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Ableton On Air is a member of the National Academy of Television Arts and Sciences Boston, New England Chapter. Welcome to this edition of Ableton On Air, the one and only program that focuses on the needs, concerns, and achievements of the definitely able. I've always been your host, Lauren Seiler, and on this before we get to our guest today, we would like to say special thanks to Washington County Mental Health, Green Mountain Support Services, and many other sponsors, including the partnership with the Association for the Blind and Visually Impaired of Vermont, and the Division for the Blind and Visually Impaired of Vermont, and many, many, many others. We would like to welcome Gary Gordon, again, to Ableton On Air to today discuss crisis, crisis intervention, and crisis and COVID, and how it is going, you know, how Washington County Mental Health Services is dealing with crisis and COVID. Thank you very much for joining me on this edition. Thank you. Ableton On Air. Thank you for inviting me. It's good to be back. Okay. Explain the missions and goals of Washington County Mental Health. Okay. Well, what I'll say first, because I want to direct traffic to our website, is that very prominently on our website is a very eloquent, stately example of what our mission and goals are. I mean, I think just to give you, I mean, in all my years here, our goals have been to provide excellent service to all of our clients, to all of our population in Washington County and the three towns in Orange County that we serve. Our mission is to be inclusive to provide these services without prejudice or discrimination to anyone in our county, no matter what this situation is. Our doors are always open, you know, and we welcome people to come into our services and we work very diligently to provide those services. We provide a range of services. We have our developmental services division. We have our children, youth and family services division. We have our community support program division and we have our intensive care services division and we're all out there working tirelessly to provide services to our clientele in all of the appropriate and supportive ways, you know, being sensitive to everyone's situation, wherever they are in their life at the time. I mean, I could go into a lot of buzzwords and things like that, but I think the bottom line is, is that we're here to serve the mental health needs of the population of Washington and Orange Counties. You know, describe a typical day of you being, because you're typical day for a screener. Typical day of working in the crisis mental health field. Okay, so a typical day. We work a 12-hour schedule. There are two screeners on. It's not three days on, three days off. No, no, we work, well, we, every screener does 36 hours of actual crisis work a week. That's the minimum. So that's three 12-hour shifts, where there are two people on 24-7. When we go into the office on a typical weekday, the shift starts at eight. First thing in the morning we get in the office, we get report from the previous night, whatever happened the night before. We may review things that happened the day before as well during the day shift. We may have other people like psychiatrists and other practitioners stopping by to see if we've had any interactions with their clients, or if we had just wanted to get a fill-in on what happened with their client the day before. And then, usually after that point, one of the screeners, or both of the screeners, we'll go over to the emergency department at Central Vermont Medical Center because, unfortunately, we're in a situation now where we have multiple people boarding is the return we use for. People staying in the ER while they are waiting to be admitted to a psychiatric unit. I think lately in the last three or four months, the EED has been averaging about four people a day. And that's bad. And that's bad. Yes. Yes. I mean, we don't want anybody staying in an ER more than a couple of hours waiting to get admitted somewhere, but due to the increased demand, which was a trend that started before COVID, only exacerbated by COVID. Is that exacerbated meaning? Increased. Increased. Yeah, by COVID. I mean, we're seeing a University of Vermont Medical Center a couple of weeks ago had, I believe it was 26 people boarding in their ER, awaiting placement, a psychiatric placement. So we're experiencing the experience in this all over the state. How, before my wife asked questions, has it gotten worse since COVID or in the middle? Oh, I think definitely got worse in COVID. Well, just look at the stress that we've all been having to endure with COVID. And you, I think a big factor was the isolation. A lot of people isolated. We were all doing things remotely. People who were accustomed to having face-to-face, multiple face-to-face contact with service providers and support systems weren't able to do that. We have people who, I mean, there's constant concern and fear. You know, the numbers are going up. People are dying. These are all things on people's minds. People's interactions. People, another issue we had was the homeless population that was in motels throughout the county and throughout the state. So you had all these people who were in isolated situations. Our routines were drastically altered. You had parents that had to stay home. Both parents would have to stay home and try to work and school their kids at home. So all these things were new. All these things were very stressful. We had reduction in services, reduction in products. I mean, you couldn't buy toilet paper. I drove all the way to Costco and I could not find a roll of toilet paper. So, I mean, all these, these, these, these very significant stress. You think that's a mental challenge in itself? Whether or not, no, no, no. I'm not saying toilet paper. I'm saying whether or not somebody has a product. Like, oh, I can't get, so they dump, they, they, like, rust a little away from somebody and go, I don't want to use the word, I don't want to use any bad words that, that describe mental health. But the word nuts, you know, over, over toilet paper that they can't find. Do you think, because people are in isolation, they, you know, they hoard also, is that, would that be considered a mental challenge that you might be able to help with? It could be. I think some people if I'm saying it wrong, please forgive me. Well, they, well, I think a lot of it was fear driven. People were afraid. And of course, once you create a situation where somebody can't find toilet paper, that just increases that, you know, so they're going to have a tendency to do what we call hoard. It's not true hoarding behavior, because this is the result of a crisis of an emergency. But yeah, we saw some of that. I don't think in my travels around outside of work, you know, going into grocery stores and stuff like that, I didn't see people fighting over things. I mean, I saw people who maybe had a list, a look of distress on their face when they couldn't find something. It's things like that. But I didn't, I didn't actually see anybody coming on glue, so to speak, while shopping. Not that it didn't happen. Did you want to ask questions? Go ahead. How many crisis interventions have you had during the pandemic? How many crisis interventions have we had during the pandemic? Yeah. Ah. Well, unfortunately, I didn't crunch any numbers before I came. What I'll say is, is that in the beginning, during the initial shutdown phases, I would say the first two to three months of the shutdown, we were actually surprised because things actually got very slow. We weren't getting very many calls at all. We weren't having, and we, we always remained mobile. We had been remote this whole time. We were doing things remotely, but when we actually needed to go out with the police, we did, you know, or if we needed to go to the ER, we did if we had to, except for that period when the ER wouldn't let anybody else in. But as soon as we were able to go back in the ER, we were back in there. But things just got really very slow. We weren't getting very many calls at all, and we were all surprised by that. I think what happened was that everybody was so busy trying to comply with the orders and trying to follow what we were asked to, you know, to do. And too busy trying to get used to their new routines and establish their new routines and things like that. And I think once all of that's set in, and then of course, after a while, it starts to wear down on you because, again, you got this constant stress of worrying about the next day and whether you're going to be able to get supplies. And there's other kinds of stress like you're on Zoom and Zoom's not working. I think that's one of the big stresses people will try to get on to a meeting or something. Oh, somebody might not know how to use it. They might not know how to use it. What did not have a device to use it? You know, that kind of thing. One of the things that we did do was we were able to use some of the money that we got from the federal government to go out and buy devices and distribute those to clients so that they could stay connected. People can keep them or they have to give them back. As far as I know, they keep them. But I wasn't involved directly with that. But as far as I know, they will keep these devices, yeah. Now, since we mentioned homelessness, how has that, you know, because I saw on the news several times, you know, people who are homeless from different states, people that are homeless in the street causing havoc, breaking windows, stealing, looting, hurting somebody, shooting somebody, stabbing somebody, defecating on the street, different acts of things that they shouldn't do? How has Washington County mental health been combating this issue with homelessness and crisis? Okay. So from the very inception of, well, first of all, in terms of just the homeless population in the county, we've always worked with the homeless population. I mean, as you know, we have a 24 seven crisis number. And what happens actually is that because we have a 24 seven crisis number, a lot of people call that number because it's there. They know they can call it. So we got a lot of calls that aren't necessarily confidential. I'm sorry, it's confidential. It is confidential for the people who call. But what happens is we get a lot of calls from people who are looking for information. So they'll call up and say, I'm homeless. I need somewhere to go. What they call that number because it's free. And it's 24 seven. They just they see crisis. They might not understand exactly what a mental health crisis is, or they'll just see emergency services and they'll call. So we actually make a lot of referrals. You know, we refer people to 211 will refer them to economic services. You know, we're referring to whatever information we have about how they can acquire housing. And of course, as we are aware, a significant number of people who are homeless do have mental health and substance abuse issues and or, you know, both. And so we do enact with that population. What we did in terms of being specific to the covert response, we were at the very beginning involved with the housing task force that was put together to address the homeless. You mean to the one through city council? No, this was this was a countywide one. This wasn't my period did their own. They did something in addition to that. But this was a countywide one. It might have been regional like you, but our CEO, Mary molten is on that task force. So Jackie Jones, who is the director of our access program. So we've been involved from the very inception of how we were going to be involved with the homeless. One of the things that came as a result of that is that we put together a team of people who actually responded to the motels and they would go meet with people in the motels and work with them. So it. So go ahead with it. Has there been a lot of alcohol abuse within crisis during COVID? You say I know the thing that was very interesting. We expected to see more of that. And initially we didn't. We were dealing with very few people. You know, right? Well, I think I think that was part of it. The fact that it was hard, hard to get alcohol. But the other thing I think is that because the people were in the hotels and motels, they weren't out on the street. Usually when a person comes to the tension of, you know, of a screener when they're using substances because they're out in public and their behavior such that it draws attention to themselves and the police get called. So since you said that define what really, I know we just touched on this in older episodes, but describe what a screener does in this case. So the screeners are the crisis response which all designated agencies are required to have an emergency response. And it's our role to go in and to work with anybody who appears to be in a mental health crisis, psychiatric, psychological, emotional. So the first thing that we're doing when we encounter somebody is we're looking for the presence of mental illness because that's what we do. Once we establish that there is or may be a mental illness, then we're going to try to make a decision whether that person is in need of treatment. So this person is established that they may be suffering from a mental illness. Now that we think they need treatment. And if we agree that they need treatment, then the next step would be is this person willing to accept treatment. And if they are willing to accept treatment, then we can go for it. We're trying to arrange the appropriate treatment for them. If they're refusing to accept treatment, which you can do in Vermont, you know, it's not allowed to you can do you can refuse treatment. There's no law saying that if you have a mental health diagnosis, you have to be in treatment, you know, the law doesn't mandate that what the law does say though. And this is the other thing that we look for is that if you do have a mental illness, and you are in need of treatment, and you are a danger to yourself or others, and you refuse treatment at that point and at that point only, we can potentially put you in treatment involuntarily, i.e. in a hospital and voluntarily, for a minimum of 72 hours. So what is a lot of teenagers in mental health crisis? Absolutely. Absolutely. We have seen an increase. I will say that this increase started before COVID. I think again, it was exacerbated by COVID. Again, it was slow in the beginning. But as the school year drug on, you know, and a lot of uncertainty about what was going to happen with the kids and, you know, kids being at home with parents when they should be in school. I mean, you know, it's very important for school-aged kids to have routine. Their routines were totally disrupted. All the things they were looking for were disrupted, you know, sports games, graduations, prom, all these things. And just being in school every day, which appears. So what described the difference between mental illness and mental challenge? Is there a difference between the two phrases? Okay. Well, I mean, we all have mental challenges. That's pretty broad. But I think the thing, when you think about mental illness, what you think about is any behavior or internal process that so disrupts your life that you can't function. So you're talking about somebody who's so depressed they can't get out of bed. You're talking about somebody who may be hearing voices that are so disturbing that they start punching themselves in the face or banging their head or running out in traffic. Or you're talking about somebody who is so distraught over a loss or a change in the situation that they feel like the only recourse is to kill themselves because they don't see any other way out. So those are the kind of things. So when we're talking about mental- What's number of suicide? I'm sorry. Would you delegate? I don't know what a large number would be. There have been some suicides. I can't say that I've noticed a sudden increase. I don't think we've seen a sudden increase. We did have a brief period where there were two or three suicides in a brief period of time over this entire COVID time, but that was that was it to my knowledge. Although the other thing though is that the interesting thing about this is a lot of times when people die by suicide, I think the public would assume that we would know it. But most of the time when that happens, we don't know it. We hear about it like everybody else. We hear about it through news reports. So if we happen to be in the ER or the police station when it happens, we hear about it that way. So my information is just based on what came in front of us and what we may have been involved in. So I don't know the overall numbers. I think the state would have those numbers. But we saw a brief surge back. I don't know, late spring maybe. There were just two or three, I think that happened. And we've had a couple happened since then, but nothing that we can look at as being a pattern. So what type of counseling along with crisis, would you give or with Washington County, give someone who's in crisis? Well, we have a range of services. So the first thing we have that's associated with the screeners is we have what we call our access program for both adult and children. This is our, I guess you can call it a gap program. So what happens is years ago, we were running to a situation where we would see somebody in crisis, and it would take them anywhere from two weeks to six months to actually get in to see a therapist because we had waiting lists. So we're able to get funded through Department of Mental Health to start the access program after Irene. So we have a team of therapists now who will pick up a new client immediately within 48 hours of contact with the screeners. Usually they do it in 24 hours. This is Jackie Jones crew out and they're based at 23 Summit Street in Berry. And they will, so like I worked last night, if I saw somebody last night that needs to get in and see somebody immediately, I would make a referral to them and within 48 hours they would be meeting with that person and they would provide them therapy and other support services until we could hand them off to our outpatient program or to their outpatient people of choice. Because a lot of times people aren't waiting lists, you know. Is there a reason why there's so many waiting lists for counseling? Because there's a high demand for services and not enough counselors, I guess, you know. Same thing with psychiatry and the same thing with psychiatric hospital beds. Okay, since you say psychiatric hospital beds, years ago they had institutions. How has the psychiatric hospital situation changed over time? Has it changed? Has it gotten better? Has it gotten more friendlier in terms of helping people? Because you know, years ago they used to just put people with mental challenges in institutions. So how has it gotten since in the past, let's say 50 years? I'm sorry to speak for the past 50 years. 50 to 100 years or 100 years? I'll speak for the last 20 plus years that I've been here. Okay, I'm sorry if I worded it wrong. No, no, no. It's an interesting question. So when I came here in 1992, we still had the state hospital. Actually within my first one or two years of being here and being a screener, I think the first or second year I was a screener. Well, let me back up. When I first came and started working as a screener, everybody who was involuntary, meaning put in a hospital against their will, they all went to the state hospital in Waterbury no matter where they were in the state. By 1995, I believe it was, it might have been a year or two before that, they actually developed the designated hospital system where the other psychiatric units in the state agreed to take people who were involuntary. So from that point on, things really changed because rather than going to the state hospital, you could go to Central Vermont Medical Center, you could go to what former Fletcher Allen UVM, you could go to the Rattle World Retreat. That was a big shift. So is the Rattle World Retreat a type of psychiatric hospital? It's a standalone psychiatric hospital. They served the entire population from children to elderly and they've been around, I don't know when they were founded, I think in the 19th century. They've been around a long time and they do good work at the retreat. They're dealing with the same kind of challenges that everybody else is, but they do good work there. But back to the hospitalization thing. And then the next big I think turning point in all of this was when Irene came and the state hospital flooded. And we decided not to rebuild the state hospital, but we built the Vermont Psychiatric Care Hospital in Berlin, smaller number of beds. So I think the beds were cut down by two thirds to a half. So 25 bed capacity, intended for only the most severe cases. We established the middle sex transitional care rehabilitation facility out in middle sex for people who didn't need state hospital level of care, but still needed some secure environment. So we did all these things. There was additional money given to designated agencies for mobile crisis response and these kind of things to enhance the ability to us to maintain and treat people in the community. That was the whole goal. So we've seen that happen. I think we're struggling right now with beds. I'm not sure what the answer to that is. That's a pretty big question. So I think we're still trying to find a balance between psychiatric beds and community treatment and what that is going to look like because the other thing is the demographic is changing. There's a lot of talk about, you know, the aging population in Vermont. There are a lot of things going on right now. So I think we're at a crossroads, but we kind of set our road and we've been following that road. And I think we're going to continue to try to figure out how to best treat people. Any other, I'm sure you got a couple of questions you want to ask. Go ahead. Like how bad has it been since the elderly? We have had some calls regard from elderly clients. And again, some of this is obviously COVID related because elderly folks have a tendency to be isolated anyway. I think a lot of them became more isolated with COVID. So we have had those calls. We've had calls from nursing homes. I can't say that we've had enough of them to think that it's anything really that significant, but I will say that those calls have been colored by the COVID response and virus. Because people are going to bring it up. It's an additional stressor, if nothing else. Since we said stressors, how has the media played over time with mental health issues either in their programs or that kind of thing? I think what I'll have to say, we just had an article published by the Vermont Digger of an interview that we did a few weeks ago that I think we're all happy with. I think they did an excellent job. We've had good media representation by WCAX in the times. I think the media in Vermont overall is fair and I think they try to do a good job when reporting on mental health issues and trying to present all sides of it. And they also, I think they try to understand and they do a good job of trying to work with us when we try to present things. So, since you said that about policing and crisis, how has that played a part within Washington County Mental Health Service? Okay, so the Washington County Mental Health crisis team was started way back in 1974. And the express purpose of it was to defer people from admission to the state hospital because at that point we had released people from the state hospital. But what happened was I think the numbers that I read was something like 300 people a month were going in and out of the state hospital. So they came up with Dr. George Brooks actually who was a psychiatrist, a well-beloved psychiatrist. Actually they named two buildings for him at the former state hospital, wrote that original grant. I actually talked to him about it. I got to meet and work with him briefly. I mean the whole point was to have somebody intervene in the community to try to help people remain in the community without going back to the state hospital. Four years after this crisis team, the Washington County screeners were founded, four years we have reduced that number to 30 a month. Okay, so we have been a mobile team and we have been responding with our partners in law enforcement here for that entire amount of time. Does that include team two? Because team two is better on the show. So team two came about after Irene when our CEO, Mary Moten, was acting as both deputy commissioner and then later interim commissioner for the Department of Mental Health. There had been a lot of research and a lot of talk around the country about mobile crisis response and there were models, different models being tried all over the country. We had a model here but we didn't have a name for it. You know, it was something that we just started doing back in 74 with our police departments. Other DAs have had different experiences with it but we've always been consistent with our mobile crisis team. So what we did was took pretty much how we work as Washington County Mental Health. We standardized that Mary did and Kristen Chandler who directs team two and they came up with this team two training to enhance the ability of our partners in law enforcement and mobile health crisis as we work together in the community trying to address the needs of the clientele. So team two became a statewide effort and we have trained, you should have Kristen come on and talk about team two. We have trained hundreds of officers and mental health clinicians across the state. We've also started to include EMS and other first responders and ER. We have ER personnel that come. We've had state attorneys come to this training and the whole idea is just to enhance the ability of law enforcement and mental health to respond together to resolve a crisis. Any other questions you want to send? They get a basic training at the academy. Team two is looked at as an enhancement to that. And now Chief Brian Peter Montpelier has brought in the idea of enhancing that even further by introducing the crisis intervention training, CRT. That's being talked about a lot of now where the police officers would get I think 40 hours of training and how to respond to mental health designated officers. Is it public safety training or is it only for law enforcement? This is for law enforcement as far as I know. But it would be it's a 40-hour mental health specific training how to respond to mental health crisis. So we would have more officers trained in addition to the mobile mental health crisis team. And I'm on the steering committee for that actually as we're working toward that. So that'll be interesting to see and the training and the training that he's talking about putting together will be offered to police officers from all over the state. So no training for the public specifically on how to deal with crisis? How to deal with crisis? I'm not aware of any training about how to deal with crisis. We do have a training that we call that's called mental health first aid that we offer that we can go on and teach people the basics about mental health that may touch on some aspects of crisis. I think that would be an interesting challenge to try to train the public in how to handle a mental health crisis. But we do like I've done training with other of our sister agencies like the Vermont legal aid and the Vermont Housing Authority. I mean I did one recently for actually doing covert for for central mont home health and hospice because they have responders who go out in the community. So we talked about how to manage people in mental health crisis. So we can go out and train very and we go into schools and things like that. So we do have trainings that we can offer around how to manage a crisis. But for the general public that would be an interesting challenge. But something that maybe we need to look at you know if the general public is interested. What is the future goals? We only have a couple minutes left. What's the future goals of crisis intervention and Washington County mental health? Well I think we're always looking at ways to improve our ability to help people. So that means in terms of like personnel we hired a clinician to work with the very city of Montpere Police Department Susan Lamar. So she is a crisis clinician. So she'll go into a housing situation. Sure. Yes she responds that's who I was talking to before the meeting started. She called me with an issue and she was actually sitting in a police cruiser at the time. She's already out so she's in Barry today. And so she rise with when they go out on call she goes with them and she helps them in that situation. She needs to de-escalate the situation of a person in the mental health crisis. I mean she'll determine what needs to happen. She needs to get the screeners proper involved. She'll call us, get us involved, make referrals. So yeah so that's one thing that we've added. Soon we will be adding another clinician with the state police barracks and middle sex. We're in the process of organizing that now. And we'll be looking at other ways that has been talked throughout the years of having a screener full-time in the emergency department. So that's another discussion that we'll continue to have. And we're always looking at ways to adapt our services to the changing needs of the community. And so a big one right now is how to respond to incidences without the police. We've always done that 70 percent of the time when we respond we go without the police. But I think the tenor of that has changed now. Because of actual events or problems that have been. Because of events and questions about what's appropriate for police to respond to. But the big thing in all of this for us and it always will be is safety. A lot of times people get frustrated with screens because they'll call us and we'll tell them they need to call the police. And they'll say well we don't want to call the police. This is a mental health crisis. The problem is that if the person that they're calling about is engaging in any kind of behavior that is putting anybody at risk of harm or putting themselves at risk of harm or danger. We have to have the police present because we may have the ability to de-escalate but we can't keep anybody safe. We can't restrain. We're not trained to do that. We can't protect people from themselves or others. That's the role that police do. And they do actually do that well. I'll say that for our local police departments they do a good job of protecting people even from themselves. So I think the big things for us going forward is better cooperation and coordination with law enforcement and other entities that we respond and figuring out ways to better adapt and meet the needs of our population. Any last questions you want to ask? Okay. Well we would like to thank you for joining us on this edition of Able. Oh you're welcome. Thank you. And for more information do you have the emergency crisis number for Washington County? Sure. The number is 2290591. Okay. So for more information on crisis intervention and the programs of Washington County or if you're in crisis and need to get in touch with Washington County Mental Health Services you can call 802-229-0591. That number again is 802-229-0591. Or the website is www.wcmhs.org. That website once again is www.wcmhs.org. We would like to thank Washington County Mental Health for this wonderful special episode of Crisis Intervention and COVID and any all the other services they provide and we would also like to thank our sponsors Washington County Mental Health Green Mountain Support Services and many others including the partnership with the Vermont Association for the Blind and Visually Impaired and the Division for the Blind and Visually Impaired and many others in Vermont and beyond. I'm Lauren Seiler. I'm Lauren Seiler. See you next time on the next exciting edition of Abledon On Air. Abledon On Air is sponsored by Green Mountain Support Services, empowering people with disabilities to be home in the community. Washington County Mental Health where hope and support comes together. 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