Crimes Against Humanity -Vermont

Save our mental health system

Lisa Lax

In recent months, Vermont State Hospital has been a regular feature in the news, with a focus on its failures. The public has been informed of decertifications, a suicide, and other evidence that this institution is ailing. We've also received the Vermont Futures Committee's recommendations for a plan to replace this institution. This committee strove to address the multiple perspectives and interests of various stakeholders in a heated environment.

It is unfortunate that their report was delivered in the midst of a mysterious shake-up that left us without a deputy commissioner of mental health and thus without a strong advocate for mental health care within the current administration. Not only are we at a critical juncture for these reasons, we also face significant cuts in federal dollars with changes in how Medicaid is allocated and reductions from other sources such as HUD that we depend upon to the support mental health care system. As a former employee in this system, I'm deeply troubled by what's unfolding and fear that we face even greater failures.

Ever since embracing a plan to de-institutionalize its mental health care system over 20 years ago, Vermont has held the goal of closing the state hospital. However, some people's struggle with mental illness interferes with their functioning to such an extent that they cannot live continuously in the community.

Despite our lofty goal to close its doors, we continued to rely on the state hospital to provide a needed service while not fully committed to support it as an institution. Recent events show us the results of our ambivalence. Clearly, we need to provide a better alternative for institutional care that is safer, more humane, and more compliant with best practices and standards of care.

The challenge in this is that any new direction will require additional resources and could easily divert attention from other parts of the system that are equally strained.

Vermont leads the nation in de-institutionalizing its system of care for people suffering from severe and persistent mental illness. During the 1980s, grant funding from the Robert Wood Johnson Foundation supported the undertaking to strengthen and create new services in local communities.

Vermont's 10 community mental health centers served as the backbone of this endeavor, providing community based treatment through case management, supportive housing, crisis services, vocational programs, and low cost psychiatry to consumers. Vermont created a nationally recognized community based care system that quickly reduced the hospital census of several hundred and kept it to less than 50 for the past 20 years.

A significant point is that community-based care, such as the state hospital, has not been adequately funded in Vermont. After the grant funding ended, community programs were never fully supported with state or federal dollars. A cycle of unending budget crises combined with dawn of managed health care has put continuous pressure on the centers. Some centers have had to make difficult decisions to eliminate needed programs in order to stay afloat.

More often than not, sustaining services meant that skilled and compassionate employees could not be paid a livable wage. As a result, staff turnover in some programs has been high, impacting the ability to provide continuous care.

Professional creativity and determination cannot continue to make up for budget cuts. Access to services will be affected. Consumers might have to wait even longer for a bed in a community residence or to see a psychiatrist for medication.

Caseloads will burgeon beyond any one human professional's capacity to respond compassionately. Consumers who are stable and living successfully in the community with the support of a particular program might be urged to "graduate" prematurely so as to empty a bed for someone in more dire need. With this strain, individuals will experience more crises which will require more hospitalizations and emergency responses, or lead to tragedy.

If we are to be a compassionate society, we need to understand that people who have severe mental illness, through no fault of their own, can suffer from debilitating symptoms which interfere with activities and social relationships that the rest of us take for granted.

A diagnosis of mental illness can plunge a person into poverty, a life of discrimination, marginalization, and isolation. Their families, already stressed and pained by the effects, can sadly suffer further from unnecessary blame and stigma. Yet people who are struck by mental illness are among some of the most creative, intelligent people in our society. Their presence adds to the fabric of society in spite of, or maybe because of, their vulnerability.

From my perspective a society's decency is judged by how it cares for its most vulnerable members. I hope that Vermonters will pay close attention to the issues and events impacting mental health care in our state and will do what is decent by ensuring that our mental health care system, which includes both community-based and institutional care, is fully funded and politically supported.

Lisa Lax is a social worker with more than 20 years of practice experience in Vermont. She is employed by the Department of Social Work at the University of Vermont, and serves as a member at large on the board of the Vermont Chapter of the National Association of Social Workers.