 Ableton on Air is sponsored in part by Green Mountain Support Services, empowering neighbors with disabilities to be at home in the community. Additional support for Ableton on Air is sponsored in part by Washington County Mental Health Services, where hope and support come together. Welcome to this edition. Six years has been focusing on the needs, concerns and achievements of the different people enabled in Vermont and beyond. Thank you to our sponsors. I'm Lauren Seiler. Arlene is off today. And with us to discuss mental health and mental health beds and crisis beds and crisis intervention is Zach Hughes of Washington County Mental Health. Thank you for joining me on this edition of Ableton on Air again for the second time. Thank you. Explain the missions and goals of Washington County Mental Health for those that don't know. Well I can explain it, did that last year, but I'll explain it again. They are really about working with folks and making sure that they can be a very productive part of their community to the best of their ability. Along with other organizations such as NAMRI Vermont and Washington County Mental Health, we're here today to talk about what a crisis is and crisis intervention, what exactly is a crisis and how does Washington County Mental Health really help with that situation? I think that what I'd like to say about crisis is that there's no real, I think everyone's crisis is a little different. My crisis could be different than maybe yours or... Can you give me an example of a crisis? Well I think a crisis for somebody is that they're not able to do what they want to do with their life, that they're stuck in a spot. They can't get out of that spot or they're not able to do that at that time. I think when people don't enjoy life, that becomes a, for them that could be considered a crisis, but I think a crisis for somebody is just being outside, well outside of where they would be. Out of their comfort zone. That's right and I want to caution because people go outside their comfort zones in positive reasonings, but there are things where if people are not enjoying their life anymore, that's a concern and if people aren't able to function adequately and I'm not talking about just because I've heard people that, well the community expects me to do this, but it's more do I enjoy my life is what I'm doing, sleeping all day, a good thing. Well sometimes if I'm tired one day I'll sleep. Right, but I think that crisis can be brought on by a number of things, I just want to give some examples in my life. It could be brought on by really, really bad news or unexpected news such as changes in my life. Relationships are a great example, I see that a lot. People who lose friends, that can trigger something. They're just starting to really look at trauma and if you've kind of talked about that with other folks, but trauma is starting to be recognized now, whereas it wasn't really. How so? How exactly? What's being looked at a lot closer, I know Washington County Mental Health looks at it very closely, all staff there are required when they join to take a course that we have training, that's three hours long. It's a one-time training that we have to take. We were discussing it a lot more, I for myself am recognizing that there is stuff in my life that could be considered trauma. You're getting bad news and you're still kind of going over it a year later, that's not a one-time thing. I think that's an important thing. Okay, crisis intervention and crisis beds. We deal with, I remember when Crocker was on the show last year, can you explain the different things now or the better things that Washington County is dealing with the crisis beds? Is there enough crisis beds? Is there not enough? I would love to elaborate on this issue because the crisis beds come in a different variety of services and what I want to see about the crisis beds right now, there are alternatives right now to hospitalization and the emergency room, particularly the news around people being stuck in the emergency room. What do you mean by being stuck in the emergency room? I'm sorry, I should clarify. That's fine, go ahead. Some folks, so say I go into the emergency room for a mental health issue and there's not a bed to serve me upstairs, I could be stuck in the emergency room for days or weeks. An example, New York has Bellevue Hospital. I know for years there's been issues with crisis beds in places like that but can you explain a little bit more about the history of that because? Crisis beds because years ago they used to be institutionalized. Yes, so that's a great thing. So the crisis bed is an alternative to hospitalization. We now have, as you were aware of last year, we did a show on generally Washington County and the Maple House crisis bed at Washington County, but that's a peer bed. But there are other types of crisis beds and they serve as an alternative to hospitalization because nobody wants to really go into hospital. So maybe they go to a crisis bed for a few days or in some cases a couple weeks. Has it lasted longer than that, months? Yes, yes. There's been a few, yeah that's true, actually you're right Larry, there have been a few instances of a few months in a crisis bed but again the crisis bed serves as an alternative to an emergency room and I would much prefer somebody who could be in a crisis bed, be in a crisis bed than sitting up in the emergency room. So a crisis bed, so what is a place to sleep, a place to eat? Well that sounds all good but the crisis bed is that plus it provides support. Like the Washington County program, the home intervention program provides that support that you just mentioned, the eat and sleep thing, the TV thing, but it also provides they're able to, they have nursing there, they have, can they help somebody, the person who wants to find a job? It would be done through their service at the agency so the case manager in the agency would help them with that, through our, you know, an employee specialist employment. No, I know Vermont from what I understand, I think it's through CVH, Vermont, does it have a psychiatric center, do you guys work closely with them? Vermont has a, yes, Vermont has a psychiatric hospital next to CVH. Do you guys work closely with them? Well I think we work closely if our people go in there and I also believe in our screening team, which is the emergency screening team, provides screenings for folks who have to go in there, because that psychiatric hospital requirement is involuntary. So what do you mean by, what's the difference between voluntary and involuntary? Oh good question Larry. So I can voluntarily admit myself to Central Vermont Hospital. And involuntary would be if I was held against my will. Because you're harming yourself? I'm a risk for others as well. What do you mean by risk for others? I mean a risk of harming other people. So if I say I'm going to kill six people, or if I'm going to go out and do something, then that's, you know, but the other thing that tends to happen is the risk of harming myself. Okay, that'll, that'll, that could turn into an involuntary situation. But I think our general, you know, purpose is to keep it, if we can, voluntary. But not everybody wants to be held against their will, and it'll be in a hospital. And sometimes it has to get down that route. I certainly don't like that idea. In terms of crisis intervention, if someone has to go to a hospital, what did it, like, a 72, I'm sure Vermont has a 72 out of a whole situation. Vermont has a, does have a 72-hour hold. Can you explain what that is? Yes, I can. I can a little bit. What happens is, and I don't have the material in front of me, but what happens is, if I'm held, if I want to be held, and not want to be held, if someone wants, if someone feels unprofessional, stop at the hospital, doctor, if I'm at risk, or screener, if I'm at risk of harming myself or others. What do they do? They do papers. No, but they take your belt away, they take your keys, they take anything sharp away from you. That's right. Yeah. Your shoes. Yes. Yeah. So, you know, you could actually, they do, you know, paperwork, but there's a process. You have to be, you know, you have to have a screening done by the, by a designated agency who has the screeners, Washington County is one of them, and these are outside folks who come in and, you know, screen me and make sure that I need to be in the hospital. Maybe I don't. And that's, and then they do papers that are set. And another doctor, besides the doctor referring, has to also be part of that process. So there's a huge process to get, not huge, but it's, it's not just your relative can have you committed anymore. I remember, I always had to say, you know, Joe, so, you know, I used to do a training exercise called the Auntie Lulu Exercise where we take Aunt Lulu to the hospital, drop her off. And that's just not how that happens anymore. There's a lot more rights to it. And, you know, Nami, who you just, you know, you just interviewed Nami, Nami has, you know, they do a lot of work in that area as well. Can you explain a little bit more about the history of, like, how people with mental illness or mental illnesses were treated back then versus now? Is it, is it a better system now than it was? I think it is a better system now than it was. How so? Because there's a lot more people out in the community able to do their thing, contribute to society, work in society, and not be stuck in a 1,500 bed hospital. 1,500. That was at its peak, around 1,500 at the state hospital in Waterbury. And they closed due to the flood and the Irene, the tropical storm Irene. And then they made it less beds? They opened the, well, they ended up opening a temporary hospital in Morrisville. And then they opened the psychiatric center in, which they discontinued the hospital in Morrisville and they opened the psychiatric center here in Berlin. And that, that has 25 beds. And just before the state hospital closed in Waterbury, they had 54 beds. But at its peak, Vermont state hospital had 1,500 or so patients. This was a while back. As far as language, that was used around mental illness or mental challenges. How has language changed? They don't use certain words that they used to use. No, they don't. The doctors don't use it. Right. They don't. They don't use those words for the most part. In fact, Vermont state laws were, the wording in the statutes in the books, law books, was changed as well. A great example was they used to use the terminology of lunatic and crazy in the books. They did change that. So it's been changed. And doctors, what I worry about with doctors, with people now, particularly, you know, I come in the peer support world is that we, peer support folks, try to stay away from using clinical terms. So I really don't like the idea of trying to diagnose anybody. I don't. We're just as normal as everybody is. That's right. Yes. Yes. Why, in terms of peer support, why are you training peer support people not to use certain language? Because, well, I'll tell you, it's real easy to fall into the language because that's where most of us came from, you know, where we would go to get our services, our case managers, and, you know, it's easy to say, yeah, he's got, here she's got schizophrenia or I think he's bipolar, needs to be on his meds. That's, you know, that's not good for folks like us, like myself, who are trying to, you know, do something a bit different than I'm not a doctor. And I'm not in the medical profession and I'm not required to follow professional, you know, I don't have to do those professional things. I can be professional, but that's something I've always kind of cringed at around, you know, when we talk about really quick here, when we talk about the idea of, you know, funding sources, including the idea of using Medicaid or dollars to do peer support. One of my concerns is that we would fall into a category where we'd have to do notes and a lot of big notes, you know, and case notes, yeah. And I do have, I will admit, we do notes, but now, but they're not these big notes that I've seen in my office where, you know, where in the crisis bed world, we have to, we do have access to notes. For example, crisis situations. Are you under the State of Vermont known, or are you known as a mandated reporter? Yes, I am. Okay. Can you explain in terms of crisis, what exactly a mandated reporter does within the crisis world? In the crisis world, well, a mandated report could be, you know, if I suspect or witness a situation that has to do with child abuse and neglect, or in the adult world, somebody who has a friend, has a so-called friend staying with them who is exploiting them through any means. An exploitation is, I'm borrowing your money all the time, I'm sucking your resources. Scams. Scams. Well, scams. Yeah. But Larry, you know, you call me up and you say, ah, I just gave $200 to my friend. He stayed with me, and then, oh, I have no food though now, Larry, and I'm really, he asked me for another $200, so I gave it to him. That's, that could be heading for exploitation. Well, those scams now, someone claims to be from the Social Security Administration. Right. Or the IRS. Right. You know. Now, the other part of many reporting in a crisis is if the person tells me, and I've had to do this in the last year, but a person who tells me that they're going to go somewhere and do some harm to other people or themselves, and I have a reason to believe that they're actually going to carry it out, I'm required to report it. And you know, I can report it to the people who are going to be affected or I can call law enforcement. Or both. Or both. And how does your agency, how does Washington County work with law enforcement when it comes to crisis? Well, they have a, well, that's a great question, Larry, and they have a great relationship with Washington County. I think it's much more improved than 20 or 30 years ago. But I think that, particularly our Montpelier Police Department, but other police departments also have a great working relationship. I've noticed that Barry Police Department also has a great working relationship with them. But I think that that's a good thing to have that ability and not, but I'll tell you, crisis and law enforcement, as far as if Joe Public is in crisis and a cop comes in, the issue with cops in crisis, with Joe Public, who is in crisis, it could exasperate Joe's mental health right there, it could cross a bigger, you know, there's something about law enforcement. We all have been through this. I don't know if you have, but I've run into a couple issues with law enforcement itself, but I respect them. But when you're on the other end of that spectrum of the cop shows up at your house and wants to know about this or calls you up out of the blue. And so as I need to just check something and you go on guard, you know, somehow there's always this, and then there are people who had plainly told me, please do not call the cops. I'll do whatever you need me to do, but don't call the police. Others tell me they don't care and the police come anyway. But you know, generally, I think, and you're a caring person and you have to help those that need help. Yes. Now, boundaries in a crisis. How important is, okay, a person says, oh, I'm having a meltdown, I'm having this crisis, I'm having that crisis. How do you know when and if to step back as far as the boundaries are concerned when you're dealing with a crisis? I have actually had a situation. Oh, that's not a bad question. No, it's, there's never a bad question. I, when I worked on the peer line, I used to have a gentleman who called me, he was quite... You don't have to mention names. Nope, we don't do that. But I will just say this gentleman used to call me. He was upset because one of our workers told their story, which we don't mind him telling stories, but this was, in telling the story, it traumatized this gentleman a little bit. So what happened was he was quite, you know, every call was, you know, about this. And at some point I had to kind of challenge him and say, is there somebody else you can talk to about this because there's not much I can do about it. I've listened to you. There's a point where you say, and it's very rare for me, but there's a point where I will say to the person, is there's someone else you can talk to? Because I can't, you know, I cannot help you with this. You know, we've been through this and I don't say like that, I'm very polite. But I felt bad for this gentleman and then he had told me, no, he hadn't seen a counselor in 18 years, but out there after he kind of stopped talking about it with me because I think he recognized that we'd reached our point. So if you can't help somebody, you either tell them to go to someone else? I will. I never tell them. I suggest to them that they go somewhere else. I don't tell them to go, I suggest that they go away from our service. I just, what I say to them is, is there's somebody you can talk to about this, maybe a counselor or something, maybe somebody who can kind of help you work through that. I think there are limitations to what I can do in certain situations. And then the same thing with a crisis situation. My goal in each crisis situation is to either facilitate it so the person feels safe enough to move to the next step to get the help that they need or desire or, you know, make sure that everybody feels as safe as we can. And that might be include that my goal is to de-escalate the crisis. Last question? Sure. De-escalation, I think I'm saying it right, to de-escalate a situation in a crisis. Define de-escalate and what does that mean? So my, when I wanted to de-escalate, my goal is to, well, getting the person to kind of, you know, come back center. So there are, a lot of people I've dealt with are angry about something. I'm talking softly and they're up here, Zach, I think this is okay. And my goal is to say, okay, Joe, I need you to, you know, we need to look at this a little more or something. We're very... I'll give you an example and if we go a little bit over, it's fine. In New York, and we can show a piece of this video to the editing, in New York somebody walked into a bagel shop and it was on the news. I want a cinnamon raisin bagel right now, you know, and everybody's looking at them, right? They're yelling at the top of their lungs, right? So in a situation like that, if someone is yelling at you, you can't help them by having them yell at you. Is there a way to de-escalate a situation if, in public, for example, someone's yelling and screaming and they might have a challenge, how do you de-escalate a situation? It depends on the situation, depends on if the person's willing to come down. It might be as simple as, you know, in your city, you want something, so it's okay. So how can we get that for you? Or I cannot do that for you right now, but let's try this. And it's... Are you doing it in a very soft, very soft approach? I think one of my goals is to always try to stay calm. I always joke about it, well one of us has to stay calm, you know, because the reality, you know, and I'm not, there are times when I used to, you know, I think it's a challenging thing because you have someone yelling and then some people think it's yelling at them, so they both get yelling. And my goal is to get that situation, you know, under control. But there may be a time also where I'm not able to do that and they don't care. They want their cinnamon bun or whatever that was that you mentioned and they don't care about my attempts. And so then that's where I see law enforcement sometimes has to get involved or, you know, and that's a sad day when that has to happen because I really, you know, I know we're about over time, but I used to deal with people, I've dealt with people who also what I called ranting where they get angry and they say things in a public space. And I always hated, I always used to think, well, if they just were allowed to rant and we left them alone they're okay. But you know, occasionally, you know, they'd rant and law enforcement would have to get involved because it got out of hand. Thank you for joining me on this. And thank you. For those that want to know more about Washington County Services, where can they turn? They can turn to Washington County Rental Health. We have a website, WCMHS.org. And what is the emergency crisis number? The emergency crisis number is 229-0591. Can you repeat that one more time? 229-0591. Well, I'd like to thank you for joining me on this edition of Abledon On Air. This puts an end to this edition of Abledon On Air. I'm Lauren Seiler. Our link is off today. Thank you to our sponsors. See you next time for another exciting, informative edition of Abledon On Air. I'm Lauren Seiler. See you next time. Abledon On Air is sponsored in part by Green Mountain Support Services, empowering neighbors with disabilities to be at home in the community. Additional support for Abledon On Air is sponsored in part by Washington County Mental Health Services, where hope and support come together.