Under the title “Reshaping Mental Health Systems Through Integration,” the Vermont Department of Mental Health held its first annual conference since the COVID-19 pandemic at the Killington Grand Hotel on Oct. 19. Self-identified psychiatric survivors jointly or independently led at least five of the day’s “breakout sessions,” among a menu of 24 lectures that discussed various aspects of mental healthcare.
Dan Towle, who founded the peer-staffed consulting firm Parker Advisors, offered two presentations: one on the role of peer specialists in mobile crisis response services and another on the state of peer support in Vermont overall.
“I live, breathe, and eat peer support,” said Towle, who works part-time answering calls for the Pathways Vermont Support Line. As a consultant, he aims to help reshape how police deal with incidents involving mental health crisis.
“Historically as, as we all are aware, law enforcement was the sole function for dealing with crisis in the street. In recent decades, we started to layer in the mental health specialists, social workers, clinicians,” Towle explained. “The third leg of the stool is peer support.”
According to Towle, peer support workers can “step in relatively quickly in many circumstances and deal with situations based on mutuality of experience and transparency.” He called them “a calming influence in what can be, in many cases, a very stressful and traumatizing experience.”
Towle mentioned that, when the police department in Alamogordo, New Mexico, hired a peer support worker, officers benefited almost as much as the public.
Officers “got to know this individual more and more, and they actually started peer support within the law enforcement,” he said. “This person helped facilitate the police officers and the staff to help each other.”
In Towle’s preferred model, however, a community mental health center or peer-run agency would employ the peer support worker, who would work with police in situations requiring a police presence. Peers and clinicians would also respond to incidents on their own.
“You ideally only want to use two legs of that stool,” Towle said. “This is kind of bending the analogy.”
Vermont’s community mental health centers expect to deliver a statewide mobile crisis program sometime in 2024, using teams of two that will, at least in some cases, include peers. Meanwhile, the state’s largest city has begun staffing a program named Burlington CARES, modeled after an alternative public safety system called CAHOOTS that gained renown in Eugene, Oregon.
In Eugene, paramedics and mental health professionals have replaced police officers for certain 911 calls since 1989. Towle urged conference attendees to examine mobile crisis response practices in their communities and to talk to their city councilors and other local leaders.
Towle’s second presentation focused on the role of peers in the rest of the mental health system. Currently, they staff respites, advocate for psychiatric inpatients, and lead support groups, among other services, but Towle believes that the peer workforce has plenty of room to grow.
In Vermont, small, peer-run organizations like Vermont Psychiatric Survivors and Another Way employ peers, but so do traditional mental health agencies, hospitals, and other nonprofits like the Vermont Association for Mental Health and Addiction Recovery and the Vermont Federation of Families for Children’s Mental Health. Towle observed that, in other states and countries, schools, prisons, and homelessness services agencies also hire peers.
According to one study that Towle had found, a quarter of all U.S. mental health facilities include peers among their staff. But he pointed out that nobody knows exactly how many peers ply their trade in Vermont – no comprehensive survey of mental health providers has asked for an accounting.
In Towle’s view, getting a clearer picture of where peer support already exists would help its advocates’ work to expand its presence elsewhere in the mental health system.
In addition to data collection, Towle emphasized a need for additional funding for peer support. DMH expects a forthcoming certification program to allow peers to begin drawing Medicaid reimbursement next year for their services.
Towle urged Vermont’s peer community to make sure that private foundations also recognize the value of their work. He noted a recent $20 million gift to the Champlain Housing Trust from philanthropist MacKenzie Scott.
“That’s the model that we want to replicate over and over and over again,” Towle said.
Towle’s presentations bookended a talk called “Only Sticks and Stones? How language reinforces implicit bias and creates obstacles to integrated care” by Anne Donahue, who formerly edited Counterpoint.
Donahue highlighted offensive terminology that remains in currency in psychiatric facilities. These unexamined linguistic choices, she explained, don’t just hurt mental health patients’ feelings – they also stigmatize mental healthcare itself, contributing to its separation from physical healthcare.
“I think the ability of the broader healthcare system to embrace the importance of holistic and integrated care is impaired by the internalized biases that are communicated by the existing mental health system,” Donahue said. “You can’t integrate care if the patient is afraid to disclose the mental condition that’s linked to the medical one.”
Donahue pointed out that, according to studies, about 50% of Americans who’ve received prescriptions for medication don’t take them as directed. The same, more or less, is true for mental health patients, but when the latter “go off their meds,” it’s a cause not only for significantly greater alarm but also for different language: what medical literature would normally call “medication non-adherence” becomes “medication non-compliance” instead.
Even job titles in the mental health field can reflect infantilizing or dehumanizing attitudes. When a psychiatric patient needs someone on hand to monitor their safety, hospitals call that employee a “sitter.”
“If you call yourself a sitter, that means you think of yourself as a sitter, and that turns the person that you are sitting with into a person who needs a sitter,” Donahue said.
Donahue observed that, in healthcare settings as elsewhere, “technicians” – such as X-ray technicians and ultrasound technicians – “tend to be specialists in equipment,” except in the case of psychiatry.
“What’s the message that people hear if you’re being treated by a psych tech? You must be a thing, a system, or maybe at best, a body part to be maintained,” she said.
Donahue reserved her strongest opprobrium for the term “behavioral health,” which clinicians use to group together mental health and substance use conditions.
“The message becomes that the cause of my condition is behavior, or that it’s being called behavioral because the symptoms are a behavior that I’m failing to control,” she said. “Every time I hear that, to me, it’s a stab in the gut.”
Donahue’s talk overlapped with “Discomfort as Opportunity: Pathways Vermont’s Relationship-First Program” by Katie Bourque and J Helms, a peer who later discussed “Disrupting the Institutional Circuit” with the Vermont Department of Corrections. All five survivor-led presentations followed a keynote address by William Kellibrew, a social worker and author who described a journey of healing following the murder of his mother and older brother during his youth in Washington, D.C., where he still lives.
Suicidal ideation led to an involuntary commitment for Kellibrew, who entered an adult psychiatric unit at age 13, one year too old for the local children’s hospital. Eventually, he met a therapist who would change his life – at first, simply by letting him eat as much ice cream as he wanted during their sessions.
“She didn’t go in there and pick food for me,” Kellibrew said. “She created an environment where I could go in there and she could learn what was important to me, what I valued in that space.”
In college, Kellibrew began to talk publicly about his childhood tragedy. That got him involved in what he called the “victim services movement,” where he learned how to assist and advocate for others who’d suffered as a result of violent crime.
As an adult, Kellibrew tracked down the therapist who’d helped him in his early adolescence. He asked her what her job title had been at the time, and she told him that, back then, she was only an intern social worker.
“I’m like, ‘An intern saved my life?’” Kellibrew said. “Well, that told me that it is anybody’s job. Everyone has a responsibility – from the lifeguard to the cafeteria worker to the teacher to the mom to the dad. Everybody has a role and can play a role.”