Editor’s note: Click on the first image in this story and you’ll find a cool photo gallery from the Mental Health Advocacy Day rally.
Nearly a thousand advocates for the mentally ill and developmentally disabled thronged the Statehouse Wednesday to deliver a straightforward message to their legislators: Don’t cut services.
“Treatment works,” observed Katina Cummings, the executive director of National Alliance on Mental Illness-VT, “but only if you can get it.” More than 23,000 Vermont adults and 6,000 children, not counting those with developmental disabilities, Cummings said, have a serious mental illness.
Advocates and “consumers,” the Vermonters, who rely on nonprofit service providers around the state, oppose the significant budget cuts to mental health and developmentally disabled adults proposed by Gov. Peter Shumlin.
Mental Health Advocacy Day was organized by the Vermont chapter of the NAMI and the Vermont Association for Mental Health. The 19 co-sponsors included advocacy groups for people with mental illness, developmental disabilities and addictions.
At a joint meeting of the House Human Services and Senate Health and Welfare committees, legislators heard from a suicidal mother whose life had been saved by quick access to care, from a doctor whose mentally ill child was failed by a fragmented system, from providers who are struggling to meet the need and from the default responders to mental health crises — a police chief and emergency room director.
Their statements had a common theme: Cutting mental health services is penny wise and pound foolish.
Margaret Joyal, the director of outpatient services for Washington County Mental Health Services, noted that 120 outpatients would lose services if 5 percent of the agency’s budget is cut. The outpatient program provides care for 7,000 people a year. As a result of last year’s cuts, she said, WCMHS’s waiting list is now longer than at any time in her 20-year tenure. More cuts would mean eliminating services for homebound elders, and there wouldn’t be time to do planning for Supplemental Security Income clients coming out of corrections.
Joyal compared caring for people with mental illness to maintaining a home. “(It’s) a constant obligation. It doesn’t go away because you fixed the roof one year or you get the house painted the next year. It’s always something.
“We are the mental health home for many of our clients,” she said, noting that 15-20 percent of her agency’s clients have no health insurance, and 80 percent have so little income they are at the bottom of the sliding fee scale.
“If we don’t maintain the system, it will crack and crumble — it will become unsafe for the people that rely on it. And in some ways, it’s already happening,” she declared. “A waiting list of other 50 people is not safe.”
Tim Bombardier, Barre City’s chief of police, fire and ambulance services, said he has worked in most of the counties in Vermont in his 30 years in law enforcement, and the situation is the same everywhere: “If we were to lose mental health services, the burden gets shifted to police and EMS.”
Bombardier said his department relies on WCMHS as the emergency responder for people with mental health and substance abuse issues.
The only other alternative for dealing with people who are intoxicated or have a mental health crisis is for officers to take them into custody and accompany them to the hospital. That shifts the burden (and cost) of care to the hospital. Moreover, it takes an officer off the street. Recently an officer had to wait with someone for five hours at the hospital.
Recently, Bombardier said, he has been looking at how to get more mental health help at the street level to relieve the burden on the police and emergency personnel. “The people in our community with treatment needs, if there’s not somebody on the streets, we’re not going to know they need help until there’s a crisis,” he explained.
David DiLego, a mental health consumer from Burlington and NAMI member, told the committee that he has a disorder that makes it impossible to distinguish delusions from reality. Five years ago, he said, he was lying on the floor screaming to God to make the voices stop. His choices were to commit suicide in order to find relief from his symptoms or to go where he wouldn’t be allowed to commit suicide. He went to the hospital and has been in psychiatric care ever since, seeing a therapist every week and a psychiatrist once a month. He takes five medications a day to manage his illness.
“If these programs continue to be cut,” he said, “there is a very clear consequence. People will die. People will commit suicide, and God forbid, may harm someone else.” He pleaded with the committee to recognize through his testimony that mental health care is essential.
“Today I’m in a much better position than I was five years ago, but my mental health remains fragile,” he said. “People who suffer from mental illness are the most vulnerable people in our society, and I believe that our culture has a responsibility to take care of those who need them most and can advocate for themselves the least.”
Dr. Mark Depman, the director of the emergency department at Central Vermont Medical Center, said of the 30,000 patients the hospital sees a year, thousands have mental health issues. Every emergency room doctor “has the same recurring terror,” he said, of sending someone home who will commit suicide or of sending someone back to a college campus who will take a gun and shoot others.
Washington County has a great system that works, he observed, and told the committee, “You shouldn’t tinker with it.” Washington County Mental Health staff are “on the phone speaking to clients around the clock, compassionately, with a sense of humor, looking for ways for people to keep their lives going” — elderly people who are homebound, veterans with PTSD, seasonal workers suffering from depression because of the long winter.
Depman called the committee’s attention to Atul Gawande’s January article in the New Yorker, “The Hot Spotters.” In it, Gawande describes a program for providing excellent medical care at a reasonable cost — “exactly the issue we’re working on in Vermont,” Depman observed.
Gawande recommended a strategy of assigning relatively low-cost resources at the community level to solve problems that could result in expensive hospital admissions. “You have that system here in Vermont for mental health. It should be the model for your medical system that you’re looking forward to,” Depman said.
After the hearing, the advocates walked over to the auditorium in the Pavilion Office Building to organize for a noontime rally.
Cummings reviewed points set forth in the coalition’s legislative agenda that the advocates could make when visiting their legislators.
(In a few meetings, the 19 coalition groups had agreed on a set of common goals. The one that attracted the most support was to integrate mental health, primary care and addiction services as a means of controlling healthcare expenditures and improving outcomes.)
Other priorities included:
- Increasing funding for community mental health services and Designated Agencies
- Replacing Vermont State Hospital, supporting the expansion of community residential services and funding comprehensive, intensive outpatient services as components of a continuum of care
- Providing early screening, assessment and intervention for youth, as well as a continuum of home, school, community and crisis services for them, and respite care for their families
- Strengthening and expanding the mental health and addictions workforces
- Providing jobs and safe, affordable housing for people with mental illness
- Educating the public about mental health and eradicating stigma.
Then Cummings asked what the results would be from cutting mental health budgets. “Homelessness,” one person shouted. “Police,” yelled another. “Exhausted and aging families,” added a third.
Busloads of advocates began arriving from around the state and poured into the auditorium while the early arrivals rehearsed. “There is NO health without mental health,” they chanted. “One, two, three, four, mental health budget cuts out the door!” “How about, ‘No axes — raise taxes!’” suggested Floyd Nease, the executive director of the Vermont Association for Mental Health.
As the advocates practiced their chants, Christine Oliver, the Commissioner of the Department of Mental Health, walked in from a house appropriations committee meeting, where the budget was being discussed.
She congratulated the crowd for making their voices heard. “I’d like to think that I speak for you all as well, and I am doing my best, but this is a long road,” she said.
“I just want to assure people that I do understand the impact of these cuts. Nobody’s happy about them, but we’re just trying to do the best we can. We are not turning our back on the most vulnerable Vermonters. We really are trying to come together and work with all of you and all of our partners, the Designated Agencies … to kind of piece together what we can piece together to ensure that people do not fall through the cracks.
“When we talk about spreading the cuts widely, it’s really to make sure that no one person really falls through the cracks,” she said. “We’re all having to do things a little differently. Maybe some services to some degree will be lessened … It really is about all of us working together, continuing to have the conversations about how do we do things, how do we help each other… I’m open to any suggestions folks have about how to do it.”
A man’s voice, high and urgent, rose from the back of the auditorium. “If you cut services, we’re just going to end up in jail or back out on the street. Do you guys want to pay taxpayer dollars to put people in jail?”
Oliver said she shared his concern about people not being able to access services and about the impacts that cuts could have on other parts of the system: “There are initiatives going on right now with the Department of Corrections, and it’s our partners in the Designated Agencies that are trying to work with that population as well so we have better transitions, but we don’t want people to get there in the first place.”
“I’ve been in jail once, and I don’t want to go back to jail or to Waterbury State Hospital!” the voice rang out.
