ST. ALBANS — When you hear the term, “mentally ill,” what comes to mind?
Typically, a community learns about mental illness in a way that’s disconnected from the illness. Media, police reports, court decisions, word of mouth: many times, these sources fail to acknowledge the crisis people may be in as they commit criminal, desperate or unusual acts.
Some local examples from the Messenger in recent months include: a man stealing a police cruiser and crashing into a telephone pole; another man wielding a knife in the local emergency room; a young man burning his parents’ barn.
Without looking at the cause behind these incidents, stigmas remain, and an opportunity to educate and strengthen the community gets lost.
Fortunately in Franklin County and across the state, efforts are being made to become more informed and respond more effectively to mental illness. Law enforcement is working with mental health clinicians, mental health first aid classes and education events are being offered to residents and service providers, community resources are being utilized, and mental health professionals are finding better ways to treat patients.
While mental health isn’t handled perfectly in this community, it’s on a good path forward, according to local officials. “I think there’s definitely cause for concern,” said Dr. Steve Broer, director of Behavioral Health Services at Northwestern Counseling and Support Services. “But I also think there’s a cause for hopefulness.”
In its May Community Grand Rounds session for Mental Health Awareness month, NCSS showed the videotaped panel called “Minds on the Edge: Facing Mental Illness.” The taped forum, filmed in 2009, included people from with law enforcement, legal, academic, journalistic and clinical backgrounds as well as those battling mental illness themselves or in their families.
Collectively, the video’s panel participants agreed: in this country, mental illness is not property addressed. In addition to a looming stigma that paints the mentally ill as violent, untreatable, outside society, finding immediate care is difficult. Unless people pose an immediate danger to themselves or those around them, chances are, they will not receive inpatient psychiatric help for weeks or even months.
In the session’s discussion portion, the attendants spoke about similar issues regarding mental illness locally.
“There’s still so much stigma out there,” said Katherine Berard-Brown, an NCSS nurse. “I wish we could just take the word ‘mental’ out.”
Berard-Brown and others pointed out that mental illness, just like physical illness, is a condition that needs treatment, something that has symptoms and solutions.
Unfortunately, treatment for mental illness isn’t always easily attained, partly because of the negative associations and especially due to the limited number of crisis clinicians and acute care inpatient beds in Vermont.
“We deal with this all the time,” said Stephen Cousino, a NCSS crisis clinician. Cousino spoke of the difficulty in getting timely treatment for those who are experiencing mental health issues but are not posing a danger to self or others that gets them involuntarily committed to a bed.
Crisis care is available 24/7 in Franklin County, but those experiencing mental health issues often have to wait for an inpatient bed, sometimes for up to a week.
In the meantime, many people end up in Northwestern Medical Center’s emergency room.
“[The emergency room] is not equipped to deal with inpatient psychiatric,” Cousino said. With so many other emergency room patients in need of help, the capacity to meet the needs of someone with an acute psychiatric crisis is limited.
In addition, many more people experiencing mental illness end up being arrested and incarcerated. A number end up homeless.
“The people that need [inpatient psychiatric] help don’t really get the help they need,” said Cousino.
As of now, 169 beds exist in the state, many of which are earmarked for special use. A total of 41 are Level 1 beds, or beds for acute patients, leaving fewer beds for general use. That number was crunched in 2011, when Hurricane Irene closed the Vermont State Hospital. Usually, beds are 80 to 90 percent full at any one time.
Additionally, 33 beds exist in Brattleboro for people under 18.
When NCSS is looking to commit a patient, it often has to call around to the six Vermont hospitals that receive psychiatric inpatients, asking every 12 hours until a bed has opened up.
“It becomes a calling game,” said Cousino.
In addition, treatment for patients with mental illness has been mostly reactive, and medication is often sought when other services would do better.
“There’s too much focus on the chemical solution,” said Broer. Where exercise, talk therapy, more sleep, and other preventative measures could take care of many lower-level mental illnesses, medication is often prescribed instead.
“Our society is so focused on medications – it’s problematic,” he said.
Alison Krompf, a NCSS quality review specialist, added, “I think there has to be a cultural shift that getting help doesn’t have to mean the hospital.”
Despite the manifest challenges inherent to mental illness, those in Franklin County and in Vermont as a whole are looking to do better.
In this community, education has become an important tool to erasing stigma and discrimination towards those with a mental illness locally. NCSS began providing Mental Health First Aid trainings in the past few years to educate community members on what mental illness is, what the symptoms are, and where to go for help.
So far, about 500 people have been trained.
In addition, the closure of the Vermont State Hospital caused the formation of Act 79, a 2012 piece of legislation meant to reform Vermont’s mental health system. The purpose of the act states that Vermont will not only work towards providing more acute inpatient beds, but it will also look to create a more community and peer services approach to mental illness.
“That’s good coming out of bad,” said Cousino.
Across the state, an addition of 17 beds will be made available when the new Vermont State Hospital building opens in mid-August in Berlin, and new programs such as Team Two and local mobile outreach also have gone into effect.
Team Two, which began in 2012, is a training program that encourages collaboration among first responders and mental health workers on the issue of mental illness.
Kristin Chandler, program director, said by phone this week that Team Two is a review of mental health law and various possible scenarios that those in the training must practice handling. There have been four regional training days so far, and Chandler hopes eight more will happen across the state within the next year. The goal is to reach all first responders.
“We want everybody to feel safe,” Chandler said. “It’s really a curriculum that’s designed to encourage collaboration.”
While Team Two trainings give responders the tools to address mental illness, mobile outreach is the on-the-ground program through which law enforcement and clinicians collaborate. In Franklin County, NCSS has three full-time clinicians on its mobile outreach team, as well as a nurse that works with the program.
They have four goals: decrease inpatient psychiatric admissions; stop unnecessary emergency room admissions; avoid arrests and incarceration for the mentally ill; and decrease the number of suicides in this community.
Tony Stevens, the Team Leader for crisis services at NCSS, said Thursday that mobile outreach has allowed NCSS to be more proactive in the community. In addition to going out and checking up on people who have called first responders with a mental health issue and continuing with case management, the mobile outreach team is often called out on the front end of local police responses.
“Any mental health calls for services, we’re really involving them right at the onset,” said Vermont State Police St. Albans Barracks Lt. John Flannigan on Thursday. “It’s a service and a relationship that has really changed in recent years. I think we’re getting better at responding to these incidents.”
This joint work the NCSS mobile outreach team does with St. Albans City Police, the Vermont State Police, and other local law enforcement has been decreasing emergency room visits and unnecessary arrests since the program began in 2012.
“That’s been a really positive collaboration,” said Stevens.
A better future?
As Franklin County makes progress in its treatment of mental illness, several themes emerge: empathy, community, collaboration. While there still are not enough beds or enough clinicians to go around for those with mental health issues, and while the physical and mental health communities still have some space to cross to find the best treatment, mental health has become more prominent in the community, and more effectively defined and addressed.
“I think the more we’re out there and visible in the community, it’s hopefully normalizing things more,” Stevens said. “We’re all in this together.”