• A better way
    November 20,2013

    In some ways the state of Vermont has become a victim of its good intentions.

    State officials are trying to devise methods for dealing with inmates whose mental problems are so severe they are likely to hurt themselves or others upon release and most certainly will end up back in prison.

    Recent experience has shown that as many as 20 to 30 released offenders may end up needing individual one-on-one or two-on-one supervision and treatment. This level of supervision is extremely expensive, costing $3 million this year. One released offender in need of supervision may cost up to $500,000.

    It wasn’t always this way. In the bad old days troubled people were thrown into the Vermont State Hospital in Waterbury, where authorities were much freer to commit patients involuntarily. People with developmental disabilities were housed in large numbers at the Brandon Training School. (Former residents of the Brandon Training School celebrated the 20th anniversary of its closing last week.)

    Eventually, good intentions prevailed. Caretakers, families and policymakers decided there had to be an alternative to warehousing people either in Waterbury or Brandon. “Warehousing” is the word that is still used to describe the old methods. Large institutions were concerned mainly with providing food and shelter and were less able to provide individualized care or integrate people effectively back into their communities.

    As Waterbury and Brandon gradually emptied their wards, communities worked to receive them. Group homes, work programs and community mental health services all grew up to provide the services needed to maintain people and address their special needs.

    But it has not been a seamless transition. Nationally, problems of homelessness and drug abuse have been exacerbated by a free-floating population of troubled people who fall through the cracks of services offered. In Vermont people with mental health and drug abuse problems form a disproportionately high percentage of our prison population. Easing them back into the community is now what the state is up against.

    We can’t go back to warehousing. We can’t continue to provide daily, intensive, expensive treatment. That’s why last year the Legislature created a special study committee to look at the problem. In the meantime, Human Services Secretary Douglas Racine put a moratorium on individual treatment plans and supervision.

    The study committee has come up with a plan that draws on the state’s experience with drug courts and other programs that work to divert people away from the prison system and toward the help they need. The plan is called the “sequential intercept model,” and it is designed to grab onto a person in need at each point of contact with police or courts.

    The first point of contact occurs after interaction with police. Thereafter, a troubled person may be intercepted before arraignment, after arraignment and before disposition of the case, or as part of sentencing. At each contact point, the aim is to steer a person toward help so he does not become a permanent acute case.

    It is a forward-thinking proposal, though reality suggests that multiple interceptions won’t alter the fact that some people will still have acute problems, no matter how many interventions occur. It is often the case in mental health, as in other forms of health care, that a few acute cases absorb a high percentage of available money. Closing Waterbury doesn’t change that fact. Money will have to be spent. The new plan may help ensure that it is spent productively, which ultimately ought to help restrain the level of necessary spending.

    Our good intentions persuade us that it is not salutary for the individual or cost-effective for the state to kick people onto the street, throw them serially into prison or warehouse them in old-style mental health institutions. We are still looking for an answer we can afford, and the new plan may point the way.

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