Monday April 1, 2013

Editor's Note: This is the secondin a three-part series on the state of
Vermont's mental health care system since the closure of the Vermont State Hospital in August 2011.

BRATTLEBORO -- As hospitals and local care providers struggle to cope with the demands of community members with acute mental health issues, Health Care and Rehabilitation Services, based in Springfield, staffs the front line of the battle.

"We developed the first police social worker program in the state about 10 years ago," said George Karabakakis, HCRS' chief operating officer. "That program began in Bellows Falls and is designed to interrupt the cycle of serious personal challenges that our clients face. The idea is to be proactive, reaching them at an earlier point in time."

That model has since been expanded to Brattleboro and Springfield.

The social worker works side by side with police and HCRS' community partners, which include housing coalitions, youth services, food shelves, shelters and others.

"The only way to effectively support people is by developing the appropriate linkages and connections for them," said Karabakakis.

Act 79, which was passed by the General Assembly and signed into law by Gov. Peter Shumlin in 2012, provides HCRS with funding for the program, he said.


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He described the program as "an integrated community-based case management program for people who fall between the cracks who have significant issues around homelessness, unemployment, mental health and substance abuse and who fail to meet eligibility requirements for major programs."

The program's aim is not to help people because they fit a particular category, said Karabakakis, but because they have a certain level of need that has remained unfulfilled.

"We are trying to do everything we can to move them toward self-sufficiency," he said.

HCRS is one of the state's "designated agencies" that serves the "catchment" of Windsor and Windham counties. It serves almost 5,000 people a year through its five major service programs: Adult Outpatient; Children's Division; Community Rehabilitation and Treatment, Developmental Services; and Windham/Windsor Recovery Assistance Program.

HCRS also supplies what are called qualified mental health professionals who are part of a screening team poised to react when a need presents itself, such as in a hospital emergency room or other community service provider.

When Tropical Storm Irene swept through Vermont in August 2011, one of the facilities it rendered uninhabitable was the Vermont State Hospital. Its patients at the time were disbursed to hospitals and care providers around the state, including the Brattleboro Retreat. But even though the state is in the process of replacing the state hospital with a new 25-bed facility in Berlin, slots for those who need inpatient mental health care can be hard to find on a moment's notice.

Instead, many of those who need care find themselves first in a hospital emergency room, and qualified mental health professionals -- or QMHPs -- from there are on the front line of that battle as well.

"Right now there are not enough beds in the state," said Karabakakis. "It's putting a real strain on our emergency rooms around the state."

A QMHP is dispatched to an emergency room and helps to determine whether someone meets the criteria for hospitalization. If a person is in an ER awaiting a bed in a psychiatric facility, HCRS' team makes regular visits to reassess the person's status, he said.

Nevertheless, said Karabakakis, "When someone is in the ER, they are a patient of the ER. Our role is to work with them and be as supportive as possible, but ultimately our role is limited."

HCRS' main focus is on community rehabilitation and training, providing "wraparound" services, a coordinated planning process that leads to an individualized "wellness recovery action plan," said Karabakakis.

"Many of the challenges we face are community challenges," he said. "The people we serve are our friends and neighbors. We can only serve them well if we are working together as a community. We can't do it as individual agencies."

HCRS has a 1-800 number that anyone in the community can call if someone is in a mental health crisis and is potentially a danger to him or her self and others and requires a more intensive level of care. That number is 1-800-622-4235. However, said Karabakakis, if someone is concerned about the safety of a person or is in fear of an imminent threat, they should first call police.

HCRS' team meets with the individual, his or her family and their care providers to develop a plan to get them through a crisis and on a path of healing, he said.

While Tropical Storm Irene was an horrific event for the state, said Karabakakis, it did restart a seemingly stalled process in dealing with the mental health crisis in Vermont.

"Irene led to the development of some projects we had been working on for years, but now we can actually fund those projects in what we hope is a sustained way," said Karabakakis. About a year ago, HCRS established a crisis care center on Linden Street, across the road from the Retreat.

"It's a way to provide a more client-friendly way to support individuals and families who are dealing with a mental health crisis," said Karabakakis.

Though it only provides outpatient care, he said, "We see it as an alternative to the emergency room."

The staffers of HCRS are also continuously learning and refining their skills, sharing their knowledge with other providers in the community, said Karabakakis.

"We have also started training our staff around ‘emotional CPR' and ‘mental health first aid,'" he said. eCPR is a public health education program designed to teach people to assist others through an emotional crisis.

Mental health first aid is a public education program designed to help people identify, understand and respond to signs of mental health illness and substance abuse.

For more information, visit hcrs.org.

In Wednesday's Reformer: The Brattleboro Retreat opens its doors to patients who would have in the past gone to the Vermont State Hospital.

Bob Audette can be reached at raudette@reformer.com, or at 802-254-2311, ext. 160. Follow Bob on Twitter @audette.reformer.