Beyond Vermont State Hospital (VSH)

Public Hearing Testimony of Mine

2012-02-01T02:13:00.001-05:00

Vermont State House
January 2012
(taken by Morgan W. Brown)

The following is my testimony concerning Governor Shumlin's plan to strengthen mental health services across Vermont before the joint legislative public hearing on mental health held on Tuesday of last week before four different committees -- two from the House and two from the Senate -- in room 11 of the Vermont State House (this version is actually a slightly edited version of what I wrote up and then read during the public hearing last week, which when read was added to ad lib; edited for the purpose of clarification and readability):

Morgan W. Brown testifying at public hearing
January 24, 2012
(taken by Sarah Launderville)

My life experiences include being a family member to persons who fell into the public mental health system, including both of my parents, among others.

In addition, my own lived experiences include having lived homeless off and on in one form or another since the age of seventeen (17), including a lengthy, painful twelve (12) year period living without permanent housing that ended in mid-August of 2009. Since then I have resided within a small efficiency apartment within Montpelier.

Along with that I have my own experiences of being someone living with severe emotional disabilities as well as being labeled with various "severe and persistent mental illnesses" and being on the receiving end of the public mental health system.

My educational background includes having earned the equivalent of a Bachelors in Homelessness, a Masters in Distress, a Ph.D. in Personal Misery and, I was recently reminded by someone, "a Post Doctorate in Never Losing Hope."

It should be understood how I am someone who could have easily landed in the Vermont State Hospital, including during the twelve (12) years previously spent living homeless.

The worst place for anyone to be, including someone experiencing what are termed as being acute episodes of "mental illnesses", is within an institutional setting, let alone a large one.

It is my belief that all of this should not be focused on beds, how many or where located. Rather the focus should be on what the actual needs are of those in various levels of need.

The best, most preferred bed is within one's own residence or, otherwise, home-like environment with an array of services and supports offered.

To do this, what is required is housing, housing and housing as well as other voluntary supports and services, including greater funding for peer-run services.

That said, it is my opinion that Governor Shumlin's plan for mental health is headed in the right direction.

Find information about the mental health bill introduced within the state legislature and related information, here, as well as Governor Shumlin's plan for mental health, here and here.

Check out the Vermont Advocacy Resource Toolkit, here.

Psychiatrist & National Empowerment Center Executive Director Daniel Fisher Visiting Vermont to Speak on Mental Health Matters This Week

2012-01-17T01:58:00.002-05:00

Things have been really hopping when it comes to mental health and related matters within Vermont, particularly of late and even more so now upon the return of the state legislature for its 2012 regular session.

Among everything else going on is that Daniel Fisher, Executive Director of the National Empowerment Center (NEC), is in Vermont.

Tuesday he plans to attend a Vermont Psychiatric Survivors (VPS) meeting from 11:00 AM to 3:00 PM (location of which is unknown by myself at this time).

In the evening, which is being set up on rather short notice due to how quickly his trip to the state was arranged, he will be having dinner with Patrick Flood, Commissioner of the Department of Mental Health (DMH), as well as with a small group that include peers from among the mental health and disability community and also certain mental health and disability advocates.

On Wednesday, Dan is scheduled to lead off testimony first thing before a joint meeting of the House Human Services and Senate Health and Welfare committees at 9:00 AM in room 11 at the Vermont State House (information, here).

It is my understanding that he will be providing comments on Governor Peter Shumlin's Plan for Mental Health.

An outline of the Governor's plan as well as embedded video clip of the announcement is available online as well, here.

If and when I am able to do so, yet I make no promises either, I will attempt to take photos as well as video, which if possible will try to make these available online and then post them along with written reports of one sort or another up to the Beyond Vermont State Hospital (VSH) blog. This will be done rather than continuing to send follow-up reports via e-mail as has previously been the case.

Therefore anyone seeking to be kept updated should check either this blog, its Twitter feed or Facebook wall for future posts and updates. This will keep inboxes less crammed and also be much less work on my end as well, which is what blogging, tweeting and Facebook posting is designed and intended to help with, not too mention being a much better and more interactive means of social networking too boot.

Thank you for your interest in these and related matters.

Bridging the Gap: By Strengthening Mental Health Services Across Vermont

2012-01-04T04:48:00.001-05:00

by Morgan W. Brown

(read shorter version, which is a slightly edited version of the piece submitted
to the Montpelier Bridge for its January 5, 2012 edition, here)

*Update*: Read Governor Shumlin's Plan for Mental Health (Version 3.0; January 9, 2012), here.

Vermont State House
December 2011
(taken by Morgan W. Brown)

Recently, someone told me of a joke going around certain circles that goes something along the lines of:

“What is the recipe for closing the Vermont State Hospital and building a much more robust community-based system in its place? Just add water.”

Others had also previously quipped in one form or another about how it took a tropical storm as well as flooding to do in one day what politicians and advocates have been talking about doing over the course of roughly thirty (30) years.

During all those many years there had been a multitude of conversations, meetings and discussions as well as study upon study done and plan upon plan formulated, including the so-called Futures planning initiative, however with no real, meaningful or lasting results to show for all the hot air expended and failed efforts, not too mention all the state taxpayer funds wasted in vain while doing so.

The Vermont State Hospital (VSH), along with the mental health system as a whole, had become virtually stuck within a vacuum, a massive black hole, seemingly sucking all the energy, available resources and life, as well as removing any opportunities for improvement in being able to do anything better and truly different, out from the realm of possibility.

Frustration and despair reigned and many people became resigned to stick with the status quo and thus settling for less, including by keeping expectations lowered.

Although some have stated there had been consensus on what should be done and this included the building of a new version of the same thing (read: same old treatment model), the only such consensus was in fact merely among those who had agreed about this course, even though there were those of us who had long argued along very different lines and consistently stated such on various occasions.

Among what was being argued by myself as well as others over the years was how crucial it would be to not to focus on beds and institutions, nor the needs of the system and service providers, but rather on what the actual needs of those being served were, including by asking persons currently being served as well as those previously served what they knew to both work and not work in improving outcomes as well as quality of life.

Then, about roughly two months prior to Tropical Storm Irene devastating much of Vermont as well as the town of Waterbury and the state office complex, which included the 54-bed state hospital, Deputy Agency of Human Services (AHS) Secretary Patrick Flood began reaching out to various stakeholders, including myself, asking for direct input concerning what to do regarding VSH and the mental system as a whole.

It had long been my view that what was missing and sorely needed was a truly open and public discussion as well as process concerning what was needed and about how to proceed. Although some suggested this had already taken place, it in fact had not been the case, not until Tropical Storm Irene forced the matter to the fore.

There have been many lengthy open discussions held since, sometimes these have occurred on a one on one basis and at other times, particularly later in the process, done in group settings with various parties attending.

A slew of various proposals were submitted to the Department of Mental Health (DMH) for consideration and two different days of review by a variety of stakeholders were held.

Out of this process, not only has Governor Peter Shumlin and his administration decided not to return to the VSH facility in Waterbury, but he and his team has come up with a plan for moving forward in strengthening mental health services across Vermont.

Governor Shumlin’s proposed plan includes yet is not necessarily limited to the following:

15 bed state managed facility in central Vermont (Fletcher Allen will provide 7 to 10 intensive inpatient beds while this facility is being constructed and staffed)
14 beds at Brattleboro Retreat
6 at Rutland Regional Medical Center
Up to 5 beds secure residential on campus of Windsor Correctional Facility
Step down beds (transitional beds as people move off acute care)
Improved emergency services
Improved individualized services
Housing vouchers and peer services (people who have been patients who now are willing to run services for others – hotline, beds any number of supports)

Although it is my opinion that the administration’s current plan still focuses too much on institutional beds, particularly what I view as being the same old treatment model and should instead go much farther in building a more robust community services system than is already being planned, one much less dependent on the medical model as well forced treatment and medication in general, at the same time I do happen to believe the plan is certainly heading in the right direction toward attempting to do so.

In a somewhat related development, Governor Shumlin also recently swapped the roles or positions of Patrick Flood and Christine Oliver, making Flood the Commissioner of DMH and Oliver the Deputy AHS Secretary.

In doing so, the Governor stated how “Christine and Patrick have both done an extraordinary job under difficult conditions over the past year. As I have worked closely with them in the wake of Irene, it has become clear to me that at this unique moment, Christine's background and talents are better suited to managing the Agency's overall work, while Patrick's legislative and state government experience make him best suited to helping realize my vision for creating a comprehensive, post-Irene mental health system.”

From here on out, the Vermont Legislature will be considering and deliberating over the plan as well as taking testimony from various stakeholders as well as members of the public concerning how best to proceed.

Anyone who desires to be heard on these and related matters should make their opinions known to the Governor as well as to their local members of the Vermont Legislature, whether -- either or both -- directly or via letters to the editor in local or statewide newspapers.

Morgan W. Brown resides in Montpelier. His lived experience includes having been on the receiving end of the mental health system as well as having lived without permanent housing (aka homeless) in one form or another off and on since the age of seventeen (17). After a lengthy and painful twelve (12) years of living homeless, he became permanently housed once again in mid-August of 2009.

*Note*: posted update and have since updated link; last updated on Tuesday, January 10, 2012 at 11:33 AM (EST).

Vermont Governor Peter Shumlin Attends Mental Health System Transformation Council Meeting

2011-12-12T04:04:00.002-05:00

Governor Peter Shumlin, Administration Secretary Jeb Spaulding and other members of his staff attended a relatively lengthy portion of the mental health system Transformation Council meeting on Friday, December 9, 2011.

Seated to the left of the Governor is Christine Oliver, Commissioner of the Department of Mental Health (DMH).

As the Vermont State Hospital (VSH) Weekly Update from DMH Commissioner Christine Oliver and Deputy AHS Secretary Patrick Flood for December 9, 2011 stated, "... The Governor stopped by to listen to peoples’ concerns about developing responses to the loss of the state hospital and the needs of the mental health delivery system."

During his initial comments to those attending the meeting, Governor Shumlin repeated his commitment vowing not to return patients and staff to VSH in Waterbury.

View brief video clip (via Morgan W. Brown):

Earlier announcement (video via vtdigger):

Governor Peter Shumlin on VSH
(October 20, 2011)

Gov. Shumlin explains the state's plan for dealing with patients from the Vermont State Hospital, which has been closed since flood waters destroyed the building during Tropical Storm Irene.

In an e-mail on the subject received Saturday afternoon in reply to an inquiry of mine seeking clarification and confirmation after coming across an article from earlier in the week that appeared to contradict such and mentioned how an option might still include a plan to rebuild VSH at the Waterbury complex (see below article excerpts), Administration Secretary Jeb Spaulding stated how "the Governor and his Administration have absolutely no plans to put the VSH back in Waterbury on a temporary or permanent basis."

Excerpts of the article in question (read article in full, here; emphasis mine):

Vermont's share of cleanup costs from Tropical Storm Irene is shrinking

By Dave Gram, Associated Press | AP – Tue, Dec 6, 2011 10:25 AM EST

MONTPELIER, Vt. (AP) -- Cleaning up from Tropical Storm Irene is expected to cost Vermont a bit less than $100 million, considerably less than the $240 million officials earlier worried the state might have to pay.

Administration Secretary Jeb Spaulding said Monday that Vermont's cost is expected to be about $88 million under a best-case scenario and about $99 million under a worst-case scenario.

More than half of that money — $50 million — is earmarked for renovating the state office complex and Vermont State Hospital in Waterbury, said Neale Lunderville, the state's Irene recovery chief. The future of the Waterbury complex, one of the casualties when Irene triggered historic flooding in late August, is still being debated. Options include rebuilding at the site or moving the hospital and several state agencies that were housed nearby to other, less flood-prone locations.

[...]

(in the above photo, underneath the first paragraph at the top of this post, Administration Secretary Jeb Spaulding is fourth from the left, seated and against the wall)

Vermont Resident Suicide Statistics Paint Grim Picture

2011-11-13T23:46:00.001-05:00

(cross-posted to Green Mountain Daily, here)

*Updated* (with the usual edits)

When it comes to the delivery of community mental health and developmental disability services across the state, there are ten (10) catchment areas and each of these are served by one of the ten (10) designated regional community mental health centers (CMHC's).

Back in early September of this year, Art Woolf blogged a post to Vermont Tiger on the Department of Depressing Vermont Statistics, which regarded the state's suicide rate (here):

In its annual compendium on Vital Statistics, the Centers for Disease Control reports that Vermont's age-adjusted suicide rate was 13.8 per 100,000 population. That translates into 89 suicides in 2007 and gave Vermont a number of dubious distinctions.
The 16th highest suicide rate among the 50 states and well above the U.S. average of 11.3. Most of the states with higher suicide rates are in the West.
Only two states east of the Mississippi River, Kentucky and West Virginia, had higher rates than Vermont.
Within New England, Connecticut, Rhode Island, and Massachusetts had rates well below Vermont and below the U.S. average while Maine's rate was just under Vermont's and New Hampshire's rate was just below the U.S. average.

[...]

Read the entire blog post, here

As saddening as those statistics and facts might prove to be, even more disturbing are the recent regional and statewide data on resident suicides that has come to light of late. Apparently, however, this data has not been widely enough known or shared and, other than when individual suicides happen, also not widely known and reported on by the press or media as of yet either.

If there was any good news to be gleaned from the Vermont Resident Suicide Statistics provided by the Vermont Mental Health Performance Indicator Project (PIP) recently, which compared certain data over the last two twelve month periods (i.e., September 2009 through August 2010 and September 2010 through August 2011), four (4) of these ten (10) catchment areas experienced a decrease in suicides within the last twelve (12) month period reported in the statistics from what they were within the previous year.

That was the good news.

The bad news reported in these same statistics was how there has been an increase in suicides experienced within the six (6) other catchment areas.

Furthermore, based upon the data received thus far, although the number of overall suicides for the given time periods appear to indicate an increase of thirteen (13) additional suicides statewide between the two, when one wades through the different catchment areas of the state served by the different CMHC's and, while as mentioned above there has been a decrease in four (4) of those catchment areas that then brings down the overall number as far as actual increases goes, some of the six (6) other catchment areas have seen noticeable increases or even a spike over last year's number (the below areas and numbers are only those indicating increases in suicides over the previous twelve month period): i.e.,

Catchment area: 2009/2010 versus (vs) 2010/2011 = Increase

NCSS (Northwestern Counseling and Support Services): 7 vs 11 = 4

HC (Howard Center): 13 vs 18 = 5

HCRS (Health Care and Rehabilitation Services of Southeastern Vermont):
14 vs 22 = 8

RMHS (Rutland Mental Health Services): 5 vs 10 = 5

USC (United Counseling Service of Bennington County): 8 vs 9 = 1

WCMH (Washington County Mental Health): 9 vs 13 = 4

Total Increase (in the above six catchment areas alone, not counting the catchment areas that experienced actual decreases): Twenty-seven (27) suicides.

Thus the decreases elsewhere end up painting a picture that is somewhat misleading when these numbers are not looked at in terms of increases in each of the given local catchment areas that had experienced such as well as then added up as a whole in terms of overall increases over the numbers from the previous time period.

Therefore this is not merely a statistical increase of thirteen (13) suicides statewide, as would be the case when taking into account the decreases experienced elsewhere, but is actually an increase of twenty-seven (27) suicides above and beyond what transpired within those particular catchment areas as indicated during the previous time period.

It should also be understood how these numbers also do not take into account any suicides that might have occurred since the end of August of this year, which would also mean the increases in suicides indicated by the data occurred during a period of time mostly prior to Tropical Storm Irene and the closure of the Vermont State Hospital (VSH), save for a few days afterwards. That said, there is also deep concern over what has transpired since then, from September 1st of this year, as well.

In addition, the data also included statistics indicating how many of the suicides within each time period were by persons connected with the local CMHC within a given catchment area and both time periods illustrate how the majority of the reported suicides were committed by persons who had not been connected to CMHC services at the time.

However, due to its very limited scope in an attempt to answer the questions posed at the time, the statistical data does not provide information concerning whether or not any of these persons had attempted to connect with CMHC or other services and, if they had, if they were on waiting lists or were turned away for one reason or another. It would be important to have such data collected and analysed.

There is also a need to ascertain other general information and data concerning the persons and what might have led to their suicide that could indicate possible patterns and potential correlations to be assessed and learned from as well, which could help inform the state as well as community service providers about what needs to be done differently and better or otherwise be put in place.

That said, the state and its various community partners need not wait until all such information and statistical data is available in order to begin doing something meaningful to address these serious matters of concern in the time being either.

Beyond the above, the state and its various local community partners can also assess whether there is something beneficial to learn from the local catchment areas that have seen decreases as well.

They are as follows:

Catchment area: 2009/2010 versus (vs) 2010/2011 = Decrease

CSAS (Counseling Service of Addison County): 7 vs 2 = 5

LCC (Lamoille Community Connections): 5 vs 4 = 1

NKHS (Northeast Kingdom Human Services): 10 vs 7 = 3

CMC (Clara Martin Center): 8 vs 4 = 4

Unknown (no catchment area listed or known): 1 vs 0 = 1

Total Decrease (in the above four catchment areas -- and one unknown -- alone, not counting the catchment areas that experienced actual increases): Fourteen (14) less suicides between the two given time periods.

As the state moves forward in dealing with these matters and determines its priorities as well as funding choices for how to proceed, it would be crucial that it not make the mistake of robbing Peter to pay Paul however.

For example, by pouring additional resources to the six (6) catchment areas experiencing the increases in suicides of late and either not also equally supporting the other four (4) catchment areas as is also needed or providing less support to them in an effort to pay for additional services where they are sorely needed elsewhere.

The fact is we need to continue to support the other four catchment areas in their work or otherwise the consequences could make matters worse.

It should also be noted how none of this is to suggest the state did not have a problem with suicides prior to this either, because it of course still did (view statistical data for 1985 through 2006, here). However, as the more recent data referred to earlier within this post appears to suggest (here), the problem appears to be getting even worse.

There will be those among the state's political leaders and other policy makers who will not want to admit it, however it will not be a surprise if the successive cuts over the last several years -- including those made during the former Challenges for Change process -- to the CMHC's as well as many other community service providers helping those most in need across the state have resulted in such a dire fraying of the social safety net as to make it harder and harder to meet the needs being experienced at the community level.

Such unmet basic human needs and the toll they take on persons, families and communities eventually show up in higher rates of usage of various types of emergency services, hospital emergency rooms, prison, other forms of costly and dehumanizing forms of institutionalization including VSH-type settings as well as also resulting in unemployment, homelessness as well as, when it seems like there is no hope and one has run out of viable options one would freely avail themselves of, suicide.

With all the above seemingly focused up to now on access or the lack of access to formal or traditional medical model mental health and related services, it should also be pointed out how it would be important to provide such services in a very different and also voluntary manner versus what has been the case up to this point in time with the mental health system having a heavy reliance or dependence on forced or coercive treatment and its negative focus as well as usually bad or poor outcomes.

This could be done in a variety of ways, including creating a more robust community services system that is much more proactive, holistic, recovery-based, trauma informed, person-centered as well as driven and, thereby, addressing basic human needs (including in areas of housing) far more upstream versus usually waiting for the worse to occur and when it is more costly to do so.

In doing this however, there should be a serious increase in funding various alternative services and supports, including those that are peer-run and operated.

If the state takes opportunity the current crisis affords to create and provide services and supports people actually need and want to use, then people would be more inclined to seek as well as access such and less inclined to avoid a system many now dread will take over their lives and make them career mental patients.

If, rather than continuing to focus the bulk of funding on forced or coercive treatment most people would rather not have foisted upon them if given an actual choice, the state instead shifted its focus and energy as well as greater funding toward voluntary services and supports needed, people who often seek out services would not be turned away or put on waiting lists due to a lack of adequate funding.

Although it appears the state is now headed in this direction, not only are there those who are pushing back against such needed change out of fear and possibly other motives as well, the increase in suicides being seen points out an obvious need how crucial such changes are needed and also how certain things need to be put in place sooner rather than later.

All this could be done if these matters remain a top priority, which it now seems to be the case and also if the political will to bring such about is exercised, not just while these matters have our attention for the moment, but also when they once again become too easily forgotten or otherwise taken for-granted and have fallen off the table.

*Note*: Made several, mostly minor, edits for the purposes of clarification and readability; last updated on Monday, November 28, 2011 at 9:45 AM (EST).

Shumlin State Hospital?

2011-10-06T20:19:00.000-04:00

(cross-posted to Green Mountain Daily, here)

*Updated* (see *Update* below)

If Governor Peter Shumlin insists on replacing the Vermont State Hospital (VSH) and, the State of Vermont ends up building a new version of same old thing in order to do so, the new institution should be named Shumlin State Hospital or, Shumlinville for short.

However, it is hoped if enough people make themselves heard on these crucial matters, this might have a chance of changing the Governor's mind as well as the minds of others within his administration on the subject or, if not, then the minds of state legislators, so the state can avoid making the mistake of going in this direction.

If you have not already done so, please consider signing onto the petition urging the Governor to build a more robust community mental health system, not a new state hospital, here.

In addition, please also urge others you know to consider signing onto the petition as well, particularly anyone living or working within Vermont.

In the meantime, as is sadly apparent from recent news articles concerning VSH, here (via vtdigger; September 15, 2011), here (ibid; September 16, 2011) and, here (via Waterbury Record; October 6, 2011), it appears the Department of Mental Health (DMH) is heavily leaning toward deciding to return patients and staff to the upper two floors of the state hospital, which is where they were before the flood occurred after Tropical Storm Irene hit in late August and patients were evacuated across the state.

Although the letter did not delve into specific details concerning what the state should consider doing down the road, various advocates from across the mental health and disability advocacy community as well as their allies signed onto a letter recently sent to Governor Peter Shumlin urging him to not reopen VSH. Read the letter (via vtdigger), here.

This is an extremely crucial step, being among the next of many vital steps that have to be taken, which include not replacing the state hospital with what would merely prove to be a new version of the same old thing, but rather to do what the aforementioned petition urges: i.e.,

... support the building of a more robust community-based mental health services system, including a major increase in peer run alternative services and supports as well as more affordable housing opportunities, in order to foster a holistic and healing, cross-disabilities, independent living, recovery-based and trauma-informed model, rather than building a new Vermont State Hospital (VSH).

Make sure your voice is heard on these matters as soon as possible, since, it is definitely now or never!

*Update*: Although there is a good chance it will not work out for a number of reasons, assuming they are successful in negotiations with the bank that owns the property, the state appears to be seriously exploring whether the former Pine Ridge School in Williston is feasible to use for a location for at least the next two or three years or so.

However, a return to the upper two floors of the now idle Vermont State Hospital is not yet ruled out either.

Read about it, here (via VPR News) and, here (via vtdigger).

In other news, while shopping at the local downtown supermarket this evening, Vermont Press Bureau chief Peter Hirschfeld came over and struck up a conversation with me, during which he also mentioned how he has written an article concerning the crisis emergency rooms are experiencing as reported to him by DMH Commissioner Christine Oliver as well as some emergency room doctors and the like.

If I recall correctly, I think Peter stated it would be in Sunday's Times Argus and Rutland Herald, more than likely behind the paywall of course.

For my part, although I conceded there is certainly a crisis and it might not get better anytime soon, I also provided the context of how this has in fact been a real bad problem for a long while now anytime the census was running near or at its maximum and the rest of the community system was deep in stress and continually under funded and overworked, long before the flood and displacement of VSH patients and staff, etc.

What is called for is an entirely new and different, more humane and holistic, healing, person-centered and driven approach, not merely more of the same old thing we already well know does not work and only ends up failing those we are seeking to assist and serve, oftentimes when it is way too late, when people are usually given up on and forgetten, then thrown away in some dumpster we term to be a "state hospital" or otherwise end up in prison, at a homeless shelter or the streets, etc., which bring about the worst of outcomes.

We can and sorely need to do better as well as differently, sooner rather than later and, guess what(?), there are many other options available to do so that not only truly work in vastly improving outcomes and quality of life, but they are also much more affordable to boot.

There is no good reason or excuse not to do so either, save deliberate indifference.

End of rant.

*Note*: posted an update; made several edits for the purposes of clarification and readability; last updated on Saturday, October 8, 2011 at 1:33 AM (EDT).

Archived Video: Vermont “Peer Support Around the World” Conference (9/2/2011)

2011-09-29T15:21:00.000-04:00

Summary is an edited version drawn from the summaries posted on the video pages:

On Friday, September 2, 2011, the Vermont Association for Mental Health (VAMH) hosted Renzo De Stefani, Director of Mental Health Services of Trento (Italy) and his UFE Coast to Coast (CTC) team at the Peer Support Around the World Conference, held at the Capitol Plaza Hotel and Conference Center in Montpelier, Vermont.

During the afternoon session (parts two and three), Kathleen Bertotti, Emanuele Torri and De Stefani as well as others presented Trento’s mental health system and its UFE program, which utilizes a unique combination of peer and professional supports. The doing together approach in Trento, which combines the expertise of peers and families with the knowledge of professionals, improves the quality of services provided by the system, placing the patient truly at the heart of the system of care.

Learn more about the Trento Mental Health Services UFE program, here.

This is an excerpt of the UFE CTC team blog post that provided a brief report of their experience in Montpelier (here; slightly edited):

[...]

Montpelier (Vermont) has closed the week. A crow[d]ed room where people exchanged stories about peer support and recovery: in this way started the day organized by Vermont Association for Mental Health and “Friends of Recovery”. Their slogan is that the recovery process can occur everywhere and that it is important working to realize this good practice at best. We feel close to this thought, we have already done something… but what else can we do? An afternoon devoted to Trento experience, but with a surprise: a huge piece of cake for our UFE Maurizio because today, the 2nd of September, he gets older… in addition to the piece of cake, a postcards with hearts, too… We wonder if Maurizio is hiding something! [...]

Earlier in the day (part one), the conference also featured presentations by some of Vermont’s peer support programs as well as a question and answer session with those in attendance.

View the archived video in three parts:

Part 1:

Part 2:

Part 3:

Mental Health Matters Interview: Dan Fisher & Lauren Spiro

2011-09-05T12:31:00.000-04:00

Psychiatrist Dan Fisher and mental health clinician Lauren Spiro, both of whom recovered from schizophrenia, are interviewed about their experiences, and about their new program Emotional CPR.

Emotional CPR (eCPR) is an educational program designed to teach people to assist others through an emotional crisis by three simple steps: C = Connecting P = emPowering, and R = Revitalizing.

Learn more about Emotional CPR (eCPR), here.

Finnish "Open Dialogue" recovery model

2011-09-04T20:41:00.000-04:00

The Finnish Open Dialogue recovery model actually works, is a more humane approach in dealing with people in crisis across the board (i.e., not just when it comes to mental health or emotional crisis') as well as being much more affordable to boot.

Read about how high recovery rates leave many psychiatric beds empty, here.

Trailer for "OPEN DIALOGUE,"
an alternative Finnish approach to healing psychosis

Trailer for "Open Dialogue," a 74-minute documentary on the Western Lapland Open Dialogue Project, the program presently getting the best results in the developed world for first-break psychosis -- approximately 85% full recovery, a far majority off anti-psychotic medication. Filmed in Finland. Directed by Daniel Mackler. [...]

Jaakko Seikkula Speaks on Finnish Open Dialogue,
Social Networks, and Recovery from Psychosis

Here I interview Jaakko Seikkula, PhD, a professor of psychotherapy at the University of Jyväskylä in Finland who is best known for his work with Finnish Open Dialogue. He speaks about the value of engaging social networks in crisis situations, the development of the Finnish Open Dialogue approach, the idea that there is meaning behind psychosis, and some unexpected benefits in Western Lapland of including family members in therapy with people experiencing psychosis.

[...]

Learn more about the Open Dialogue documentary film as well as related films, which are available via DVD and can be purchased, here.

Additional information about the Finnish Open Dialogue project is available on the National Empowerment Center (NEC) Website on the Additional Studies of Alternatives to Hospitalization page (here), which includes links to two follow-up studies about the Finnish Open Dialogue project (via PDF; Adobe Acrobat Reader required), one at two years, here and, the other at five years, here.

Taking the Road Less Traveled

2011-09-03T14:57:00.000-04:00

(cross-posted to Green Mountain Daily, here)

While reflecting upon and then pondering where the state currently is with what is proving to be a fork in the road when it comes the enormous and severe damage caused by tropical storm Irene across Vermont, including at the state office complex as well as the Vermont State Hospital (VSH) facility in Waterbury (here) and, what lies ahead as well as how this crisis provides a unique opportunity for finally accomplishing what previously had been talked about for over twenty years as concerns VSH, the last three lines of the final stanza of Robert Frost's poem The Road Not Taken comes to mind:

[...]
Two roads diverged in a wood, and I—
I took the one less traveled by,
And that has made all the difference.

In this particular case, as pertains to VSH and what would be the best course to take in terms of the future of the mental health system across the state, doing so would take plenty of courage, prudent risk taking, wisely changing one's priorities, exercising the will and leadership to make it happen, widening one's circle of those to be included in the process from the get go outside the usual inner circle as well as providing for complete and thorough transparency at all levels.

Up to now, when others who should be equals at the table have been part of the discussion -- if one can even call it that, for the most part what they have to say is not fully considered on par as is the case with certain others, particularly when it does not fit with the fixed or rather set agenda as well as selected priorities and goals of those seemingly bent on leading from the top down as best serves their own interests.

It is high time for inclusion rather than exclusion and openness rather than continuing to do things behind closed doors or otherwise during meetings or other conversations with mostly insiders as well as those with direct and financial interests.

This is public policy after all and a lot is at stake, including what will determine the future of the mental health system in Vermont for the next 50 years or more as well as millions upon millions of taxpayer dollars too boot.

In my opinion, I believe the citizens of our state are up to the task if they are only given the chance to consider being part of the solution beyond their being expected to pay for it over the years. In addition, those who have also been invested in these matters for years upon years*(1) certainly have been doing all they can to be part of the process of improving the mental health system as well.

*(1: e.g., various stakeholders including peers [read: people with lived experience of being on the receiving end of the mental health system], family members, advocates, etc.)

It is only hoped that the state's political leaders, rank and file members of the state legislature and those working in the mental health field, among others, will be up to doing what is required as well. Only time will tell however.

If you have not yet signed the petition urging Governor Peter Shumlin to support the building of a more robust community-based mental health services system, including a major increase in peer run alternative services and supports as well as more affordable housing opportunities, in order to foster a holistic and healing, cross-disabilities, independent living, recovery-based and trauma-informed model, please consider doing so, here.

VSH Evacuated Due to Flood Damage

2011-08-29T22:07:00.001-04:00

(cross-posted to Green Mountain Daily, here)

*Updated 5x* (view *updates* near bottom of post, below the fold)

News accounts and other sources have reported that the Vermont State Hospital (VSH) has been evacuated, with those locked up there being sent to various sites across the state, here (via Burlington Free Press).

State Representative Anne Donahue (R-Northfield), who also is editor of Counterpoint, reported (via e-mail; posted with direct permission):

I was at the state hospital this afternoon; many unsung heros there. They were without power beginning last night. Ground floor flooded several feet deep (this includes the intake offices and the Brooks Rehab patient unit.) Those patients were moved to spend the night in the treatment mall. Red Cross brought McDonald’s breakfasts this morning. The estimated time for repair of the state office complex is 2-3 weeks, thus beginning this morning, staff began identifying emergency placements for all 51 patients, and expected all evacuations to be completed by nightfall. About 16 going to the Brattleboro Retreat, 7 to Fletcher Allen, other scattered with staff in groups of 3 or less, one group temporarily housed at Springfield Corrections with their own VSH staff in a separated area. Doug Racine and Christine Oliver were on site throughout. All was going on without power and with impaired phone contact… forget about electronic health records. I saw the chair of the dept of psychiatry at FAHC loading a cardboard box of patient files into his car to take to Burlington.

Longer e-mail from Anne Donahue (excerpted; posted with permission):

... estimated 2+ weeks before VSH can reopen.
Here’s the breakdown (I may miss a few):
16 Brattleboro Retreat
7 FAHC
7 to Southern Corr. Fac, staying on a separated unit with GMH (not corrections) staff
5 to Second Spring, which is temporarily accommodating an “over census”capacity
1 Meadowview
1 Pines Nursing Home
1 Lamoille (discharge was already anticipated)
3 Batelle House
4 [can’t read my scrawled notes]
Doesn’t quite add up perfectly…

In most cases, they were being accompanied by VSH staff, to be providing the necessary extra staff.

National Guard had been called in last night on standby if Plainfield dam had a water release, for an emergency evacuation then, which was not necessary. However, there was no electricity or food since losing power late yesterday, Staff functioned in the dark overnight. Reception and Brooks Rehab were flooded out (many feet of water), and Brooks Rehab patients stayed in the treatment wall.

This morning it became clear that restoration of power and other repairs would be lengthy, and they began the process of making calls to place patients.

Doug Racine says BGS said it would be 2-3 weeks time for the campus, but he told them all efforts must focus on VSH first.

Patient files were being hand carried to go with patients.

[...]

The river surge power a was incredible. Office furniture was strewn around rooms. The staff locks on Brooks Rehab were knocked onto the floor. Everything was slippery with mud.

Racine, Christine Oliver, etc, etc, were there all afternoon.

[...]

So, as I understand it based on news accounts as well as other sources, including Anne Donahue among others, fifty-one (51) or so people who had up until today been locked up at VSH have been or currently are being transferred elsewhere across the state due to the recent flooding and damage caused by it.

This, however, potentially proves a point I have made over the years of how the state not only could have closed the state hospital long prior to now, but could have also relocated patients elsewhere in order to do so.

In my opinion, the state should not reopen VSH and, particularly for those placements that might only be considered more temporary in nature of one sort or another, the state should find other placements for those who could be elsewhere, including where appropriate, within permanent housing in the community of their choosing for those who should no longer be held at VSH or other such facilities but have continued to be held there due to lack of either other less restrictive setting placement or permanent housing, etc.

*Update 1*: Word is, much like most of the rest of the Waterbury office complex as I understand it, which includes the headquarters of the Agency of Human Services (AHS) as well as some of its departments, the Department of Mental Health (DMH) has no e-mail at this time, as their servers either had been underwater or are still without power or both.

Word also is that Washington County Mental Health Services (WCMHS) has taken ten (10) people total from VSH into Second Spring and other facilities of theirs.

WCMHS has also created shelter for nine (9) people from the Kirby House community care home within their transitional recovery program in Waterbury and have taken two additional residents to crisis beds and have arranged for cots through Red Cross for sleeping. The WCMHS "Sunrise House" day treatment program located in Montpelier is preparing and delivering food.

In addition, WCMHS provided support to residents during their evacuation and bus ride from a trailer park in Berlin and assisted Red Cross at the Barre City Auditorium.

Have also received word about how four (4) people from VSH were placed at Hill House and Robinson House at Counseling Service of Addison County.

*Update 2*: From the Burlington Free Press, here (paragraphs 18 and 19):

[...]

Nearby, the Vermont State Hospital, where 51 psychiatric patients were housed, was evacuated Monday. The patients were sent to various private facilities around the state and the state prison in Springfield. Some employees were sent with them and are being housed in motels, Mental Health Commissioner Christine Oliver said.

Oliver said the details of how much the state will pay those facilities or how long the patients will be there had not been worked out when the move was made. Racine said Wednesday that the arrangements were made with the expectation that they would be for weeks, but because it now appears it will take months to make repairs in Waterbury, some of those patients might have to be moved again.

[...]

*Update 3*: In response to the above update (i.e., update 2), which I had sent out via e-mail as well, someone replied with the following (posted with permission on condition of there being no attribution):

It takes a village to raise a child. It takes a hurricane to close a state hospital.

*Update 4*: Within an e-mail to Governor Peter Shumlin and top members of his administration, I shared the following (excerpted):

[...] based on conversations I have had with others who have been following and very interested in these matters whether via e-mail, instant messaging or in-person, I have found I am not alone in my sentiments that repairing and reopening the Vermont State Hospital (VSH) is not a wise or prudent decision, nor a good or best use of taxpayer dollars and other resources. This, particularly given how prior to tropical storm Irene and the destruction it caused, top members of the administration -- including Agency of Human Services (AHS) Secretary Doug Racine -- have previously stated how VSH should have been closed 20 years ago and is a not suitable or safe environment for persons who are locked up there or staff working there, nor could it be rehabilitated in order to improve it enough to make it more suitable either. The crisis at the state hospital and what to do with after the facility was damaged so significantly by tropical storm Irene should be taken as the opportunity that it is and VSH should be shuttered once and for all. It makes no sense to attempt to repair it as much as can be afforded when there are plans to close it down the road, no sense at all. That said, do not take my word for it, ask around and find out for yourself. If you have not already done so, please reconsider this decision very carefully.

Morgan W. Brown
Montpelier

For those who are so inclined, although he and members of his administration are quite busy with many other matters at the moment, now is the time to weigh in and share your views on the subject of VSH as well as the mental health system as a whole with Governor Shumlin, well before they proceed any further, here. This is well worth doing! It is now or never!

*Update 5*: It is my understanding that the Department of Mental Health (DMH) has received five (5) proposals that would reduce the numbers of VSH beds, however the proposal by Collaborative Solutions Corporation (CSC) would appear to completely eliminate the need for state hospital beds and allow for closing the facility.

That said, the proposal is still very much residential and institutional heavy, nor is it entirely truly community-based and certainly does not appear to include peer-based alternative approaches, nor permanent housing opportunities for people to move onto, either. In addition, many of the sites would have more than six beds, when three to six beds are better. Not too mention how this is still the medical model approach, highly dependent on the use of psychotropic medication, including of the forced drugging variety, not to mention shock treatment (ECT).

To my knowledge this proposal was written and submitted to DMH well prior to tropical storm Irene and done so in response to an informal request stated by DMH Commissioner Oliver for proposals for a community-based approach after the administration decided to go through the motions of reconsidering its plan to build a new version of the same old thing all while at the same time continuing to barrel ahead full steam with their original plans.

One fear is how the administration and others concerned could also now consider more fully rehabbing the existing VSH facility in Waterbury and remaining there when it is once again habitable, given how it would take at least a few months to restore enough to bring people and staff back again anyway, so what is another few or more months added on.

This despite how administration officials -- including Agency of Human Services (AHS) Secretary Doug Racine -- had previously stated how VSH could not be sufficiently rebuilt in order to provide a safe, sound facility.

Rather than being what it took to close VSH, tropical storm Irene could be what it takes to rebuild it and remain in place for 50 or more years.

Stayed tuned ... (as additional information as well as reports become available, this post will be updated accordingly)

*Note*: posted an update; last updated on Friday, September 2, 2011 at 12:09 PM (EDT).

TOTD (thought of the day): On 'Normal', 'Crazy', 'Insane', et al

2011-08-25T02:01:00.003-04:00

If it is true that there is no such thing as 'normal', then it is also true there is no such thing as 'crazy' or 'insane' and so on, save these merely serving as convenient rationalizations and labels providing those embracing them with both justification and means to marginalize as well as discriminate against whom or what they do not understand, disagree with, are prejudiced against and fear.

Mental Health Advocacy Humor Break

2011-08-21T21:24:00.000-04:00

(cross-posted Green Mountain Daily, here)

As sent to Vermont Department of Mental Health (VT DMH) Commissioner Christine Oliver, among others within the administration, fyi (hey, if one cannot have a little fun in this "business", it just isn't worth the bother doing):

Mental Health Advocacy Humor Break

Since it is on sale this week, I bought my first pint(s) of Ben & Jerry's Ice Cream in a real long time. Could not decide on which of two different flavors to get, so ended up buying both. It is good to be able to enjoy the premium brand name version, rather than generic (lesser quality) versions, of my one and only preferred anti-depressant medication, which is always best when taken proactively of course. I only wish doctors were able to prescribe such and insurance covered it, then I could afford it more often when needed. The fact is I am not, nor have I ever been "treatment resistant", just very particular about using what works, not what doesn't.

Okay, the humor break is over now, sort of anyway.

Moral of the story aka food for thought:

Maybe if the State of Vermont were to consider voluntarily offering Ben and Jerry's Ice Cream, as well as, even more importantly, other things people could use to meet their basic human needs, including safe, decent and affordable housing when needed, rather than trying to find ways to make it easier as well as faster to force medicate and otherwise "treat" them (read: "treatment") when they are experiencing a major crisis leading to the emotional and or so-called mental or psychiatric variety or vice versa, people would heal and eventually get better, outcomes would improve, as would their quality of life and, it would be more affordable to do too boot.

While the ice cream might not seem to be so important or vital in the greater scheme of things, it surely could not hurt and certainly would be an improvement over many of the damaging psychotropic drugs, including with all their hazardous effects, people are forced to take.

That stated, the key factor is most of the time they are denied choice in what should be their own treatment decisions, which should not be up to anyone else to make for them.

Do not take my word for it however, try a pint of Ben and Jerry's and then try the medications forced on people locked up at the Vermont State Hospital (VSH) for yourself and find out which you would most prefer if truly given the choice.

Although the above also touches on more serious matters and concerns afoot of course, it is hoped it is received and taken with the dose of humor it is dipped as well as wrapped within.

:-) [smile]

Morgan W. Brown
Montpelier, Vermont

"Nothing in life is to be feared, it is only to be understood. Now is the time to understand more, so that we may fear less."
-- Marie Curie
French (Polish-born) chemist & physicist (1867 - 1934)

Time to Close VSH, Support Community Services

2011-07-24T02:40:00.000-04:00

Governor Peter Shumlin recently declared his firm commitment to replacing the embattled Vermont State Hospital (VSH) with a new version of the same old thing. Besides building along these lines, the administration's plan also includes providing an additional 16 to 24 beds elsewhere as well.

This all to the tune of millions and millions of state taxpayer dollars in remaining dependent on an outdated institutional treatment model surely to follow wherever the facility or other such beds would be located.

This is much like had been done in New Hampshire to the detriment of the community mental health system there and, as a result, the state came under scrutiny by the U.S. Department of Justice, which issued a scathing report earlier this year (here and, here).

Such monies, as Governor Shumlin is recommending be put aside to replace the state hospital in this fashion, could be better used to build the holistic as well as more robust community-based system needed in closing VSH and, not replacing it, save for a small forensic facility to be located somewhere within the state.

If we could close the former Brandon Training School without building a new version of the same old thing, creatively putting in place a more robust community-based system for people who formerly had been locked away at Brandon, we can indeed close VSH and, although there might be differences in such a system, do much of the same for our fellow citizens currently forced to languish at the state hospital, in prison, in homeless shelters or on the street.

When it comes to huge investments of state funding as well as long-term public policy matters of this nature, there also is a need for more of a detailed public discussion and input process than has been the case up to now.

It is time for concerned citizens to let Governor Shumlin and his administration hear directly from them regarding these matters.

As the cross-disability community slogan states: Nothing about us without us!

Read more on the subject, here.

Read Joseph Gainza's letter to Governor Shumlin on the subject, here.

Governor Shumlin Stuck On Building New VSH

2011-07-22T00:02:00.005-04:00

The 7th and 8th paragraphs of an Associated Press article concerning state budget and revenue issues would appear to confirm Governor Peter Shumlin's solid commitment to the plan to build a new version of the same old thing (read: institutional treatment model) when it comes to replacing the Vermont State Hospital (VSH):

‎[...]

Shumlin responded to the slightly upgraded forecast by saying he wants to boost the amount of money the state sets aside in its reserve funds to boost them from 5 percent to 8 percent of the state's overall budget. The first-term Democrat said he would also like to set aside some of the excess revenue to pay for a new state hospital for the mentally ill when plans for the facility are finalized later this year.

The state has been struggling for more than a decade to decide what to do about replacing its existing, 120-year-old hospital in Waterbury, which has been decertified by an arm of the U.S. Department of Health and Human Services, costing the state about $8 million a year in federal money.

[...]

Read the article (via Greenfield Reporter), here.

Vermont Public Radio (VPR) also reports (12th and 13th paragraphs, here; emphasis mine):

[...]

(Dillon) The state closed the fiscal year with about $37 million more than projected. But Shumlin says the money is needed in two areas. First, he wants to raise the state's reserve funds in order to have money set aside for future economic downturns.

(Shumlin) "If the last few years taught us anything it's that our reserves are not high enough for tough times. And second, I very much want us to start putting aside money to build the state hospital. We have our most vulnerable population of Vermonters in unacceptable conditions. That's not the way we treat people in Vermont."

[...]

This is not good, not at all.

Besides building a new state hospital, the administration's plan also includes providing an additional 16 to 24 beds at the Brattleboro Retreat as well, all to the tune of millions and millions of taxpayer dollars in remaining dependent on VSH and the outdated institutional model that will follow no matter where it is located.

This is much like had been done in New Hampshire and, as a result, they have been under the gun by the U.S. Department of Justice (here and, here).

Such monies, as Governor Shumlin is recommending be put aside to replace the state hospital, could be better put to use as bridge money that could be used to leverage additional funding toward building up the holistic community system needed in order to close VSH (e.g., including creating more Safe Haven's, affordable housing, additional peer-run drop-in centers, peer-run respite beds and other services and supports needed across the state, etc.) and, not to replace it, save for a small forensic facility to be located somewhere within the state.

If we could close and not replace Brandon Training School with a new version of the same old thing, building the community system people formerly locked away there now enjoy instead, we can indeed close VSH and, although there might be differences in the system that is needed to be put in place, do much of the same.

Now is the time to let Governor Shumlin hear from concerned citizens regarding these matters directly (briefly, to the point and, most importantly, politely).

If one e-mails the Governor and, are so inclined, afterwards feel free to send me a copy of the same e-mail (within it let me know if I can quote from it for a blog post on the subject for Vermont Watch and whether I can include your full name (or only first name) and town/city (refer to my profile for contact information).

In helping make this more of a public discussion, which is how this public policy should be (as well as should have been up to now), if one is on Facebook, one can also post a comment about such to his Facebook page as another means to provide feedback (here).

If one uses Twitter, one can tweet him as well by adding @vtgovernor to such tweets (include #vtgovmh hashtag). Also consider following my tweets posted on @vtwatch.

In addition, read and, also feel free to join, the conversation taking place within the comments section of a blog post of mine posted at Green Mountain Daily on the subject, here (in reply to a request for reading material, I have posted several links to studies and articles, etc., within the comments section as well).

Yet another online advocacy resource is the Vermont Advocacy Resource Toolkit.

Do not wait to speak out and be heard on these matters, it is now or never!

What is crucial to keep in mind is this effort should not be so much about providing push back against these plans by the administration, but rather to push forward toward building the enhanced community-based system that is needed and what we know works versus what does not as well as why, etc., instead.

Found on the Vermont Center for Independent Living (VCIL) 2011 Vermont ADA Celebration informational page (here):

[...]

Congress passed the Americans with Disabilities Act in 1990 with an eye toward preventing discrimination, in all aspects of society, against people with disabilities. President George H.W. Bush signed the act into law, proclaiming, "Let the shameful walls of exclusion finally come tumbling down.”

[...]

Remember: Nothing about us without us!

Shumlin Administration Floats Its Plan to Replace VSH

2011-03-28T07:17:00.006-04:00

*Updated 2x* (update 1 is below fold and following article excerpts)

This mornings' edition of the Brattleboro Reformer includes an article about how Governor Peter Shumlin's administration is floating what is purported to be the beginning stages of their plan to replace the Vermont State Hospital (VSH).

However, as an aside, unless the reporter knows something most of the rest of us do not, it appears they got the last name of the Commissioner of Mental Health wrong. Had thought her name was Christine Oliver, not Christine Rivers. (*Update 2*: online edition of news article has been corrected and, as such, the below excerpts were updated accordingly)

~~Other than that, k~~[K]ey excerpts of particular interest are (paragraphs 2, 5, 10, 11, 15 and 16; entire article, here):

[...]

Vermont Commissioner of Mental Health Christine Oliver was in Brattleboro earlier this month to take a look at the facilities and see if the Retreat will be able to take some of the state's most severely mentally disabled patients.

[...]

Now, Oliver said, state officials are sketching out a plan to construct a new stand-alone facility on the grounds of the Central Vermont Medical Center in Berlin.

[...]

Oliver said the Department of Mental Health is taking a fresh look at the state hospital plan and she said the Shumlin administration is hoping to bring its new idea forward to the Legislature next year.

"The plan to build a new hospital at Waterbury is out," said Oliver. "We have a (certificate of need) to build in Waterbury but everyone wants to take a fresh look before we commit to anything."

[...]

Oliver said the newest plan is in the very early stages and she could not say how much it would cost or when the state hospital could be closed.

If the 15-bed hospital is built in Berlin, the Retreat would possibly take some of the patients, with the rest going to Rutland Regional Medical Center, the Veterans Administration Center in White River Junction and Fletcher Allen Health Care in Burlington.

[...]

Read the article in full, here.

*Update 1*: Having placed a call earlier to make an inquiry this morning, just before noontime I received a call back from Susan Kruthers, Vice President of Community Relations and Development for Central Vermont Medical Center (CVMC) on behalf of CVMC President and CEO Judy Tarr.

Out of our conversation the following was learned:

There have been two (2) meetings between Commissioner Christine Oliver, Vermont Department of Mental Health (DMH) and Judy Tarr as well as Richard Morley, Vice-President of Support Services, CVMC.

DMH approached CVMC to inquire what they might be willing and able to do in terms of helping to replace VSH by building something on CVMC grounds.

Susan Kruthers stated that "CVMC certainly supports the idea of replacing the facility in Waterbury with a facility comparable or greater size to the state hospital" and the "building of a standalone 54-bed state hospital near CVMC." However. she also stated that there would be "no new hospital built on CVMC grounds, because we do not have the space in the campus." In addition, "CVMC is not planning to own, manage or build it."

*Note*: posted updates; last updated on Tuesday, March 29, 2011 at 7:17 AM (EDT).

Try "People with ..."

2010-11-13T02:20:00.005-05:00

Below is my comment post posted in response to an article which does a rather poor job at pretending to ask "what should we call people with mental illness" when the author is really asking about "what should be done with such people" and what is the author's true agenda behind such obfuscations and their purported justifications: i.e., forced drugging aka forced treatment, here (via Huffington Post [last paragraph slightly edited for purposes of clarification and readability]):

The question posed both within the title as well as the article was answered within the same.

Just as if it were cancer, heart disease or diabetes being discussed, it should be no different: i.e., "People with ...".

As far as the other, separate questions raised and also somewhat confused within the article by its author, the other terms mentioned (e.g., ''Client'', "Consumer" or "Survivor") would appear to speak more to one's perspective as well as experiences within treatment settings or systems of care than to whether people should be referred to as being people or labeled as either things or what disease or illness they are either diagnosed as having or perceived to have.

The fact is the article attempts to compare apples to oranges.

The difference is found within the context as well as the application.

By the way, I am known to independently employ the term 'people with lived experience,'' and, speaking for myself, prefer to use this concerning those profound, "serious and persistent" life experiences others term as "mental illness" *(1), homelessness and the severe abuse received at the hands of others that had preceded these experiences of mine and the resulting trauma, not too mention abuse and additional trauma experienced afterwards, including what was called treatment.

*(1: as if these were something merely either wrong with or broken within me)

Lastly, no matter what is being debated, we all ~~our~~[are] more than the sum of our parts, including our brains.

Read the article, as well as the other comments posted in response to it, here.

Under the Dome Videos: Public Hearing - Mental Health Oversight Committee Parts 1 & 2 (8/19/2010)

2010-08-28T02:37:00.000-04:00

Under the Dome: Public Hearing - Mental Health Oversight Committee Part 1 of 2

Under the Dome: Public Hearing - Mental Health Oversight Committee Part 2 of 2

The Legislative Mental Health Oversight Committee holds the third of four statewide hearings to learn about mental health and substance abuse services offered from the community perspective. The Committee will hear from representatives from HowardCenter, Fletcher Allen Health Care, the business community, civic organizations, police departments and from the Department of Mental Health.

[via CCTV, here (Part 1 length: 1:59:26) and, here (Part 2 length: 1:20:03)]

VT Dem Guv Candidates Answer Question re: VSH & Mental Health At Large

2010-07-29T00:13:00.000-04:00

On Tuesday, July 27, 2010, during a Vermont Democratic Gubernatorial candidates forum televised as well as streamed online by local cable access CCTV - Channel 17 - television in Burlington, VT, the first caller into the forum (yours truly) asked each of the candidates about if they were the next Governor, what they will do concerning both the Vermont State Hospital (VSH) as well as mental health at large across the state.

View archived video of forum:

Susan Bartlett for Hyde Park, Matt Dunne of Hartland, Deb Markowitz of Montpelier, Peter Shumlin of Putney, and Doug Racine of Richmond seek to win the Democratic Primary for Vermont Governor. Hosted by Rob Michalak and co-sponsored by Vermont Businesses for Social Responsibility.

[via CCTV, here; length: 1:15:40 hours/minutes/seconds]

Jim Leddy Op-Ed: Two Crises, One Solution

2010-06-14T22:29:00.002-04:00

Back in 2004, then State Senator Jim Leddy offered the following comments concerning the dreadful conditions of the Vermont State Hospital:

New England Psychologist
Suicide likely to delay plans to revamp Vermont State Hospital
(December 2004 Issue)

[...]

Legislators and others have expressed concern that the administration of Governor Jim Douglas is moving too slowly on the hospital planning initiative. "I suggest we have lost a year," says Mental Health Oversight Committee co-chair State Sen. Jim Leddy (D-Chittenden) in remarks before the annual meeting of the Association for Mental Health. "I can't imagine that for another population, another disability, we would take so long to figure out what we should do."
[...]

[...]

Read the entire article, here.

That was then and, nearly six years later, the following op-ed submitted to area newspapers for publication is now (posted as is with direct permission and with thanks to Jim Leddy for thinking to send it my way; am including an excerpt from his note since it hits the nail on the head as usual):

[...] ... The treatment of Vermonters with serious mental illness often exists below the radar screen. Hopefully this op-ed will help focus attention on a problem too long ignored.
[...]

--Jim Leddy

Read Op-Ed by Jim Leddy, here (via Vermont Watch blog).

Involuntary?

2010-05-16T00:39:00.007-04:00

*Updated* (with the usual edits)

(cross-posted to Green Mountain Daily, here)

Within the two-year legislative session that recently ended, the State of Vermont once again attempted to make it both easier and quicker to impose its will upon people who come within the mental health system concerning what it perceives and terms as being a necessary form of treatment (here; via ACLU-VT legislative update).

It should also be noted that the context of these efforts were addressing non-emergency settings only and not emergency situations.

In fact the Agency of Human Services (VT AHS) and the Department of Mental Health (VT DMH) tried to sneak it in as part of the Challenges for Change 2 bill (the legislature declined doing so however).

That stated, rather than focus on those efforts and how they played out, I will instead speak to the use of language and what appears to be behind such as well as some of its consequences, relating to the use of the term involuntary within the context of mental health treatment settings.

When it comes to the use of force and violence imposed by the state upon persons in any mental health or behavioral treatment setting (i.e., institutional or community), the jargon usually employed is involuntary treatment as well as involuntary medication.

These uses of the term involuntary makes such actions against individuals much more socially acceptable and also causes many people to further their beliefs that whomever is on the receiving end must be well deserving, oftentimes without any questions or concerns being raised (read: deliberate indifference).

Although it might be true that definitions of the term involuntary include any action done against the will of an individual, not willing or voluntary or, put another way, something done without the informed consent of the individual upon whom an action is taken, it is also true that the term is defined as an action having been without intention or done unintentionally, etc.

The truth of the matter is that when the state inflicts its will upon individual persons in this fashion, it involves outright force and violence as well as degradation inflicted upon the person.

It might not be desirable for someone to be locked up against one's will for any length of time, however it is even worse to be drugged and otherwise receive treatment (e.g., shock treatment, also referred to as ECT) in such a manner; which can often happen by the use of rubber stamp court appointed guardians that the state recruits for these purposes so they can get their way, if they cannot do so otherwise.

Many of those who have undergone force drugging and treatment compare it to no less than rape.

Not only have I heard people refer to forced drugging as such, but I have also witnessed the obvious and sometimes not so obvious wounds and scars caused to their emotional health and soul.

This makes one wonder why, if it would of course be totally unacceptable among most people within our society to term either sexual molestation or rape as being involuntary touching or involuntary sex, why is it then permissible as well as acceptable -- simply due to it being done on behalf of the state -- to term forced drugging and forced treatment as being involuntary medication and involuntary treatment?

Such actions taken against citizens by the state should rather be understood as well as termed what they indeed are: i.e., forced drugging and forced treatment.

It should also be noted that none of this is about the use of politically correct language either.

Instead, what this is about is calling things what they truly are, as well as, defending the civil rights of all citizens, including those whom some in society would like be kept out of sight, out of mind (sometimes quite literally, or so it seems).

If you have not already done so, please read related commentary of mine, here.

*Note*: made several edits and corrections for the purposes of clarification and readability; posted cross-posting link; last updated on Sunday, May 16, 2010 at 2:59 AM (ET).

ACLU-VT: Changes To Mental Health Laws Turned Back

2010-05-15T22:36:00.001-04:00

*Updated* (see below)

ACLU-VT 2010 legislative wrap-up

May 14, 2010

[...]

Changes To Mental Health Laws Turned Back

The Douglas administration tried but failed to make changes to the involuntary medications law. It also sought to collapse commitment and involuntary medication into one procedure.

The proposals, contained within the administration's Challenges for Change bill, were part of an ongoing struggle to deal with the planned closing of the state hospital in Waterbury. The plan has been to have designated regional hospitals provide necessary mental health services.

Contention has arisen around exactly how those hospitals would carry out the important procedures that provide the due process needed to commit someone or force them to take medication. The ACLU, and other advocates, believe the proposals violate due process rights and increase coercion.

Despite this year's success in fighting these changes, the issues won't go away until the state addresses the need for services now provided at the state hospital. (It should be noted that legislation did pass to send individuals back to court who were sent to an in-patient setting for forensic psychiatric evaluation but were found not to need hospital-level of care. We'll be watching this to see if it leads to inappropriate incarceration.)

[...]

[above excerpt via ACLU-VT 2010 legislative wrap-up, here]

*Update*: Read a blog post of mine questioning the use of the term involuntary, here.

*Note*: posted a related link; last updated on Sunday, May 16, 2010 at 1:16 AM (ET).

The hidden damage of psychiatric drugs

2010-04-28T09:26:00.002-04:00

At Beyond VSH we're always glad when news of the dangers of psychiatric drugs, dangers that people who deal with the mental health system every day are already familiar with, crosses over into the mainstream media. Here's an interview in Salon with the author of a new book, Anatomy of an Epidemic.

The timing of Robert Whitaker’s "Anatomy of an Epidemic," a comprehensive and highly readable history of psychiatry in the United States, couldn’t be better. An acclaimed mental health journalist and winner of a George Polk Award for his reporting on the psychiatric field, Whitaker draws on 50 years of literature and in-person interviews with patients to answer a simple question: If "wonder drugs" like Prozac are really helping people, why has the number of Americans on government disability due to mental illness skyrocketed from 1.25 million in 1987 to over 4 million today?

More on State Hospital decertification

2010-04-02T06:00:00.000-04:00

It's almost a week now that we've known about the latest denial of certification for the Vermont State Hospital, but we just got the actual report from CMS, the federal Centers for Medicare and Medicaid Services, earlier this week.

The way the state tells it, CMS is picking on them, and they really haven't been doing anything wrong.

If you dig into the report, though, the facts are something very different.

Take this tidbit. One of the problems they identified was in incident in which a patient barricaded herself in her room with her bed, and used the time she was in there to reopen a self-inflicted wound on her arm. It apparently didn't last long, but it could have resulted in a serious injury. It was kind of a mystery, though, how a patient could do this.

From the report:

During a group interview with facility Administration and staff at 2:10 PM on 3/10/10, in response to the surveyors's question regarding the above event, the facility's Executive Director and Staff Educator #1 both stated that the beds in patient rooms were not movable.

Per observation, while accompanied by Staff Educator #1, at 3:30 PM on 3/10/10, of rooms #11 and #19 (the room Patient #20 had occupied at the time of the event) on the Brooks 2 Unit, there were wooden framed beds in each room that could be easily moved about the room and pushed up against the door. Upon observation of the beds Staff Educator #1 stated; "they do move....am I embarrassed."

We'd provide the link, but it seems to be kind of a challenge to find the report at the Department of Mental Health web page. Maybe that's what they mean by "Challenges for Change".

Vermont Council of Developmental and Mental Health Services Gubernatorial Forum Video

2010-03-29T22:57:00.002-04:00

Gubernatorial forum on mental health, substance abuse, and developmental disabilities. Moderated by Kristin Carlson, Senior Political Reporter for WCAX Channel 3 News. Sponsored by Vermont Council of Developmental and Mental Health Services. All candidates invited.

[via CCTV, here]

Breaking--VSH Again Denied Certification

2010-03-26T15:49:00.003-04:00

Beyond VSH has just learned that the federal Centers for Medicare and Medicaid Services has denied certification for Vermont State Hospital.

It is anticipated that this means that the state will lose another $8,000,000 in federal funds that were anticipated to help support the operating expenses of VSH, which are now running at about $22,000,000.

Vermont Council Gubernatorial Candidate Forum Report Open Thread

2010-03-22T21:09:00.001-04:00

This is an open thread solely focused on the Gubernatorial candidate forum on developmental & mental health services hosted by the Vermont Council of Developmental and Mental Health Services and held at the South Burlington High School this evening. Those whom attended the forum in person are invited to provide a report regarding the forum via posting a comment in order to share such with others.

Behind the Scenes

2010-03-19T23:48:00.004-04:00

As is obvious to anyone who might try to follow this particular blog as well as the other blogs I am a blogger on, I have not been very good at blogging either much or on any sort of consistent basis, even since I have been permanently housed these last seven months.

After twelve lengthy years of lacking permanent housing and living houseless (aka homeless), it is taking me a while to transition and get fully settled in ways many others easily take for granted. In fact I have only just begun the slow pace of processing a lot of varied life experiences that sort of ended piling up.

For some time now, most of my blogging has taken the form of micro-posts using Twitter to do such whenever there is something that seems worth sharing, yet not enough to blog a post about or otherwise not having enough time or energy to do so.

It is one thing to share information, but it is another to take the time and thought to compose blog posts.

In addition, I am often kept busy with other things I do online, including wading through, mining and sometimes forwarding information received or found online as well as replying to e-mails, etc.

This takes work as well as time and energy, all done on a volunteer basis since no one pays me for my work or time. Call it a labor of love, at least when I am up to the tasks involved.

Recently, concerning a tasering incident by Barre Police of a woman living homeless whom is also reported to be labeled with mental illness, someone encouraged me more than once to blog a post on the subject.

However, up to now, I have been so busy with working on the matter in the background and also occupied with various other things going on in my personal life of late, I had not been able to do so; not to mention the fact that the subject has been getting so much play in both the media as well as on certain blogs since the incident happened, it did not seem necessary.

That said, because it now seems to be time for me to weigh in on the matter as well as provide some of the information, news articles, editorials and blog posts garnered thus far, I am currently working on a detailed blog post. This should hopefully be posted in the next day or two.

Stayed tuned.

Real people, locked up

2010-02-19T21:05:00.003-05:00

Charlie Lord, Mental Ward Photographer And Activist, Dies At Age 90

I wasn't familiar with Lord's work before this. I spend plenty of time on the wards at mental hospitals. I would never claim that today's mental hospitals are the same as those documented here, but I do think it's important to point out what Charlie Lord was illustrating: you can't consign these human beings to some category of "other", at least not if you want to keep your own humanity.

Restoration of VSH Canteen Threatened in VT House

2010-02-09T05:20:00.002-05:00

*Update*: This just in from state representative Ann Pugh:

We've just voted on the sixteenth proposal of amendment (the Vermont State Hospital: Canteen Plan. yes 6 no 115. Amendment to remove the canteen language failed. So the canteen amendment as proposed by the Senate remains in. [...]

Back to original post:

Below is a press release issued by concerned mental health advocates and others within the state regarding legislative efforts to restore the Vermont State Hospital (VSH) canteen.

Press Release:

FOR IMMEDIATE RELEASE

Senate restoration of state hospital canteen threatened in House; advocates rally

Montpelier, Vermont, February 8, 2010 --- On December 4, the Vermont State Hospital canteen was shut after decades in operation. Mental health service users, advocates and hospital workers united to protest its closing. The Senate Appropriations Committee took testimony and voted unanimously to amend the budget adjustment bill (H.534) to restore the canteen. The Senate amendment gives the VSH director until March 15 to submit a cost neutral plan to reopen the canteen by July 1, 2010.

On Tuesday morning the House is scheduled to vote on H.534. According to the House Calendar, Rep. Martha Heath, Chair of House Appropriations, will offer an amendment that includes striking the Senate language about the State Hospital canteen from the bill.

"We can always hide behind these challenging economic times as a reason not to do something. There are some things we can't afford not to do and this is one of them. And the Senate proposal is cost neutral to the General Fund," said Senator Vincent Illuzzi, after learning of the amendment to strike the Senate language. Former canteen manager Curtis Sinclair commented: "It's incredibly cruel to punish the patients because the administration was so irresponsible."

Sinclair sent records to Senators showing the canteen was self sustaining -- even turning a modest profit until the hospital administration insisted on changes that made it operate at a loss. In internal correspondence VSH director Terry Rowe acknowledged the canteen's importance to patients and staff, and admitted: "The fact is that we could raise prices, cut back on staff and not eliminate the service."

Canteen supporters are rallying to preserve the Senate language, and delivering the attached flier to all House members.

Contact:

Ed Paquin, Executive Director
Disability Rights Vermont
802) 229-1355

Ken Libertoff
Vermont Association for Mental Health
802) 223-6263

View the informational flyer mentioned within the above press release, here.

Now is the time to contact your local state representative in order to encourage them to support restoration of the VSH canteen.

Find your state representative (hover mouse over map to find your town and then click onto your town), here.

*Note*: last updated on Tuesday, February 9, 2010 at 11:46 AM (ET).

Hudson River State Hospital Part One – The Kirkbride

2010-01-18T11:08:00.002-05:00

We don't usually put up a whole link from other bloggers, but this post from Five Before Chaos is definitely worth a long look.

I can’t begin to describe what I saw, in that it’s breathtaking in an architectural sense (and sad that it is in such a state of decay) and it’s incredible to see the way that buildings decay, even over a relatively short period of time. As soon as a building is not heated, and when it is exposed to the elements from broken windows and such, the transformation is rapid and dramatic.. rot, peeling paint, crumbling plaster, it goes quick. Yes, it’s dangerous as all hell at times, but we exercised extreme caution, especially in the women’s ward, where the decay was incredible; there were collapses that went through all four floors, debris everywhere, etc. It’s also amazing the amount of stuff people leave behind. And of course, from a psychological perspective, it’s pretty nuts. One’s senses are heightened, and although I don’t believe in the paranormal in the least, it’s still creepy as hell. Remember, all those horror stories about mental asylums? This is one of those ones where all that shit actually happened.

Vermont Advocacy Resource Toolkit

2010-01-07T05:26:00.008-05:00

*Updated* (with the usual edits)

During the 2010 legislative session the Vermont Department of Mental Health (VT DMH) will be pushing for several legislative changes, including those designed to make it much easier and quicker than it already is for the state to force treat and force drug Vermont citizens against their will.

Summary of Vermont Department of Mental Health 2010 Proposed Legislation, here (PDF; via Google Docs).

These are your rights they are after! If you do not stand up for them, who else will?!

If you want to be heard on these and related matters (including what is really needed and what truly works versus what does not work and is not needed), it is crucial to do so now and in various ways, including by contacting your local state legislators who serve in the Vermont General Assembly in Montpelier, as well as to write letters to the editor (LTE) both to your local newspapers as well as to newspapers with a more regional or statewide circulation (e.g., Burlington Free Press, Rutland Herald, Times Argus as well as vtdigger).

Some newspapers limit a person to one letter to the editor per subject per month, so when you write, besides keeping it simple, brief and to the point, make it count. Most importantly, use your own words: i.e., keep it original.

Tips on Writing Letters to the Editor

Letters to the editor are great advocacy tools. After you write letters to your members of [the Vermont Legislature], sending letters to the editor can achieve other advocacy goals because they:
reach a large audience.
are often monitored by elected officials.
can bring up information not addressed in a news article.
create an impression of widespread support or opposition to an issue.
Keep it short and on one subject. Many newspapers have strict limits on the length of letters and have limited space to publish them. Keeping your letter brief will help assure that your important points are not cut out by the newspaper.

Make it legible.Your letter doesn't have to be fancy, but you should use a typewriter or computer word processor if your handwriting is difficult to read.

Send letters to weekly community newspapers too. The smaller the newspaper's circulation, the easier it is to get your letter printed.

Be sure to include your contact information. Many newspapers will only print a letter to the editor after calling the author to verify his or her identity and address. Newspapers will not give out that information, and will usually only print your name and city should your letter be published.

[...]

The above tips on writing LTE's were drawn from an ACLU Web page on the subject [edit and emphasis above is mine], here.

An advocacy resource listing for e-mail or online submissions of Letters to the Editor (LTE) to Vermont newspapers (however, please note, this is not a complete listing of all Vermont newspapers), here (via Google Docs).

If a letter to the editor of yours gets published and made available online on the newspaper's Website, feel free to send me the full Web address for it.

Additional advocacy resources (via Vermont Coalition for Disability Rights: VCDR):

*Note*: made several edits and changes for the purposes of clarification and readability; last updated
on Thursday, January 7, 2010 at 11:46 PM (ET).

Career Opportunities with Pathways to Housing Inc.: Service Coordinators/Peer Specialists

2009-11-11T13:01:00.002-05:00

Read the employment want ad, here (via 7Days Classifieds).

Commentary: Do Not Cut to the Bone

2009-11-10T08:32:00.005-05:00

(cross-posted to Green Mountain Daily, here)

Opinion

Do Not Cut to the Bone

The state should be cutting where the fat truly exists, not to the bone as had been its inclination: i.e., there is no need or justification for many departments or agencies across state government -- most particularly within the Vermont Agency of Human Services (VT AHS) -- to retain and have so many top and middle management positions that have grown since the current administration came into office: e.g., deputy commissioners.

As specifically concerns the Vermont Department of Mental Health (VT DMH), one of the positions that should be cut is the Deputy Commissioner position as this would result in cost savings and sparing much more needed positions further down the food chain.

While the DMH commissioner and others within the department may depend on the deputy commissioner quite a bit, it would seem that when one measures priorities about what is truly most important and what gets the taxpayers the most for their dollars as well as provides the most to those the DMH is supposed to serve, this and other such high level positions should be cut instead.

Morgan W. Brown
Montpelier

Sarah Launderville: Public Comments re: Closure of VSH Canteen

2009-11-09T13:48:00.001-05:00

Upon my request, Sarah Launderville e-mailed me the following written comments of hers that she shared during last Friday's VSH canteen press conference held by advocates and concerned citizens:

My name is Sarah Launderville and I am the Executive Director of the Vermont Center for Independent Living, a cross disability rights organization. I also have a psychiatric disability and have spent time locked up on psychiatric wards of different hospitals.

Hospital life is hard living. You are told what to do, when to do it and how to do it. You are given different types of drugs to help “stabilize” you, or make you “fit into society.” I was made to feel like a prisoner when I was suppose to be receiving treatment. I had done nothing wrong-- I acquired my disability by the age of five, after surviving serious abuse at the hands of a family member.

In the hospital, laying in what was called a “quiet room,” a place where the hospital administration puts you so they do not have to hear you - I would sob and think - why now was I being punished? Locked on a ward, given medication that made me feel out of it, and have little contact with Doctors that were overseeing my care.

As people with disabilities, we understand what treatment works and doesn’t because we have lived it first hand. This issue affects not only us, but our families and our communities.

The sooner someone is able to live outside the restricted environment of a hospital or institution, the sooner our communities benefit. If I had not been given the proper treatment, I eventually received, like time off the ward, taking walks, visiting with family and friends, and other types of therapies besides seclusion, restraints and medications, I would not stand before you today a grown women who has a Masters Degree, full time job, and a family of my own.

The most successful types of treatment I received are the types of treatments being stripped away by the Administration. Over the past years patients at the Vermont State hospital lost access to the gym, library and other social settings. The Canteen is the last straw! By closing the canteen patients are restricted to confined areas and not taught skills to return to living outside a confined ward.

According to the Vermont Department of Mental Health website, “the Vermont State Hospital task is to help patients achieve a stability and return to their home communities ASAP.” By stripping away services, it will take longer for people living at the state hospital to return to their lives outside the hospital, costing the state more in the end and costing our communities a great loss.

The Vermont Center for Independent Living joins with this coalition in strongly urging the Administration to reconsider this serious cut.

VCIL: Statement Against Cuts to the Vermont State Hospital

2009-11-09T13:47:00.002-05:00

Prepared Vermont Center for Independent Living (VCIL) position statement read by Executive Director Sarah Launderville during last Friday's VSH canteen press conference held by advocates and concerned citizens:

The Vermont Center for Independent Living

Statement Against Cuts to the Vermont State Hospital

The Vermont Center for Independent Living (VCIL) is opposed to the closing of The Canteen at the Vermont State Hospital and urges the Administration to reconsider this decision.

The Canteen allows patients to be integrated into the community while still remaining in the environment of the hospital. Sarah Launderville, Executive Director of the Vermont Center for Independent Living has lived in hospitalized settings in the past and attributes her success to moving out, living back in the community, to therapies other than restricted environments. “I remember getting to the point that I had to relearn how to live in the community. Hospital living is very hard- you find yourself being given medications and in secluded rooms which are not positive therapeutic answers. I found that some people would come back to hospital living often because they got use to that way of life. By offering other options as part of the therapeutic environment people with disabilities have more success after they move out.”

As a cross disability rights organization, VCIL is people with disabilities working together for dignity, independence and civil rights. The Vermont State Hospital has been moving back in time and creating a very restrictive environment. There is no longer a gym, library or other social areas for people. This is unacceptable.

“This issue is not just something that effects a few”, says Launderville, it affects all Vermonters. “By stripping away important therapeutic settings people will remain in the hospital setting longer costing the state more money. It is important for the Administration to make decisions based on quality of life, otherwise the unintended consequences will cost us all more.

Vermont Center for Independent Living (800) 639-1522

Sandra Steingard, M.D.: Open Letter to Governor Douglas re: VSH Canteen

2009-11-08T20:37:00.002-05:00

An open letter to Governor Jim Douglas concerning the Vermont State Hospital (VSH) canteen written and submitted by Doctor Sandra Steingard:

November 6, 2009

Governor Jim Douglas
State of Vermont
Montpelier, VT 05601

Dear Governor Douglas,

I am writing to respectfully request that you reconsider your decision to close the canteen at Vermont State Hospital. I have been involved in community psychiatry in Vermont for 16 years. I worked at VSH for two years from 1993 – 1995 and I have been a psychiatrist at a community mental health center since 1995. My clinical work throughout my career has been centered on working with people who suffer from schizophrenia and other psychotic disorders. I have treated many patients who have been hospitalized at VSH.

I have followed the problems and challenges facing VSH closely. I have served on the Futures committee and recently reviewed proposals for VSH replacements. I understand the fiscal crises we face in our state.

However, I also know that quietly and without fanfare, the VSH canteen has embraced the principals of recovery that everyone – on all sides of the discussion – embraces and values. Patients, who have had no hope in their lives, found solace and comfort at the canteen. It has served a critical rehabilitative function for clients and former clients and it is a place of camaraderie and support for patients who are currently hospitalized.

During my many experiences sitting through meetings and hearings about the future of VSH, I have been impressed by the multitude of opinions and I often despair over the prospects of finding resolution. In that context, it is striking that many parties – who are often on opposite sides of the discussion – have come together in uniform agreement over the value of the canteen. That should weigh heavily in the considerations of those who have the power to make decisions in this matter.

Please reconsider your decision.

Respectfully submitted,

Sandra Steingard, M.D.

CC: Representative Michael Obuchowski
Representative Ann Cummings

Letter to the Editor: Reverse VSH Canteen Closure Decision

2009-11-08T09:51:00.001-05:00

Below is the op-ed/commentary/letter to the editor version I wrote and submitted to various newspapers across the state concerning both the closure of the canteen at the Vermont State Hospital (VSH) as well as the future of mental health service delivery across the state in general for publication.

Reverse VSH Canteen Closure Decision

While the Vermont State Hospital (VSH) remains open, I have come down on the side of opposing the closure of the hospital canteen out of respect for those currently as well as formerly incarcerated at VSH who have indicated the canteen is needed for the time being as their one small bright light at the end of the tunnel, even if only a glimmer of hope is provided by such.

That said, I am also among those who have long been working to have VSH closed down as well as at the same time working to have put into place a very different system of providing for the actual needs of those either currently or previously incarcerated there as well as those who could be in the future and, will not shy away from continuing to do so at all.

These needs include real, safe, decent and affordable housing, income, training, employment, transportation and other such supports and services that allow one to live independently where and how they may choose to reside.

This of course runs contrary to what has basically been the sole focus of the commissioner of mental health to chiefly replace the role or functions of VSH and merely move what is done there in the form of institutionalization in one fashion or another to other places elsewhere, while mostly providing poor lip service to providing truly community-based opportunities and real inclusion for people whom too many within our society would rather keep out of sight out of mind.

The fact is that dumping people without their being offered basic housing as well as independent living opportunities and supports or services they can freely choose from when they are without such is no solution either.

The commissioner along with their supporters have mixed up priorities and, as such, have been headed in the wrong direction for quite some time.

Even though closing VSH is highly desirable and sorely needed in order to move ahead with what will be required, the closure of the canteen while the current facility remains open is not desired, certainly not among those incarcerated or employed there, nor by those of us who stand in solidarity with them either.

Morgan W. Brown
Montpelier

An Open Letter to Governor Jim Douglas: Reverse VSH Canteen Closure Decision

2009-11-07T22:40:00.003-05:00

(cross-posted to Green Mountain Daily, here)

Dear Governor Jim Douglas, State of Vermont:

An Open Letter re: Reverse VSH Canteen Closure Decision

Sent to: Secretary Hofmann, Vermont Agency of Human Service (VT AHS); and,
Commissioner Michael Hartman, Vermont Department of Mental Health (VT DMH)

cc: State Representative Michael Obuchowski, Chair, Joint Fiscal Committee;
State Senator Ann Cummings, Vice Chair, Joint Fiscal Committee

While the Vermont State Hospital (VSH) remains open, I have come down on the side of opposing the closure of the VSH canteen out of respect for each and every one of those currently as well as formerly incarcerated at VSH who it is reported have indicated the canteen is needed for the time being as their one small bright light at the end of the tunnel, even if only a glimmer of hope is provided by such.

That said, I am also among those who have long been working to have VSH closed down as well as at the same time working to have put into place a very different system of providing for the actual needs of those either currently or previously incarcerated there as well as those who could be in the future and, will not shy away from continuing to do so at all.

These needs include real, safe, decent and affordable housing, income, training, employment, transportation and other such supports and services that allow one to live independently where and how they may choose to reside.

This of course runs contrary to what has basically been the sole focus of the commissioner and his supporters to chiefly replace the role of VSH and merely move what is done there in the form of institutionalization in one fashion or another to other places elsewhere, while mostly providing poor lip service to providing truly community-based opportunities and real inclusion for people whom too many within our society would rather keep out of sight out of mind, unless the plan is to allow them to rot on the street or in jails and prisons, etc., which already happens often enough already.

The fact is that dumping people without their being offered basic housing as well as independent living opportunities and supports or services they can freely choose from when they are without such is no solution either. Not everyone has the means to provide for and support themselves after being released from such incarceration, particularly right away or so easily.

The current administration in office and the commissioner of mental health along with their supporters have mixed up priorities and, as such, have been headed in the wrong direction for quite some time.

Even though closing VSH and, not merely moving its functions elsewhere, is highly desirable and sorely needed in order to move ahead with what will be required, the closure of the canteen while the current facility remains open is not, certainly not by those who are incarcerated there, nor by those of us who stand in solidarity with them either.

Morgan W. Brown
Montpelier

Closing VSH Canteen “Last Straw” for Mental Health Advocates

2009-11-07T20:54:00.006-05:00

(cross-posted to Green Mountain Daily, here)

vtdigger: Closing the Vermont State Hospital’s Canteen the “last straw” for mental health advocates (here):

Advocates hold press conference

Advocates, employees and former patients are outraged by Douglas administration's decision to close the Canteen at the Vermont State Hospital. They say it's the only place left for patients to get a break from the hospital's locked down wards.

In order of appearance: Malcolm Sawyer, former VSH patient; Joe Yoder, a psychiatric technician for VSH; Sarah Lunderville, executive director of the Vermont Center for Independent Living; Curtis Sinclair, Canteen coordinator; and Michael Sabourin, a patient advocate.

[via YouTube, here; posted by anneegalloway (November 7, 2009); length: 10:31 minutes/seconds]

Check out the blog post where the video was originally blogged up and also to read comments that have been posted concerning it (including mine, which is posted below), here (via vtdigger).

My Reply to the vtdigger video post:

Although I am among those who have long been working to have VSH closed down as well as at the same time working to have built and putting into place a very different system of providing for the actual needs of those either currently or previously as well as in the future who could be incarcerated there and, will not shy away from continuing to do so at all; while it does remain open, I have come down on the side of opposing the closure of the VSH canteen out of respect for each and every one of those currently as well as formerly incarcerated at VSH who it is reported have indicated the canteen is needed for the time being as their one small bright light at the end of the tunnel, even if only a glimmer of hope is provided by such.

These needs include real, safe, decent and affordable housing, income, training, employment, transportation and other such supports and services that allow one to live independently where and how they may choose to reside.

This is of course versus what has basically been the sole focus of the commissioner and his supporters to chiefly replace the role of VSH and merely moving what is done there in the form of institutionalization elsewhere in one form or another, while mostly providing poor lip service to providing truly community-based opportunities and real inclusion for people that too many within our society would rather keep out of sight out of mind, unless the plan is to allow them to rot on the street or in jails and prisons, etc., which already happens often enough already.

The fact is that dumping people without their being offered basic housing as well as independent living opportunities and supports or services they can freely choose from when they are without such is no solution either. Not everyone has the means to provide for and support themselves after being released from such incarceration, particularly right away or so easily.

The current administration in office and the commissioner of mental health and his supporters have their priorities mixed up and have been headed in the wrong direction for quite some time.

Even though closing VSH and, not merely moving its functions elsewhere, is highly desirable and sorely needed in order to move ahead with what will be required, the closure of the canteen while the facility remains open is not, certainly not by those who are incarcerated there, nor those of us who stand in solidarity with them anyway.

That is my opinion, what is yours?

Joshua (Malcolm) Sawyer: Public Comments re: Closure of VSH Canteen

2009-11-07T15:54:00.001-05:00

The following is the written statement of Joshua (Malcolm) Sawyer he shared publicly during yesterday's VSH canteen press conference held by advocates and concerned citizens:

My name is Malcolm Sawyer. I have been to the state hospital twice. Sometimes while there I would wonder if my life was over. The canteen was the only place that made me feel alright. Being at the canteen gave me hope that one day I might return to the real world. Without the canteen, my stay at the hospital would have been really hard to get through. I can't believe that it is even being thought to close it down. I think the only sane move would be to keep it open. I implore whoever is responsible: Don't get rid of the canteen!

Joshua (Malcolm) Sawyer

Michael Sabourin: Public Comments re: Closure of VSH Canteen

2009-11-06T21:01:00.001-05:00

Upon my request, Michael Sabourin e-mailed me the following written comments of his that he shared during today's VSH canteen press conference held by advocates and concerned citizens:

I’m Michael Sabourin and I have been the patient representative at Vermont State Hospital since March. My son was a patient at VSH for a year. When I told him last night that the canteen was supposed to close he replied, I love the canteen. That’s were people meet - especially when it’s to cold to go outside.

The canteen has proven itself a vital place for patients. As a former patient commented, “it is an oasis of informality.” For long term patients, it is an important adjustment to the “real world”.

The patients I have spoken with are upset by the news of the canteen closing. Eliminating it would be disheartening, demoralizing, and dehumanizing.

A couple of days ago a recently admitted patient said to me that he was looking forward to visiting the canteen. I hope that in the future patients will still have that option.

Rep. Anne Donahue: Public Comments re: Closure of VSH Canteen

2009-11-06T19:49:00.003-05:00

The following is by way of an e-mail via State Representative Anne Donahue in response to my request for an electronic copy of the print version she had available at today's VSH canteen press conference held by advocates and concerned citizens:

Public Comments on the Closing of the Vermont State Hospital canteen

– Rep. Anne Donahue (R-Northfield)

The budget decision by the Department of Mental Health to close the canteen at the Vermont State Hospital raises disturbing and profound questions for Vermonters during this time of severe revenue crisis. It should be reconsidered.

As a result of increasing restrictions at VSH, the canteen has been the sole remaining opportunity for informal socialization experiences for patients at the Vermont State Hospital. The opportunity to meet with family and friends and to be exposed to aspects of everyday life in a non-hospital environment is critical for persons who have experienced long periods of hospitalization and are rebuilding skills for a successful transition to community life. State hospital staff have helped lead the advocacy opposing this decision, out of the commitment to patient recovery and knowledge of the importance of the canteen. The canteen is open to the general public and has either made a profit or broken even until just two years ago, when DMH transferred a position line item to the canteen budget, and refused to increase below-market food prices.

This was a budget decision made exclusively by bureaucrats.

We cannot, as a state, commit to maintaining all programs at existing levels during a revenue crisis. We can, however, commit to responsible and inclusive decision-making.

1. Budget cuts are not an excuse for making fundamental changes to long-term state public policy – such as the (now federally mandated) policy of consumer-directed mental health.
Consumers most directly affected by specific potential program cuts must be allowed the opportunity for collaborative decision-making and the discussion of alternatives.

This decision was a breach of that commitment.

2. We have built a system that has benefitted our state budget for decades by maximizing the "leveraging" of federal matching funds – well aware of the risks. A significant majority of state human services now require three times the service cuts in order to achieve the same general fund savings.
We must make policy decisions based upon effectiveness and importance of individual programs, not primarily on which programs are solely state funded.
We must base "equality" in cuts across all state services upon the equivalent impact on the services, not primarily on an "equal" impact on the general fund, which disproportionately hurts human services.
3. The administration has identified the need for restructuring state services to meet long term fiscal realities.
Restructuring is a thoughtful process of how to achieve public policy through greater efficiency and carefully defined priorities – not the slashing of positions and programs based primarily on numerical targets, and not artificial savings made through positions cuts that disregard revenue offsets – such as with the VSH canteen.

Advocacy Coalition Holding Press Conference & Protest re: VSH Canteen Closure

2009-11-06T02:33:00.004-05:00

(cross-posted to Green Mountain Daily, here)

*Updated* (updated information posted, below first item)

From an advocate's e-mail concerning a press conference, followed by a protest, planned for Friday, November 6, 2009 at the Vermont State House beginning at 12:15 PM:

On Friday, Nov. 6 at 12:15, a coalition of organizations opposed to the closing of the Vermont State Hospital canteen will hold a press conference at the Statehouse in the Cedar Creek room, after which there will be a demonstration outside the Statehouse. Advocates, former patients and VSH workers will speak out about the impact of losing the canteen and why it should be saved.

The co-sponsors of this event have endorsed the following:

Joint Statement by Vermont Psychiatric Survivors; Disability Rights Vermont (formerly Vt. P & A); Vermont Center For Independent Living;
Vermont Association for Mental Health; Vermont State Hospital Workers;
Vermont Coalition for Disability Rights; Another Way, Inc.; National Alliance on Mental Illness-VT; National Association of Social Workers-VT

The Vermont State Hospital canteen has been serving patients, visitors and staff for over four decades. Last month the Department of Mental Health announced that as part of planned budget cuts, the canteen would close on December 5. We oppose the planned closing of the canteen and ask that this decision be revisited.

The canteen is integral to the quality of life for patients and significant to the quality of care they receive. It is also vital in reducing the pressures on the hospital wards by providing a positive incentive and a humanizing and integrated setting where patients can get away from the crowded, volatile ward environment. It is a place where patients can meet with visitors off the ward, and for some patients, the canteen has also provided vocational training.

In the past seven years, the hospital has become an increasingly restrictive setting as patients have lost access to the gym, the library, the Hideaway (an off ward social space) and Father Logue's camp in Duxbury. Now the State is taking away the only place patients have left outside the confines of the secure area.

Cutting costs is the stated reason for closing the canteen. But at one time it was reportedly breaking even, and it might do so again. Just how much would be saved is open to question; what would be lost is clearer. Regardless of whether the canteen is considered directly connected with patient care, its loss would have a serious negative impact on that care, and on the living and work environment at the State Hospital . We urge the administration to reconsider the planned closing and to maintain this unique and invaluable service.

[...]

*Update*: After blogging this post up I was sent the following information as a follow-up by the same advocate who had sent the above item:

the latest list of endorsers, below. [...]

Vermont Psychiatric Survivors; Disability Rights Vermont (formerly Vt. P&A); Vermont Center For Independent Living; Vermont Association for Mental Health; Vermont State Hospital Workers; Vermont Coalition for Disability Rights; Another Way, Inc.; National Alliance on Mental Illness-VT; National Association of Social Workers-VT; Mental Health Law Project of Vermont Legal Aid; Vermont Psychological Association; Rep. Warren Kitzmiller; Rep. Anne Donahue

Back to original post content:

From Vermont Coalition for Disability Rights (VCDR) on the subject:

To: VCDR Alert List
From: Deborah Lisi-Baker, President VCDR

Coalition to Save the VSH Canteen Holds Press Conference Friday

A coalition of individuals and organizations are working to save the VSH canteen, a key resource for patients and visitors at the state hospital and for state employees. A press conference has been scheduled for Friday at 12:15 in the Cedar Creek room at the Statehouse. Afterwards people will gathering on the street outside for a demonstration. Coalition members include Vermont Psychiatric Survivors, Disability Rights Vermont, Vermont Center for Independent Living, Vermont Coalition for Disability Rights, VSH Workers, Vermont Association for Mental Health, Another Way.

Background Information:
The Vermont State Hospital canteen has been serving patients, visitors and staff for over four decades. Last month the Department of Mental Health announced that as part of planned budget cuts, the canteen would close on December 5. We oppose the planned closing of the canteen and ask that this decision be revisited.

The canteen is integral to the quality of life for patients and significant to the quality of care they receive. It is also vital in reducing the pressures on the hospital wards by providing a positive incentive and a humanizing and integrated setting where patients can get away from the crowded, volatile ward environment. It is a place where patients can meet with visitors off the ward, and for some patients, the canteen has also provided vocational training.

In the past seven years, the hospital has become an increasingly restrictive setting as patients have lost access to the gym, the library, the Hideaway (an off ward social space) and Father Logue's camp in Duxbury. Now the State is taking away the only place patients have left outside the confines of the secure area.

This blogger will be on scene for the event as well.

If you are concerned by the pending closure of the VSH canteen, please consider attending as a public show of support. Keep in mind that protest signs or banners are not allowed within the state house, so please save them for use outside during the protest after the press conference. Buttons are permitted however.

*Note*: added informational update; last updated on Friday, November 6, 2009 at 4:01 AM (ET).

The baleful influence of Big Pharma

2009-10-24T09:44:00.004-04:00

Yesterday's New York Times covers an issue that Vermont patients' rights advocates have been trying to address for years. NAMI, a national organization that attacks the patients' rights movement and the very concept that anyone would have the right to refuse treatment by labeling mental illnesses as "brain diseases", received almost $23 million from the drug industry in the last three years, almost three quarters of its funding.

What is true nationally is also true in Vermont. While Vermont's legislature has banned drug companies' "gifts" to doctors, if you visit NAMI-VT's annual conference on November 6 and 7 you'll see an ample array of note pads, Post-Its, clipboards, pill containers, and other drug company swag on display.

The dependency of NAMI on the drug companies is so complete that at least one advocacy group has called NAMI a Pharma front organization which, far from advocating for patient rights, has actually opposed the issuance of black box warnings for drugs with known cardiac risk factors.

In 2004, NAMI opposed the FDA issuing “black box” warnings on antidepressants about their increased risk of suicidal thoughts and behaviors in under 18-year-olds.

In 2006, despite overwhelming evidence of serious adverse cardiac events and sudden deaths caused by ADHD drugs, NAMI took the position that the “black box” warning on ADHD drugs was “premature.”

There is no question that many NAMI members are sincere, generally parents and other family members truly concerned for the impact of mental illnesses on their relatives. Nevertheless, until NAMI rejects its ties to Big Pharma it will never be a truly legitimate voice for the rights, needs, and concerns of people with mental illness.

Psychiatrists to Big Pharma: Get Lost!

2009-10-15T09:05:00.006-04:00

Great piece in Sunday's Times Argus about how two psychiatrists responded to the blandishments of Schering-Plough, one of the big drug companies, this year.

Vermont legislators have long recognized the corrupting effect, and intent, of payoffs to doctors by the drug companies:

(4) The court in IMS v. Sorrell also found that drug detailing encourages doctors to prescribe newer, more expensive, and potentially more dangerous drugs instead of adhering to evidence-based treatment guidelines.

(5) According to a 2009 report from the Institute of Medicine of the National Academies, acceptance of meals and gifts and other relationships are common between physicians and pharmaceutical, medical device, and biotechnology companies. The report found that these relationships may influence physicians to prescribe a company’s medicines even when evidence indicates another drug would be more beneficial to the patient.

(6) According to the April 2009 Report of Vermont Attorney General William H. Sorrell, in fiscal year 2008, pharmaceutical manufacturers reported spending $2,935,248.00 in Vermont on fees, travel expenses, and other direct payments to Vermont physicians, hospitals, universities, and others for the purpose of marketing their products. Of Vermont’s 4,573 licensed health care professionals, 2,280 were recipients. Of the above amount, approximately $2.1 million in payments went to physicians. The top 100 individual recipients received nearly $1,770,000.00 in fiscal year 2008.

So does that mean the drug companies aren't going to do it?

No, it means that this practice works, so of course they're going to keep doing it, even if it means they have to disclose their "gifts".

When Schering-Plough wanted to market their new antipsychotic, Saphris, they came to Vermont, and all over the country, looking to spread some money around.

Schering-Plough's job offer was simple: Spend a few lunchtimes giving presentations to local doctors about the company's new product. That's worth a few hundred dollars. Sometimes the company could even send you to another part of the country – flights, cars and hotels all paid for – to talk to larger groups of doctors.

The company will pay a doctor up to $3,000 for one of those sessions.

On the second page of the letter in the 14-page packet, New Jersey drug company Schering-Plough offers $170,000 over two years to promote Saphris, its new drug to treat schizophrenia.

The Times Argus story points out that they picked some odd people to approach for this project, including Vermont psychiatrist Sandy Steingard.

"I was a little surprised to get this in the mail," said Dr. Sandra Steingard, the director of medical services at Burlington's Howard Center, a private nonprofit that offers mental health treatment and other services. "I don't take money from these companies. And I'm very outspoken about my concerns."

"This is marketing masquerading as education," Steingard said.

As the article points out, Steingard recently had a letter published in the American Journal of Psychiatry attacking the corrupting role of money in medical practice.

In their recent commentary, published in the February 2009 issue of the Journal, Sanjay J. Mathew, M.D., and Dennis S. Charney, M.D. (3), recommended several changes in the methods employed to evaluate the efficacy of new drugs. They suggested the development of "academic disease-focused clinical research centers." Therein lies the problem: Academic departments that have long-standing financial ties to the pharmaceutical industry should not be given the charge to change the system.

So it's newer and more expensive. Is the new drug any better?

Not necessarily. According to Dr. Daniel Carlat, another psychiatrist identified by the Times Argus report:

I haven’t yet reviewed the studies to see if SAPHRIS has any advantages over other antipsychotics, but I do know that Jeffrey Lieberman, MD, who is Chair of Columbia University Department of Psychiatry as well as the head of the APA's Council on Research, was quoted in this article as saying that “The studies haven’t shown that [SAPHRIS] provides any unique therapeutic advantage. The main contribution is that clinicians and patients will have yet another choice.”

Another mental health blogger gets into the details of the research a bit more and summarizes it this way:

If one reads a lot of research, then you'll know that these results are no different than any other drug on the market. This is pure advertising. Personally, I cannot wait for the next conference I attend. I can't wait to see the pharma puppet actually try to push this "unique human receptor signature" shit on his audience.

I guess when they write the studies to say what they want, that's what they call "evidence-based psychiatry".

No word yet on when this new drug is going to find its way into psychiatric practise in Vermont, but this is a big Beyond VSH thumbs up to Drs. Steingard and Carlat for standing up to the pressure of big bucks, and to Dan Barlow and the Times Argus for breaking this story.

State plans to close VSH canteen

2009-10-15T00:30:00.003-04:00

Picture this: you're scooped up out of your apartment and taken against your will to the Vermont State Hospital. Waterbury. You've heard of it before, but now you're there. You don't know anybody there, you have to eat and drink whatever food they serve you, and you're stuck in the building twenty-four hours a day.

Eventually you start doing what they want you to do, mainly taking meds, and they give you off-ward rights. One of those rights, which is built into a lot of patients' treatment plans, is the right to go to the Canteen. It's not fancy, but maybe you can get some potato chips or order a sandwich or a burger; maybe you'll listen to the juke box or watch cable news on TV; maybe you just want to be off the ward for a little while. Believe it or not, the Canteen is so important it's written into Vermont statutes.

The superintendents of the Vermont State Hospital and the Training School may conduct a canteen or commissary, which shall be accessible to patients, students, employees and visitors of the state hospital and training school at designated hours and shall be operated by employees of the hospital and the school. A revolving fund for this purpose is authorized. The salary of an employee of the hospital or training school shall be charged against the canteen fund. Proceeds from sales may be used for operation of the canteen and the benefit of the patients, students and employees of the hospital or training school under the direction of the superintendents and subject to the approval of the commissioner. All balances of such funds remaining at the end of any fiscal year shall remain in such fund for use during the succeeding fiscal year. An annual report of the status of the funds shall be submitted to the commissioner.

A lot of people say that the Canteen is the best, or the only good thing about the State Hospital.

Now they're closing it down. Employees learned Tuesday that as part of the state's budget-cutting project the Canteen will be closed down in about a month. It enables the state to cut three full-time positions.

The only problem is, what do you do if you're stuck in the Hospital and you don't want to spend all day every day, including all your meals and snacks, on your ward? I know patients at VSH who basically get no time off the wards except the time they spend going to the Canteen. It may be the best part of their day. Forget about whether it's therapeutic, and I think it is, because it's just about the only chance to spend time integrated in the larger community, it's the best part of their day that the state is taking away.

I guess if the state has to cut, there are only so many chances to take something away from people who have nothing.

Robert Guy Mandatta (aka Butch Ponzio): You Can't Drown Love

2009-10-01T15:55:00.001-04:00

Special Reprint

YOU CAN'T DROWN LOVE!

By Robert "Butch" Ponzio

Vermont's first documented mental patient was a successful politician and young lawyer named Richard Whitney. Although little is known about his Massachusetts childhood, before turning thirty he not only had moved to the Green Mountains, he also had become Vermont's Secretary to the Governor and Council, a prestigious and powerful position. When his term expired in 1804 Whitney established a promising law practice in Brattleboro. For the next several years he became a prominent figure in the community, but by his late thirties Whitney’s behavior reportedly had become so bizarre that he had to be physically confined in nearby Hinsdale, New Hampshire.

Although at the time the mad were no longer thought to be in league with Satan – possessed of evil demons and deserving death as witches – they generally were not considered medically ill. Yet a group of physicians from the Brattleboro/Hinsdale area decided to treat Whitney. Historian Henry Burnham describes this in Brattleboro, Windham County, Vermont (1880):
At that time little, if anything was known in regard to the proper treatment of insane persons. The faculty who were attempting to treat Whitney were vainly groping in the dark for a potent weapon with which they could meet this mysterious enemy of human happiness called insanity. Many, especially the devoutly religious classes, attributed this malady to supernatural causes. Therefore they considered all remedial efforts vain, and nothing could be done but to confine the unfortunate victim and wait for death.
As remarkable as the doctors' decision to treat Whitney may have been, their choice of treatment was even more extraordinary: They decided to force Whitney completely under water until he lost consciousness, at which point they planned to reawaken him to a new life. Burnham reports that it was believed that this treatment would "divert his mind, break the chain of unhappy associations, and thus remove the cause of his disease."

Imagine Whitney's bewilderment when his doctors first grabbed him, then led him to a tub of water. Then imagine his terror as he realized they intended to drown him!

Whitney struggles, screams for help, resists their overpowering hold on him, but it does no good. There are too many of them. Whitney screams again, resists with all his might, but his head is violently shoved under water. He manages to fight his way to the surface momentarily before being forced back down. This time he swallows a huge mouthful of water, begins to choke, cough, swallows so much water that he’s unable to breathe. He starts to suffocate under the heavy weight of their hands pinning him to the bottom of the shallow tub where he sinks down into darkness, knowing he is doomed…

Eons later Whitney awakes. His body aches and his chest feels heavy and inflamed. Slowly he opens his eyes to focus on a ring of solemn, expectant faces peering down at him. He recognizes his persecutors at once, glares at them and exclaims defiantly, "YOU CAN’T DROWN LOVE!"

The doctors, disappointed but not disheartened, confer quietly in a corner of the room. According to one version of the story, they decide to repeat the experiment. They again successfully drown their patient, but this time they're unable to revive him.

Historian Burnham, however, reports having been told by the son of Whitney's keeper that
the physicians, upon mature deliberation, concluded that they were on the right track, but had not used the proper agent for the stupefaction of the life forces. The next and last resort was opium, and Mr. Whitney died under the treatment.
Among the attending physicians was Dr. Perley Marsh, who died a year after the tragic incident. It is commonly believed that the Whitney affair suggested to Marsh’s widow, Anna, the need for an asylum for insane people. In fact when she died in 1834 Anna Marsh bequeathed $10,000 for that purpose. The trust that was established laid way for Vermont's first asylum and, consequently, nearly two centuries of institutionalizing people considered insane.

The nature of Whitney's treatment, and the fact that he had been treated at all, are significant in and of themselves. Although the prevailing beliefs of the day maintained that those afflicted with madness were in God’s hands alone, Whitney’s physicians attempted to cure him. That the doctors tried at all was directly related to Whitney’s social position. Had Whitney come from the lower classes of Brattleboro he would not have received medical attention. At best he would have been allotted the meager resources set aside for the dependent classes by an emerging community. Ironically, he most likely would have gone on living, presumably insane and probably mistreated, but alive.

In retrospect Whitney's attempted "cure" seems more like magic than medicine, more like torture than treatment. Because Whitney died as a result, it apparently paved the way to asylum and the longstanding practice of institutionalizing the mentally ill in Vermont. Moreover, this shocking incident exemplifies three key themes that dominate the varied medical and legal responses to madness in Vermont:
First, crazy people generally have been mistreated by those who assumed responsibility for their care, even when they did so benevolently.
Second, there always has existed a double standard regarding the care provided the rich versus the poor insane.
Third, and in many ways the most important, regardless of social class people considered insane have been historically denied a voice concerning their own confinement and treatment.
The above was taken from my 1981 thesis, Madness, Law, and Medicine in Vermont: 200 Years of Institutionalization, which was part of my Masters degree in mental health law and public administration from Vermont College, Norwich University. The complete thesis is available in the Vermont Collection at the Law & Documents Library in Montpelier, as well as in Dana Medical Library at Dartmouth College.

Originally posted (with permission), here (Friday, September 23, 2005).

*Note*: Butch has since changed his name back to Robert Guy Mandatta.

Revisiting Mental Health Treatment within Vermont

2009-09-30T17:54:00.005-04:00

*Updated* (with the usual corrections)

Revisiting Mental Health Treatment within Vermont

Self-determination and independence versus force and dependency revisited

By Morgan W. Brown

The very nature of self-determination as well as independence would seem to dictate not merely having freedom of choice, but rather also include both the freedom and the right to ensure one's self-defined and self-expressed wishes, choices and decisions are not defined, limited, narrowed or controlled by outside influences, no matter how well-intended or well-meaning.

Each person needs to decide as well as do what is best for themselves and, as such, they are the only one who actually knows what that is during any given moment or circumstance.

When it comes to health care and, most particularly concerning mental health treatment and related matters, save (i.e., except for retaining one's own) true and actual freedom of choice regarding such decisions, this means that like most anything else in this life there are truly no absolutes, nor should there be any imposed on any person(s) by anyone else.

Hence, in order to ensure true parity between health care and mental health care treatment systems (versus merely addressing how these separate and unequal systems and services are paid for under the pretense of parity), the use of force and coercion within the mental health systems needs to be completely done away with before these systems can truly become ones of empowerment for everyone involved. This would be real change, since it is what is sorely needed and because it is also very long overdue.

In addition, the criminal justice system should never be misused simply to compel forced or coerced mental health treatment when no actual or real crime has been proven to have been committed by an accused person. There needs to be serious protections against such being allowed to happen as well as stiff penalties imposed and enforced upon those who falsely report someone else of a crime the person in fact did not commit in order to attempt to compel treatment for that individual.

Whether on an inpatient, outpatient, or community basis, the use of force or coercion in mental health treatment is clearly wrong. Force and treatment do not go or work together. In fact, each works in opposition to the other.

Treatment that is free from the use of force or coercion in all forms embodies what is essential to what often becomes termed as recovery: i.e., person-hood, self-determination, hope, faith, responsibility, and independence, as well as interdependence.

Force and coercion only works to foster and enforce dependency, victimization, anger, violence, helplessness, and irresponsibility.

Force and the fear as well as the intense anger and even rage that it creates does not ensure safety or security; rather, it is the use of force that destroys them. Using force is easy. Choosing alternatives to force may at times appear to be difficult, yet it need not be impossible. Many options are available when force and coercion is not the governing paradigm.

If the force/coercion paradigm were no longer in place, the power imbalance that currently exists would cease or, at least its base -- or, otherwise the basis for it -- would lose its authority.

Resources currently being employed to bolster the force paradigm could be better and more readily used instead to meet the basic human needs of individuals; needs that are either not met in a way of a persons choosing or not met at all.

The varied needs of people within the mental health system include, yet are not limited to: non-segregated, non-congregate housing; tenant-based rental assistance programs; home ownership programs (designed by persons they are meant to assist and packaged to assist persons living on very low incomes); income; food; properly funded peer support programs and services; training; employment; quality health care, including dental care, etc.; and, transportation.

Meals on Wheels, personal assistance services (modeled along the same lines as someone with a physical disability would be eligible to receive), and Part B-Independent Living Services as well as other such essential programs and services can play meaningful and vital roles in supporting individuals labeled with psychiatric disabilities to live independently in communities as well as living situations of their choice.

To accomplish such however would take a major shift in resources to fund these and other much-needed programs and services. That said, the money for doing so already exists and is instead being spent in one form or another elsewhere, typically in the most costly fashion and often in a manner or mode that is too little, too late and, in addition, could be termed as well as considered deliberate indifference.

What will be required is the political will and courage to redirect funds in order to meet the needs of those the system is supposed to be serving, but is currently failing; not merely by political leaders or bureaucrats either, but by every citizen.

We must do several things, including but not limited to these:

End civil commitment and abolish the insanity defense for persons labeled with psychiatric (or emotional) disabilities;
Hold people fully accountable for their actions if a crime is committed and then proven within the criminal justice and correctional systems, regardless of whether or not an individual is labeled with a psychiatric disability;
Shift resources to fund a system that helps to meet the needs of individuals labeled with psychiatric disabilities in a way of their choosing and make mental health systems completely voluntary;
Use a voucher system to allow people real choices both in selecting care and/or service providers and the actual care and/or service that they may choose to receive.

Often there are concerns raised about what should be done if someone is out of control, troubled or in need of treatment when their state of mind and/or behavior is being questioned.

While the issue appears to be complicated by several factors, including current constitutional law regarding an individual's rights in criminal proceedings, it is my belief that people can be held more accountable by changing how they are treated, by abolishing the insanity defense, and by ending civil commitment of individuals labeled with psychiatric disabilities.

Being out of control or labeled with a psychiatric or emotional disability should not be an excuse and violent or other criminal acts should not be tolerated if a person is proven to have committed a crime.

If no crime is proven to have been committed however, yet the person appears to be out of control or troubled, they should be offered voluntary assistance only or otherwise be left alone. In addition, more tolerance and understanding of others and their differences is actually needed, not less of it.

If an individual is not committing a crime, but her or his actions are annoying others, then they should not be detained or interfered with -- just like anyone else. Being annoying, out of control, or being labeled with a psychiatric or emotional disability in itself should not be grounds for imposing society's will.

We should not be able to hold people accountable for actions that we think that they might do at some future point in time.

People should, however, be held fully accountable for proven criminal violations of the law.

In closing, it is my strong belief that it is possible for us as a state and society to finally rid ourselves of the terrible burden of force and coercion within the mental health system.

Doing so would be very liberating to mind, body and spirit on both an individual and collective basis, especially when sharing with and supporting each other as we journey into the unknown together.

Morgan W. Brown is an advocate, writer and blogger living in Montpelier, Vermont.

Author's note (Wednesday, September 30, 2009): the above commentary is drawn various previous writings of mine including commentary entitled Self-determination and independence versus force and dependency published in the Spring 2001 edition of the National Empowerment Center (NEC) newsletter (here), which was drawn from original commentary that was initially written and then edited into various versions during the period of late 1996 and early 1997.

*Note*: made several edits and corrections for the purposes of clarification and readability; finally managed to correct the dates listed within the author's note; last updated on Wednesday, October 7, 2009 at 7:42 PM (ET).

Michael Hartman, VT DMH Commissioner, Interview on Connect with Amy Miller Radio Show

2009-08-11T13:16:00.000-04:00

Connect on the Radio

WSNO 1450 AM, Saturday 9:00am to 10:00am
http://www.blogger.com/img/blank.gif
Connect with Amy Miller: Mind, Body, Soul, Spirit and
get inspired! [...] Sixty minutes of radio dedicated to health and empowerment. [...]

August 8th, Michael Hartman, Commissioner of Mental Health
Michael Hartman, the Commissioner of Mental Health for the State of Vermont, joined 'Connect' to discuss the care of our veterans, Vermont research results on substance use and depression in our teenagers, depression & anxiety of all ages throughout Vermont, suicide, mental health care services & where to turn if in need and more.

[...]

[via Connect with Amy Miller, Connect on the Radio, here]

Listen to the archived audio via the below available online streams:

Full-time Focus

2009-05-12T01:14:00.011-04:00

(cross-posted to Green Mountain Daily, here)

*Update* Join the Beyond VSH live blog coverage (via below CoverItLive widget) during the VPR VT Edition broadcast concerning Vermont State Hospital (VSH): i.e., Tuesday, May 12, 2009 starting at noon (ET).

Food for thought:

"The key to change... is to let go of fear."
-- Rosanne Cash

It is high time for change! And, we are it (i.e., the very change we seek), if only we let go of our fears and move ahead together.

Live blog Coverage: VPR Vermont Edition re: Vermont State Hospital
*Back to original post*:

A glimpse back, albeit brief, concerning Vermont's mental health system in order to help in envisioning just how much progress or rather lack thereof has been made thus far:

Week of February 23, 2007
Vermont Guardian
[former statewide weekly newspaper; since retired]
Editorial
Full-time focus
[emphasis mine]

[...]

It’s time for less talk about titles, and glossy blueprints, and more about ways to provide the right care at the right time, and put the patient, not policy, first.

Read the editorial in full and, make certain to note the date or rather year it was originally published (i.e., February 23, 2007), here.

With that duly noted, listen to Vermont Public Radio (VPR) Vermont Edition at noontime today (Tuesday, May 12, 2009) when the show features the following focus at the top of their show after the news (here):

For the second time in a year, the federal government has denied certification to the Vermont State Hospital. We look into the continuing issues of patient care and building upkeep at the state-run mental health facility. The continued failure to meet federal guidelines is costing the state close to$10 million a year in lost federal revenue. We check in on the state's reaction, and on plans for alternatives to the Waterbury hospital. Our guests include Vermont's Mental Health Commissioner, Michael Hartman, and Republican State Representative and longtime mental health advocate, Anne Donahue.

One can listen to the show live either locally via radio or online using the VPR audio player or, otherwise, listen after the show has aired and it is posted online afterwards (click onto "listen" within right-hand sidebar on episode page), here.

(episode page includes related informational links at bottom of page)

*Note*: added live blog tool widget; added food for thought quote & comments; last updated on Tuesday, May 12, 2009 at 4:26 AM (ET).

VTblogosphereTV 13a: Interview with Morgan Brown AKA norsehorse Mental Health Advocate

2009-05-07T19:27:00.004-04:00

*Updated*

This is a ten minute clip of the half hour 13th episode of VTblogosphereTV I was interviewed for and, which has been airing on local cable access channels within Vermont of late.

This particular clip is where I was answering questions about mental health as well as housing matters and leads off with addressing the cut to the Vermont Department of Mental Health (VT DMH) housing coordinator position:

[via YouTube, here; posted by cowlick66 (May 7, 2009); length: 10:01 minutes/seconds]

Since Michael Abadi had listed the clip as 13a, it looks like he may attempt to upload one or more additional clips as well, since YouTube limits one to about 10 minutes worth per uploaded video usually.

Therefore, later on sometime, make sure to check his YouTube channel for additional clips, here.

*Update*: Michael Abadi, host of VT Blogosphere TV, blogged a post to Green Mountain Daily: "A Convenient Myth".

*Note*: posted an update; last updated on Friday, May 8, 2009 at 8:56 AM (ET).

Letter to the Editor: Cutting Too Close to Home

2009-04-27T16:53:00.002-04:00

Week of Wednesday, April 15, 2009
The World
[Washington County, Vermont]
Opinion section
Letter to the Editor

Cutting Too Close to Home

(by Morgan W. Brown Montpelier - April 15, 2009)

Editor:

During the last meeting of the Vermont Department of Mental Health (VT DMH) Transformation Council, "Commissioner Michael Hartman briefed the group of twenty consumers, providers, advocates, and staff on the elimination of positions necessitated by projected deficits in the FY 10 budget. Two positions, Quality Management and Housing, are subject to reduction-in-force provisions pending the outcome of legislative deliberations on the budget. Two other unfilled positions have been eliminated."

The official title of the housing position in question is listed by the state personnel department as being a "mental health community services coordinator," one which is more commonly known by those of us within the state's mental health, housing and homeless circles as the VT DMH housing specialist or housing coordinator.

There is never a good time to cut a position of this sort. Additionally, there is certainly no worse time to do so than under the dire budgetary circumstances currently being faced by local governments, communities and human service providers across the state, as well as the families and individuals served by them, which of course includes those of us who live with serious mental illness and whom also may find ourselves living without permanent housing (i.e., homeless) or otherwise at great risk of such.

The truth is this matter is also about much more than purely being an issue concerning money, funding or revenue or, having enough of these to meet basic human needs. This is particularly the case when it comes to those of a highly vulnerable population at an increased risk of living on the street, staying in a homeless shelter longterm or, either in jail, prison, the state hospital or, some other psychiatric unit or institution elsewhere.

This position is more crucial now than ever. As such, it is the type of position definitely deserving to be spared from the budget ax.

If you agree, please contact your local state representative and state senator(s) as soon as is possible in order to urge them to not allow positions like these to be cut from the state workforce.

Otherwise it could be too late down the road for many of my peers as well as myself in our hopes to find or maintain safe, decent and affordable housing of our own and live independently within our communities as we may choose.

Morgan W. Brown

Montpelier

[via The World, here]

Earlier, longer commentary length version of the same letter, which also includes video version as well, here.

Mental Health Advocates to State Legislature: We Need a New Look at the “Futures Project”!

2009-04-16T11:23:00.002-04:00

*Update*: Waterbury Record (April 30, 2009): Amid closure demands, hospital staff honored

Jointly Signed Letter from Members of Vermont Mental Health Advocacy Community to Legislators re: Relooking at Mental Health 'Futures' Project:

Vermont Protection & Advocacy, Inc.
141 Main Street, Suite 7
Montpelier, VT 05602

VP&A is the Protection & Advocacy System for Vermont

(800) 834-7890 (Toll-Free)
(802) 229-1355 (Voice)
(802) 229-2603 (TTY)
(802) 229-1359 (Fax)

[... (e-mail address omitted)]

Date: April 15, 2009

To: Members of the Vermont General Assembly

From: Vermonters concerned with mental health services.

Regarding: We need a new look at the “Futures Project”!

A number of advocates for mental health issues have expressed very serious reservations about certain parts of the “Futures” project proposal to replace the various services that are currently delivered at the Vermont State Hospital, with the ultimate goal of closing the facility.

Doubts have been expressed about the expense involved in the proposal to build a new facility as part of Rutland Regional Medical Center because of its complex financing scheme that replaces capacity for VSH and replaces their current unit for RRMC. There is also concern that making it, in effect, the initial ‘triage’ point of the system is not consistent with progress towards a community-based system and will also discourage deeper participation by other community hospitals, making the closure of VSH a more distant possibility. This is especially true since the other local hospitals will still need to serve patients NOT served at Rutland when the beds there are filled – and they need to be filled to make the financing package viable. We will be left needing VSH for the foreseeable future!

There has been considerable support for the development of community residential recovery resources and peer-run alternatives as well as support for the development of secure residential capacity, though without consensus on location and the final form a facility might take. There is also considerable concern that current planning has not accounted for such factors as the stress that the community mental health system is under and the particular need for housing options for people with mental health issues.

Yet most would agree that the state hospital should close sooner rather than later and ask what is the answer or answers to the replacement of its functions! Here are some thoughts that may be of some use.

The Futures project started with a large number of interested individuals with a broad range of interests and experience being brought together to devise a solution. Five years later VSH is still operating with a 54 bed capacity.
With all that has happened since the process began it seems clear that if we are to close the facility several things need to occur:
Whatever plan is adopted needs to have the clear goal of closing VSH, with a target date!
There needs to be leadership that is willing to put together a plan based on the values expressed in the early “Futures” legislation that include being community based, Recovery oriented, and trauma informed,
That plan should be presented to and discussed with a broad range of “interests” and leadership should be willing to work WITH the community to refine and modify when appropriate,
Under-served areas and a reasonable geographic distribution of services should be considered,
The mental health needs of inmates who currently lack meaningful access to inpatient services require greater consideration,
The plan should not hinge on diminishing civil rights or due process for people facing involuntary treatment.
Is such a course of action possible? We believe it is if there is an understanding of the goals and if it is clear that solutions rely on the broad community and not just the willingness of one particular player to participate. All of the designated hospitals, and in all likelihood some other community hospitals, need to be involved in meeting the needs of their local areas. We need to rethink the idea of responsibility at the local level. This means that some new version of a “no-reject” policy needs to be worked out so that evaluation and clinically appropriate services can be delivered without the VSH as a “safety-valve”. And solutions need to be developed for individuals with long term needs.

There are a number of possibilities for partnerships that ought to be considered, that could lead to closing VSH and that may, together, create a more promising system in Vermont. Some of these have been discussed and cursorily rejected; some of them have not received serious consideration. All of them present challenges, but none should be rejected without further consideration with a problem-solving orientation:
St. Johnsbury – in an area of the state underserved in psychiatric inpatient services a unit could be developed either by the hospital or the state that could serve up to 16 patients,
St. Albans – the Northwest Medical Center has potential for developing 3-4 beds within their facility, if they could do so with support of the state,
Bennington – the Southwest Medical Center used to have a facility that could serve 12, perhaps that could be redeveloped without great capital expense,
Springfield – the beds closed at the Windham Center could be re-opened adding 6-10 new beds, again without capital expense,
Burlington – could FAHC develop a small, specialized unit within its current footprint to serve medically complex patients, adding 6-12 beds of capacity to the system?
Rutland – could the Medical Center utilize some of their current licensed capacity or develop a unit less reliant on the state than the current plan and serve 6-12 new patients?
Berlin – locating a state facility near the Central Vermont Medical Center has been proposed. This could be a potentially better choice than the VSH “campus” for a secure residential facility serving 15 clients,
Brattleboro – The Retreat is likely a willing partner with the state and could possibly increase capacity by 6 beds without great capital expense.
This list has the potential for 70 or 80 beds to assist in the closure of the 54 bed VSH and, in the case of units that may be developed by the state, meet the needs of people with serious mental illness who are currently spending shameful amounts of time in segregation in our correctional institutions.

No one of these possibilities is the be all and end all solution.

No one of these could happen without a real consideration of obstacles like corporate structures, IMD rules, staffing challenges, and re-imbursement hurdles.

None of these suggestions will occur without active engagement with community players, respecting their financial challenges and their view of the local community’s needs.

No one community should provide such a significant part of the solution that the state concentrates so much of its resources that other parts of the plan becomes impractical.

What is “the community” and who needs to be part of the solution?
Individuals who have lived with mental health issues,
their families,
local hospital leaders,
designated mental health agencies,
advocates,
the state administration,
experts in Medicaid and Medicare,
the medical profession, and
the public at large!
Vermont is capable of developing services that respond to our citizens’ needs. We would never have closed Brandon without the imagination to build a community based system different from what went before.

We have developed Second Spring and are in the process of developing Meadowview in Brattleboro, as well as a peer run respite center. We now need to look at our larger institutional partners, the community hospitals, across the whole of the state, as part of a coherent delivery system. Our system for physical health has evolved in that way and we should consider no less for individuals with mental health issues.

Respectfully Yours,

Laura Ziegler, Plainfield

Morgan W. Brown, Montpelier

David Fassler, M.D., Charlotte

Michael Sabourin, Marshfield

Ed Paquin, Executive Director,
Vermont Protection & Advocacy, Inc.

Sally Parrish, South Burlington

Bethany G. Knight, Northern Knights Consulting, Glover

Xenia Williams, Barre Town

Marty Roberts, Montpelier, Vermont Psychiatric Survivors,
Adult State Mental Health Standing Committee

Larry Lewack, Executive Director,
National Alliance on Mental Illness of Vermont

Gwen Budd, Montpelier

Jack McCullough, Project Director,
Mental Health Law Project, Vermont Legal Aid

fyi: Vermont Protection and Advocacy, Inc. (VT P&A)

*Note*: posted link to related news article; last updated on Friday, May 1, 2009 at 12: 13 AM [ET].

Cutting Too Close to Home

2009-03-29T03:25:00.008-04:00

[cross-posted to Green Mountain Daily, here]

by Morgan W. Brown

Within its most recent bi-weekly update (dated: March 25th), the Vermont Department of Mental Health (VT DMH) indicated that during the last meeting of the Transformation Council, "Commissioner Michael Hartman briefed the group of twenty consumers, providers, advocates, and staff on the elimination of positions necessitated by projected deficits in the FY 10 budget. Two positions, Quality Management and Housing, are subject to reduction-in-force provisions pending the outcome of legislative deliberations on the budget. Two other unfilled positions have been eliminated."

The official title of the housing position in question is listed by the state personnel department as being a mental health community services coordinator, one which is more commonly known by those of us within the state's mental health, housing and homeless circles as the VT DMH housing specialist or housing coordinator.

Late last week in its weekly report (dated: Friday, March 27th), the Vermont Mental Health Performance Indicator Project (PIP) provided "information on the proportion of adults with serious mental illness served by Vermont community mental health programs during CY2008 who were also served by community programs for the homeless during the same year."

Among the key findings documented within the brief report was of how this population of Community Mental Health Center (CMHC) "clients were more than ten times as likely as members of the general population to receive homeless services."

There is never a good time to cut a position of this sort. Additionally, there is certainly no worse time to do so than under the dire budgetary circumstances currently being faced by local governments, communities and human service providers across the state, as well as the families and individuals served by them, which of course includes those of us who live with serious mental illness and whom also may find ourselves living without permanent housing (i.e., homeless) or otherwise at great risk of such.

For some of us, there are times when we need these very public servants -- also known as state employees -- and, others elsewhere whom they coordinate with, in working together in a team effort with us as we either seek or attempt to maintain what it takes to acquire or keep housing, employment, supports and services in helping us meet the various, yet different basic human service needs we may individually need assistance with.

If anyone thinks this is easy or simple accomplishing, I can personally attest via years of personal experience and observation to the fact that it is far from being so.

The truth is this matter is also about much more than purely being an issue concerning money, funding or revenue or, having enough of these to meet basic human needs. This is particularly the case when it comes to those of a highly vulnerable population at an increased risk of living on the street, staying in a homeless shelter longterm or, either in jail, prison, the state hospital or, some other psychiatric unit or institution elsewhere.

It is also about those being in such positions who have the necessary breadth of knowledge, experience and institutional memory required to get the job done, as well as also having an array of contacts all across the state at various levels and maintaining communication and relationships with each and every contact, whether the person is in the mental health, housing, homeless or other such field in a hands on fashion rather than just being focused more on policy matters concerning such.

The committed and dedicated state employee, who has for years served as the VT DMH housing coordinator and, just like their predecessor has performed their work across all Agency of Human Services (AHS) populations as well, is such a person.

This position is more crucial now than ever. As such, it is the type of position definitely deserving to be spared from the budget ax.

If you agree, please contact your local state representative and state senator(s) as soon as is possible in order to urge them to not allow positions like these to be cut from the state workforce.

Otherwise it could be too late down the road for many of my peers as well as myself in our hopes to find or maintain safe, decent and affordable housing of our own and live independently within our communities as we may choose.

Morgan W. Brown
Montpelier, Vermont
Sunday, March 29, 2009

fyi:

Legislative Directory:

Find your state representative or state senator (via map)

State senators by district (county)

State representative by district

Contact Governor Jim Douglas, here.

Another Way Drop-In Center News

2009-03-05T22:41:00.004-05:00

The Another Way Drop-In Center has a new management team, which started on Monday, March 2, 2009: i.e., Steven Morgan, Executive Director and Lauren Sales, Assistant Director.

Please welcome them on board.

Do these guys have a clue?

2009-01-14T10:55:00.001-05:00

In my job I deal with the Department of Mental Health every day. I dealt with them when they were the Department of Mental Health, I dealt with them when they were the Department of Developmental and Mental Health Services, I dealt with them when they were the Division of Mental Health of the Department of Health, and I deal with them now that they're the Department of Mental Health again.

I had cases with them when all their offices and staff were in Waterbury, and I could walk across the parking lot to talk to them, and I have cases with them now that they're in Burlington, and they have to drive down to Waterbury to try cases, do witness interviews, and go to meetings on the Vermont State Hospital.

Now, apparently they may be moving again. According to a story in today's Free Press, the state's considering another move, back to Waterbury.

It's fine with me. I'm sure there will be some advantages in having DMH staff in the same place as the State Hospital (motto: "We'll be closing sometime") and other departments who deal with the same clientele. It makes you wonder, though: are the same people who thought it was such a great idea three years ago making the decision that it's a great idea to move back?

Complainers in China Hospitalized

2008-12-08T14:16:00.000-05:00

BEIJING — Local officials in Shandong Province have apparently found a cost-effective way to deal with gadflies, whistle-blowers and all manner of muckraking citizens who dare to challenge the authorities: dispatch them to the local psychiatric hospital.

Evidence suggests CIA funded experiments at state hospital

2008-11-30T08:37:00.004-05:00

Louis Porter has an investigative piece in today's Rutland Herald/Times Argus. The information is suggestive at this point, but it could be that publishing this first story will help to get more information out. There is no question that the CIA was running a clandestine program called MK-ULTRA that involved giving drugs to mental patients; what is yet to be known is whether Vermont State Hospital was involved.

By Louis Porter Vermont Press Bureau - Published: November 30, 2008

Few people in Vermont remember Dr. Robert W. Hyde, but one of his former patients can’t forget him. The doctor was involved in one of the nation’s darkest chapters in medical science: In the 1950s, Hyde conducted drug and psychological experiments at a Boston hospital through funding that apparently originated with the CIA. Later, he became director of research at the Vermont State Hospital.

The patient, Karen Wetmore, is convinced that Hyde and other researchers subjected her and possibly other patients to experiments paid for by the CIA at the Waterbury facility.

Madness Radio: Reinventing Bipolar Steven Morgan (8/27/2008)

2008-08-26T10:39:00.001-04:00

Steven Morgan was recently interviewed on Madness Radio by Will Hall about his story and his experiences within the world of mental health, here (via Freedom Center; 8/25/2008).

Psychologists and Torture

2008-08-16T10:22:00.002-04:00

There are plenty of people who consider anything they do to you in a mental hospital--restraints, forced drugging, the works--to be torture.

The American Psychological Association, though, is looking at the official use of psychologists to torture prisoners. Sure, the people who do it claim it isn't torture, but we already know they're lying.

What they're arguing about now is whether psychologists should be allowed to participate in these "interrogations".

Based on this description, and on other available information, decide for yourself if you think it's torture.

They have closely studied suspects, looking for mental quirks. They have suggested lines of questioning. They have helped decide when a confrontation is too intense, or when to push harder. More than those in the other healing professions, psychologists have played a central role in the military and C.I.A. interrogation of people suspected of being enemy combatants.

Beyond VSH listed as one of top 100 mental health blogs

2008-08-11T06:22:00.001-04:00

Although it was difficult to narrow thousands of noteworthy resources down to the top 100, below is a categorized list of what we feel are the most popular, informative and/or unique mental health and psychology blogs on the Web. While any list of this kind is subject to oversights and omissions, it is our hope that with these top 100 sites you will find an excellent resource from which to educate yourself on mental health and psychology issues.
General Psychology

Some psychology blogs focus on more narrow sub-topics. However, the blogs listed below cover many issues across the board.

3. Beyond Vermont State Hospital - This is a group blog about mental health matters related to the Vermont State Hospital and beyond.

Steven Morgan's Paper: The Other Side of Mental Health Science

2008-07-09T22:15:00.006-04:00

Steven Morgan has written a short document called The Other Side of Mental Health Science [Note: PDF version; Adobe Acrobat Reader required. Document via Vermont Recovery Website].

Steven writes (within an e-mail):

This document is an attempt to clearly and simply present many of the ignored facts from the scientific community about psychiatric disorders. To that end, I have hyperlinked each reference so that readers can easily research the primary information themselves. Of course, I welcome any feedback that you may have!

His contact information is available, here.

P.S.

In addition, if you have not already done so, check out a previous blog post regarding another paper by Steven: Must-Read: A Challenge For NAMI National.

Report: Integrating Peer Services in Community & Inpatient Settings in Vermont's Mental Health System of Care

2008-07-09T12:57:00.004-04:00

On May 29th and 30th consultants Gayle Bluebird and Holly Dixon were presenters at forums on the integration of peer services and the community mental health system co-hosted by Vermont Psychiatric Survivors and the Vermont Council of Developmental and Mental Health Services.

Recently Gayle Bluebird submitted the final version of their report, which is available online at: Integrating Peer Services in Community and Inpatient Settings in Vermont's Mental Health System of Care.

Psychiatry Handbook Linked to Drug Industry

2008-05-21T14:43:00.002-04:00

If you work in the field of mental health, and even if you don't, you're probably familiar with the DSM, the Diagnostic and Statistical Manual of Mental Disorders. It's the thick handbook mental health professionals rely on to decide just what might be going on in your head. It's famous, among other things, for the volte-face on homosexuality, listed as a disorder in the first edition, then dropped in DSM-II, the second edition in 1974.

Well, it's time for a fifth edition and Montpelier author David Dobbs has a post that proves that they haven't left behind the possibility of controversy or (some might say) corruption. The American Psychiatric Association has appointed a committee of 28 members to oversee the development of DSM-V, due out in 2012, and it turns out that the majority of the members have financial or other ties to the drug industry.

The New York Times blog has a post, and the first comment, from a psychiatrist, is instructive: A board certified psychiatrist for over 30 years I think the DSM is little more than a financial roadmap to guarantee reimbursement and manipulate policy. It’s diagnostic criteria are often overbroad sometimes labeling variants of normal behavior mental illness and like Soviet psychiatry sometimes laced with political correctness.

You can view the list of all committee members, along with their Big Pharma ties, here.

Mental Health Video TimeTube

2008-05-10T18:17:00.000-04:00

via TimeTube, an excellent video search tool, which searches YouTube videos for a given search term(s) (e.g., mental health). Read about it, here [via LifeHacker].

'New England Psychologist' Article

2008-05-08T08:40:00.002-04:00

Future of Vermont’s mental health care services documented in video, here (May 2008).

Related article: Strategies examined to replace Vermont Hospital (February 2008 Issue).

From yesterday's Times

2008-04-28T11:28:00.001-04:00

Diagnosis: Female
By KATHRYN HARRISON

MAD, BAD AND SAD

Women and the Mind Doctors.

By Lisa Appignanesi.

535 pp. W. W. Norton & Company. $29.95.
Back when Zelda Fitzgerald, her skirts wet from diving into public fountains, was accelerating from madcap toward outright madness, a Wharton School economist named George Taylor made the seemingly fey observation that hemlines rose and fell with the stock market, proposing a causal connection between two presumably separate spheres of human enterprise. Fashion, as the now familiar “hemline index” suggested, is socially determined. With prosperity come optimism and tolerance for risk; women are emboldened to show off a more daring length of leg. But what of more empirical, utilitarian domains? Surely doctors hypothesize independently of whatever forces drive style. Take, for example, the diagnosis and treatment of mental illness. Most of us trust psychiatry to remain immune to fads. And it does, doesn’t it?

One of the consistently fascinating and disturbing aspects of “Mad, Bad and Sad: Women and the Mind Doctors” is Lisa Appignanesi’s assiduous tracking of the modishness of what might be mistaken for a sui generis discipline. Of course, as anyone who has visited a psychiatric hospital — or ridden the subway — can attest, crazy is what we call people who refuse to conform to accepted norms of behavior. And the definition of nonconformity must change in step with styles of conforming.

From Friday's Times Argus

2008-04-20T10:53:00.000-04:00

Don't marginalize mentally ill

April 18, 2008

The desire to assign blame for the abysmal failure of those ostensibly involved in attempting to formulate a plan to address the pressing care needs of persons in Vermont with chronic mental illness is fervent, but likely fruitless.

It is clear from the fact that the Vermont State Hospital, with its dismal, antiquated environs and over-worked staff, continueing to limp along with no concrete plan in motion to replace or improve it, that those responsible are impervious to the fact that their gross inaction serves to perpetuate the historic, insidious and intolerable marginalization of people with serious mental illness in our society.

L. Gans

Montpelier

The Future of Mental Health Care in Vermont

2008-02-11T18:12:00.000-05:00

Consciousness Raising Discussion:

Focused on Recovery and Meeting the Needs of People within the Community

Mary Ellen Gottlieb
Albert Galves
Xenia Williams
Bill Newhall

Vermont State House
Room 11
Montpelier, Vermont
Wednesday, January 23, 2008

[...]

Video recorded & edited by: Morgan W. Brown

Video camcorder courtesy of: Vermont Coalition for Disability Rights (VCDR): www.vcdr.org

[via Google Video, here]

EAI "Don't Send Me to Waterbury" Report 1/24/2008 Roundtable: Full Length Video

2008-02-05T00:15:00.000-05:00

*Updated*

Description:

Ethan Allen Institute (EAI) 1/24/2008 "Don't Send Me to Waterbury!" Report Roundtable Video

Event held on Thursday, January 24, 2008: 12:15-1:30; Vermont State House, Room 11, Montpelier, Vermont, USA.

"A New State Mental Hospital, Or 'Recovery in Community'?"

This EAI hosted roundtable discussed "the crucial question of whether the state should replace the Vermont State Hospital by spending $100 million or more building one or more new psychiatric care facilities for 53 prospective patients – or shift the focus to community-based recovery programs for non-criminal patients."

Moderator: John McClaughry, President, Ethan Allen Institute

Panelists:

Michael Hartman, Commissioner of the Vermont Department of Mental Health (VT DMH) and formerly director Community Rehabilitation and Treatment (CRT) services for Washington County Mental Health Services (WCMHS).

Rep. Ann Donahue (R-Northfield), editor of CounterPoint -- a Vermont publication of news, commentary and arts by psychiatric survivors, mental health consumers and their families: www.vermontrecovery.com/counterpoint.html

James Leddy, former State Senate Health & Welfare Chair, Burlington

Dr. Albert Galves of Las Cruces, New Mexico. He is an authority on peer-run crisis intervention. He has a Ph.D. in Clinical Psychology and is a licensed psychologist in Colorado, and is a member of the Board of Directors of the International Center for the Study of Psychiatry and Psychology.

Read the EAI "Don't Send Me to Waterbury" report online at: www.ethanallen.org

For additional information concerning mental health and related matters within Vermont, visit the Beyond Vermont State Hospital (VSH) blog.

Video recorded & edited by: Morgan W. Brown Video camcorder courtesy of: Vermont Coalition for Disability Rights (VCDR): www.vcdr.org

[via Google Video, here]

*Note*: Replaced the initially posted part one (1) introductory video with the full length version; also added the video description as well; last updated on Friday, February 8, 208 at 3:07 AM [EST].

Commentary by Anne Donahue

2008-01-04T02:50:00.000-05:00

Involuntary medication acts to divide, here [via Times Argus; 1/3/2008].

Must-Read: A Challenge For NAMI National

2008-01-04T02:21:00.001-05:00

*Updated*

Steven Morgan's challenge to NAMI goes blog, here [via Furious Seasons]!

Check out his Vermont Recovery Website.

*Update*: Have recently been reminded by Anne Donahue that Steven Morgan's piece was also published within the Winter 2007 edition of Counterpoint (page 16) as well as the NAMI VT response both to him and others concerning such as well as related matters (page 17), which is available online now via the Vermont Recovery Website (via PDF; Adobe Acrobat Reader required), here.

By the way, Steven Morgan also has a MySpace page featuring an offering of music, here.

*Note*: last updated on Saturday, January 5, 2008 at 12:10 PM [EST].

New Report On VT State Hospital Alternatives: EAI News Conference: Monday, 11/26th, 10:00 AM; VT State House, Cedar Creek Room

2007-11-24T14:03:00.000-05:00

Ethan Allen Institute (EAI) report:

"Don't Send Me to Waterbury!" (November, 2007).

This report chronicles the often dark history of the 110-year old Vermont State Hospital for the Insane, explains the arguments for permanently closing the now-decertified institution, offers examples of successful "recovery in community" alternatives for persons with mental illness, and makes strong arguments against creating a very costly (~$100 million) new institution to replace the present Hospital, as desired by the current state bureaucracy and the state employees' labor union.

[...]

Read the executive summary of the report, here [pdf version; requires Adobe Acrobat Reader].

Read the full report: here [pdf version; requires Adobe Acrobat Reader].

EAI Press Release:

Ethan Allen Institute
4836 Kirby Mountain Road
Concord VT 05824
Voice 802 695 1448, fax 802 695 1436
eai@ethanallen.org http://www.ethanallen.org/
Contact: John McClaughry
[...]
News Conference: Monday, November 26, 2007 10:00am State House Cedar Creek Room
(Full report on the Web Saturday at www.ethanallen.org/publications/specialreports/VSH.pdf)

New Report Urges Mental Patient Recovery in Community, not in Large, Costly New Facilities
"Building an enormously expensive new replacement facility for VSH, at the urging of a state bureaucracy and its employee union allies, over the objections of the Public Oversight Commission and most advocates for the mentally ill, will create a large and unnecessary burden for a generation of Vermont taxpayers, while offering inadequate recovery services for Vermonters with mental illness. It is not sound public policy."

That's the conclusion of a new report on the future of the Vermont State Hospital and treatment of severe mental illness in Vermont, issued by the Ethan Allen Institute Monday.

The Institute released the report, entitled "Don't Send Me to Waterbury!", in anticipation of a major debate on the future of the new-decertified Hospital in the 2008 legislative session. Both administration and legislative study commissions have proposed retaining the 110-year old hospital, or creating a new state-run institution system at a cost of as much as $100 million.

"A major policy question," says report author Bethany Knight," is whether the inmates of the 110-year old Hospital will move to community settings, or to one or more costly new state institutions. That question must be informed by a modern awareness of the nature of mental illness, and the efficacy, expense, and humanity of various alternative methods and settings for treatment and recovery."

"Perhaps most importantly, public policy and practices must be shaped in close partnership with the dedicated community of Vermonters who have lived experience with mental health crises, rather than shaped by the preferences of bureaucrats, clinicians, and the employee labor union."

"Vermont now has the opportunity to fully develop mental health care system where three fourths of the present Hospital's population can find support and healing in small, safe, secure and far more cost-effective community settings."

The report recommends that

The operative policy for Vermont's seriously mentally ill population ought not be removal from society, but recovery in community. Vermont's mental health system should be centered on community-based services, not built around a centralized psychiatric facility.

The Department of Mental Health should abandon its relentless quest for the construction of new high-cost state-owned mini-VSH facilities, whether in Waterbury, the FAHC Burlington campus, or elsewhere.

The DMH and designated agencies should welcome new private providers of services, such as residential recovery housing, and faith-based and peer-run drop-in centers. Every temptation to secure a monopoly, so damaging to the interests of consumers, must be stoutly resisted.

Community hospitals must evolve to holistically address the physical and mental health of the people in their communities, and address the issue of forced medication as a serious question of medical ethics.

Designated mental health agencies should employ peers and give them authority to serve creatively, not simply direct new workers to provide old models of care. Providers should seek new compassionate staff members who like people and are not looking for opportunities or evidence to punish clients.

The report contains numerous examples of community-based recovery programs, including three in Vermont (Safe Haven in Randolph, Home Intervention in Montpelier, and Second Spring in Williamstown). Of special interest is the highly successful Fairweather Lodges, founded in 1968 in Minnesota.
The report is sharply critical of the present state hospital's penchant for forcible medication of patients. It also opposes the use of physical restraints on patients, a practice which has brought sharp criticism of the Waterbury hospital by the U.S. Department of Justice.

The report also says that "notwithstanding the reemployment language pushed into Act 147 of 2006 by the Vermont State Employees Union, providers should avoid automatically hiring former VSH staff members for patient care positions. Anyone who has been a part of the dehumanizing seclusion, restraint and forced drugging investigated by the U.S. Department of Justice and others ought to seek other types of employment."

Of the union's efforts to preserve at any cost the 200 union jobs at the present Hospital, the report notes that "legislators will need to keep in mind the interests of mental patients and of their taxpayer constituents when the VSEA presses for its special interest in preserving state employee jobs."

The report's principal author, Bethany Knight of Glover, was formerly executive director of the state nursing home association. She has served on the Vermont Human Services Board and the Public Oversight Commission, and as a volunteer in free peoples' clinics in India.

The Ethan Allen Institute is Vermont's independent free-market public policy organization. It earlier released comprehensive reports, also authored by Ms. Knight, on the Vermont developmental disability program and the home health care monopoly.

#####

Counterpoint Now Available Online

2007-11-19T14:01:00.000-05:00

Recently I found out that Counterpoint -- a Vermont publication of news, commentary and arts by psychiatric survivors, mental health consumers and their families -- is now available online [via Vermont Recovery Website; editions via pdf; requires Adobe Acobat Reader].

Rights Manual Available Online

2007-11-19T11:21:00.000-05:00

Your Rights as a Vermonter Diagnosed as Having a Mental Illness; 2005, VT P&A [pdf version; requires Acrobat Adobe Reader; via Vermont Protection & Advocacy (VT P&A) Website, publication page].

The End of Seclusion and Restraint; Vermont Bar Journal; Summer 2006

2007-11-19T11:12:00.000-05:00

Read: The End of Seclusion and Restraint
by Linda Cramer, LICSW, A.J. Ruben, Esq. and Ginny McGrath, Esq.
Published within the Vermont Bar Journal, Summer 2006
[pdf version; requires Acrobat Adobe Reader]
via Vermont Protection & Advocacy (VT P&A) Website, publication page

Legislative Consultants' Final Report re: the Future of VSH ... (11/09/07)

2007-11-17T10:34:00.000-05:00

Read the final report of the Vermont Legislature's consulting group on the future of the Vermont State Hospital and systems of care (PDF, 183 KB, requires Acrobat Adobe Reader), here [via Vermont Legislative Website].

The same report is also available, here (PDF) [via Vermont Department of Mental Health Website].

One can find the final report cover memo, here (PDF) [via Vermont Department of Mental Health Website].

In addition, read two different news articles concerning the legislative consultant's presentation yesterday (Friday, November 17, 2007) before the Mental Health Oversight Committee as well as to the members of other standing legislative committees in attendence, here [via Boston Globe Website] and, here [via Times Argus].

MHOC Draft Report posted on DMH Website

2007-11-09T06:19:00.000-05:00

This just in (via e-mail from MentalHealthNews):

At the request of the Mental Health Oversight Committee, the Department has provided a draft preliminary report on the work of the inpatient options analysis. The Draft Report to the Mental Health Oversight Committee is posted on the DMH website at the following address: [here; PDF document, Acrobat Adobe Reader required]

fyi: Mental Health Oversight Committee (MHOC)

CCV students explore "Crazy"

2007-10-30T16:51:00.000-04:00

To acknowledge National Disability Awareness month, on Friday, October 26th in CCV's famed LL-7 classroom, students from Glen Hueckel's Abnormal Psychology and Kate Maynard's Interpersonal and Small Group Communications classes watched "Crazy" a performance art piece created and performed by Gail Marlene Schwartz. A panel discussion followed with guests from Mental Health Education Initiative, Vermont Protection and Advocacy and a local psychotherapist. Students explored questions of stigma and meaning about anxiety and depression via the discussion and an interactive workshop which included a spectogram, poems and speaking body sculptures!

[...]

[...]

Read more, here [via CCV Burlington: Blog; Tuesday, October 30, 2007].

fyi:

Community College of Vermont (CCV)

Mental Health Education Initiative (MHEI)

Vermont Protection and Advocacy (VT P&A)

*Note*: posted photos included within update of original blog post as posted at CCV Burlington: Blog; last updated on Wednesday, October 31, 2007 at 10:12 AM [EDT].

Zyprexa, Fraud, and the Future of Eli Lilly

2007-09-22T08:52:00.000-04:00

I'm passing along a post by Mary Ellen Gottlieb about Eli Lilly and the psych drug that has caused severe medical complications for thousands of patients, many of whom had no say in whether they would be forced to take it:

April 03, 2007
The Zyprexa Chronicles: Eli Lilly Shareholders Sue Eli Lilly
Well, you had to kind of know this was coming: A Pennsylvania law firm announced yesterday that it had filed a complaint against Eli Lilly as part of a class-action suit against the company. A press release states:
"The Complaint charges Lilly and certain of its officers and directors with violations of the Securities Exchange Act of 1934 for disseminating false and misleading statements concerning Zyprexa, the Company's best-selling product. More specifically, the Complaint alleges that the Company failed to disclose and misrepresented the following material adverse facts which were known to defendants or recklessly disregarded by them: (a) that they were aware of the clear link between Zyprexa and diabetes; and yet failed to warn the public at large of the serious and material risks associated with Zyprexa use; (b) that they had engaged in an illicit scheme to offset a drop in sales that was certain to occur (and, in fact, did occur) when reports of Zyprexa's side effects surfaced, by creating a marketing plan for Zyprexa which included, as a primary component, the evaluation and pursuit of sales opportunities for the drug based on "off-label" uses; (c) that the growth rate in Zyprexa sales would not be sustainable once information about the health risks of Zyprexa and Lilly's illegal marketing plan were disclosed publicly; (d) that they disregarded data that undermined the "safety and effectiveness" of the drug; (e) that their "quality-assurance procedures relating to the quality and integrity of scientific information and production" as it pertained to Zyprexa were woefully inadequate; (f) that, by engaging in an illicit "off-label" marketing" program as to Zyprexa, they had not "enhance[d]" its policies and procedures designed to assure that its marketing and promotional practices and physician communications "compl[ied] with promotional laws and regulations;" (g) that they failed to warn the public of the serious health risks associated with Zyprexa use and that its illicit "off-label" marketing program was a direct violation of its own code of conduct as set forth in "The Red Book;" and (h) that their illicit scheme of concealing the side effects of Zyprexa and engaging in a massive illegal off-label marketing campaign potentially subjected Lilly to substantial regulatory fines, penalties and other legal action, thereby compromising the Company's overall financial condition and prospects."
I have not seen this so-called Red Book but methinks it has nothing to do with Chairman Mao.
Shareholders must be pissed at Lilly, especially now that the company faces lawsuits by seven states, a Congressional investigation and 1,000 or more remaining individual lawsuits (some of which go to trial this month)--and this is after having settled about $1.2 billion in class action lawsuits in the last 20 months related to Zyprexa.
Of course with such shareholder allegations, it makes you wonder if the SEC is far behind with its own investigation of Lilly as I pointed out back in February.
You just have to wonder when the other shoe--or shoes--might drop since, to date, the FDA and Congress have taken no substantive actions against the company over Zyprexa. And, for all the bloggers out there who like to bitch about the mainstream media (and pimp the whole Web 2.0 paradigm in the process), you'd be wise to remember that much of this wouldn't have happened without the work of the New York Times, which a judge was later dumb enough to call reprehensible, and a couple of people who leaked out the secret Zyprexa documents.
I'm sure the folks at Drug Wonks will find a way to spin this so they can claim that shareholders are trying to scare patients off their meds. Or do the claims of fellow free-marketers mean more to them than those of aggrieved patients?

VPR VT Edition Show Archived Audio Podcast re: Police Mental Health Training/Deadly Force

2007-09-05T15:08:00.000-04:00

Today's Vermont Public Radio (VPR) Vermont Edition show (Noon - 1p.m. weekdays, hosted by Jane Lindholm) aired this afternoon concerning:

Police officers are prepared to face anything while their on the job. But a few high-profile incidents in recent years have raised questions about how police are trained to respond when an incident involves a person who is mentally ill. We talk with Cindy Taylor-Patch, the training coordinator at the Vermont Police Academy, about new protocols that aim to heighten officers' awareness of mental illness.

[via Vermont Edition archives]

The audio of today's show is now archived, here.

fyi:

About Vermont Edition

Cindy Taylor-Patch,
Training & Curriculum Development Coordinator,
Vermont Criminal Justice Training Council

'Second Spring'

2007-09-03T00:03:00.000-04:00

The following two articles -- the second of which (a commentary piece) was penned by yours truly -- concerning the Second Spring Community Recovery Residence (CRR) located within Williamstown, Vermont were published within Spring/Summer 2007 edition of The Independent (A Vermont publication for elders and people with disabilities; Volume 14, Number 3):

Second Spring's Promise

Reflections On The Community Recovery Residence (CRR) In Williamstown

[via Vermont Center for Independent Living (VCIL) Website]

Tasers at the Brattleboro Retreat

2007-08-07T08:48:00.000-04:00

And on kids, no less!

You probably know that the Brattleboro Retreat is making a bid to replace at least some of the beds at VSH when VSH goes out of business sometime later this century, right?

And you may also know that four years ago the Retreat called the Brattleboro Police to the Tyler 3 ward to help them control a 16-year-old patient, the police used their Tasers on him, and Vermont Protection and Advocacy (P&A) investigated that report. P&A found:

Vermont Protection & Advocacy concludes that the Brattleboro Retreat’s reliance on the police and the subsequent use of a Taser on A.N. was a treatment failure of serious proportions. Our investigation demonstrates that A.N. and his parents were clear about their concerns leading up to his hospitalization and the difficulties the Retreat could expect to encounter related to A.N.’s behavior. Further, our review of the Retreat’s response to the October 10, 2003 incident indicates an overly heavy reliance on psychopharmacological interventions. VP&A concludes that the use of force on A.N. by the police and the subsequent administration of involuntary medication may have been unnecessary had adequate treatment planning and proactive crisis planning occurred prior to the triggering events that led to A.N.’s agitated and aggressive behavior on October 10, 2003. VP&A also concludes that the Retreat apparently failed to adequately exhaust the de-escalation techniques that staff are trained and certified in, including therapeutic hold when appropriate, prior to calling for police intervention. The facility’s documentation around the resort to police assistance was inadequate to demonstrate its contention that all other reasonable means of de-escalation were attempted and applied appropriately. Our concerns about the physical environment, that being the location of the seclusion room, and the failure of the seclusion room door to withstand damage, are also areas where VP&A believes more forethought by Retreat staff and administration could have provided for a different outcome in this situation.

So what does it say about the Retreat, the Brattleboro Police Department, and the way Vermont law enforcement officials relate to people with mental illnesses when it happens again?

Whatever you might say about VSH, I don't recall ever hearing about them using Tasers. It certainly makes me think twice, or even more, about whether the Retreat should ever be considered as a replacement for VSH, and whether they should be entrusted with the care of anyone in this vulnerable population.

Heavy use of antipsychotics in Corrections

2007-07-01T10:10:00.000-04:00

A new reported shows that the Vermont Department of Corrections may administer antipsychotic drugs to more of its prisoners than any other state. A study done by the Associated Press shows that 46% of all prisoners held by the Department of Corrections were prescribed antipsychotics.
Even the Department seems to admit that these drugs are overused. For instance, Dr. Susan Wehry, the medical director for the Department of Corrections, admitted that some powerful drugs, such as Seroquel, are given to help prisoners sleep, and that sometimes doctors prescribe antipsychotics for prisoners who request them rather than have to deal with a grievance from a prisoner who wants them. "Quite frankly, I think docs get worn down," she told AP."

Given that the incidence of schizophrenia worldwide is estimated at 1%, the adminstration of antipsychotics to 46% of Vermont prisoners seems very difficult to justify.

Aside from whether all this use of antispychotics is justified, it is important to consider the impact of this news on the VSH Futures effort. As you know, this has been going on for years in an effort to design a replacement for the Vermont State Hospital. Naturally, one of the big questions has been the size of any new facility, which, of course, entails an understanding of the need. For years, mental health advocates have been arguing that the State has sytematically understated the number of Corrections inmates with severe mental illnesses, and for just as long the State has been reporting laughably small numbers for these prisoners.

Here's an excerpt from the minutes of one meeting earlier this year:

Hospital Futures Plan from February 4, 2005, that the VDH/Division of Mental Health prepared for then Secretary of AHS Charles Smith. She distributed excerpts of the plan. Discussion of the group's charge stimulated discussion around several issues:
o Given a number of different populations currently served at VSH, should we create multiple inpatient programs to address each population?
o How do we meet the needs of people in Department of Corrections custody?
o How would we estimate the inpatient capacity needed for Corrections?
The February 2005 Futures Plan reported the Department of Corrections' estimate of four to ten persons in DOC custody needing psychiatric hospitalization for whom no appropriate inpatient service site was available. The inpatient mental health needs of Corrections is required for capacity planning for the Futures project.

So tell me: if the mental health needs of DoC prisoners are so high that almost half of them need antipsychotics, what should we be doing to plan for their mental health needs in the future?

VDH Mental Health Update: Alternative Involuntary Transportation Proposal; 6/15/2007

2007-06-20T12:31:00.000-04:00

[excerpted, via Vermont Department of Health (VDH) Weekly Mental Health Update for the week of June 15th, 2007, here [pdf document; Adobe Acrobat Reader required]

Vermont Department of Health

Mental Health Update
June 15, 2007

Alternative Involuntary Transportation Proposal
HowardCenter and Washington County Mental Health are joining together to develop two new specialized transport teams for adults being transported to hospitals under an involuntary status. Currently most adults, who are transported involuntarily to hospitals throughout Vermont, are brought by Sheriffs in restraints.

Presenting to the Adult Standing Committee on June 11th, Bob Bick of HowardCenter, and Mary Moulton of Washington County Mental Health, announced the plan to build a nonsecure transportation alternative that will be funded through the Division of Mental Health. Under this new proposal, emergency services clinicians assessing patient and public safety for transportation will have a broader range of options to extend to involuntary patients. Additional transport options will be:
two trained transporters in an unmarked vehicle

trained transporter(s) in an ambulance

trained transporter(s) riding with family
The representatives from these two community mental health centers described a plan that calls for hiring transporters who will receive specialized training in communication and behavioral deescalation techniques. Goals to begin are modest with hopes to divert one person per month in each region from secure to nonsecure transport.

Additionally, HowardCenter will extend its transport team beyond Chittenden County to include Addison, Franklin, and Grand Isle Counties. Washington County Mental Health will extend to both Orange and Lamoille Counties. This will provide a more regional approach for the overall plan. A review of each transport will be performed, noting challenges and successful interventions in this evolving alternative transportation option. Protocols have been drafted and will be revised, as needed, with input being sought from providers, consumers, and family groups.

The two agencies will be seeking a number of parttime and oncall staff to provide transportation to individuals being involuntarily hospitalized. People with backgrounds in mental health, first response, and law enforcement are encouraged to apply. The program is expected to be operational in 46 weeks. HowardCenter and Washington County Mental Health will provide a progress report to the Adult Standing Committee with a progress report in three months. The legislation that guides this change is 18 V.S.A. § 7511. and may be referenced at the following link: [ed: here]

[...]

Read a detailed Burlington Free Press news article concerning these matters, here (Wednesday, June 20, 2007].

WCAX - Ch. 3 - 6:00 PM News Series on VSH This Week

2007-05-29T10:35:00.000-04:00

*Updated 2x*

WCAX - Channel 3 TV - News had a promo on this morning for a series they will be airing this week during their 6:00 PM news show regarding the Vermont State Hospital (VSH).

*Update 1*: Check out each of the excellent and very well done WCAX Vermont State Hospital In Crisis series segments, both text versions and a link to the archived video clip of each segment is available on the article page for each:

In Crisis, Part 1
Channel 3 gets a rare tour inside the Vermont State Hospital

In Crisis, Part 2
Find out what some of the options are to replace the Vermont State Hospital.

Helping Their Peers
Meet two patient advocates trying to change the stigma of mental illness.

*Update 2*: By the way, although the transcript of part one (1) does not include it, the on-air version as well as the news script for it includes the following information that was part of the original segment intro and closure portions read by the news co-anchor during the newscast [below highlighted script text mine]:

Wed 30-MAY-2007 6 P.M. News Script

[...]

12} VSH_INTRO

When Vermont's mentally ill patients are in crisis - they're sent to the Vermont State Hospital. It costs 22 million dollars a year to run. But some patients have not gotten the care they need -- and others were put at risk. Tonight Kristin Carlson begins a special report -- taking you inside for a look at what's gone wrong at the hospital -- and how its being fixed. One note -- for patient privacy we do not show their faces.

[...]

14} VSH_GREEN

The state hospital is close to being recertified. A hired independent firm will do a mock survey in July -- and if the hospital passes - federal regulators will be invited in for a real review. But even if it the hospital regains certification -- the aging facility is set to close within about 5 years. Tomorrow night In Crisis - the debate over what should happen next for patients, and what it will cost Vermonters. Ok - thanks Kristin.

[...]

*Note*: last updated on Friday, June 1, 2007 at 3:26 PM [EDT].

Vermont's First Residential Recovery Program Opens

2007-05-14T11:17:00.000-04:00

*Updated*

[...]

Second Spring in Williamstown, Vermont opened its doors to three residents on May 7th. Gradually more residents will transition from Vermont State Hospital until the program reaches its planned capacity of eleven residents.

Second Spring staff has completed a two-week orientation and training program and is working in concert with VSH treatment teams to create a successful transition for each resident.

[...]

[via VDH Weekly Mental Health Update for week of Friday, May 11, 2007, here; PDF document, requires Adobe Reader]

*Update*: Speaking of recovery, check out Steven Morgan's Vermont Recovery Website [via The Clearinghouse blog, here (Tuesday, May 08, 2007)].

*Note*: last updated on Tuesday, May 15, 2007 at 10:12 AM [EDT].

Reflections on the Community Recovery Residence (CRR) in Williamstown: 'Second Spring'

2007-04-24T14:15:00.001-04:00

A friend of mine who -- as I understand it -- had been born and raised in the Williamstown area, whose grandparents had once owned, worked and farmed the property of what later became the (now former) Autumn Harvest Inn, told me about how some of their family would often gather at the Inn for small reunions once a year or so and also tour the place.

One weekend day during mid-August of last year my friend brought me for a ride there and showed me around as best they could.

It was of course evident at the time that some of it would certainly require quite a bit of work and rehabilitation, however it was also clear to me that it was a nice place. Additionally I also sensed a strong healing energy in and around the entire property, both inside and outside.

Overall, I believe this is an excellent site and property, not just because of the scenery either. There is definitely a healing energy and I hope it stays that way.

If the concept of recovery is to be much more than just a part of its general name or description as a Community Recovery Residence (CRR) and, is actually its very foundation and functions as the core within everything else that goes on there, hopefully the healing energy I could sense flowing freely throughout the former Inn and surrounding property will then end up becoming a real part of the lives of everyone who enters, stays, works and eventually moves in from the Williamstown CRR once it opens as well as throughout its entire operation until maybe one day it is no longer needed as a CRR.

Although, typically, I would not want to live as a resident of a mental health facility of any type, no matter how much the concept of recovery may be said is a part of its name or program, ironically enough it seems to me that particular place is somewhere I could either manage to live or work regardless.

These reflections of mine concerning Second Spring are being shared since it seems to possibly be a statement, especially from the likes of myself, particularly when given the fact -- one many people either simply are not aware of or otherwise do not remember -- that long before I ever ended up on the receiving end of the public mental health system, I was the child of persons who had been themselves as well; starting from my very first year of life with one of my parents whom I was taken away from as a result and, then again, during my early mid-teen years with the other parent whom had been raising me on their own.

[above photo of Morgan W. Brown (Spring 2005; taken by a friend)]

'Second Spring' Update

2007-04-07T13:45:00.000-04:00

New facility aims to offer skills and new hope for mentally ill, here [via Barre - Montpelier Times Argus (Friday, April 6, 2007); includes photo].

Additionally, there is an employment Want Ad within the Seven Days Classifieds, here (April 4, 2007):

Collaborative Solutions Corporation is seeking several Recovery and Nursing positions for our new Community Recovery Residence located in Williamstown, VT.

[...]

Read the entire ad, here.

Last week, on the day of the Second Spring Open House, the Burlington Free Press published an article about it, here (Saturday, March 31, 2007).

VDH Mental Health Update: Second Spring Prepares for Opening

2007-03-24T11:30:00.000-04:00

Vermont Department of Health (VDH)

Mental Health Update
March 23, 2007

[...]

Director Roy Riddle reported this week that he has hired half the program staff, including an assistant director, three nurses, ten recovery staff, a social worker, a vocational counselor, two cooks, one housekeeper and a human resources person. Renovations are essentially complete and much work has been done to get the kitchen up and running. An initial round of staff training is complete with more to come after all positions are filled. Many staff are residents of Williamstown, an asset that will help to create connections between the residents of Second Spring and the community. Licensure requirements will be completed by next week.

All are invited to an Open House on Saturday, March 31, 2:00 – 5:00 p.m. Guests will have a chance to tour the facility, enjoy refreshments, and celebrate the opening of the first new community residential program of the Futures Plan.

[...]

[via Vermont Department of Health (VDH) Mental Health Update for Friday, March 23, 2007]

Vergennes ousts incumbent mayor

2007-03-07T20:34:00.000-05:00

From today's Free Press:

Remember April Jin, the mayor who blacklisted mental patients in Vergennes last year? Well, she was up for reelection yesterday and was soundly defeated, and will score few points for grace in bowing out of Vergennes politics. There isn't much indication of why she was defeated, but we do know that it's pretty rare for Vermont voters to turn out incumbents anywhere.

"I feel like getting the hell out of this town and out of this state. I'm disgusted," Jin said. "I've served on a lot of organizations. Somehow it doesn't seem to matter."

Not quite "You don't have Nixon to kick around anymore," but she doesn't seem to be adhering to the old advice to keep your words soft and tender, in case you have to eat them later.

Non-hospital Alternatives

2007-02-21T19:49:00.000-05:00

You may remember a year or so ago when both Vergennes and Greensboro came out and spoke as with one voice against accepting mental patients into their hallowed communities. Since then we have Second Spring in Williamstown well on the way to opening, but no sign of any alternative locations on the horizon.

One of the best ways to keep people out of the hospital is to make sure they have somewhere else to be. That's why I and several other advocates are proposing the following resolution at next week's VSH Futures meeting.

It's hard to see what there is to object to here. We'll see how it goes.

RESOLUTION ON RESIDENTIAL TREATMENT FACILITIES

Adopted by the VSH Futures Advisory Committee

1. The State of Vermont has a legal obligation to provide mental health services to all eligible persons in a setting that is as integrated in the community as possible and in the least restrictive setting appropriate to meet their needs.
2. The State of Vermont has repeatedly stated that many patients are confined to the Vermont State Hospital not because they require the level of care that can be provided only in a hospital, but because there is no non-hospital alternative available to meet the needs of those persons.
3. Confinement of patients to Vermont State Hospital when they do not need hospital-level care violates their civil rights; unnecessarily segregates them from their families, their friends, and the lives of their communities; and imposes needless and excessive costs on the public mental health system.
4. During 2005 and 2006 the State of Vermont attempted to place residential treatment facilities in Vergennes and Greensboro, Vermont, but abandoned those efforts in the face of community opposition.
5. In response to the community opposition to the placement of residential treatment facilities, the Vermont Commissioner of Health announced a policy that the State would never attempt to place a residential treatment facility in a community whose residents opposed it.
6. Since that announcement of policy the State has been able to secure approval for a residential treatment facility in Williamstown, but has had no success in placing, or even attempting to place, a non-residential facility anywhere else in Vermont.
7. The community opposition to residential treatment facilities in Vergennes and Greensboro has been based in part on prejudiced and stereotypical beliefs about people who receive mental health treatment, has perpetuated prejudicial images and treatment of people who receive mental health treatment, and has unnecessarily prevented patients who could safely be treated in the community from being discharged from the Vermont State Hospital.
8. The community opposition to residential treatment facilities based on the fact that they will be occupied by persons with disabilities constitutes unlawful housing discrimination prohibited by 9 V.S.A. § 4503 and the federal Fair Housing Act, 42 U.S.C. 3604(f)(1)-(3).

THEREFORE, THE VERMONT STATE HOSPTIAL FUTURES COMMITTEE RESOLVES:

1. That the Vermont Department of Health should immediately retract and reject its policy of acceding to community opposition to the placement of residential treatment facilities.
2. That the Vermont Department of Health should immediately institute efforts to create and locate additional residential treatment facilities in the state, and should take actions to ensure that such residential treatment facilities are located and in operation by the end of 2007.
3. That the Vermont Department of Health should not contract to create, license, or add new inpatient hospital beds for the treatment of mental illness until all practicable opportunities for non-hospital treatment have been exhausted.

New & Improved Look

2007-01-17T15:54:00.000-05:00

Yes, this blog is back and with a newly improved look too.

(more on this later ..., when I have more time)

Paul Engels: Let's integrate psychiatric patients

2006-09-25T15:53:00.000-04:00

Must-read, here [via Burlington Free Press; Opinion section; Free Press Writers Group segment; Sunday, September 24, 2006].

Paul Engels is a financial services professional who lives in South Burlington. He has lived in Vermont for most of the past 35 years and is a member of the Free Press Writer's Group, a weekly column written by Vermonters.

fyi: 2006 Writers Group (includes photos).

Rearranging the Deck Chairs on Vermont's Titanic Mental Health System Anyone?!

2006-08-18T22:26:00.000-04:00

Two items from the press in as many days (here [via Burlington Free Press; Friday, August 18, 2006] and, here [via Vermont Public Radio (VPR); Thursday, August 17, 2006]) concerning how some of the more vocal and well-resourced types within Vermont's mental health advocacy circles seem to believe the superb solution for all or at least most of mental health woes within the state is to have a commissioner of mental health.

As if this is the magic pill or something that will resolve the problems in leadership as well as the quality of that leadership both within the Agency of Human Services (AHS) and higher up in state government.

Even though, well before AHS Restructuring ever took place, having the Division of Mental Health (DMH) under a commissioner level appointment did not do anything whatsoever to prevent or resolve what are now the current as well as yet unresolved problems (with lots of moving parts) being experienced within and across the state's entire mental health system (not merely at the Vermont State Hospital either) that either originally happened or at least started to happen during that earlier time period: i.e., when there had previously been a commissioner overseeing the DMH.

Why there are those who want so badly to return to that sort of leadership again, I haven't a clue. How soon people forget! Go figure!

Of course, as always, there is a whole lot more to all this than meets the eye.

Looks like the next legislative session in Montpelier will get mighty interesting, to say the very least.

Armed Men at the Gate?

2006-08-07T22:22:00.000-04:00

I was in a VSH Futures Committee meeting today in the Skylight Conference Room in the Waterbury complex. One of the things we were talking about was reducing coercion in services, and how non-hospital services could be delivered in a non-coercive way.

Or at least, that was what I hoped we would be talking about. Unfortunately, since the main topic of discussion of the Futures Advisory Committee is replacement of VSH, the real question is how to deliver services that will replace, if not replicate, the services in the coercive, involuntary Vermont State Hospital. Thus, the idea of reduced coercion is only a relative matter.

As the discussion progressed I noticed the mural on the wall opposite me. The set was controversial when it was installed over ten years ago, and I thought it was relevant to the discussion. The mural shows a priest holding a crucifix, hoping to save the souls of the natives, but the viewer knows that the church is simply serving as an adjunct to the conquerors.

(To read more about these murals, look here.)

In the mental health system, I have no doubt that most of the professionals are well-motivated, but I am concerned that their talk of services, autonomy, and meeting patients' needs serves to support what has been characterized as a massive deprivation of liberty. Until we develop services that respect patients' rights, and facilities and services that community members will value and seek out, so that coercion is no longer necessary, will the acolytes of the state-run mental health system be allies in a move away from coercion and toward freedom?

Editorial re: Proposed Williamstown Community Recovery Residence (CRR)

2006-08-07T20:27:00.000-04:00

Second Spring offers chance to heal [via Burlington Free Press; Monday, August 7, 2006].

Related news article: A place to call home [via Burlington Free Press; Sunday, July 16, 2006].

Written Public Comment Period Extended by VDH on Williamstown CRR Application to Thursday, 8/10/2006 (until the end of day)

2006-08-05T20:22:00.000-04:00

Public Comment Period Extended to August 10, 2006 on Williamstown Residential Recovery Application

The Department of Health will continue to accept written comments about the proposal until the end of day on Thursday August 10th. Written comments can by submitted by regular mail to Dawn Philibert, MH Systems Development Director, Vermont Department of Health, PO Box 70, Burlington, VT 05402, or electronically to dphilib@vdh.state.vt.us.

[via Vermont Department of Health (VDH) Friday, August 4, 2006 Mental Health Update, here (PDF format; Adobe Acrobat Reader required)]

The Williamstown Certificate of Approval (COA) Application and related documents can be found online by going to the VDH Mental Health Futures Web page and, scrolling to the bottom of the page to the section under the heading of: Certificate of Approval to Develop a Community Residential Recovery Program in Williamstown, Vermont.

Read a news story regarding the public hearing, which was held at 4:00 PM last Thursday (August 3, 2006) at the Pavilion Building auditorium [and, which by the way had very little, if any, advance -- or rather, widely announced -- public notice or warning], concerning the proposed Williamstown Community Recovery Residence (CRR), here [via WCAX - Channel 3 TV - News (video clip available on page as well)].

[with apologies, once again, for the lack of posting by myself to this particular blog for such a lengthy period, including and most especially concerning this subject and related matters of great importance and interest]

Settlement between the feds and the State

2006-07-21T17:30:00.000-04:00

I just finished skimming the settlement filed today between the federal government and the State regarding conditions at VSH. It's a thirty-page PDF document, so it takes a bit of effort to wade through it. It's hard to see that they think they need to change anything from their present practice, and almost all the required steps are keyed to 24- or 30-month deadlines.

I would be interested in checking in with the Department to see what their reactions would be to a whole bunch of questions, including the following:

1. What present practices, policies, and procedures need to be changed to comply with the settlement agreement?
2. What findings or interim reports have been made by the monitors designated by the settlement, and let's have copies of all of them?
3. What patients or patient representatives were consulted in arriving at the settlement agreement?
4. In implementing the corrective measures and changes required by the settlement agreement, who will be responsible for action on each point?
5. In implementing the corrective measures and changes required by the settlement agreement, what are the internal timelines established by the department to ensure that the ultimate timelines will be met?
6. What sanctions or enforcement mechanisms exist to ensure compliance with the terms of the settlement agreement?
7. In the opinion of the Department, will compliance with the terms of the settlement agreement be sufficient to qualify VSH for recertification?

I'm sure there are many more questions that should be answered, but this seems like a start.