775-6772
BURLINGTON: Waystation/Wilson 802-864-7402 FREE TRANSPORTATION: Disabled American Veterans:
Toll Free: 1-866-687-8387 X5394
Homeless?
Vermont Veterans Services (VVS) program for homeless veterans with very low income, call 802-656-3232.
www.MakeTheConnection.net Web site sponsored by The Department of Veterans Affairs with testimonials by veterans to help connect with the experiences of other veterans, and with information and resources to help transition from service, face health issues, or navigate daily life as a civilian.
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