 I am JoLinda LeClaire, Director of Drug Prevention Policy for Vermont. I oversee the Governor's Opioid Coordination Council, which Governor Phil Scott established by executive order in January 2017. Since then, the Council has focused on its mission to improve Vermont's response to our opioid challenges through prevention, treatment, recovery, and enforcement. This crisis touches everyone in our state. Many Vermonters have family members and loved ones who have become addicted after receiving opioid prescriptions for pain. Others were exposed to opioids and other drugs through friends, dealers, and traffickers. Regardless of how they were exposed, we know we have among us many who now have the chronic, isolating, and too often deadly disease of addiction. We are making progress. Prevention is available across the state through Vermont's nationally known hub and spoke system of treatment. Recovery centers in our communities are providing effective wraparound support to help people achieve long-term recovery. Many communities are building prevention coalitions to provide our children and families the tools they need to be resilient in the face of life's challenges and traumas. Vermont law enforcement has steadily worked to increase community safety and to decrease the supply of illegal drugs. They also work hard to support prevention strategies that will reduce the demand for opioids. There is more we can do and must do to turn the curve on Vermont's opioid challenges. Drug prevention education is a top priority for schools and communities, increasing intervention opportunities in emergency rooms and other places will help more people enter treatment and recovery. Individuals and families in recovery need support to obtain jobs and rebuild their lives and support for harm reduction through safe and appropriate use and disposal of drugs and syringes will increase safety in homes and communities. Everything we all can do to take every opportunity to raise awareness and reduce stigma by talking about addiction. To highlight the science of addiction as well as the cultural, social and economic challenges associated with addiction, the producers and hosts of Vermont Cable Access and the Opioid Coordination Council have created an eight-part series entitled, Understanding Vermont's Opioid Crisis, Working Together to Create a More Resilient Community. The seventh in this series is about co-occurring disorders, substance use and mental illness. Many people suffer from both substance use disorder and depression or other mental health challenges. In this segment, host Pat McDonald and her guests explore effective prevention and treatment strategies for people with such co-occurring issues. Well, thank you, Jolinda. Thank you for the introduction. As Jolinda said, tonight we are talking about substance use disorders and mental illness, co-occurring diseases and the treatment available for those combination of disorders. And I have three pretty, I would call experts tonight with me who are going to help us sort this all out, Sienna Fontaine, who is a licensed clinical social worker at the Howard Center. Yes. Welcome. Thank you. I'm going to go away with three guests. Mary Moulton, who's a repeat guest, is the Executive Director of Washington County Mental Health Services. Mary. Thank you. And Rebecca Porter, who is a licensed alcohol drug abuse counselor from the Department of Mental Health. Is that correct? I got that right. Yes. Yes, thank you. Thank you all for coming. So we always start out as Mary knows, talking a little bit about yourself. So I'll start with Reba. Okay. So my background is I'm duly licensed, which means that I have a license in addiction treatment as well as mental health treatment. And I currently work at the Department of Mental Health in the Quality Division overseeing work at the designated agencies to ensure certain quality standards for services and documentation of services. And my direct service background is in working with a variety of different populations. I've worked with court mandated individuals through the Department of Corrections, also incarcerated women, pregnant and parenting women who are working towards reunification with their children or avoiding losing their children. I've worked on inpatient psychiatry unit and street outreach and crisis with children and families. So I've worked quite a bit over the three or four years. I've related a little bit on the prevent child abuse Vermont board. Yeah. And I was told the other day at a board meeting that the numbers, we were having them go down for child abuse, but now because of the opioid crisis, their numbers are going up, but it's mostly because of neglect. Mary? Well, I'm one of the designated agencies that I've been watching all the time. So I'm the Executive Director of Washington County Mental Health Services, and I've been at Washington County for about 27 years now, started out as an emergency services clinician and worked with law enforcement for years on a mobile crisis team. And I did a stint at the Department of Mental Health after the flood as the Deputy Commissioner actually of the Department of Mental Health and the Acting Commissioner for a period after that, coming back to Washington County as the Executive Director. So we were glad you're back, Mary. Thank you. You're welcome. I'm one of Mary's biggest fans. It was good to get back. I make no bones about it. Thank you. Sienna? I am actually also a duly licensed, licensed alcohol and drug counselor and a licensed independent clinical social worker. And I am another designated agency, so I work for the Howard Center in Burlington, so designated agency for Chittenden County. And I do direct service for any adults in Chittenden County above 18 for both mental health and substance abuse. I do groups for recovery and I do work with a mix of court mandated clients from the state government or from the federal probation office and clients who are self-referred. Do these clients volunteer to come into your classes or do they have to be referred? They have to have an assessment and be referred from inside of our agency or referred from mandated. That's great. Sienna Rieber, they told me you were the only one who had the dual license in the department, so I thought it sounded like it was a unique thing, but I didn't realize that's great. It is. In the Department of Mental Health, I do believe. Yeah, and I also think that across the state, the numbers I have are kind of old. I don't think that they've changed much, but I think there are about 230 duly licensed clinicians in the whole state. Not a perfect time to have the dual license because, sadly, it's a huge issue. Right. I think some people probably specialize in one and stay on that track, but as we know, they're not disconnected. No, I don't know how you can separate them, which is what we're talking about tonight. Tell me a little bit. Your job, do you weigh in? If you see something in one of Mary's files and you say, Mary, maybe this person should be sent for further evaluation or something, is that what happens? Yes. We actually, the Department of Mental Health designates certain agencies, which are community mental health centers across the state. So in each part of the state, there's a designated agency that provides mental health services and those funds, Medicaid funds, flow through the Department of Mental Health to each of those agencies. And then the Department of Mental Health is tasked with overseeing documentation standards and clinical care standards. And so I work as part of a quality team and we go around the state and we review clinical documentation and we also talk to different people at the agencies, including like the Board of Directors, but also clients and family members to learn about what their experiences are at the agency. So the chart review part is where we really look at the clinical documentation and we see like one of the standards is that we want to make sure that each person is screened for substance abuse treatment, even though we're overseeing mental health. But that's so integral, integral to people's treatment to not miss that. To make sure that's being assessed. So screening and then if there's a positive screening, which means that there's a reason to believe a person might have a problem, then we would want to see evidence that that was followed up on in the chart and then the treatment plan would include information about how it's going to be addressed. So you're looking at a patient coming in, your folks are, I don't know how much one-on-one you do with the folks, probably not so much in your job. In my job as Executive Director, well we have so many doors that people come through, Pat, so having adult and children's outpatient services and an emergency services team, certainly people with developmental disabilities, who we are also seeing an increase in by the way of using substances. So what we're working on in our region overall is just making sure we have no wrong door and Washington County Mental Health is one of the doors that people come through. I like that analogy then, some of the other ones we've used over the past. It seems more open and friendly, just pick a door. Pick a door. If you go into the Turning Point Recovery Center, we want to make sure in our region that you know, or they know who to refer to, or if they come into our door, if they go into a primary care practice, if they go into the Central Vermont Substance Abuse Services door, and in our region, Central Vermont Substance Abuse Services is a preferred provider. So along the Department of Mental Health designates us and the Alcohol and Drug Abuse Program, ADAP, designates the Central Vermont Substance Abuse Services versus Sienna might talk about Howard, where they are both a designated agency and a preferred provider. Okay, so tell us what a preferred provider is, because I actually embarrassingly don't know, and I'm ashamed to say that. So what is a preferred provider versus a designated agency? My understanding is that we cannot turn anybody away. So if someone comes to us for an assessment, if they don't have any insurance or don't have the funds to pay for it, that ADAP, as mentioned, will cover the costs of the assessment and the treatment. And that's under the designated agency, umbrella, or the preferred provider. So ADAP has preferred providers, and the Department of Mental Health designates agencies as like community mental health centers. Oh, that makes sense, I get it. Right, so we divide it by county, so if I have someone coming in from Virginians, I will refer them back to their county for services if they're billing under Medicaid or Medicare or ADAP. So could you talk just quickly about Howard Mental Health? We've never had anyone on the show from your agency, and I think people know where Mary's from. But you had Dr. Brooklyn, I believe. Yes. Yes, so Dr. Brooklyn is somewhat involved in us through the hub and spoke model at the Chilling Clinic. To talk about a loss. Correct. Yeah. But Howard Center is vast and broad across Chittenden County from developmental services, children's services, emergency services, we have advanced inpatient services, a lot of hospital diversion programs for crisis, job training, yeah, we're involved in the center point school for teenagers who have co-occurring disorders, we have our outpatient facility, street outreach team, psychiatry, group homes. You mentioned about co-occurring, what group was that that you were talking about? For adolescents. For adolescents, because I know Jolinda would very much like us at some point in the show to talk about the youth and what's happening with the young people, which apparently isn't good, right, if numbers are increasing or anything. I have to say, I had a work for the merchants back years ago, and they used to hire cleaning help from the Howard as a training model, and it was so cool, because I always work late, something's wrong with me, I know, and they would come up and clean, and some of the clients were just so charming, it was a great, I felt good that they were doing it and they were learning how to have some skills, and that was a good thing. So I hate to stick to go to relapse right away, but when we were talking about, that must be something that you're obviously fighting against, but it's almost, it just happens, doesn't it? And is there a way to make, if you're going through all of this issue with both mental health and rehab, how do you, I mean, just to get one under control must be a God sender, must feel like you won something, because the turmoil for the person, I was sitting on the thinking, if you have a mental health disorder and opiate, I mean, the constant ying and yang and pulling, I mean, how, how do they not relapse? How's that for a question? Well, I think it's not uncommon for people to have a co-occurring mental health issue at the same time that they have a substance use issue that they're struggling with. I think it's one in five people experiences a mental health issue. I mean, in the population, really. Yeah, so it's pretty common, depression and anxiety are common issues that can be short term or more long term for people to struggle with, and I think part of it is being able to recognize the whole person, and you were talking about no wrong door, and similarly with a person, it's a whole person, and if you do a good clinical assessment and really identify what's going on, then you can more effectively treat the whole person. The anxiety issue and the alcohol issue may be connected where a person gets anxious and they drink and they feel calm, and so that's a coping skill they develop which ends up causing a lot of problems and can lead to death. But just working on these things together and also giving people information about kind of why they're doing some things that they're doing which they may not even be aware of. Does information to the client help? I mean, when you really sit and talk to them, and I'm sure you're probably open and honest with them and tell them, here's where you're at, because I think information is important to these people that they can digest it, that understands what's going on, help them a little bit to balance it. Do you do that a lot, focus on information and telling them what's wrong? Yes, I like to be as transparent as possible, so I like to openly talk about diagnoses and they're involved in their treatment plan process. Oh, they are. What concerns do they have, what are their goals, how are we going to get there, how do we know we're there, which we check in on periodically, and I believe with what we have to approach is with opiates that relapses do happen and normalizing and validating from a strengths-based perspective, and yet the trick with opiates is that the relapses can be fatal. And so you're working to do maybe a harm reduction approach and also preventing relapse while also allowing them to really accept their process of recovery and develop self-compassion and not judgment. Right, right. Do you have a lot of group peer groups where peer-on-peer help and support? Because I had a discussion last week with the doctors and they were saying how that really works when you're talking to somebody who may not have even the same mental health issue or level of addiction, but it's still good to talk to somebody that maybe understands. I think it's important to have options for people. I always say it's different strokes for different folks. So as a systems person, I'm here with two excellent clinicians. I'm more of a systems person. And so what we try to do is make sure that, yes, we have referrals to peer groups. So we could suggest people go down to the recovery center, seek out a 12-step program. We have the best practice within our Center for Monodiction Medicine program of therapy with the Medicaid assistant treatment so that we couple the medication with the therapy. That's very important because that's where you work on those, the harm reduction, the coping strategies, the skills, the individual, what they're comfortable with. That's an important combination. And then even as we've looked at prevention in our agency, Pat, we think about things like mindfulness. We think about things like acudetox, which is an acupuncture process of putting needles in one's ears. And some people feel a real stress reduction. It helps them to cope better. So we actually offer some of these what we call complementary therapies within our facilities. It's a different time so that folks can tap into different methods to help them to cope and reduce their stress because as Reba was saying, what comes first, the chicken or the egg? I'm highly anxious. I'm going to take a drink. And so we want to be having some different methods for people to be tapping into. So when I walk in the door and I've been referred from my doctor, how do you assess where I'm at in that co-occurring disorder thing? You must have, how do you do that? I'm just going to keep quiet and let you answer. You see the papers coming in, right? Yes. And I think that they're pretty similar across the designated agencies. And I think that's because there's a pretty clear list of ingredients of what should be included in a full comprehensive assessment. And that's things like family, situation, legal situation, work history, educational history, current functioning, trauma screening, and addictions related assessment. So when they've come to you, though, the doctor that sent them has said, we think we've got two things going on here or maybe they're not so sure. Because, I mean, you guys have dual licenses. Do you train your people that you work with, the staff, to how to identify? Because, I mean, maybe they're specialized in mental health, but how do they pick up on the addiction? That seems to me to be pretty complicated how to balance. Do you train people in your organization of how to identify it? And then what the heck to do with it? Yeah, I mean, all of our initial assessments are a comprehensive mental health and substance abuse assessment. So even if someone's coming in saying, you know, I have a lot of depression, I'm asking them, you know, when's the first time you've used alcohol in your life? How many drinks do you drink? You know, how often? And we go through screening criteria for every person. The only difference is if I know they're already coming in primarily for concern of substances, I'll have them do a urine analysis test. But I can tack that on if I'm picking up that that's also very present in an assessment. We ask the same questions. We have a single point of contact at Washington County Mental Health, and the person that does that intake, our intake coordinator, is dual licensed. Oh, no. So, you know, so is able, but it is about content experts. It's about having a Sienna or a Reba who can then share information with those who might not have that dual license. And there's a supervision process within all of our agencies where you have individual supervision. In fact, to get a license, you have to have the supervision. There's required hours. But after that, you have ongoing supervision with clinicians. And sometimes we have a group supervision where, you know, you are gaining from many clinicians around the table. And that is a regular part of our practice within designated agents. Do you have your clinicians sitting around talking about a patient and back and forth about what's the best course of treatment here? And they could be bringing up a case to share. Yes. Yeah. And how often do you see these people? Because I would think addiction needs to be constantly monitored and because you can fall pretty quickly. Do you have them come in every day or? Well, one of the nice things about the assessment is that we get to gauge, you know, what is the level of care? So if they need intensive outpatient, which we call IOP, they're going to come in three times a week for three hours each day in a group setting. It's nine hours. So that would be our level before an inpatient stay or going to Valley Visto or calling the Broad River Retreat or any other rehab facility. I have a group that meets once a week for an hour and a half. And those are for people who have periods of sobriety behind them, want to stay engaged in their sobriety, maybe find that more helpful than a group meeting in the community and just need extra skill work and processing. So are you a residential facility at Howard when you said in, do people stay overnight there? No. So our intensive outpatient, the IOP, is outpatient. Is outpatient, right? Yep, they're coming in. They're sitting in a room for three hours. They're headed home. So sometimes when you do an assessment, you find that the person needs a level of care that may be the organization that you were for can't provide. So then you would refer them to an inpatient or residential rehabilitation program. And that's the ones that you mentioned. Yeah, those are the ones in Vermont now that maybe the office isn't open. And I thought for a while there, the beds were a little scarce. Were we talking about that at some point, Mary, where did these folks go? Well, for both psychiatry and substance use treatment, we had maple leaf clothes, and so we lost those beds. There's conversation now going on about adding some beds on. And some beds were added in for gens, I believe. Yes, yes. Because I think it would be harder for these people to be away from their family. I'm sure if they've got a supportive family, it's helpful for them to see family members on a regular basis. So I found a list of treatment strategies. And some of them we've already talked about. But I thought one of them was educating counseling for families. So you must reach out to the families of these people, too. Is that part of the treatment for I walk in and I need help? And do the families get help on how to deal with me? Or? It's this little thing called family dentistry. Oh. So that depends. Right. I will have partners come into a session sometimes. So it might look more like a couples counseling session, but we do offer some psychoeducation, some general information about the substances, maybe withdrawal, relapse. We do have a family support group at the Chittenden Clinic for families who have children, or just spouses, or relatives who are dealing with an opiate addiction. But that is kind of on a different voluntary level. Prevent child abuse, Vermont. They have a lot of parent sessions where parents are maybe that's the place where they could get how to help. Because I would think it would be difficult to know how to respond to a loved one who's home and struggling. I think it would be ideal. What I do see most often is that the home life and the family life may not be healthy. Right. And you're navigating a lot of that as well in recovery. And you're not dealing with a whole family system when you're dealing with one individual. I definitely saw that when I did crisis work with children and families, sometimes there would be an identified sick person. And then everything became that sick person's, for lack of a better word, fault. When clearly there were family dynamics where everybody was involved in some kind of situation. So now we're faced with this opioid crisis. And I'm sure for years you were mentioning alcohol and drugs, and that's always been an addiction. And now we've got this opioid crisis. So you've probably had to make some changes to react to this new lovely crisis of ours. And it is everywhere. It is. It is just everybody I talk to is scary. I mean, having been in this field for 27 years, I have to say, I remember when it was, heroin was hitting the streets in certain places. And then it was coke for a while. And it was always alcohol. And it's still alcohol. We cannot forget that we have a significant issue with alcohol in Vermont and throughout the nation. But this one is really pronounced. And I have to say that folks that run my programs have said they have not seen it so bad. Effect on children, you mentioned that. Yes, right. And could you expand on that a little bit? Sure. I mean, we also have a school that we run. We have interventionists in all of our schools. And they certainly, from early childhood on through high school, are seeing children come in with more trauma. Certainly the neglect is prevalent. Parents are not as responsive if they have an opiate addiction, perhaps not as present for that child. And that's where the neglect issue comes in. So we're, to say nothing about a mom who is going through addiction while she is in utero with a child, a pregnant. And then there may be attachment issues, yes. So these things we're all seeing that certainly within our children's division, they've brought up great needs for more child care, more wraparounds for parents, more education, more intervention and support. And so just in the family side and the child side, that's really pronounced. And emergency services has definitely seen an escalation in people that they're screening that have a co-occurring drug use situation going on. I'm sad. Yeah. Well, especially when you're born with that addiction. I mean, the poor baby hasn't done anything except be born. Well, and I just want to say, too, that I have seen a lot of really amazing recovery happen. Oh, good news. Yeah, working with pregnant and parenting women at Lund Family Center, I think there was a time when nobody was identified as having any kind of drug or alcohol problem at Lund Family Center. And when I worked there from like 2005 to 2007, it was rare to have someone come who didn't have some kind of family struggle of some sort or wasn't affected themselves. And I worked with a lot of really amazing resilient women who loved their children and with the proper treatment and being treated with respect. I was going to say a little self-confidence, probably. Yeah, and also having a safe place to live with their child, adequate food, and all of the basic human needs would be met. And then you would watch people kind of thrive and flourish and become these amazing moms. That would make you feel good. Well, we talk about the potential for maybe safe baby courts, which we don't have in our region. What is a safe baby court? Well, if a mom is in danger of seeing her parental rights terminated, that the court will actually bring in the supports and begin to help that person in a more planful way toward recovery to give them the opportunity to reestablish, reconnect. Right, and so we don't have that in my region, but certainly something that my clinicians have talked about would be just such a tremendous asset. But it's elsewhere in the country, in other states? Yeah, it's called Safe Baby Court. And it's had that kind of success. And I would love to see it. I don't know if Burlington has it, Sienna, but we used to have more programs for women through the hospital. And a lot of children would be born. And we put on Suboxone or Motherhood Right to wean off and detox. I think that some of the funding or some of the programs have shifted. Really? I've worked with many women and men who have been TPRed or had their parental rights terminated by DCF for substance use-related reasons. And I have worked with a couple of women who regained custody. So it's the exception. Because we tried to push that, I think, in Vermont, where the best place for the child is with a functioning family. But it can take a lot of wraparound services, especially for a single mother or single father, to regain custody. And it's a fight. And it's amazing to see when it happened. It must be hard for all these people going through treatment to retain their job. Because if they're at your place for nine hours a week, that's sort of tough on the employment part of things. Right. So it really takes the community to understand, the employers to understand, and really honor that. Do you work with employers to explain the situation or to somebody? I really try to protect everyone's confidentiality, so unless they sign forms and want me to talk to their employer. But there's a lot of vulnerability in sharing a story like that, because there's still a lot of stigma and a lot of judgment. And if a client is advocating for that and wants us to be a part of that, we are more than willing. But they have to be the one to drive that direction. Because I think we had a methadone clinic open up here in Berlin, and we have another one at the hospital, I forget what that drug, the suboxone, is that? Yeah, brupenorphine. But when we were opening up that methadone clinic, I was blown away by who came to me and said, my son, my daughter, people. I think that's what's the most surprising. Acted in the community, and letters after their names and degrees, and they said, please, please open this up, because my son or daughter is driving with the kids to Burlington, to down in New Hampshire somewhere. And I've never broken their confidentiality, but I was just amazed. I knew. Yeah, I had a friend actually when I was a teenager, the poor methadone came to Vermont, and he lived in the Chittenden County area, and he was so ill with heroin addiction, and his mother would drive him every day to Greenfield, Massachusetts. I remember when it was in Greenfield. It was an eight-hour round trip, and he would not be alive today if it wasn't for that. And I remember when methadone came to Vermont. I was so excited. I went to the press release conference. Well, it was well accepted in our town, and people, the women with their children would drive at some ridiculous hour to get to work and to get the kids to school in time so that they retain their jobs. So they'd be driving to Burlington at five in the morning to get the treatment and then get back to work. So anyway. So, Sandy, we were talking about, I can't explain this, how do you manage to keep people moving forward? Because it's like, how do you keep them going? No, that's a good question. Because all I keep thinking is you've got all these things in your head happening, your mental illness, and then the desire for drugs. And somebody's telling you, fix this and don't do this. And how do you keep them going? And because I don't know. I'm sure they have an idea though. In a couple of months, I'll be good as new. But I don't think so. I think this is a lifelong, lifelong commitment. Incredible hope that we retain and realism in being very valid about that fact that it's going to be something that they're going to think about. And they're going to want to think about for the rest of their life. If they want to maintain sobriety, if that's their goal. And we can't separate out a mental illness and a substance abuse disorder just as they can't. So the treatment of them looks very similar. We're working on healthy coping skills. We're working on daily goals. We're working on small goals. We can't climb Everest without figuring out, where is it? What do I need to buy? How do I train? And so we want to have the gratification of getting to a small step. But we want to have the longer goal in mind. And we can maintain support and hope and empowerment. Is there always psychiatric treatment involved in whatever is happening here? Do they know? That surprised me. There's not, they don't talk to somebody who's a psychiatrist who could help them or? Our psychiatrists do medication and medication management. So the bulk of your counseling is going to be with your therapist, right? Your counselor, your mental health counselor, social worker, you know, we throw all these terms around. But yeah, the overarching thing is, yeah, would be with your therapist counselor. So at what point do they leave the Howard Center and you say good luck or do they never leave? It really depends. I mean, I work with a lot of people who are on pre-trial or probation. So I have some people who leave because they need to start their sentence, you know? So they're gonna leave because. And I hear corrections is not as well as it could be in support. I do hear it's trying to get better. But you know, or you know, some people move or, you know, change counties, you know, it is amazing when we have people who do complete treatment and we do. The reality of addiction is that a lot of times you lose a client because they stop coming. Right. And they don't call back. Then you may never know. And you may never know. What happens? And yeah, I mean, I've worked at Howard Center for three years, but it's long enough for me to see people come back. Sure, sure. Right, and you know, they're always changed. So there's, yeah, there's a million ways to come in and there's a million ways to kind of leave the agency. The same of you, Mayor. What your experience has been with them? How do you keep them? Well, you know, I think with addiction and mental health challenges, it's a waltz. It's, you know, sometimes two steps forward and one step back. And however, people do recover and that it is all about the hope. And you know, I think the other part of it is uncovering the stigma of coming forward and asking for help. Right. You know, we know that it is something that's affecting families everywhere, whether it's alcohol, whether it's opiates. And so when one needs help to come forward, I'm really impressed, for example, by the airport in Burlington. Yes. And the wonderful messaging that has been put forth on the... Well, it's the messages on the windows as you walk by to come into the airport. And it's all about addiction and recovery. And there's an ongoing video of people speaking about their recovery, about how they came forward to get help, about how you can make it and it can make a difference. And so the messages are written and they're quotes from people. It's an encouragement. And it's around the opiate crisis. But it's an encouragement to get the help you need. And that's the kind of messaging we need to have in our communities throughout because we can't pretend this is not happening. And I think even when people die and obituaries actually say now that this person died of an overdose, an accidental overdose. I mean, that's part of families, I think coming to grips with wanting to make a change for someone else. And so that's reducing the stigma and saying enough of this with mental illness or with substance use. Let's stop this nonsense. This is health. This is about taking care of ourselves. And we absolutely should encourage people to come forward. And it's about how we create a healthy community so we don't have people feeling left out that they can be part of. This is such a long title. At the Opioid Awareness Something Day at the State House recently, that was like a title about 10, but anyway, there was a young woman there who spoke before the commissioners and after and the governor was there. And she told her story. So powerful. It was amazing and she's very attractive, very young and articulate. And she is now a counselor. She's completely her family, they've got the kids back. And the story was just, there was nothing, there was a dry eye in the Cedar Creek Room. It was powerful. Yeah, and to extend that though, I do feel like it's all of ours to educate because what I find is so often that burden of the message falls on the person who experienced the addiction or the illness. So I always invite everyone to talk about it. And if you know someone in your family, obviously protect their story, but be open about it and ask questions and support them and talk about it. Right, that's great. We've talked about, I mean, I'm sure homelessness, incarceration. I wanted to do a show on corrections, but I was looking into it. I don't think their program there is as full and encompassing as it should be. So I think when they come out, there's probably more issues than when they went in, right? I think opioids sort of make you feel good for the moment, right? Right, or it allows you to keep working. Yeah, if you have chronic pain. Yeah, it can allow some people who do very labor-intensive jobs to keep working. So they can buy the groceries. And yeah, or they're like, I can't take two weeks off to completely detox and withdrawal at home. I have to go to work. And so that keeps them in that cycle just so they feel like they can function. So do you deal with young people a lot in Howard Mental Health? I personally don't do direct service with anyone under 18, but we do offer those services. But I will have 18, 19, 20, 21 under my groups. Because we have very high suicide rates. One of the highest in the country in teenagers. Is that inaccurate? I think I'm right on that, but I heard that somewhere. We're seventh in the nation for a suicide rate overall. Oh, overall? Yes, overall. I don't know what the breakdown of that age group is. But that is a very sobering number. And we really need to work on that. And that I think is part of the stigma because we are actually rated for access for mental health care as number one by the National Institute of Mental Health. But we are seventh. That's strange that if we have so much access. It's about, it makes one question, what is that about? Is it about our messaging? Is it about people not coming forward for help when they might need it? So while we have access, not enough because we certainly have issues around that. But this is in comparison. And we all know nationally, there's a lot of problems with access. So what does that mean that we're number one? Well, it doesn't mean tremendously great. You said that we're getting better on stigma, but I have a feeling that we have a long way to go. Yes. If people, if we have all the services, which thank God we're in Vermont, but it's not getting to the people that need it, maybe it is a stigma thing. Well, people don't come forward for it. And so how do we make access to our services something that's more comfortable, more inviting, primary care offices, having screenings for suicide is very important. And that is a significant factor that we need to have more mental health screening within primary care. So we're working on that as a state and getting better and better at it. So do you have a lot of young people in your group of clients? Yes, within our group of clients. And have gotten higher numbers? Yeah, well over a thousand. And so, but that's for mental health treatment. And I couldn't tell you sitting here what the screenings have been on substance use. Certainly these kids have had tremendous trauma. Because it is so available in the schools. When I did the law enforcement segment, they were telling me how available things are. Sure, yeah. And a lot of kids have access to money, so that's not a problem. Anyway, so what do you see in your records when you're dealing a lot of children all over? Because you look statewide. I mostly focus on adult services. We do have a children's division and I have participated in just one chart review with them. And you do see kids like Mary was saying with significant trauma histories, sometimes substance abuse, issues of their own. Certainly they all have mental health issues, which is why they have a chart. But certainly family dynamics. Well, I like to focus on like alternative treatment you were mentioning, acupuncture, massage must be one of them. Sign me up for that. But I think that anything to relax people and to make them feel safe. Well, and connection, Pat, I think one of the questions that's on the Vermont Department of Health Youth Risk Survey is whether youth feel connected to their communities. And the number is not great there. And again, I'm not gonna remember it exactly, but what the point is, we are in our region in Washington County, we have developed what we call an accountable community for health. And that's providers from all different human services coming together to talk about how we address food insufficiency, how we address mental health, how we address housing and those other social determinants of health, and how we help people feel a part of their community. And we get off on these talks, one was in Iceland, for example, kids go to school for a half a day and they are required to have a hobby. Required, and we couldn't do that here. But you know, people that were sitting in this group were like, aha, you know, a sense of belonging, a sense of learning, of participating. How do we, you know, our schools do some of that, you have to do like a capstone project before you can graduate, which is about volunteering in your community. How do we do more of that? It helps to enrich life, teach skills. Well, it gives them a buy-in into their community. Absolutely, which helps, which is an asset to help you when you're faced with high-risk behaviors. And I think that's true. That's another big piece of peer recovery, self-help groups, and other self-care activities, like yoga centers. I think there's a lot of mindfulness and also body focus that happens there that really seems to help people be grounded and get out of their heads a little bit in a way of being here now in the present moment. It don't mean to be sexist here, but I mean, how do you, I'm just thinking of my husband. Man, I'm sorry, I mean, he has a... Okay, Bruce, wait a minute. I know, he doesn't watch this. He has a built-in, you know, no yoga, no massage, but I think they would be a little difficult to get to relax unless they're really whatever you say I'll do, but I think they might be a little hard to get them to relax. You know, I think that goes to the different strokes for different folks, and so it might be that someone would prefer exercise, really, you know, really getting out for a run. Right, right, right, right. Team sport, doing some woodworking, knitting, you know, knitting is one of Reba's great, great hobbies. Yes, I'm sorry you didn't bring it. So, you know, I mean, these are the things that, whether it's gardening, I love to do that, so the things that help us to actually, you know, feel a sense of purpose and connection. And switching gears, yeah. You said something before that I have to highlight. Years ago, when I worked in state government, it was very hard to get other people to come to the table. Everybody, I used to call it turfing down as mine, but I have seen in the last couple of years where everybody's coming to the table and working because I think this thing is bigger than a bread box. I think everybody's realizing we all need to be part of it and help. And I don't even know, like the viewer was listening, what they can do to when they, you know, see something, say something, or do something is, you know, you see it out there, kids with drugs, and I think, I've just seen it, maybe I'm sure Chittenden County's the same way. Everybody's pooling together because they know they can't do it by themselves. And that's a good thing. Yeah, I mean, you know, in lines of like restorative justice models that it really is the responsibility of all of us. So it's the responsibility of not like discriminating someone because they might have a criminal record, right? It's the responsibility of doctors, not discriminating clients because they might have a past of addiction. And so they might treat them differently when they're talking about pain. And it's the responsibility of community members, of friends, of other people in schools to really support the families. And I understand that everyone's human and especially with opiate addiction, why I think so many people are coming to the table is that it goes past a lot of our stereotypes of race and drugs. So that we realize that there's no like wrong door into addiction, that it doesn't care who you are, how much money you have, or what business you own, or what law degree you have. Exactly. And a lot of people end up addicted to opiates from car accident or pain. So there's many different ways into this addiction that are very different from some other drugs we might see. And many of the doctors that were here said it started with prescription. Description, yeah, I mean, that surprised me. Of course, I think, speaking of pharmaceuticals, but when these things were introduced, they said they were not addictive. It's sort of like cigarettes in the beginning, they're not addictive, wrong. And so here we are. And I think, because I had an argument with them, I've said this before on other show, you know that zero to 10, they always ask you, where's your pain scale? Well, you put the zero there, does that? I'm expecting zero. And so they were giving you what you wanted. And that's a problem. That's a problem. But I also think there's drugs elsewhere. They're everywhere. And in different forms, and I had a box in one of the shows that came from Barry, I don't know if you've seen it. It's a display box of all the different types of drugs going back like in the 60s. Oh, it's fascinating. Because a mom was a LSD in the 60s, that's what we, there's a little box there with LSD and all these other things that were popular then. And you look at the paraphernalia and the different forms they take, you know, and the candies and the different things, it's really. Well, the big thing now, like not to omit fentanyl, is the main problem right now with most overdose deaths of heroin are because fentanyl is mixed in with it. So I do want to name that because that's the main, as the main cause of death. Right, now that comes from the outside world, right? Into, or is that in our? I mean, fentanyl is a pharmaceutical, prescription for high pain. So if you're on certain treatments for cancer, it comes in patch form. Patches from the fentanyl, or a fentanyl drip. Yep. In the hospital, yeah. Excellent, thank you. And it really has contributed to, it's what kicks it up and over. Does it really? Absolutely. And so it's the combination of fentanyl with whatever it's, yes. And people can't necessarily detect that there's fentanyl in the drug that they're buying and using. And so they're expecting to become intoxicated and to feel relief and it suppresses their breathing and their central nervous system and they die. And then that's where the NARCAM kicks in, everybody. My husband just had surgery and they gave us NARCAM to take home and I was blown away. We didn't put the prescription in, but I said, you know, I don't want to, I'm expecting him to behave and not to do anything foolish. But I guess they're thinking people will do that. That's great that they did that. I didn't think that they were prescribing that automated somehow. Yeah, they do. That's wonderful. And they're actually encouraging people to have NARCAM with them because you never know but you have to know how to use it. And you can't keep it in your car for a month. So yeah, you can carry it around in your purse. Exactly. Listen, we have just four minutes left and I just would like each one of you to sort of wrap up this crisis and what you'd like to see going forward, what you need for help to help you do what you do. Well, I think that it's very important for people to be able to talk to their kids and not be afraid to bring this up with their kids. I think adolescence is a time where people expect kids to be moody or change their behavior. And so sometimes I think it's easy to write off changes in behavior due to people going through puberty but also to recognize if your kids are changing friends and starting to isolate more or be more secretive. It would be a really good time to try to talk to them or get some information. There's a really good resource on the Department of Health website called Parent Up that has a lot of information for parents and other people who are wanting to know more about how to talk to their kids. You've got a lot of good information on your website. Yeah, it's really like checked it out. Mary? Well, I think we're definitely seeing in our region where we're working more as providers on that no wrong door piece to really encourage all around the state that people work on that. So that as whether you're a primary care provider or you're an emergency room doc or you're a mental health center or a private clinician in the community that you become educated on where to send people for assistance so that you can provide them that information and get them there and into treatment really quickly. We're working on something called on-demand treatment right now so that even if someone comes in with an opiate addiction into our emergency room we can actually do the screening. We're working on this piece to be able to start the treatment right there. We're bringing in our recovery, turning point recovery center. We have peers that will transport people for further assessments over to the, over to the substance use assisted medication center. So, and further through our emergency screeners to treatment within Washington County Mental Health or wherever else is needed. And our police are totally on board with that. Yeah, well I will say that's great here. I think that's the piece. We've got to come together on this and work on that unified system. Great, thank you very much. I mean I would really just advocate to stay curious and to do research and try to stay out of judgment zone and really acknowledge this is happening in Vermont, sexual exploitation and human trafficking is happening in Vermont and being willing to look at the issues and not hide them. And as we raise kids raising them that feeling, their feelings is okay and feeling upset and sad is okay and teaching them tools how to feel those feelings so that they don't wanna numb out when they're adults and when they're adolescents. Oh, there's an inscription numb out, yeah. Yeah, that's it. You know when Governor Shumlin did his state of the state on drugs, I sat there and I'm like, what is he doing? Because I think I live in a little bit of vacuum in my life and comes to turn, he was just exactly right. He said it at the right time and he really created an awareness that we have a big problem in this state. Thank you for tuning in. As you know, this is a series of one video and a series of eight other videos on the crisis and stay tuned to Orca and we'll tell you all about it. Thank you. Thank you. It was great. Excellent. Good shoot.