"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 30’s, 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 60’s and early 70’s, 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. Colorado’s 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.
It’s 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 Attorney’s office to create community
based options to the incarceration of youth. We have beds in the
Youth Corrections’ 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 isn’t enough money as it
is. We can’t 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. We’re going in November. I would like to
become proficient enough in Spanish to work with Spanish speakers in
Boulder County. I don’t 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 don’t
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.
Copyright 2002 A&H Publishing Corporation