"Rewriting the Myths, Redefining the Realities"
By Homer Page
Phoebe Norton retired this summer from a 35-year
career with the Boulder County Mental Health Center. During the last
twenty years, she directed the Center. Phoebe has also been a
leading advocate at both the state and federal levels for persons
who have mental illness. She has witnessed the movement to
deinstitutionalize those who have mental illness, but she fears that
we are using our jails and prisons and nursing homes to
reinstitutionalize this vulnerable population.
Ms. Norton is the mother of two daughters. One daughter is a psychologist and the other is a doctor.
Phoebe contracted multiple sclerosis when she was in her 30ís, but with the exception of having some vision problems, she has experienced relatively few symptoms. Phoebe Norton is a person with a disability who has given her life to making the world better for others. We can learn a great deal about running a mental health center and being a human being from Phoebe Norton. The Colorado Quarterly sat down with Ms. Norton to gather her perspective on life and the state of services to persons with mental illness. Here is what she had to say.
The Colorado Quarterly: Tell us something about your background.
Phoebe Norton: I grew up outside of Cleveland, Ohio and attended Worchester College and the University of Chicago. My academic training is in social work with an emphasis in group work. In my early years I had quite a lot of experience with children and youth. I also worked in a large, old mental institution in Cleveland where patients were heavily medicated and simply warehoused.
While I was in Chicago I worked at Hall House. I was there in the last years before it was torn down to make way for the University of Illinois, Chicago Circle Campus.
After finishing school I worked for a number of years as a school social worker, first in Champagne-Urbana and then in Trenton, New Jersey. In Trenton I worked with pregnant teenagers. I went into their homes to provide support and to help keep them in school.
I had two small daughters who were in public school and I saw first hand the inequality in the opportunities that were available to children of differing racial and economic backgrounds. I saw the need to become an advocate. During those years I made two vows to myself. If I had the chance, I would do something to free people from being warehoused in institutions that destroyed their lives, and I would help teens who get pregnant to have the opportunity to make something of their lives. I am grateful that I have been allowed to make contributions in both of these areas.
TCQ: You came to Boulder County just as the movement to deinstitutionalize persons with mental illness was getting under way. What was that like? Did we do an adequate job?
PN: In the late 60ís and early 70ís, the Boulder County Mental Health Center was just a small clinic. It had perhaps ten staff members. The federal community health legislation passed during the Kennedy/Johnson years introduced new options and provided funding. I believe we did a good job serving people in our communities until recently. Coloradoís community mental health programs were ranked in the top three in the nation, although we were only about 25th in funding. We are nothing like that now.
Managed care has drained off as much as 15% of our funding to another unnecessary layer of bureaucracy, while not reducing the Medicaid administrative burden one bit.
We are using jails and prisons and nursing homes to reinstitutionalize too many people. This is particularly tragic with regard to juveniles. We know how to work with kids in the community. Itís less expensive and it will not destroy the lives of the young people, but we still lock up kids who need treatment. The legislative Committee on Mental Illness and the Criminal Justice System has been a huge disappointment. It has failed to provide the needed direction so that we can stop wasting these valuable lives and resources.
TCQ: You have directed a well-regarded mental health center for two decades. What should a good mental health center offer?
PN: We are making advances in the bio-chemical and medical treatment of mental illness. A good community program must collaborate effectively with medical programs such as community clinics that serve the medical needs of persons with mental illness. We must do much more, but this is very important.
A good center stays close to its clients. We encourage them to take their meds but we know that, if there is not a court order, people may not take them. We also know that there are people who will refuse services. Even though we may regret their choices, they have a right to choose. It is only when a person is dangerous to himself or herself or to others that medications and services have to be mandatory.
I believe that a good mental health center must collaborate with a wide range of other community agencies. We work with the schools, the courts, the law enforcement agencies, County Social Services, other disability services, programs for the homeless, and many others. We cannot now be truly effective unless we wrap all those services together around a client. We must all work together.
Affordable housing is very important. We have some congregate housing for those who need supervision, but for the most part we favor vouchers that will allow persons to live independently in the community.
We try to provide a continuum of employment opportunities, but it is harder and harder to do that. At one time we had work in our workshop that provided jobs in a sheltered environment but automation is taking away many of those opportunities. We have to subsidize that end of the continuum more and more. Our Clubhouse Program provides support to our clients as they look for employment and even after they find it. Employment is an activity that can be very affirmative, but providing employment services may be a losing battle for us. We may not be able to afford it.
A good center works all the time to keep people from being institutionalized. We have worked with the courts, community corrections, and the District Attorneyís office to create community based options to the incarceration of youth. We have beds in the Youth Correctionsí facilities for Boulder County that we never use. This saves money and it saves the kids. They do not return to the community as hopelessly damaged adults.
Finally, we try to provide prevention programs. This is hard because our mandate is, rightly, to work with the more severely ill, but there are things that we can do. Our Genesis Program has been nationally recognized. It intervenes with teen moms to provide peer support, case management, educational support, and career development. This has been a successful program, because it offers real hope.
TCQ: What are the key issues needing advocacy?
PN: The most important is criminal justice. Too many persons with mental illness are being institutionalized in our jails and prisons. There are facilities in Colorado where inmates are denied their medications and psychological treatment. The waste and inhumanity of reinstitutionalizing the mentally ill in our jails and prisons is heartbreaking.
Another issue is managed care. I believe it is wasting up to 15% of our Medicaid mental health dollars. There isnít enough money as it is. We canít afford to waste anything.
TCQ: Now that you have retired, what are you going to do?
PN: I have promised my sister for years that I would go to Mexico with her and take part in a three-week intensive Spanish language course at a senior hostel. Weíre going in November. I would like to become proficient enough in Spanish to work with Spanish speakers in Boulder County. I donít think I can do therapy, but I think I can do case management.
I want to volunteer and do some groups, and I want to do some home-based counseling with youth.
I also want time to play with my grandchildren and my partner, Jan. I need a rest from the advocacy work at the legislature. I donít want to feel scattered. My health is good. I want to enjoy a balance of work and play and time to rest.
TCQ: When you look back on your career, what gives you the most satisfaction?
PN: Those times when we were able to collaborate to do something really worthwhile. All those persons with whom I have shared a common vision have nourished me. Things done together that are of value give me great satisfaction.
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Copyright 2002 A&H Publishing Corporation