IT HURTS TO SAY GOODBYE
Pathways took on a funereal atmosphere in early January. Some staff who got rehired suffered from survivors’ guilt and received dirty looks from colleagues heading toward unemployment. A client handed Clayton a farewell card. “I’ve got to go,” he told the client and turned away in tears.
Pathways staff at Salmon’s farewell party, days before the unit closed, bit down on angry tongues. “They could have changed this model,” one said. “Instead, they bring down the ax.”
Falvo is unrepentant. She recalls a woman at a Pathways town hall standing up in tears. The woman, Falvo says, said that, “ ‘Pathways is my life.’ At that moment, I knew closing it was the exact right thing to do because treatment should never be your life.”
But for many of Pathways’ severely mentally ill clients, long-term, day-to-night treatment was essential for their care and inevitably led to close relationships with staff. “It hurts,” 30-year-old client Kristie Tribe said at Salmon’s farewell. “I don’t want to say goodbye.”
Her friend, 67-year-old Dee King, a former trucker and now legally blind, had no idea who would be managing her case come Feb. 1 when the treatment center closed. She was more concerned, she said, “about the clients who aren’t as tough as I am surviving the closure.”
Julie, who had spoken up vehemently against the changes at a town-hall meeting, was scared. She couldn’t hug her two daughters, she said, “because my skin is too sensitive.” Her 65-year-old mother, Joyce Johnson, expressed concern. “Now I can’t go to work and feel comfortable she’s safe,” she said.
Salmon gave a brief speech, noting Pathways had sponsored 32,000 groups and classes. A Bosnian client took the microphone and sang a lament. Client Julie told those listening, “The only thing you can count on is change. It’s very hard for people like me to do.” Tribe said she’d written a poem about Salmon but lost it on the bus. “In a way, I owe my life to you.”
On Pathways’ final day, Julie went to say goodbye to Salmon. She grabbed hold of her, and sobbing, cried out, “How am I going to manage? I can’t do this all by myself.”
Holly Chapman Blank, a 49-year-old with bookish glasses, was another Pathways client who feared its end. Pathways “opened a new world for me,” she says. When she started, she was so introverted, “I was worse than a wallflower, I was the wall.” She found “empowerment and responsibility” at Fresh Start, a series of client-run classes and activities that replaced the socialization aspect of Pathways’ services. While higher-functioning Pathways clients have continued to attend Fresh Start and Wellness for Recovery—which provides support classes on schizophrenia and diabetes as well as leadership skills—“a lot of lower functioning clients haven’t come back,” she says. “Pathways meant a lot to them.”
Three months after Pathways’ closure, many former clients remain angry about both the closure and what has replaced it. Sasha, who requested her last name not be used, has yet to be assigned to one of the care-coordinating teams Valley said every client would receive, one of many “bright pretty promises” made at the town-hall meetings she says were never fulfilled. Last fall, 35-year-old Sasha started classes at the University of Utah. The closure of Pathways, where she’d been a client for eight years, made her question going on. “I don’t fit in anywhere,” she says. “Where am I supposed to go for support?”
Fresh Start, she says, “doesn’t help me to shower when I’m too paranoid to get into the bathroom.” When Pathways was open, she could talk to a therapist without an appointment. “Now I’m isolated, I have no one to talk to.”
Tribe is “disgusted” with the changes. At Pathways, “I was doing good, on my meds, going to groups. I never had any friends, then I went to Pathways and I met friends.” Tribe stays in her South Salt Lake apartment with her boyfriend and struggles with paranoid hallucinations. “It’s killing me not doing anything,” she says. “I just sleep all day.”
Prewitt, meanwhile, attends one Wellness two-hour class a week. She can’t bear Fresh Start because her higher-functioning peers, who run the classes, “don’t listen to us,” she says. “They just talk to us.” She stays in her apartment and her drug use escalates her fears of going out, her sister says. Where once Prewitt had Pathways’ socialization to get her out of her home, she now feels, her sister says, “she has nowhere to go.”
The jury is still out, Salt Lake County’s mental health director Whalen says, on whether Valley’s reconfiguration “will be a success.” Out of the four programs slated for closure, only Pathways closed. Out of the 125 intended layoffs, 91 employees left, but Falvo is unable, or unwilling, to say how many were laid off.
Whalen says Falvo told him that the county “can come on in, the lights are on, we can look where we want.” Two staff under Whalen are reviewing clinical and billing records. “I want to make sure we’re getting what we purchase,” he says. Falvo is less than thrilled. “I’m always concerned about additional, repetitive oversight.”
At the end of 2010, Valley Mental Health will bid for the Salt Lake County mental-health contract. Before October 2009, says Pat Fleming, Valley was a “shoo-in” for being the sole source provider for Salt Lake County’s mental-health needs. Post-reconfiguration, he says, the county seems more interested in bringing market forces to bear, “as they can only improve services.” Along with the county looking at what other treatment providers offer, the question of whether the contract should be broken up—or “unbundled”—hangs over Valley’s future.
Falvo says, “I don’t believe personally [that unbundling] is the best way to provide care for people with serious mental illness.”
She acknowledges some staff have “trust issues” with her, and that employees and clients are nervous. “Everybody keeps saying slow down. If we slow down, we will get passed by.”
Krause, meanwhile, continues to battle with Valley Mental Health to find care for her sister. Prewitt was kicked out of one county-funded evening alcohol and drug program she attended for six months because she talked about feeling suicidal. The county referred Prewitt to an intensive Valley program called Mentally Ill Chemically Addicted, only for a furious Krause to discover Valley had just closed it.
Krause and Prewitt attended a meeting with county officials to review Prewitt’s care by Valley. Prewitt spent the meeting with her head in her hands, crying. “But can you help me?” she said. “I need help.” In a subsequent meeting, chief clinical officer Richard Hatch told Prewitt she would be entering Valley programs that in the past Krause had been told her sister was too severely disabled for. While Prewitt is “greatly optimistic,” her sister says, Krause is concerned that Valley is just getting her hopes up.
“I feel helpless,” Krause says. “I never thought I’d have to fight the system that’s supposed to care for my sister. I kick, I claw, I scratch for help, I don’t know what else I can do.”