Full-time Focus

(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.


*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

*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

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”!

*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

[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:

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Contact Governor Jim Douglas, here.