Good news is reported in mental health care in Vt.
By Peter Hirschfeld
Vermont Press Bureau | June 22,2013
MONTPELIER — Before he turned even 20, Ivan Deutsch had been through 20 foster families, 15 visits to the psych ward, and more run-ins with police than he cares to remember.
For his entire teenage life, Deutsch suffered the slings of a mental illness that robbed him of a normal childhood. Thanks to a newly sprouted eight-bed residential treatment facility in Westminster, however, Deutsch said the future has finally started to look promising.
“If they hadn’t stuck with me like they had, I wouldn’t be here right now talking to you,” Deutsch told a panel of lawmakers Thursday. “I thought I was always going to be on the borderline of not living. But thanks to Hilltop, I made it.”
Amid the persistent turmoil of a mental health system under siege, Ivan Deutsch, and the Hilltop Recovery Residence that helped save him, offer at least a glimmer of hope for the reformation of a mental health system plunged into crisis by Tropical Storm Irene.
Nearly two years have passed since the historic floods inundated the state’s 52-bed psychiatric hospital, crippling the state’s ability to care for its most acutely ill residents. Vermonters experiencing psychotic breaks saw their wait times in emergency rooms spike to all-time highs in May, and Gov. Peter Shumlin himself has described the lack of secure, in-patient hospital beds as a disaster waiting to happen.
But amid all the bad news — and there is plenty — come stories like the one told by Deutsch, in which programs borne out of a wide-ranging mental health bill passed in 2012 are beginning to offer help to Vermonters who might not previously have gotten it.
“We are able to do things today that we would not have been able to do two years ago, and it’s having an incredibly positive impact on our ability to intervene in meaningful ways,” says George Karabakakis, chief operating officer of Health Care and Rehabilitation Services of southern Vermont.
Landmark legislation passed in Irene’s wake placed a new emphasis on community-based interventions. Instead of plowing state resources into another 50-plus bed state hospital, lawmakers and administration officials opted for heightened investments in earlier-stage interventions they said would prevent many patients from ever needing involuntary in-patient committals.
Whether the 25-bed facility now under construction in Berlin will prove adequate for the segment of patients that will inevitably need hospital-level care remains an open question. But Karabakakis said he’s convinced the investments at his organization have headed off situations that would have otherwise devolved into crisis.
At Health Care and Rehabilitation Services, which serves clients in Windsor and Windham counties, increased public funds have allowed the nonprofit to embed trained staff at police departments, probation and parole offices, addiction-recovery centers and other venues at which people with emergent mental health issues are statistically likely to show up.
Karabakakis said the organization has also held training programs for police officers, town officials and members of the clergy, wherein HCRS staffers supply basic skills for identifying mental illness, and helping people suffering from it. Karabakakis said bolstered funding post-Irene has enabled the hiring of 15 staffers, people without whom the more robust outreach wouldn’t have happened.
HCRS has also been able to secure 10 single-occupancy apartments between White River Junction and Brattleboro, providing temporary refuge from homelessness or problematic living situations.
“The earlier in the process we’re able to intervene, the more success we’re going to have,” Karabakakis said. “Because once they get rolling through the criminal justice system, things can get very difficult, and more difficult often than they needed to be.”
The 2012 legislation, called Act 79, has also funded an increase in the number of residential centers like Hilltop, a voluntary program with a self-directed treatment regimen that gives patients control over things like whether or not to take medication.
Deutsch, who graduated from the program after seven months, credits this non-secure setting for a turnaround that might not have happened in a more restrictive hospital setting. “They treat you like a human, not a prisoner,” Deutsch said.
“I’ve been locked up a lot, so I know a lot about it,” he continued. “At Hilltop, it’s all in your hands how quickly and how well you want to recover.”
Julie Tessler, executive director of the Vermont Council of Developmental and Mental Health Services, said the community-based model is proving to be a sound one. Act 79 directed nearly $20 million in new funding to a slate of nonprofit “designated agencies,” which administer mental health programs and services on the state’s behalf.
“We have made tremendous headway,” Tessler said. “And Act 79 is a huge step in the right direction. We can do a lot more for people in the community with mental health services than we have in past.”
But Tessler said the system is still one that reacts to crisis, instead of trying to prevent it in the first place. Rectifying shortcomings in the system, Tessler said, will mean allocating to mental health care the same level of financial resources being directed to more conventional health care services.
“We really need a whole lot more to make a difference,” Tessler said. “These interventions are still upstream to where people are severely ill. And only preventative care is going to solve that.”