Sharron Lobaugh was interviewed by Bill Schneider on September 24, 2010 at her home overlooking Fritz Cove in Juneau, Alaska. Sharron is the parent of a son with mental illness and a longtime mental health advocate. In this interview, she talks about how she became involved in mental health issues, establishing the Alaska Alliance for Mental Illness, her role in the mental health trust lawsuit and settlement, and the evolution of mental health services in Alaska.
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Section 1: Her personal background, coming to Alaska, and what she did before her involvement with mental health issues.
Section 2: Her son's diagnosis of schizophrenia leading to her getting involved with Alaska mental health issues, and helping to organize the Alaska Alliance for Mental Illness (AK AMI).
Section 3: Goals of the Alaska Chapter of the Alliance for Mental Illness and how their efforts fit into the national scene at the time regarding research on and treatment of mental illness.
Section 4: Trends in delivery of mental health services moving from family assistance to consumers of the services being empowered to be in charge of themselves.
Section 5: Getting involved with the Mental Health Trust lawsuit and legislation.
Section 6: The Mental Health Trust lawsuit, effect of expanding the beneficiaries, and the State of Alaska's opposition to the lawsuit and legislation to try to resolve the problem.
Section 7: The State of Alaska's opposition to the Mental Health Trust settlement, and fighting over land claims and management.
Section 8: Role of the Mental Health Commission and resolution of land claims.
Section 9: Disappointment with a lack of settlement of the Mental Health Trust case in Governor Cowper's administration, the lack of change in delivery of mental health services, and an increase in user population sharing the same amount of resources.
Section 10: Discusses the role of the Mental Health Trust Authority and the State of Alaska in delivery of mental health services, identifies key players in the history of the mental health trust issue, and discusses the continued need for improved community services for the mentally ill.
BILL SCHNEIDER: Today is September 24th, 2010, I'm Bill Schneider. We have the pleasure today of doing an interview with Sharron Lobaugh. So thank you for taking the time to do this. And we're here at your home in Juneau on Fritz Cove Road, and beautiful, beautiful Juneau day, with a little bit of gray. So thank you for taking time to do this. And let's start with some of your personal background. And then bring us up to the issues that got you involved in the -- in the trust.
SHARRON LOBAUGH: Uh-hum.
BILL SCHNEIDER: So tell us a little bit about your personal life. SHARRON LOBAUGH: Well, just briefly, I was born and raised in Pullman, Washington, and went to the university there, where I met my husband, Cliff, who was a veterinary student at the time. And in 1962, we came to Alaska to make things short there. I studied art while I was there, and also some education, as well. Then after moving to Juneau, I was pretty much a full-time mom raising four children, boys, all of them, here in Juneau, who are still in Juneau. And then became very interested and active in the arts. And I served as well on the Arts Council and a number of boards and commissions in the early '60s and '70s, including a lot of work in the conservation area.
My husband and I are both activists in environmental area, and worked very hard on Admiralty Island selection for wilderness, as well as other D2 lands and lobbying in Washington, D.C. and a number of very interesting active things. In 1967, I was chair of the Centennial Art Exhibit, which went to 22 places in Alaska, as well as Seattle. And it was a juried show. And it was a very interesting experience, taking me as far as Gamble and St. Lawrence Island. And so that was what I did prior to mental health. Section 2:
And then, I guess, the life-changing event was my son Tim, who was learning disabled in elementary school, went through many, many tests to try to determine what kinds of learning disability he had; and it wasn't until high school where he started acting as if he didn't want to attend school at all, and was very frightened, and I remember saying at one time, my goodness, you act like you're paranoid, you're afraid to go to school, that's just kind of really odd, and used to have to take him to school. And with some help with the counselors at the time, we were referred to a psychologist here who referred us then to child studies centers in Seattle, and he was determined to have schizophrenia. And for a long time the only assistance he had was we met with doctor -- a doctor at the Public Health Center for a while, and then doctor -- after a little bit of activist, we were able to persuade the City and Bureau of Juneau to start some mental health services. And at that time they didn't even have any mental health services in Juneau except to go see the state psychiatrist. And we got pills once a month, when I didn't understand at all what the pills once a month had to do with this illness.
So it wasn't until the start of the Mental Health Center here in Juneau that I became conscious of what being a -- having schizophrenia meant. One psychiatrist recommended I read, hmm, let's see, something like I Never Promised You a Rose Garden, which actually turns out to be about a girl who had a different type of illness, so we were pretty much blind to what it meant for about 10 years. And then I -- one of the psychiatrists in Juneau who happened to be married to a friend of mine recommended that I get in touch with a couple of other women in the state who had been in touch with him about organizing a group of -- of parents who had family members with mental illness. And that's when I was able to touch base with Lola Reed and Ann DeNardo of Fairbanks. Ann DeNardo of Fairbanks and Lola Reed of Anchorage. This person said, you know, I happen to have some public education money that's left over, and I'd like you to just arrange a conference on mental illness, and I'll be able to -- I'll be able to fund it before the end of the year because he was -- you know, it was the end of the year budget sort of thing. If you form this organization. So we met by teleconference for a few months, and organized the first conference for persons who had family members with mental illness. And that was held in Fairbanks.
And then we formed the chapter of the Alaska Alliance For Mental Illness. And we called ourselves AMI at the time, AK AMI, I believe. And affiliated with the National Alliance on Mental Illness, which was then only about a ten -- maybe five or six years old, it was less than ten years, and went to their national conference, and the whole world changed for me then when I realized that much more is needed than a pill a month, you know, a prescription a month to keep people healthy who have a mental illness. Section 3:
BILL SCHNEIDER: Who was the psychiatrist that --
SHARRON LOBAUGH: It was Dr. Phil Shapiro, Dr. Shapiro at the time.
BILL SCHNEIDER: Uh-hum.
SHARRON LOBAUGH: And his wife is Whitney, and she was a close friend, even before she lived in Juneau, she lived here way early on, I got to meet her then. So anyway, he was the one that said look I think it's time you organized or helped organize something. And then we did organize the NAMI. I had a job at the time working for the northwest coast -- Northwest Regional Educational Laboratory out of Portland. And my job required me to travel to the -- all kinds of education -- all of the educational institutions in the state and train in race and sex equity. So I held workshops, which were required for teachers to take race and sex equity. And so I was able to go to a number of communities that would -- would otherwise not be able to travel to. And when I held those workshops, they usually lasted for a couple of hours for the teachers, and then I would have half days off where I could contact the mental health centers in these different communities and meet parents and family members.
And so, in a quick couple of years, we organized 12 groups that were affiliated with the National Alliance with the Mentally Ill.
BILL SCHNEIDER: Wow. SHARRON LOBAUGH: It was very lucky that I had that opportunity to meet people person to person.
BILL SCHNEIDER: Yeah, it sure was. And you were quite active, too.
SHARRON LOBAUGH: Yes, I was, for a number of years. I was vice-president to Ann DeNardo, but she had a stroke in the first year of office, and so I became president and I was president for about five years.
BILL SCHNEIDER: Uh-hum. SHARRON LOBAUGH: And that's when we catalyzed the stand and formed these connections that were so critical in the lobbying effort that we had to do for the Mental Health Trust.
And at that time, it -- it was also the time when nationally things were happening. Mrs. Carter was very influential in organize -- in doing research on what kinds of things are necessary to -- to improve mental health of persons who have mental illness. And she instituted studies that were done to try to find out what people needed because if you recall, back at the time of deinstitutionalization, which was about 10 years or more before her term, or her -- as first lady, they let mentally ill people out of all of the institutions in the United States. And that was because it was considered inhumane to keep people in institutions against their will for long periods of time.
Often, there was no medication that would be effective for people with mental illness at -- during the -- between the 1900 and 1950. So the only kind of medication that was used was Thorazine, which is a -- results in a serious tranquilization, and there's lots of drooling and side effects like jerking or often a permanent muscular issues that -- that would result from use of Thorazine. So it wasn't until after her influence that money became appropriated nationally to the national alliance -- no, to the National Institute of Mental Health, NIMH, to fund grants in order for people to do -- for researchers to do work on trying to find new and different medications. And so it was -- it was at that period of time when she was able to initiate conferences and seminars on community mental health. Up until that time, a lot of the mental health centers focused on -- and I'm sorry for the term, but we called them the "worried well." They were people who had issues like divorces or financial troubles or other family concerns, you know, personal concerns, homosexuality was one of them, and that type of thing where they were receiving counseling for this kind of disorder, but for people who had serious mental illness, they were not able to help them in the mental health centers. So we looked at the word deinstitutionalization, and we thought, what does an institution provide. An institution not only provides a place to live, but they provide meals, they provide places for -- for patients to work, like on the grounds or in the kitchens and things like that. They provide support. You know, there was -- there was counselors or the gatekeepers, if you will, who helped them in and out of institutions. And of course, the psychiatry, the medical information, all these things constitute an institution. They are within the walls. So the idea is community mental health centers need to provide community support services so that these people can survive effectively in their -- in their homes. And so that was the goal that we were looking toward as -- in the Alliance is to try to broaden the services that are available in the community to -- to provide housing, to provide jobs, to provide places for them to meet and socialize, and those are the goals that we worked for as an alliance. Section 4:
BILL SCHNEIDER: And it seems that that grassroots effort was really so important. So many of the people we've talked to say that there was -- there was very little support and that people had to organize themselves in terms of getting mental health services. SHARRON LOBAUGH: Yes. The -- as far as I know, the most successful people at the time when they had -- before they had a community support services, most of the people who were successful lived with an active family member who took charge and became their caseworker, if you will, and in fact, that's still kind of the way it is today. Most people really do need active people behind them to -- to help them through these troubled times, although there is a new movement that's happened within the past 10 years for the consumers themselves to become empowered, and they are their own advocates. So I think that there are even some groups who don't really want or prefer not to even involve their family members in these -- in their -- in their program. Because they really want to do it themselves. But there is a body of -- of people who are not really able to do that. So one of the things, the most progressive things we have today are like the Polaris House in Juneau, which is aimed at encouraging consumers themselves to -- to learn and to help them help each other to succeed in society.
BILL SCHNEIDER: Say more about the Polaris House. SHARRON LOBAUGH: Okay. Well, the Polaris House is founded on a program similar to Fountain House in New York. One of the benefits of being involved in the alliance is that we were able to go to a great number of national conferences and regional conferences. And so I recall once in Boston, and then again in -- I guess it was New York being able to go to and visit a Fountain House program. And of course, in a big city like that, the Fountain House has many resources. When -- when we visited, we first of all, meet the receptionist who is a consumer and able to call on another leader to come and -- and provide a tour of the house to the visitors, and they have many, many people, they have a large building with four different floors, and you know, the first floor might be more social activities, a second could be things like cafe and barber shops and -- and different services that are offered, and then there might be an administrative unit and so forth. So Fountain House is a very effective model in a big city.
So we wrote a grant and it was funded by the Mental Health Trust in about the year 2001, I believe, to provide this type of smaller program here in Juneau. So that -- that's what the Fountain House model is, and I think recently, they were accepted as a Fountain House organization. You have to meet certain criteria, so I believe they were successful in doing that.
BILL SCHNEIDER: Hmm. That's interesting.
SHARRON LOBAUGH: Uh-hum. Section 5:
BILL SCHNEIDER: Well, you also became politically active in fighting for restoration of the trust.
SHARRON LOBAUGH: Yes. That happened kind of -- when we were a new alliance, we were trying to find out what kinds of things were -- were being done in the state, and we heard about the fact that in -- I guess her name is Green, and she was from Oregon, she was a Representative, and it was before statehood and we learned that she had some concerns because a lot of Alaskans were impacting the mental health services in Oregon by having them travel down to the state from out -- from Alaska, so they were taking in some of the mental health patients in their institution there in Oregon. And she thought, well, they should be funding their own program. So she had a bill passed in Congress that allowed the mental health -- allowed the State of Alaska to choose lands for purposes of dedication towards the support of the -- of persons who had mental illness in Alaska. So we heard about this, and learned that there was a lawsuit that had been filed, and contacted Steve Cowper, who was formally a legislator here in Juneau, and I talked to him about the lawsuit that I guess Vern Weiss had initiated through him, and he was in charge of the case. So after a year or so, just trying to keep abreast of what was happening, he was having a great deal of difficulty getting movement on that litigation. And actually contacted me and wanted to see if I would know of anyone who might be interested in taking over the case because he was going to run for governor. So I recommended a friend, David Walker, as someone who was a bright, young lawyer and could possibly be interested, and Dave did take over the case from him. And then, the big push was to try to get some legislation to resolve this because it had been 25 years before, you know, and already the issue is quite old at that point and there wasn't any resolution. So I worked a great deal with Jim Duncan, our senator, Senator Duncan was a very important player in this, as well as a number of senators and representatives on the other side of the aisle, some representatives, as well, I'll think of that in a moment.
BILL SCHNEIDER: Sure. SHARRON LOBAUGH: But anyway, we crafted a bill, and we had weekly meetings with a lot of the people who were involved, you know, especially the alliance, the national -- state alliance members, and tried to keep them involved in development of the legislation and its progress through the House and Senate. And it did -- it was a quite a wide-ranging bill, I think fairly treated the issue because a million acres -- was it a million acres? Wait a minute. BILL SCHNEIDER: Well, the Mental Health Trust lands.
SHARRON LOBAUGH: Yeah. It was a million acres? No. It wasn't that long.
BILL SCHNEIDER: Doesn't matter.
SHARRON LOBAUGH: Yes, it does. Yeah. There are 365 million acres in Alaska. Yeah, a million acres of Alaska lands is a lot of land. And apparently during the previous administration, when this bill was passed, Phil Holdsworth, I believe, was the Commissioner of Natural Resources, and he -- there were no lands at that time other than federal lands, there were no lands for the state. So he took the opportunity to -- because he was a mining engineer by profession, to select some very high prime land for the Mental Health Trust land. And so his work included quite a bit of acreage that was minerally rich, as well as areas around state -- around municipalities that would possibly grow. For example, the bench lands around Juneau were part of it, and some really quite valuable lands in his -- in his initial selection. But they were still short. They didn't have quite enough lands identified at the time.
But anyway, at the time of our work on the bill with Jim Duncan, we knew that there -- that it was going to be a really hot issue because the state itself had already -- statehood had happened, and they had a goal of trying to acquire the best lands, as well. So although we had a bargaining chip, we didn't have any -- any real authority to -- to move this forward until legislation, you know, was accomplished.
So after two years, I believe that the political climate changed, and Wally Hickel became elected again, and he -- his ideas were totally different about mental health. So he had his Attorney General at the time, and I'm sorry, I don't remember his name, but anyway, moved quite quickly to change the entire scope of mental illness -- of mental health. Section 6:
One of the things that was in the original legislation -- excuse me, the federal legislation was that the -- they were to build an institution and they were also to provide services for persons that had mental illness and similar conditions. So a number of other groups joined in the lawsuit and became the developmentally disabled and then that group expanded to persons who may have developmental disabilities, such as children that have more -- are likely to become mentally ill; in other words, they are at risk for becoming mentally ill. So the definition broadened. Then it became persons that had alcohol problems. So the -- because I know for a fact that the mentally ill had almost no services before this all began; by the time the pie got bigger and bigger and bigger, the chance of really building a community support program for just the mentally ill is -- is decreased. And then another thing happened at the time because not only was the group getting larger, but the -- the administration at the time believed that they could change the intent so that they could say that, well, we have been providing mental health services, we've had a -- we've had the Department of Health and Social Services and we've had a Commissioner of Mental Health for a long time, so we've been doing quite well, and we don't really feel that it's fair to say that there should be cut out a certain amount of acreage to provide for -- for these services. They should be able to count all these years of service, you know, against the -- the mental health, and we don't believe that it's right to -- to set up a separate pool of money, which is what the Duncan bill would have done. The Duncan bill would have actually put a separate, so almost a -- almost like a Permanent Fund, only not quite, but because there is a federal -- I mean, there is a state law against dedicated funds, there was a feeling that the setting -- setting out that million acres for the mentally ill would be similarly dedicating those monies. So that's why the scope, and it's one of the reasons why the scope changed, but I think personally the reason it changed was those mental health lands were very valuable. They're very, very valuable. And so by the time that the Native corporations and the cities and all the people who had overlaid claims on the mental health land and mining companies and oil companies, the amount of land that was remaining for unappropriated or un -- unaffiliated or unclaimed diminished quite -- quite severely. (Recording paused momentarily.) Section 7:
BILL SCHNEIDER: Okay. We're back on and we're talking about changes that occurred in the state.
SHARRON LOBAUGH: Okay. Well, at the -- we were not able to be successful with the mental health bill that Jim Duncan had worked so hard on, and the term ended, you know, before the resolution happened. And at that time, Governor Hickel was -- was reelected to a second term. And he -- his Attorney General looked at the bill and believed that there was no need for a separate fund to be set up for mental health for the -- and because they felt that the -- that there had been mental health services provided all along. There had been developmentally disabled programs. There are programs, there was Harborview, and there was Alaska Psychiatric Institute they had been managing, and then the community -- community mental health. So he said there was lots of state money already, and we need to count that against the settlement. And the original intent of the settlement was that these lands be managed solely for the purpose of providing services. So the intent changed because -- I think really politically changed, but not -- but the message they were delivering was, well, you know, there are these lands -- I mean, these monies have been spent by the state in the large sums to provide services already, and that needs to be counted against the settlement, is what they were saying. So I think the real intent, though, the reason for the change, is not so much that some services had been provided, but because there was a lot of pressure from -- from organizations like the city and borough of different communities that lands around belonged to or should -- they had been double claimed. You know, the city wanted some and the Native corporations wanted theirs, and the mining and oil companies wanted to continue their claims, and so these overlaid mental health lands. And there were, I think, a lot of political pressure saying, no, wait a minute, you can't let these people manage these lands and get all that money because these -- these lands really should be used for other purposes. So that being said, the new bill provided that there -- that the claims that are validated from the different sources are -- proceed, and that the lands transfer to those entities, and that the remaining part, the remaining lands, which had not been claimed for other purposes, can be managed by the Mental Health Trust Authority, which is what they later created. Section 8:
Well, I forgot one of the most important steps that was an outcome of the effort that the -- we had initiated, and that is up until the -- until there was -- the litigation had moved forward, there really wasn't a lot of knowledge about what lands we were talking about, other than the fact that some of them were mineral lands and around cities. So there was a commission established, George Rogers was the chair, Lidia Selkirk Craig was on it, while I was an alternate, and K. J. Metcalf who was a forester, and then we had staff that was assigned to us that -- to help identify the lands. And that took a two-year process to try to work through that. And then when that -- those lands were identified, we were able -- then the political pressure began to build up because we recognized that -- I mean, that there was a lot of city and borough land, there was university land, there was land for mining claims and oil claims and Native corporations, so there was almost two-thirds of all of the million acres were already pretty much committed. But they hadn't real clear title because there was this Mental Health Trust overlay on -- on those lands. So that created the political climate that I was talking about a little earlier, put a lot of pressure on the administration to try to find a way to give clear title to those entities. So that's the -- one of the pressures that created the resolution that we now have, which was that, you know, a certain proportion, I don't recall exactly the number of acres, be managed for mental health. And the Mental Health Trust Authority was established, and that's the outcome that we are with today. Section 9:
BILL SCHNEIDER: One question I've always wondered about is why wasn't there a settlement during the Cowper administration?
SHARRON LOBAUGH: Well, that's one thing I've been wondering, as well, because that was kind of a little bit of an expectation on my part, for sure, because he did say, oh, you know, I've got this litigation, I need to -- it needs to be moved forward, and we -- but I'm going to run for governor. And so we -- we did put some -- some pressure on -- on that, but at the same time, I guess it -- he just was not a mover in that area. He didn't feel apparently that committed because nothing happened. And then it was after his term that we began to realize that we had to find another advocate, and that's why, in the next term, we began to work with some of the other legislators and senators at that time.
It was a very big disappointment, to be honest with you. We tried to get -- we got some additional services through, but still, you know, not very much happened. In fact, one of the things that we did get a bill through that would provide parody of some sort for mental illness, in other words, insurance that would cover mental health problems, we got a bill, a parody passed from the House and Senate, and that was amazing that we got that bill passed. And I never really even realized the insurance company got to him and he vetoed it. So it was pretty clear that his -- he didn't have the commitment that we expected, and it was a false expectation on our part. You get all the way threw up to the Governor's office, and then he vetoes it, you know. So --
BILL SCHNEIDER: Yeah. SHARRON LOBAUGH: Anyway, maybe -- I -- I don't know. I just -- I think there were a lot of mysteries during his administration that didn't -- things that didn't move forward.
BILL SCHNEIDER: Well, so, we do have a trust settlement.
SHARRON LOBAUGH: Uh-hum.
BILL SCHNEIDER: And how has it worked out? SHARRON LOBAUGH: Well, we do. And we -- I continue to hear the same problems from persons that have -- whose families have mental illness and consumers that there is no -- still not enough service. The -- it's true that to have a full complement of community mental health services for mentally ill, for example, in centers like Bethel or Ketchikan or you know, places where our service centers, you know, some of that was initiated, but the mental health budget itself has just been devastated. In Juneau is a good example. We do not have enough money to even have active case managers anymore. It's very disappointing. It's -- it's really wrong. And what happened was that the state says, now, we're going to continue to sustain the kind of service we always have had because we've been doing a really good job. And the Mental Health Trust Authority has some money, but they have been using it to start a new initiative, you know, and they've been doing a lot of new initiatives. You know, things that would enhance programs, but the mental -- but the state has a commitment to maintain the programs. But there was never an inventory done at the time of the settlement -- or the legislation that passed. You see, they really needed to say, okay, here's our baseline, we have these kinds of services going on right now, and we will continue those services as long as there's money in the state because we are committed to settlement. We are committed to this purpose. And that's what we have agreed to as a state. I think there's a lawsuit there. I really do. I think we can go back -- I mean, I'm not certainly going to take it on, but I think we can go back and determine, now, I forget the year, but whatever year it was that the settlement was done and say, these things were in place, we should continue and we will continue to provide that base level of care because it's not being done. It's definitely not being done. So as the -- the increase in population naturally occurs, a certain percentage more should be added to mental health services. And I now am talking about all of the beneficiaries because it became pretty clear that the state was -- would be able to make new populations added to the -- to the base. In other words, for example, persons with physical disabilities, like amputees or people that are bedridden, you know, could be added as beneficiaries. Because at the time of the initial 25 years ago, there were a lot of different types of people other than mentally ill people that went to Morningside in Oregon. You know, people with serious alcohol disabilities, or seizure disorders, or, you know, things that were not necessarily considered normal ailments here in Alaska, and cause problems of -- of basically a social nature in their community, they were sent to Morningside. So it -- it's easy for the state to make a claim that, well, we'll just add this population and then we'll add that population, and then it looks like we're funding a lot of people. We're funding a lot of people with disabilities, see, so they've taken the age way down to practically at birth, you know, anybody that's born with a defect of some sort could be added, and they have expanded the base, but divided -- it's like multiplying the number of people and dividing the resources and/or -- and so every time you do that, it subtracts from some population some services. So I think that's what happened. Section 10:
BILL SCHNEIDER: So when you think about the trust, we've talked about the state and what they are doing. How effective is the trust?
SHARRON LOBAUGH: I believe the Trust Authority is well intentioned, and they report annually to the state at the legislature, and so forth, and they have promoted some new projects, you know, in their way. Particularly, I think, helped to encourage, like, bring the children home, that was one of their -- one of their successful efforts, they've done some push in terms of the housing shortages; but in the long run, it's my opinion that they are more of a thorn in the side of the state to try to promote and pursue changes, but I don't see that they have been really effective in -- in promoting and encouraging the state to do their obligation. I think that requires a stealth, you know, a real effort to, you know, put their nose where their mouth is and get on it because, you know, I just hear way too many reports from all of the beneficiaries that the progress has -- has not been made. The funding is not there on the state's part. They are not funding the programs that they -- they should be funding. And I don't think -- I'm not sure that the Trust Authority makes that much difference in what the state does. So I think it's an impasse. It's possibly even a -- another lawsuit waiting to happen, but it -- it might happen because I don't -- I think they are not holding up their obligations that they agreed to in the final legislation. BILL SCHNEIDER: The state?
SHARRON LOBAUGH: The state is not holding up their obligations, and I think the Trust Authority is pretty powerless to impact that.
BILL SCHNEIDER: When you think back about the history of your involvement and other people's involvement, who are some of the people you think we ought to recognize for their -- the role that they played, whether they were contributors or detractors? SHARRON LOBAUGH: Well, certainly everyone recognizes Jim Gottstein's contribution. He really was very persistent in his pursuing the settlement. We -- we parted ways on certain issues, we didn't necessarily agree, but at the same time, I think that he's really the strongest advocate. And of course, people recognize that John Malone and Vicky Malone were helpful, and other -- other leaders in an alliance effort have been pretty steadily advocating, like, the efforts that were started in Anchorage, I mentioned Lola Reed, she still was involved for 20 years or more. And others.
And of course, recognizing the contributions that George Rogers made was quite considerable. And then there were others, you know, Pat Clasby was active for a long time. And I can't -- I'm sorry, I'm probably leaving people out.
BILL SCHNEIDER: That's all right. Oh, sure.
SHARRON LOBAUGH: But, of course, there's a lot. Of course, John Pugh was a very good advocate for a number of years. BILL SCHNEIDER: Yeah. Okay. What sort of things are we missing that we ought to pick up on?
SHARRON LOBAUGH: I -- I guess I just need to put out a plea for persons with mental illness. I really still believe that it's a very serious stigma that goes on, and with good care and good community support, you know, there's no reason why a person with mental illness can't be a productive member of our society. But it really does take help from the community. And I really -- I'm not quite certain that we have made it there yet. They are still among the most frequently homeless, they are the most frequently involved in alcohol abuse, or alcohol, you know, they very commonly have a dual diagnosis there. And Polaris House being an exception, and there's a few other kinds of centers in larger communities, but for the most part, I really think we've missed the ball on really providing them the full amount of services that they need in the state. So I just want to put that plug in.
BILL SCHNEIDER: Okay. Thank you for taking the time to do this interview today.
SHARRON LOBAUGH: Oh, you're welcome.
BILL SCHNEIDER: Yeah.
Section 1: Her current work with the law firm of Sonosky Chambers Sachse Miller & Munson in Juneau, Alaska helping tribal groups with self-determination and self-governance of health programs in their communities.
Section 2: Appreciation of her career in Alaska.
BILL SCHNEIDER: Tell me about your current job and how it fits in with all the background we've talked about.
MYRA MUNSON: Okay. In 1990, when I left the post of commissioner, I joined the Sonosky, Chambers law firm, I was offered a partnership in the firm and I opened a Juneau office for us. The Sonosky firm is a Washington, D.C., based law firm that is -- has now has -- at that time it had the D.C. office and had an Anchorage office, and I opened a Juneau office. Since then we also have offices in Albuquerque and San Diego.
The mission of the firm is to represent and advocate for Native American interests, for tribal interests specifically. And I had worked -- as commissioner, I had been very involved with the Alaska Native Health Board and with tribal health providers and Indian Health Service; and when I joined the law firm, I started representing those tribal providers and have been very, very involved in the development of the Alaska Tribal Health Compact to bring together all those folks, and their individual programs, have assisted them in a lot of Medicaid issues. I mean, I -- I get a chance to do the flip side of a lot of the same things, and I represent -- we represent, as well, some other -- some non-tribal health providers, as well, a lot of them around behavioral health issues, the smaller programs, behavioral health programs. The -- in the -- a lot of my work has been around negotiating and advocating for the Indian Self-Determination Act, and then most recently the Indian Healthcare Improvement Act, I've been involved in every iteration of health reform since Hillary Clinton tried.
And in the course of that have -- you know, when we were working in Healthcare Improvement Act, the -- the strategy chosen in Alaska, it became law, in fact, was to integrate behavioral health in the Indian health programs. So I have chance -- you know, what I hoped when I went to law school, I have a chance to -- this chair is squeaking. Oh, I see why.
I had a chance -- you know, what I wanted was to be able to integrate fundamental principles of social work and law, and so in my career, that's what I've always gotten to do. When I came back from school and was doing training and policy development, worked a lot with tribal programs, run child welfare, and actually guardianship proceedings, and a variety of things.
And then certainly as commissioner and then in this practice, you know, I do a lot of consulting in addition to, you know, what might be considered more conventional practice of law. So it's been a perfect opportunity to weave them together. My sort of fundamental view of community health and to some extent individual health is that people need to feel in control of their own lives. They need support when they need it, but there's almost a visceral need to -- to not feel out of control, to not feel powerless. And so in Indian law, the chance to assist tribes who have been in so many ways disenfranchised and had power stripped away, to be able to help them exercise power and to improve the quality of their communities, and -- and as the law says, exercise self-determination and self-governance. And that means running their own programs and making their own choices and mostly good, some not so good, but at least as good as the choices being made by anybody else on their behalf. So it gets me -- you know, I'm just enough involved in direct delivery in terms of interacting with clients, but also was really involved in the development of the community health aide program standards. I mean, the program --
BILL SCHNEIDER: Oh, really?
MYRA MUNSON: -- existed before, but I actually drafted the health -- or figured out with the board's help, I drafted the first Community Health aide program standard, or converted them from the standards people had been using to what they ultimately became. I drafted the dental health standards with the help of dentists who actually knew something about dentistry, and ultimately the behavioral health standards, that year of work that had been going on, a huge group of behavioral providers in the Native community and tribal community, along with some folks in the state who had been participating, and then turned those into the community health aide program behavioral health aide standards. So I get to keep my hand in. BILL SCHNEIDER: Well, that's great.
MYRA MUNSON: Yeah.
BILL SCHNEIDER: We have a Jukebox on community health aides, and so it was -- it's -- your comments are right on the spot there.
MYRA MUNSON: Yeah. Section 2:
BILL SCHNEIDER: Your career sounds fascinating in that you started off with that tremendous foundation of social work, and then the legal basis for it, and then the chance to play a part in the administration, and now the legal --
MYRA MUNSON: Yeah.
BILL SCHNEIDER: -- advocacy.
MYRA MUNSON: I'm so lucky. I mean, you know, our -- so lucky to be in Alaska --
BILL SCHNEIDER: Yeah.
MYRA MUNSON: -- which is small. When I was more actively involved in the NAS -- National Association of Social Workers [NASW] in Alaska, I was -- for a period I was president for one term, an infinite period of time it felt like at the time. But -- but before -- I mean, when I was here still working at a Bachelor's Degree, I was very active in NASW and in legislative advocacy, and so on. And when I came back and was doing training for social workers, there is some truth to the fact that people who work in the arena, whether it's mental health, substance abuse, the whole arena of behavioral health services, tend to take on kind of a sense of victimization or status tied to their clients. So if you're working with really well-to-do people in a private mental health center, it's a pretty high status kind of practice. If you're working in a community mental health center with -- or in a substance abuse program with alcoholics or you're working with child abusers or you're working with others, the status seems to attach to the client load, or at least the perception.
BILL SCHNEIDER: Yeah. MYRA MUNSON: It's so interesting how beleaguered people feel.
But I remember saying -- you know, talking with folks about the fact that this is a state in which anybody who wants to be something, with a little bit of good luck but the will to do it, can. There really is not much barrier. Everybody can contact the legislator, everybody can meet the governor. You know, everybody can sit down with the commissioner if they want to. Everybody can play a role if they really want to. Now, do you -- does -- I used to, when I was giving a speech as commissioner, say, wow, I get to be here, you poor souls have to listen, perhaps, and all -- most of you, many of you could be up here doing this. And the insights you have and the experience you have would be every bit as valuable as what I have, I've just been lucky enough to be in this position. And there is really a lot of truth to that. We're -- we're just, you know, so you've had a chance to have a forum that I might not have had but for the, you know, the good fortune of being able to get that job.
But if we -- if we look around, the commissioner now was the head of a mental health program in the Mat-Su, you know, a couple of then university folks, one was an ornithologist. I mean, this is not a state in which people are -- can't get there from here. BILL SCHNEIDER: That's right. That's right.
Well, thank you. This has been good.
MYRA MUNSON: Oh, my pleasure. I hope it's helpful to your project.
Myra Munson was interviewed by Bill Schneider on September 7, 2010 at Elmer E. Rasmuson Library on the University of Alaska Fairbanks campus. She is an attorney with the law firm of Sonosky, Chambers, Sachse, Endreson and Perry in Juneau, Alaska. She was Commissioner of the Alaska Department of Health and Social Services (DHSS) from 1986-1990, and prior to that was Assistant Attorney General in the Alaska Department of Law primarily representing DHSS cases. In this interview, she talks about the evolution of mental health services in Alaska, the community mental health movement, the state's role in funding and delivering mental health services, and the integration between mental health and substance abuse treatments. In addition, she discusses the mental health trust lawsuit and settlement and why it was not resolved during the administration of Governor Steve Cowper.
Part two of this interview.
Click to section:
Section 1: Personal background and education.
Section 2: The need for and a lack of services for the mentally ill in the early days of Alaska.
Section 3: The community mental health movement, the effect of budgetary issues on development of services, and the Mental Health Trust settlement.
Section 4: Her work to change the budgetary power of the Alaska Mental Health Board and other boards related to drug abuse and developmental disabilities when she was Commissioner of Health and Social Services, and their work for addition of beneficiaries to the Mental Health Trust settlement.
Section 5: Why there was not a settlement to the Mental Health Trust lawsuit during the administration of Governor Steve Cowper.
Section 6: The factors involved in why the settlement did not happen until it did.
Section 7: The lack of mental health services in the State of Alaska in the 1970s and 1980s.
Section 8: The tensions that existed between the treatment of co-occurring mental health and substance abuse issues, and the development of community based services in Alaska.
Section 9: Problem of there being a lack of integration between treatment for substance abuse and mental health issues.
Section 10: The benefits of treating the whole person, and understanding the relationship between crises, life stages and the chance for re-occurrence and the need for supportive services.
Section 11: Reflects on changes in services and treatments in her years of work.
Section 12: Provides an assessment of the Mental Health Trust Authority in terms of delivery of mental health services.
Section 13: Delivery of mental health services and how they are affected by the insurance and Medicaid system.
Section 14: The closure of Harborview Hospital for the developmentally disabled in Valdez, Alaska.
Section 15: Lack of community-based services filling in the gaps when hospitals can not care for people, and need for continued improvement in delivery of mental health services.
BILL SCHNEIDER: Today is September 7th, 2010. I'm Bill Schneider, and I have the pleasure of talking today with Myra Munson. So thank you for taking the time on your trip up here to Fairbanks.
And let's start a little bit on your background. You grew up here in Fairbanks?
MYRA MUNSON: I did. I was born in Juneau. And when my -- I was just a few months old, my parents moved to Fairbanks and my younger sister was born here just a few months later. And when they divorced, my parents divorced when I was two and a half, some three, something like that, my mother stayed here and homesteaded, so I grew up here.
BILL SCHNEIDER: I'll be darned.
MYRA MUNSON: Yeah. And then we were out of state for about three or four years. Just before I started high school, I came back here and went to high school and college, and lived here after college for a while, and then went on to graduate school. BILL SCHNEIDER: Uh-hum. Uh-hum. So you probably went to Lathrop or West Valley?
MYRA MUNSON: I did. No, I went to Lathrop. There wasn't a West Valley when I went to school here.
When I was at Lathrop, it was so packed that they were holding classes in the foyer outside the library. And in -- I mean, every nook and cranny had students packed into it. There were no other high schools other than the one at Eielson, so it was jammed. You know, I can't remember the number, but it was way more than two or three times the size of the student body that it was built for.
BILL SCHNEIDER: Okay.
MYRA MUNSON: Yeah. BILL SCHNEIDER: And your education, you -- after college?
MYRA MUNSON: After I got a Bachelor's degree here at UAF in social -- what was then sociology and psychology, and then after working in Child Protective Services in Fairbanks for five years, I went to the University of Denver where I got a dual degree in law and social work.
BILL SCHNEIDER: Oh. MYRA MUNSON: Same three-year window, not a lot of time. My kids were a year and a half and four, without the -- I had a stipend from under Title 20, for people as old as me who might remember that, but -- but we knew it wouldn't last, so we crammed -- I crammed it all in, in three years.
BILL SCHNEIDER: That sounds like a really unusual program. MYRA MUNSON: There actually -- there -- even then, this was in -- I started in '77. Even then, there were a number of them. There was one in Denver, Washington University and Saint Louis, Syracuse up in New York, and University of Chicago all had programs.
But, you know, my husband -- my ex-husband now, but my husband at the time and I were both Alaskan kids, you know, and young adults, and the thought of moving to one of those big industrial cities was a pretty -- he was a builder, it was pretty overwhelming, so Denver was kind of a perfect location. And I knew people in Denver from working, from placing kids in Denver at some of the youth programs there. So it was -- it was a good choice.
And there are actually -- I attended a few years after I was back, a couple years after I was back from school, actually a law and social work conference, and there were a whole lot of us who had law and social work degrees, there was some other lawyers and social workers in the state, in fact, although most people get their degrees at separate, at different times, typically they will get a social work degree and go back and get a law degree, and occasionally the other way around, but so many of us getting dual degrees. Section 2:
BILL SCHNEIDER: One of the things that we've been very interested in is this whole area of community services, and providing community services to people with disabilities, and what a tremendous struggle it was in the early years. Could you talk about that?
MYRA MUNSON: Yeah. You know, when I -- when I worked -- well, first of all, I should say, my mother suffered from an affective disorder; she had quite serious mental health problems. She was hospitalized occasionally for suicidal, and at the time we went Outside, it was because she was in -- in really deep weeds. Our cabin burned down and she just couldn't cope. And I don't think she ever got anything -- any -- any treatment that would be considered effective by any definition we use now. Mental health issues are sort of prevalent in my family. My oldest sister made suicide attempts from the time she was in the early twenties, maybe her teens even, but she committed suicide when she was 35 while she was hospitalized in a psychiatric hospital. And depression is just everywhere in our family. And the -- so it's always been a subject of some interest to me. When I started working as a social worker in Fairbanks in 1971 as an intern, and '72 I was in Child Protective Services, there was a community mental health center that was run by the state, it was a state mental health center, had a psychologist, a Ph.D., and a psychiatrist, maybe, it's like I can't remember even, probably, and some masters people who -- who were able to practice there. And the services were really limited. I mean, that was really it.
There was some -- a little bit of a private psychiatric community that developed. Irv Rothrock's clinic was active in that wind -- period. The hospital over at Fairbanks Memorial build up a unit that's designated -- what now, or at some point became designated, built up a mental health unit. So certain services developed, but for the -- but they were always really limited.
And one of the tensions that I became aware of by -- in the '70s that, you know, was really caught up in, I was in Child Protective Services is the people that I was working with, certainly some of them experienced serious mental illnesses, but lots of them had simply experienced so much trauma. Child abuse and neglect, the issues associated with alcoholism, depression, that sort of thing.
And we were desperate to get services for those children and for their families. And for the most part, you really couldn't. Occasionally, we'd get -- sort of work out a deal with mental health center, I had a colleague there who we actually worked on some cases together where there were just sort of lots of kids and lots of family issues and we'd work on things together, but mostly just couldn't get services. As I became more and more conscious of the issue and was working with other people in the community. Of course, it was at a time of great advocacy; I mean, the pipeline had started, there was lots of stuff going on. And the -- this tension between what became -- you know, what people talked about is kind of the walking wounded, and the services for seriously mentally ill and seriously emotionally disturbed kids, these are all labels that are probably out of date now, but the -- became really, really clear. And as the advocacy for people who really had been left out, and I mean, I'm not minimizing at all the disastrous lack of services and the necessary range of services, but for that population who -- who really needed services --
But the tension and the need for services for them and the advocacy from their families really became -- became really stark. Section 3:
The community mental health center movement was happening around Alaska since the state centers were becoming community mental health centers, community controlled. The institutionalization was -- you know, had swept the country with some good results and some not very good results because the community-based services hadn't evolved fast enough to back up behind them. And so there was just this real tension. And it -- it was -- it was starting in the '70s, before I left to go to graduate school, and it was in full force in the early '80s when I got back from graduate school. And in some respects, as is often the case in situations where there just isn't enough money and there's sort of a zero sum gain, there were -- there were huge advances being made in mental health in the availability of funds for mental health services, you know, the Mental Health Trust case helped with that a lot, Bettye Fahrenkamp's advocacy as a senator from Fairbanks was hugely important in it, and some others who were members of the legislature, and the fact that there was some money from the '80s because the oil revenue, all of that made a huge difference. But in the process, the services for people who didn't experience chronic mental illness or severe emotional disturbance, the kids who had been abused, their families, didn't grow to correspond. If anything, in some respects they diminished. And then when the pressure on mental health, fast forward a decade or, I mean, less than a decade, when pressure on the budget started, then those services began to diminish even more because they didn't meet the Medicaid definitions, and as everything started to shift toward Medicaid, that fundamental notion of community mental health center started to slip. BILL SCHNEIDER: One of the reasons why we're really interested in this is because in some of the interviews we've tried to get at the history of Morningside.
MYRA MUNSON: Uh-hum.
BILL SCHNEIDER: And sending people out, and the lack of services here.
MYRA MUNSON: Yeah. And you know, I -- I only -- my only experience with Morningside is really just historical. I've read about it a lot. I read -- I did a lot of reading about who had -- and who had been at Morningside, as we were -- when I was commissioner from -- see, I was appointed by Cowper in '86 -- end of '86 and served through '90, and, of course, there was all this work going on to figure out what the Mental Health Trust was going to be. Court case had been won, but getting a trust established hadn't been accomplished.
BILL SCHNEIDER: Right. MYRA MUNSON: And trying to figure out the role of all the advocacy groups and who should be entitled to services was really a huge issue during that window, and continued to be, of course.
And so I -- I read it, but it's -- none of that is meaningful to me in a direct way. I mean, I don't know that I can think that I personally knew a person, anyone individually who actually had been at Morningside. I may have. But I -- I don't -- I did, you know, know a lot about the folks who were being sent to Harborview because of the developmental disabilities, and -- and the -- and substance people who had experienced chronic mental -- chronic alcoholism, all of whom, you know, at one time or another were populations that eventually got added in to who was understood to be part of the Mental Health Trust.
But not Morningside specifically. I don't have anything to add, unfortunately. Section 4:
BILL SCHNEIDER: Were you actively involved in those decisions that were made about on the trust beneficiaries?
MYRA MUNSON: I think so. You know, I'm trying to remember, and I don't want to exaggerate any role, but during the window in which -- during that window on which I was commissioner, the issue of who should be served was really hot. And we were working on -- there was a substantive, there was an alcohol drug abuse board, and there was a -- there was the developmental disability board advocacy board, both quite -- "powerful" overstates the case, but at least very -- had a real definite life. They were well acknowledged, we really sort of knew who they were. And then there was the question of what was the mental health board. You know, what... And the -- this is a different -- this is a digression, but I think that the principal contribution I made in terms of the mental health piece of it was believing that there needed to be a board, a mental health board, advisory board of some kind, and that it needed to have the authority, statutory authority to present a budget to the legislature; that it wasn't good enough that budgets came through the department because, you know, I trusted me. You know, I was commissioner, I trust me to play fair, but I also knew even -- even while I was commissioner, every budget eventually goes to OMB [Office of Management and Budget]. Every budget goes to governor. Every budget is constrained by how much you're allowed to ask for. And there -- that's the role of the administration. I mean, somebody has to play that role, it's a necessary part of government, but it shouldn't be the case that the legislature doesn't have a real picture of what the need is when they are making their decisions. That can't come from the administration in many cases because the administration has to create a budget that balances overall. And somebody has to choose how to weigh those things. Now, I probably wouldn't agree with those choices more often than not, you know, I'd want more going to the programs I cared about, and health and social service programs than maybe transportation or something else, but somebody has to make those choices. But in the end, it seems to me that there had to be a role for the advocates to communicate real needs. So during the course of my tenure, we did get a mental health board that had -- we got -- basically eliminated the one that had been there which had -- was extremely weak, and substituted a board that had specific authority to take a budget to the legislature. I can't recall if we made similar changes or if they were even necessary in -- with regard to the alcohol and drug abuse board and the developmental disability boards, but I do know that before I left, we were bringing all three together to come up with a package. And in the course of all of that, there were these discussions over that four-year window, and the timing of it fails me or eludes me, but about to what extent were people who experienced chronic mental -- chronic alcoholism or serious alcoholism or other drug abuse I suppose included to what extent were people with serious developmental disabilities covered. It was our view they were covered. And it -- you know, it seemed to me that was the history of who had been served historically, those were the folks who should be.
And eventually, that's what came to pass is that all three classes were included. Other people were working on that, as well, and played an instrumental role, but it was certainly -- we were certainly working on it and it was certainly consistent with the point of view we had about who should be served. BILL SCHNEIDER: You were working on it as a --
MYRA MUNSON: As -- as commissioner, yeah, in the department, that was something we were working on. Yeah. Section 5:
BILL SCHNEIDER: Okay. I guess one of the big questions that I asked Steve Cowper, and I would ask you, is why wasn't there a trust settlement during that administration?
MYRA MUNSON: You know, I saw Tom Koester's response to that actually, when I was browsing through --
BILL SCHNEIDER: Yeah.
MYRA MUNSON: -- your pages, and I think his point is right. I think a couple things. I think Steve Cowper was -- had played such an active role that he did have to step back some from it. I think just his -- you know, he had to. The other thing is the Exxon Valdez happened in the middle of his term, and then he decided he wasn't running again; and so the kind of attention it might have gotten from him over -- you know, if he'd served out -- if he hadn't been distracted by the Exxon Valdez and all the sequelae of that, if he had run for a second term and won, had more time, maybe it would have happened in the time. You know, I think it didn't happen in part because I'm not sure the governor could have made it happen no matter how engaged he was. I don't think he could have made it happen. My own observation was that it took -- it took the time it took for people to get their head around it. It was really difficult that a lot of the people who had advocated for the mental health litigation were concerned about their children who experienced serious mental illnesses, their adult children. Chronic alcoholics, chronic alcoholics, people with developmental disabilities were not on their radar screen when they filed that litigation. The fact that it was expanding was not part of what they thought was -- there was a not-very-polite war going on about who got the benefit of this. No one knew exactly what the benefit was going to be, but whatever it was, everybody wanted in on it. And you know, there were additional lawsuits, I mean, it was evolving. It's still evolving, is my sense of things. And I actually don't think that it could have been forced through the legislature. I think it would -- there -- there was -- there wasn't sufficient consensus in the community of advocates around what the answer should be. I think it was my third year in office, I don't think it would -- I don't think it could have been the last year, it had to have been the third legislative year, we made a really, really serious run at trying to get something. I don't even remember what the elements of it were. Jay Kerttula was very active, there were some other. Ron Larson, some others in the legislature were really serious about trying to make this work. Master tacticians in the legislature, this was one of those things happening right at the end of the session trying to put something together.
The -- you couldn't build a con -- you couldn't build a base for something at that point. So instead, what we tried to do is get -- you know, we took sort of the next steps. The advocates would work out their own settlement over time, it -- eventually there would have to be one from the point of view of -- of at least my administration of the department, it was make sure that all those boards, the advocates had strong voices, direct to the legislature that could bypass -- had to come to the department, too, of course, but could get to the legislature directly so that it wouldn't get stifled during periods in which there wasn't enough money, and -- and try to get more money for services. And getting a settlement, establishing a trust, figure -- I mean, people were still struggling over how much -- how much should management of land be the focus of a board of a Mental Health Trust, and how much should it be mental health services or the -- the mix of what is described as mental health services might now be called behavioral health services more generically. These were all things that were still -- still really being thought through, and I don't think there was any consen -- I don't think there was a basis for a consensus then. And I think it took -- well, when was it that it was finally sort of done. I mean, I don't remember the year, but it was -- it was still a ways out.
BILL SCHNEIDER: But -- MYRA MUNSON: So I don't think it could have been done then. I think -- I don't think -- and had the legislature tried to do something, somebody would have challenged it. It would not have been -- there simply wasn't support. Section 6:
BILL SCHNEIDER: So your contention is that it would -- it -- the time was needed for those different beneficiary groups to work out their relationship because --
MYRA MUNSON: I think so.
BILL SCHNEIDER: -- how much of the pie it was going to be --
MYRA MUNSON: Yeah. I mean, I don't think -- I don't think I understood that entirely at the time. What I knew is that you couldn't get consensus on what color the sky was, let alone how to structure the Mental Health Trust among all the players that were interested and concerned about this issue. And so when I look back, and when I apply the training I have, you know, my just life experience about things, some things just aren't ready 'til they are ready. This one wasn't ready.
BILL SCHNEIDER: Yeah. Well, I was surprised in the interview with Steve Cowper because he said that it was the most important case he tried.
MYRA MUNSON: Uh-hum. BILL SCHNEIDER: I think those were his words.
MYRA MUNSON: I'm sure it would have been.
BILL SCHNEIDER: And yet, when I pressed him about the -- why there wasn't the settlement during his administration, his response was more in terms of, well, it wasn't appropriate for the governor to push too hard since I was sitting on the administrative side. MYRA MUNSON: See, I'm -- I'm not -- I can't speak for him. You know, I learned that when I was commissioner serving under him. I didn't speak for him then, I'm not going to try to interpret what his own comments were --
BILL SCHNEIDER: Yeah. MYRA MUNSON: -- but I think that's right in some ways, any more than it would have been.
I tried really hard a couple of times to find a way, as a commissioner, to get it settled, to think of something that would settle it, but it became clear every time we put together some concept, you couldn't get three people, or you know how I mean, I'm exaggerating, but you couldn't build critical mass around it to support it. And what that says to me is until you -- you don't have consensus until you have it. And it would have been -- if the legislature had forced something through, it would have failed in the end. It just needed time. And I think he was right, I don't think -- I think in some respects, maybe what he -- I can't speak for him, but one -- what one might have learned from the litigation is that this was something that peculiarly needed the advocates or the -- the stakeholders to find their own solution in some senses, and that having either the court or the administration, whichever, any administration, try to craft it and force it -- force it, would have ultimately failed. I mean, in the end it had to go through all those processes of being approved by the court and, you know, approved by the legislature and so on, but it still -- it needed first to have all that time to work it out.
BILL SCHNEIDER: Uh-hum. Yeah. And I know people like Judge Greene spent years of her life --
MYRA MUNSON: Right.
BILL SCHNEIDER: -- figuring out how to make it work.
MYRA MUNSON: Yeah. That's right. And in some respects, the court proceedings and the legislative process and all these boards that were meeting constantly about trying to figure out who was head of services and what kinds of services, all along with just the advocates who sort of had no -- sometimes they didn't even have a formal place, they were just there sort of constantly beating the drum, all played a role in trying to figure out the right balance. Section 7:
BILL SCHNEIDER: So using that as kind of a base, how would you describe the evolution of services over the years? And part of -- part of what our project is, is to look at what -- what is the evolution of services to folks with disabilities in the families.
MYRA MUNSON: Yeah. Let's -- let me start back and I'll --
BILL SCHNEIDER: Sure. Sure.
MYRA MUNSON: -- move forward.
BILL SCHNEIDER: Sure. MYRA MUNSON: As I said, you know, my mom experienced serious problems. She would have resisted any treatment. Sort of the nature of her illness, she would have resisted it. Any treatment she ever got would have been -- was the hospital care. I mean, she'd go to the hospital and be there awhile and then get discharged. I don't think there was ever much of anything else. The state mental health center kinds of services and what -- and the services that were developing privately through the -- was it Fairbanks Psychiatric Clinic, I can't remember what Irv Rothrock's clinic was called, but his group, and you know, now that I think of it, probably not the '70s, maybe not until the '80s. I'm sort of conflating the two time periods when I was here. I think that was not until the '80s that that was really prevalent. So in the '70s, I don't think that -- there just wasn't much. There was just a little bit of service.
And there was Alaska Psychiatric Institute for people who needed that intensity of service were that much at risk. The joke in the '70s, the joke in the '80s, before people could be evaluated and admitted at FMH [Fairbanks Memorial Hospital] was that before the troopers could get back from delivering the patient to API, the patient would be back here in Fairbanks. You know, it was a revolving door with -- and nobody perceived there to be any meaningful planning. In the '70s, a lot of kids ended up at API, a lot of kids ended up in out-of-state treatment programs, residential, what we would now think of probably as residential psychiatric care weren't characterized that way then. Mostly because they -- they would run, and there was no place in Alaska that could contain them, so you sent them far away, and they were too scared to run away, for the most part, and so they would settle in, and some of the programs were pretty good and so they got pretty good treatment. When I started practicing so -- when I started practicing social work, Child Protective Services in 1971 -- '2, we were still advising the parents of severely developmentally disabled babies to give them up for adoption and just terminate their contact because it was going to be too devastating for their family. That was the conventional wisdom. That's what you did. That was the benign way to behave.
That had changed; even by the time I left in '77, it was changing, meaningfully changing, but in '72, there was not much doubt about it. That's what -- you know, I started out as a -- I was 22, working as a CPS [Child Protective Services] worker, that's what we were told to advise families in that situation. And kids would go to Hope, to one of the Hope programs. And maybe they'd end up in some -- you know, in a foster home some day, maybe, but mostly not. I mean, it was just -- so the more severely disabled they were, that's what happened. Section 8:
For people who suffered from alcoholism, there were a handful of programs, you know, not very many, not very good. The split between mental health and substance abuse, which I don't perceive to be resolved, by any means, but was so powerful then and into the '80s that it was from -- from the standpoint of somebody doing Child Protective Services, so working with the kids so that that becomes your focal point, but it gives you this insight into what's going on in the family. What we know now is that nearly all those families have co-occurring -- all those parents, people, have co-occurring conditions. They have mental health issues, they have substance abuse issues, often poly-substance abuse issues, even in the '70s, and certainly by the '80s, that was not uncommon at all. And -- but there was a total Catch-22. You couldn't get a substance abuse program to accept them as long as they were taking any med -- any drugs, psychotropic drugs of any kind, there weren't all that many then but there were some; and they wanted their mental health issues under control before they would get substance abuse treatment because it would interfere with the substance abuse treatment if they weren't. And the mental health folks would say as long as a person is drunk, you know, don't bother sending them into us, there's nothing for us to do. But the concept that people were whole and that you had to treat this whole person, and in fact, I think a whole family, was a long ways away in the '70s in the state.
I don't have -- I don't work in Child Protective Services much. I do interact with some of the other programs some. Now in my current practice, lots of work going on to try to change that dynamic, but we're not there yet. There's still this terrible tension. Some of it's out of what I perceive to be a political history of the way in which substance abuse services developed, from the way in which mental health services have developed, and this has been sort of a national cycle of being together, being apart, trying to be back together again, but with a better balance of who -- of control than -- than there used to be. So then by the '80s, oil money hit, the advocates for chronically mentally ill adults and seriously emotionally disturbed children found a voice, and really powerful voice, and they were tremendous advocates. And -- and did more than advocate. Of course, they were building their own programs, they were just literally building them out of toothpicks practically to find ways to get services to their own kids. JAMI in Juneau, which just -- people building their own program. And literally almost that in Fairbanks, too, but with a little more financial support because of Bettye Fahrenkamp's support, or at least what we hoped would be. So -- so that services for that population began to take off, and the understanding about the whole need for a community-based system that wasn't institutionally based but -- but included all kinds of support services was dawning, and people were starting to try to fund it and build services for them.
But it was coming at this tension about were mental health centers part of the solution or part of the problem. And a -- really, a fight over who was going to control those mental health centers. And was there going to be funding for and were there going to be people whose jobs that were focused on families and the needs of people who had experienced divorce or depression or other mental health issue, you know, other -- other kinds of issues, child abuse, domestic violence, but weren't diag -- weren't seriously emotionally disturbed or chronically mentally ill. Section 9:
BILL SCHNEIDER: So dealing with the whole person?
MYRA MUNSON: Yeah.
BILL SCHNEIDER: And has -- have we gotten there?
MYRA MUNSON: No. No. We're not. I don't think we're even close. I mean, I think we're better. The fact is there are treatment programs that -- in which children can come with their parents into some, there are -- the effort the department's making to -- that's been underway, my God, since I was commissioner, to consolidate mental health and substance abuse services, and to have consolidated rules and grants and, you know, all these things, they are all -- they are sort of nominally there, but I don't have a -- I don't yet have any confidence that they wouldn't just fly apart again at the first window of opportunity that somebody wasn't saying you will stay together no matter what. If they weren't enforcing it, I don't -- I don't have a sense that the advocates for the various groups have yet come to real common ground about how to -- how to -- how to build on the strengths and the specialized knowledge of each of the professions that contribute, each of the -- the history and the understanding of disease -- of the disease process that's in place, coming together to take advantage of the -- the -- that specialized knowledge, but still treat a whole person. And bring it together for the person as opposed to programs focusing on their theoretical model and the -- that which they are most comfortable with.
And -- and there is still such a -- my perception is -- and I'm not in this field to the same extent I used to be, but I interact a fair amount -- I think that there's still a very big gap in the perception of status and the perception of the right treatment model between folks treating substance abuse issues and folks treating mental health issues. Much more recognition of co-occurring conditions, which is a big step forward, but not really a good integration of how to bring treatment modalities together in some integrated way that actually necessarily will work for those folks, and particularly when it requires residential care. So I'm -- I don't think we're anywhere close to being done with that yet, but I don't think that's unique to Alaska, I think that's nationally, I don't think we're anywhere close.
We -- in -- in part, I'm not sure we can be because, to a very large extent, we still -- substance abuse is still so heavily associated with criminal conduct, it's still perceived as a moral weakness, and -- and it's hard to separate. There's certainly criminal elements to it, particularly if people are using certain drugs that are illegal, or if they are engaged in certain illegal conduct in order to get the resources for drugs, and -- and so on, but it taints -- it sort of taints everything about the process. And in some respects, the best evidence of it is that we -- the jails are still our largest mental health provider. And as long as they are, it's the best evidence that we haven't yet found a true integration of behavioral health, and we don't -- we're not making it available early enough, long enough, consistently enough. We basically -- we treat substance abuse as -- well, as I said, I think we treat it as a moral weakness and a crime more often than a disease. Section 10:
The funding, the legislature and others are impatient for progress; they want to see that somehow you're making this work without, I think, understanding that I -- my own view is whether a person is suffering from depression, chronic depression, or they are suffering from other chronic mental illnesses, or they are suffering from substance abuse, chronic substance abuse problems, relapse is a part of the disease process. Relapse and recovery and relapse and recovery. And I think that we -- I think folks who don't understand it, who -- who are looking for a fix, they are looking for a cure, I mean, we are, if nothing, impatient in this country about everything, we want there to be a cure. And we understand that a diabetic will have to have treatment forever, and they will have times in which their diabetes becomes more brittle, less manageable, they'll need more intense treatment and case management, and so on, in order to be treated well, and we accept that. We don't do nearly as much about it as we could, but we at least accept the premise and don't view it as a personal failing. We do not do that with behavioral health issues. We don't do it with mental health illness, we don't do with substance abuse. We do it with developmental disabilities to a large extent because it's something that's tangible, you can sort of see the disability, at least in the more extreme versions. I'm not sure that we do with people who experience developmental disabilities that are less immediately recognizable. Fetal alcohol syndrome, for instance, and the milder forms, or the fetal alcohol spectrum disorders, I guess, now, at the lower end of that spectrum, I'm sure we recognize that children have been affected by cocaine, and a variety of -- Aspergers maybe, I'm not in that -- I'm not enough in the field to know anymore, but I think we're probably no better there. But it was my conviction when I was doing Child Protective Services that the consequences of being abused, whether in domestic violence or child abuse, the consequences of being sexually abused were lifelong. That what happens is that you use the crisis, if you have the opportunity to use the crisis therapeutically to bring about change, in an ideal model, you would be able to assist families to recognize how much -- for individuals, children and their families, recognize how much progress had been made, celebrate that, but remind them that at the next developmental crisis in their life, this is all going to come flooding back, because it does for all of us. And that there will be another window of opportunity which you need support again, maybe mental health treatment, maybe substance abuse services, and maybe just somebody to talk to, somebody to help get things stabilized again, but this is going to come up.
We would build a model in which there were -- we expected recurrences of these things, we reached out in anticipation on -- and we did it in a non-judgmental manner that didn't require courts. I know more about that than I know about substance abuse and mental health treatment, per se, but I believe that the same principles apply that what we have to anticipate is that these are illnesses that even when people appear to have them under control, that is, we all go through the developmental stages of our life, and experiences the losses and crises that occur inevitably, that there are going to be times of risk and times of relapse, or -- and even if somebody doesn't begin to drink again in the case, or they don't go off all their meds, although, you know, for somebody who is experiencing a serious mental illness and may be being medicated and various ways to manage that depression or whatever, there will be times when it all needs to be adjusted again, and they'll be acting out in behavior that's not acceptable to them or to the other people around them during that period. If we don't build a mental health environment, a behavioral health environment that contemplates the whole person who has a developmental -- a life that will develop over time, that will experience developmental crises, which supports are made available on a routine, non-judgmental coherent way that is not dependent on qualifying for Medicaid at that given moment, if we don't build that, then we will continue to have jails and hospitals be overfilled because the crises are inevitable. They just -- it's just a given. So that anybody that expresses any surprise about it, and looks at the providers as failing somehow, is missing the point that what we keep asking providers to do is a model of treatment that simply cannot work. It is insufficient from start to finish. Better than nothing. Section 11:
You know, when I -- when I was doing -- first practicing in the '70s, God, we did so many things that were -- you know, I look back on. But I thought -- I said at the time, and I thought even more, we'll look back, I'll look back on my practice as social worker, and God knows I have, as Child Protective Services worker, I'll look back on it and feel like the doctors must have felt who were leeching George Washington had they had the advantage of going forward some number of years. You do what you can do with the technology and the knowledge and the resources you have, the support you have in community, you do what you can do; but if you're the least bit intellectually honest, you don't get too whetted to it because you appreciate that you're operating with way too little information and way too few resources, and largely in a political environment that is so non-supportive of human beings generally --
BILL SCHNEIDER: Right. MYRA MUNSON: -- that it can't succeed. I mean, a society that was supportive of human beings, every family would have supports from the day there was child conceived, certainly by the time the child was born, it would recognize that all human beings require support and help from other people. Some are lucky enough to get it in their families or from close friends somehow, it's just there in their community for them. But even they may need more than that sometimes. And for lots and lots and lots of people, those things aren't there, for a large -- lots and lots of reasons, they are just not there.
BILL SCHNEIDER: Uh-hum.
MYRA MUNSON: I should be paying you to --
BILL SCHNEIDER: Say, what? MYRA MUNSON: I said I should be paying you to get the chance to rant about some of these things that I care so much about.
BILL SCHNEIDER: Yeah. Well, I'm -- I think your perspectives are refreshing, and they add to the record here, that they haven't -- haven't been emphasized in that way. The complexity of the delivery and the need to recognize that it's not a cure at one point for all time, that there are you need a safety net.
MYRA MUNSON: Yeah. Section 12:
BILL SCHNEIDER: Well, how well do you think the trust has worked out?
MYRA MUNSON: I'm probably not the best judge of it because, in some respects, at the point at which I left the commissioner's office, I think I mentioned when we were talking earlier, last -- or a week or so ago, that I served on the JAMI board, I was privileged to serve on it for some time. The -- I pretty much chose to stay out of it. I mean, the trust was still -- all those issues were still going on. I stayed somewhat aloof from it. I felt like I'd had my shot and other people were going to sort this out. And there were things that I was interested in, but that was not one of them, that particular political fight. There's no question in my mind they've been the voice for tremendous expansion, they've -- they've -- it appears to me that they pilot things, and they create opportunities to -- to pursue ideas and to try to bring some coherence to a system, and so on, all of which I think is probably good. I am constitutionally probably perhaps just too cynical. I'm -- I distrust institutions. You can't -- you can't get by without them. I mean, we needed the trust, no question in my mind about that, but I worry about institutions that begin to be certain that they know the answer and begin to impose it through their funding mechanisms, or their -- which things they'll support and which things they won't. And so on one hand I celebrate the power, relative power that the Mental Health Trust appears to have in the legislature and the administration, and on the other, I'm -- you know, I'm pretty cynical about it, and wonder -- and I'm not -- you know, I'm not part of that community, so I -- in terms of the work I'm doing now, so I -- I -- everybody may be totally happy, but my guess is they are not, and they feel like they sometimes have to go in the direction that the trust goes. You know, fundamentally, all social human services in this country have shifted around based on where the money is. Well, the trust simply became the newest source of money, so Medicaid pulls you in one set of directions, the trust pulls you in one, whatever the latest national initiative is, where there might be new grant funds pulls you in another. Do any of them really provide a vehicle for this kind of coherent, lifelong, integrated service system to human beings? I'm doubtful. Can they? Probably not in the political environment we're in. And so do I fault the trust for that? No, not particularly. I wish for them the same intellectual honesty that we described before is to recognize that no matter how certain they are that the step they are taking now is the best step they can take at any given moment is the one they think is best, that they recognize that the odds they are right is just about -- you know, I don't know if it's 50/50 or if it's 20/10 -- 20/80, you know, I don't know. Our record isn't all that great and haven't been forecasting the right way to do this kind of work. And so, you know, I don't know. Section 13:
BILL SCHNEIDER: But you would think, you would think with a state with the resources that the trust has that -- that we could have the best delivery of services.
MYRA MUNSON: One might think, but we may have -- you know, there -- there are a lot of resources, no doubt about it, but the demand is -- is so huge. I -- I don't have any -- any notion what the percentage of the population in Alaska that needs these kinds of services, but the kind of model of delivery that I think had -- needs ultimately to be there is one that's serving everyone from the walking wounded, the folks that were somewhat dismissed in the early '80s when folks were fighting over the pennies, those folks who experience a crisis after a divorce or the loss of a parent or child abuse, neglect, who don't have a diagnosed illness at that moment, may never have one, but may very well at some point down the road if we don't provide some support intervention. You know, to -- the problem, the extent of alcoholism in the state, the extent of the alcohol abuse is still extraordinary. People are still experiencing the losses of the tuberculosis epidemics and the time spent in boarding homes and the loss of language and the economic environment in villages in ways that are so profound as to be hardly -- hard -- hard to even conceive of in many respects. The impact of mental health issues, the impact of fetal alcohol syndrome, impact of developmental disabilities, you know, those are all huge things. And you know, I don't have a -- I have a sense the trust has got more resources -- I mean, there are more resources devoted to these issues than there would be absent the trust, but I don't have a sense of them being anywhere close to that which is necessary; and in part, I guess I judge that on the basis that the system is largely -- has become largely driven by Medicaid. BILL SCHNEIDER: What has?
MYRA MUNSON: By Medicaid. The whole system --
BILL SCHNEIDER: The system.
MYRA MUNSON: -- of health care is being driven by Medicaid. And we began that while I was commissioner -- I mean, there were no options. If there were federal money out there to be had by taking advantage of Medicaid dollars, well, any nitwit would have taken advantage of the Medicaid dollars. But our political environment is such that, instead of keeping this general fund dollars there to supplement for the things that Medicaid won't do, it's not designed to do, because Medicaid is designed to treat individual illnesses; but in the process of doing that, you lose all that development -- that work that needs to be there, all those pieces that need to be there when a person isn't experiencing that crisis that will somehow justify a Medicaid intervention.
BILL SCHNEIDER: The net. MYRA MUNSON: The net. And that's really what the -- you know, my view of the mental health, behavioral health system, substance abuse, all those programs, was that there should be kind of three pieces of them.
In terms of money, Medicaid buys individuals, and private insurance, too, although, obviously, to a tiny extent, maybe it will be better under health reform, maybe not, but it buys services, it pays for certain services that individuals certainly need, and it provides a source of funding; but for folks who don't have access to Medicaid or other insurance, or whose illnesses won't meet the criteria for payment for those services, then there still needs to be somebody to pay for that service because the need for the service didn't go away because the person didn't qualify. And the need for basic fundamental prevention and education programs in communities, the kind of outreach, the -- the work that goes on to help families appreciate, help individuals appreciate that what they are experiencing is not unique, that everybody needs help sometimes, and they should get it when they need it, and that there's a place to get it when they need it, and to create non-judgmental, non-court related kinds of -- of services for folks that are out in the community, you can't bill Medicaid for that. Not much. I mean, you know, if you tie -- if you can only provide those services to the extent you can put a group together of people who are eligible, well, you're back into the model of let's find some sick people, that doesn't get you to a model in the community that acknowledge -- in which people who are not -- who may never be qualified for those services or may never be willing to acknowledge that are still able to get some -- get some service. And until we have that mix in our community, then I think we will continue to see lots of kids in the child welfare system, lots of domestic violence, lots of substance abuse, lots of mental health issues resolved by people ending up in jail. And again, where developmental disabilities fit in here is some -- is -- I have the least sense of it. I was very actively involved in issues around Harborview closing and thinking through issues about building that system of -- of community supports. I've always sort of viewed that as a little bit in isolation from the other two parts of the system. I think there are -- I think there's some -- a little bit of overlap, and there's certainly people who are developmentally disabled who are experiencing mental health issues and substance abuse issues, which now you have these sort of three -- you have the worst triumvirate possible at work, and I think the folks who experience all three issues are really in trouble. I mean, I think we really truly don't have much to offer them systemically. But at least when children -- when people are young, or if they are severely enough developmentally disabled, they are not perceived as being at fault in their own life problem. And this concept of fault is so bound into the way in which we treat people in this -- in Alaska and in this country that I think anyone who can avoid that is -- at least has one tiny step up on everybody else. Section 14:
BILL SCHNEIDER: Why do you think Harborview was closed?
MYRA MUNSON: I -- during my tenure as commissioner, there had been efforts before I was commissioner to close it. We got really close to closing it or being ready to close it by the time my term ended at the end of the '90s, and then that collapsed later. And then it took another round, whole another cycle before it finally closed. I think it closed for a number of reasons. It was enormously expensive to operate. And for many -- I mean, there was a -- there -- many of the parents and family members of people who had grown up at Harborview and had lived there virtually their whole adult life, in some cases not even into their childhood, were desperate about it closing, they were frantic, because they didn't trust that their community-based system would meet the needs of their family members. I don't think their fears were unwarranted, I think they are entirely warranted.
Institutions are frightening, really frightening. Harborview seemed to me -- although, you know, I wasn't there often, it seemed to me to be one of the better run, fewer abuses, fewer terrible stories coming out of there, it seemed to be a pretty good place. But it's still an institution. So to the extent that we can provide care for people outside of institutional settings, then sort of the obvious human thing to do is to try to do that.
And there were lots of advocates, particularly people who -- who -- the advocates are keeping it open came from two communities. They were the families of people who were there forever, and they really didn't want their care disrupted. That was really their home and their families didn't want that changed. And there was the community of Valdez, which didn't want to lose Harborview. It was the base of their hospital, it was the -- you know, it was a huge economic engine, it was a big deal. And they looked around and said, look, we are running a good program here, why would you close it?
Institutions are huge, you know, they just are in terms of the economy of communities. On the other side of that were all the -- were the advocates, Todd Risley, you know, who came to work for me as a deputy, or actually as the Director of Division of Mental Health and Developmental Disabilities, and his pred -- you know, other people who have been there, all the folks who had worked in developmental disabilities were working on trying to find community-based solutions, and building individualized treatment plans in which people could get all their needs met someplace else, no matter how impaired they were developmentally or certainly physically. And so there was this huge pressure to -- to make it available.
I became convinced that it was possible. I -- I wasn't when I started, or, I mean, I at least was doubtful, but I became convinced that it was possible to build really truly individualized plans that could meet all the needs that an institutional setting was. And I learned that from -- from -- God, a young woman who was a quadriplegic who had grown up in a nursing home here, she wasn't mentally impaired, huge physical disabilities, who became a tremendous advocate for deinstitutionalization that if you put enough supports in. Well, if you put enough supports in to somebody in her situation, you can put enough supports in for somebody with developmental disabilities. The crunch and the piece that I was not confident of then and I remain not confident of today is when, in an institution, if a staff person leaves, it's an institution, somebody's still there. Now, can the institution collapse and become a terrible place? Of course, they can. But it's -- in a community-based system, if a person has -- in order to have a decent plan of care, they have to have somebody who -- a van driver who picks them up and takes them someplace, and a place to go, and somebody who brings meals, and somebody who makes sure they are getting whatever medications they need, mental health care they need, and on and on and on and on, it takes a huge array of people to provide all that care, if the person who is managing that care quits their job, do we know that there will be somebody stepping in who actually knows that whole plan of care and can keep it alive and working? And what happens when pieces of it start to collapse? Does that person simply become homebound in a much worse situation than they would have been in the institutional setting because really basic things may not be being done. They could be -- you know, they could really get into serious trouble. Section 15:
So because I have a certain measure of cynicism about how all institutions work, and ultimately, the home-based system is -- becomes its own institutional system, it's tremendously dependent on the person who's responsible for that care plan, and on all -- and on all the financial supports for all those pieces remaining in place. If they start to fall off, then you can have people with tremendous disabilities living in the community, or not living ultimately in the community, with nobody really making sure that they are okay. And you don't have a failsafe anymore because that institutional setting is gone. And so I worry about it, you know, because of this tremendously vulnerable population. We saw it in hospitals, psychiatric hospitals were closed in anticipation of community-based services that never came to pass or didn't come to pass fast enough or comprehensively enough. BILL SCHNEIDER: Or when Morningside closed --
MYRA MUNSON: Or when Morningside closed down.
BILL SCHNEIDER: -- John Malone spoke about --
MYRA MUNSON: Yeah.
BILL SCHNEIDER: -- people, the Dear Johnny letters that patients would bring back and, you know, here's my medications and here's what I'm supposed to take --
MYRA MUNSON: Right.
BILL SCHNEIDER: -- but there was no network. MYRA MUNSON: Right. And we still have that. I mean, we still have that here. We have -- we downsized API [Alaska Psychiatric Institute] to make it both affordable to build and because we had an image of a community-based system, and reliance on community-based hospitals that could do these things, but we didn't support the private hospitals adequately to actually provide those --
BILL SCHNEIDER: Services.
MYRA MUNSON: -- mental health services, inpatient services that people need on a short or a little bit longer term. We don't have an adequate community-based system that actually -- you know, really is engaged in outreach and follow-up, so we still have people being sent to API, or -- or having no place to be sent if they are -- you know, necessarily. If they are not -- if they are not involuntary, they may have no place, really, to be sent, if -- if they don't qualify for -- for Medicaid. So we still have these huge gaps, and when they get home, we don't have -- my impression is there's actually a lot of stuff going on to try to build those links. I mean, tele-mental health appears -- what people tell me that I'm reading suggests that there's really a lot going on that -- that may make that better, that connect -- ties the community back to the hospital much more effectively than they ever were before. So I'm not pessimistic about that. But technological solutions are still a long way away from making sure that all the pieces are in place at the other end, and I don't think we have that yet.
Elaine Ritschard - Tape #ORAL HISTORY 2006-15-22-tp2
Elaine Ritschard was interviewed by Bill Schneider and Karen Brewster on April 20, 2010 at Summerset Lodge retirement community in Gladstone, Oregon, a suburb of Portland, where she currently lives.
Return to part one of this interview.
Click to section:
Section 1: Stresses and strains as a staff member at Morningside Hospital.
Section 2: Relationship amongst staff at Morningside Hospital, and care of patients in the geriatric ward.
Section 3: Variety of methods used for the treatment of mental illness.
Section 4: Staff dynamics and working conditions at Morningside Hospital.
Section 5: Assessment of doctors who worked at Morningside Hospital, and type of psychiatric and medical care the patients received.
Section 6: Care of private and voluntary patients at Morningside Hospital and her concerns about children removed from abusive homes being allowed to return for weekend visits.
Section 7: The physical layout of the buildings on the Morningside Hospital campus.
Section 8: Transfer of Alaskan children to Harborview Hospital in Valdez, Alaska near the time of Morningside Hospital.
Section 9: Care of the children at Morningside Hospital and their eventual transition elsewhere.
Section 10: Staff longevity at Morningside Hospital and the type of care the children there required.
Section 11: Types of adult patients at Morningside Hospital and types of activities and treatments provided to them.
Section 12: Assessment of patient care and experiences at Morningside Hospital, overview of the rest of her nursing career, and why she left her job at Morningside.
BILL SCHNEIDER: What were some of the stresses and strains that you faced as a staff member working in that environment?
ELAINE RITSCHARD: Well, there were two areas that I felt there was conflict going on. But because I was independent of this in my workplace, and because I came and went directly to work and right back home, and was interested in my family, I wasn't involved, but I would hear things like the conflict from Mr. Henry Coe, Jr., and the doctors debating some kinds of treatment or equipment or cost.
Mr. Coe was also having financial problems. Mr. Coe was also having family problems, personal problems. I think that's why he stayed in his apartment periodically and had an apartment on the grounds. I made it a point not to be involved in any of this because it wasn't something I was interested in. I had a job to do and that ended there.
There was conflict in the nursing level, and I was treated with much respect because I had a very stable home and a husband and family. And they respected me for what I did on the job. I did not attend the administrative meetings, I didn't attend the nursing meetings, I gave them the reason that I had to go right home, take care of my family, because my husband was working as a police lieutenant for the City of Portland, and he was baby-sitting while I was working and I'd baby-sit while he was working. I was not involved with any of the personal, financial conflicts of roles that these people were playing. I stayed completely out of it. And they respected me for it. They even allowed me to miss these meetings. A lot of the women and nurses and RNs were required to go. And if they didn't, they looked down on them. But they left me alone. If there was a conflict, I made it a point not to get involved. Not even to know about it. The job I did had to be done and I did it my own way and my own ideas, and they -- they supported me. They gave me whatever I needed. They followed up on giving me whatever equipment I wanted. And I didn't have any problems. And I stayed out of everything. But I know there was conflict, especially on the administrative level. And what I heard was something I just didn't -- I tuned out. I didn't want to hear it. I didn't want to know about it. I had a job to do. Section 2:
BILL SCHNEIDER: What about that second conflict amongst the nurses? Can you say more about that?
ELAINE RITSCHARD: I -- no. It would be not something... I will not share.
BILL SCHNEIDER: Okay.
KAREN BREWSTER: Did -- you mentioned that you went home every day and took care of your own family. Were there other staff members who were residential at Morningside? ELAINE RITSCHARD: No, but they lived close enough to come and go, and they were there for the meetings. And they are the ones I heard the stories from, were my coworkers, not from -- I didn't involve myself with the administration people at all, but if I heard anything, it was from my coworkers, another RN. Or maybe an RN was treated poorly. Maybe she was given a job that she didn't want to do. But they left me alone. Nobody bothered me. I -- I -- I wasn't involved in anything but there was some that would say she didn't like this job or she didn't want to do that job, and that's where I heard it. But I just let it drop right there. That was the end of it. But now that was at the tail end. Remember, it was 1963 to 1968. I did start in 1960, but I was off for a period. But I -- I didn't have to worry about anything because they left me alone.
KAREN BREWSTER: Why do you think they left you alone and were so supportive of giving you what you needed to do the job? ELAINE RITSCHARD: That's the part I'm not going to talk about.
BRAD RITSCHARD: Can I share something when you're talking?
BILL SCHNEIDER: Sure. Let me just introduce you -- it's Brad?
ELAINE RITSCHARD: It's Brad Ritschard, yes.
BILL SCHNEIDER: This is Elaine's son, Brad, who has joined us here. And thank you for coming.
BRAD RITSCHARD: Thanks. I just -- when you're talking about stressors, I just want to expound that I remember, and I was 8 or 10 at the time, that what you talked about that bothered you in stress was the kids, you talked about the failure-to-thrive babies. I -- I remember the conversations with you and dad about the electric shock, that you didn't like that, and I think I remember something about lobotomies. I don't --
ELAINE RITSCHARD: The what? BRAD RITSCHARD: Lobotomies. Were they performed out there?
ELAINE RITSCHARD: No.
BRAD RITSCHARD: Okay. But I remember you talking about the electric shock. And you didn't like --
ELAINE RITSCHARD: I said -- I said that contributed to the state of the patient. The patient that we saw in geriatrics had had electric shock and lobotomies and were limited in their ability, but that was before.
BRAD RITSCHARD: Before your time?
ELAINE RITSCHARD: Before my time. BRAD RITSCHARD: Because I -- I know you've always talked about --
ELAINE RITSCHARD: Uh-hum.
BRAD RITSCHARD: -- how you didn't like that.
ELAINE RITSCHARD: Uh-hum. Uh-hum.
BRAD RITSCHARD: Okay. Section 3:
BILL SCHNEIDER: Yeah, that's great. It's very interesting that you came in after that more modern progressive ways of treating illness, and let you had -- you were dealing with the legacy of that in some cases.
ELAINE RITSCHARD: Yes. I had that in nurses training. When I -- when I was in nurses training, I went to a Holiday Park Hospital and the Salem State Hospital, and that's where I saw the experiences with the electric shock, lobotomies, insulin shock. Even -- let's see, they took the patients in all kinds of states. Water therapy, now, we did use at Morningside Hospital, we did use showers and water therapy and relaxation therapies. We did use that. I saw doctors order that.
BILL SCHNEIDER: Were those effective?
ELAINE RITSCHARD: Pardon?
BILL SCHNEIDER: Were they effective? ELAINE RITSCHARD: Oh, yes. And electric shock was effective if you had a qualified therapist, Doctor, with -- that knew how to do electric shock, and that's still used today. Electric shock is used today. And it is very good in certain diagnoses. I still recommend electric shock for certain diagnosis of patients. But the doctor has to be well qualified, has to know his business, and it's used in a limited amount of time. And treatment. And they still -- it's still something I would recommend for certain things.
I have a cousin who had bipolar, and it was used in bipolar, and she's beautiful today. She functions just beautiful. And she got that at Gamisch Hospital (phonetic), which was a hospital that was built after our State Hospital was limited. So it's still recommended, but you have to have quality and educated people that do those things.
So I'm not saying electric shock was not something that shouldn't be used, I'm saying that when it was used and overdone. The thing that I disliked the most was the lobotomies. I didn't like that ever done. I didn't feel that was something I would approve of. But then that's probably why you heard those stories from me. If those were the after effects. We -- these were the patients that had these things, and we were getting them in the stages of them not being able to function, and not being able to even respond to medications, you see. It was too late at that point. Section 4:
BILL SCHNEIDER: Did you develop any friendships with the residents that carried on outside of the professional relationship?
ELAINE RITSCHARD: No. No. We had a very busy home life and very busy family. We were very active in sports, in our church and our family. We had a very active -- I wouldn't have time for any of that. No, I didn't -- I didn't build any friendships. I did know a couple of RNs because they had married some of my classmates in Gresham, from Gresham High School. But no.
KAREN BREWSTER: How many other nurses and doctors and aides, what was the size of the staff over the years you were there? ELAINE RITSCHARD: When I was there, there were -- there were five doctors on staff. There were probably eight RNs. I would say there were at least four caregivers; and what qualifications they had as training and education, I don't know, but they were on staff as nurses aides, orderlies, and there were at least four to every ward. No ward was ever left without staff. Even when we walked them to the cafeteria, if there were two or three people that couldn't walk to the cafeteria, they were left with -- with staff to supervise. Some of the RNs that had been there before I came were unhappy with the relationship of their supervisor, superintendent of nurses. But when I listened to them and talked to them, I felt it was part their fault that they put up with it. Or that they allowed themselves to be manipulated. I didn't take anybody's side or advise because I thought, well, maybe it's something you should do about it. BILL SCHNEIDER: What were those issues?
ELAINE RITSCHARD: They were manipulated by the superintendent and the assistant superintendent. The assistant superintendent was very jealous. And was very controlling. And some of the nurses were intimidated by her. I never had that problem.
BILL SCHNEIDER: Were there substantive issues in terms of --
ELAINE RITSCHARD: What were they intimidated about? How they did their work. How they related to the patient. What their relationship was to the superintendent of nurses. That's it. BILL SCHNEIDER: Well, we'd love to know more about that, but I respect your --
ELAINE RITSCHARD: That's it.
BILL SCHNEIDER: Okay.
ELAINE RITSCHARD: And I have no problem whatsoever and I don't think anybody that was working there, if they were an adult, and if they were mature and if they knew their job, they could do it.
And I will say that Morningside Hospital had all of the things that was needed for the patient while I was there, they provided it. Section 5:
KAREN BREWSTER: And what about the relationship with the doctors? How often did they come around and interact with patients?
ELAINE RITSCHARD: All doctors, in my estimation, whether they are psychiatrists or whether they are pediatricians, are just human beings. And they do not need to be revered or stand on a pillar. They are just human beings like the rest of us. There are good ones and there are bad ones. There are qualified ones and there are some that I wouldn't go to. Okay?
Saying that, Morningside Hospital had a very good doctor in Dr. Bowerman (phonetic). He came about in -- he came in about 1961 or '2, and he was there for a while. I liked him very much. He was interested in the patient. He was trying new things, like lithium for depression. He wanted to do new things. He was good.
KAREN BREWSTER: He was a psychiatrist?
ELAINE RITSCHARD: They are all psychiatrists. I'm speaking of all psychiatrists. The doctor that was on call for the emergency, he was good but he was near his end of retirement, and he didn't want to be involved with a lot of things. So he was -- he didn't want to be bothered. But if you caught him, he was good. The doctor that came for the community people, the one that saw a lot of our walk-in, short-term patients, I thought he was zero because he could be manipulated by the patient, the patient could do anything he wanted to do. Remember, in that period of time, that's when all the drugs were coming in. So he was seeing a lot of teenagers. We had some wonderfully interesting patients that came in. There was a group of patients that came in from the Job Corps. They came from New York. They lived on the streets of New York, and had never even seen a tree. They sent them up to the national forest to work in the forest. They had crisis. They had breakdowns. They couldn't handle the wilderness. Of course, they couldn't handle the wilderness. Okay. We had young men. That was very interesting. But to see how Dr. Moss worked with them, we never respected him. He would be manipulated and we'd tell him so. And he'd say, really? You think so? Well, anyway. Dr. Bowerman worked right along beside him, was very good, so naturally we went to him.
We had good doctors come in from the community. Those children were checked over for foot problems. We had pediatricians, we had a clinic once a week that these children were looked at and checked on for anything that we picked up during the week. A child that has a lot of disabilities as far as birth and illness where they are regressed quite a bit, they have a lot of upper respiratory problems. Okay. These pediatricians came in. We had dentists come in. Sometimes a child had to be taken out to private clinics. It was done. They were taken. Section 6:
The patients that I felt bad about, and that I didn't respect the administration about is they took children away from parents that were abusing them, then the parents would pick them up on weekends and take them home for the weekends. There was no consistency in protecting that child. That upset me. But those were private patients that were not Alaskan patients that I saw. Like I say, I never saw an Alaskan relative or friend come and visit those kids. If they did, it was not when I saw it. I was not available to it. But the private patients that came in, and that was probably -- we started hiring help for private patients because of the lack of patients, and it was a financial thing, you had to fill up your wards. So that was where the administration was admitting anything. But I wasn't involved in that, other than the children that I saw going back into a home where the abuse was, and after that, I didn't -- I saw that. BILL SCHNEIDER: But you couldn't do anything about that?
ELAINE RITSCHARD: No, I couldn't. We could report it. We questioned it. We questioned it to the doctors. Why do you let them go back home? And he said, well, legally, we have to. They voluntarily brought them in. I don't know what "legally" meant, but they -- the doctor just washed their hands of it, so I don't know -- do you know anything about that, legally? BRAD RITSCHARD: I know what it is in the '70s, '80s, and '90s, but not back then. I believe if it was voluntary --
ELAINE RITSCHARD: I don't know what kind of laws they had then.
BRAD RITSCHARD: If it's voluntary, of course, they can leave any time they want.
ELAINE RITSCHARD: Yeah.
BRAD RITSCHARD: But if the state takes -- I don't even know if they had child care back then.
ELAINE RITSCHARD: Okay. These were not state. These were not state admitted, these were the families bringing them in.
BRAD RITSCHARD: Yeah. Yeah.
ELAINE RITSCHARD: Okay. BILL SCHNEIDER: Were there other Morningside people, staff people, that are still alive that we should maybe try to contact?
ELAINE RITSCHARD: If there are, I don't know where they'd be. I have -- I didn't keep in contact with anybody and I don't know if they were local. The RNs that I knew that were working there were local, but I know two of them have passed away. The other one might be living but she's remarried, so I don't know her married name. And that's the one I told you from Gresham.
BILL SCHNEIDER: Uh-hum. Uh-hum. Section 7:
KAREN BREWSTER: I don't know if you -- you mentioned, you know, the photo of the main building and that there was a children's ward, and you mentioned other wards. I don't know if we've gone through what they were and sort of the layout of the whole place.
ELAINE RITSCHARD: Oh, okay. In the picture, there's the main building. In the main building, you had the emergency short-term unit that was a treatment unit, it was the area that the police brought them in. They were holding cells. They were actually lock-and-key holding cells. They were short term because they had to go through legalities, maybe jury, maybe -- maybe -- it was a lock-up. Okay. That was Multnomah County people. Okay. Or patients. Off the street, from homes, wherever the -- the occasion, the mental health breakdown occurred, the police would bring them in. And then there was the cafeteria and the kitchens were in that building on the one end. And that was well done. That was a big building. There was a storage unit for supplies, and there were the administration offices, nursing administration offices. That was in that one large building, that first one on the left, coming into the complex. Behind it was the little red schoolhouse. Beyond that was the barns. Over behind the -- I didn't see that in the picture, but connected to that building by a breezeway was an empty warehouse that was a hospital unit at one time that they gave me for the activity building. Then the children's ward were originally 3 wards, and there were 60 children there. The 8 that I told you about that were so limited, there was one with 30, and one with maybe 20. When I arrived, there was only about 10, 20, and 8. And they were connected by a breezeway so the children walked through the breezeway, they didn't go outside, through the breezeway into the cafeteria to eat. That was on the left. Then there was the administration building, and I know you've got that one, that's facing this way, toward 102nd and Stark. It's facing the main road. There were parking lots in the front and then there were grounds all around with trees and flowers and shrubs. Then there was the -- there was a unit that was half short-term patients that we were now getting as private, and there was a half unit of young ladies still Alaskan patients that were still being treated. They were maybe manic depressive, maybe, or bipolar. They weren't called bipolar, they were manic-depressives then. Alcoholics that were being treated. These were lock-up rooms. These were -- but they weren't cells. They had private rooms and then a social room. But they had their own rooms. That was -- that was right next to the administration building. So that came and went short term. And then sometimes we'd discharge them and send them out to that male and female unit. They were separate buildings. And then we had a geriatric unit. And that takes care of all the buildings. There was one, two, three -- four buildings of patients out there, and then three for the children. There was the administration building, and -- but you have them all in your picture. And then there was large gardens. Those gardens were and barns and storage. That's -- that's what your picture was. Section 8:
KAREN BREWSTER: So were you ever involved in any intake of Alaska patients or discharge of Alaska patients?
ELAINE RITSCHARD: The only part I saw or involved -- involved was when they started going home. And then we had to get the -- get the clothes together, get their belongings together, packed up and boxed up. I don't remember more than four children while I was there going back to Alaska on that plane. Most of them came from that unit where the young men and women were.
Now, remember, they were 16 to 55 female and male. And I don't remember more than two airplane lifts to Alaska. There may have been more before I came. May have been more after I left. I don't think there were any more after I left. I think they were all gone. I think I was still there when they were all gone.
BILL SCHNEIDER: What was the reaction of the children when they were told they were going back home?
ELAINE RITSCHARD: What were their?
BILL SCHNEIDER: Reactions. ELAINE RITSCHARD: Reaction? Some of them were crying. They didn't want to go. This was the only home they knew. They didn't want to go. Nobody came for them that they knew. The only people that accompanied one -- accompanied them were the people that had been taking care of them. They didn't want to go. I assumed they were going to Valdez to the same type of unit that they were coming from. I don't know where they went. See, I don't know whether they went to families or whether they went to the hospital. I don't know that. But they didn't want to go. This was their home and their family and their friends. And they used to call that first mother and father, mother and father, mama and daddy.
BILL SCHNEIDER: Was there any follow-up at all once they left?
ELAINE RITSCHARD: It was really an unsettled hospital after the Alaskan patients left. There -- I -- I didn't -- I didn't work there after all the patients were gone, but they -- it was unsettled even at the point when they were beginning to move out because the function of the hospital was an Alaskan State Hospital, and it was functioning as a hospital and a residential area for the Alaskan patient and resident. And when they were gone, the purpose for the hospital hadn't been identified yet. They didn't know what they were going to do with the hospital. And other than the community coming in, because we were here in Oregon, we were using it as emergency and short-term care. We were getting patients, by the way, from the Warm Springs Indian Reservation, and some of those were Alaskan. We were getting them in -- but they were in Oregon. They were in Oregon. They were Oregon residents. And we were getting patients from them. So it was un -- when I left, it was unsettled what was going to happen to the hospital, what it was going to become, what they were going to do. Section 9:
BILL SCHNEIDER: What I was wondering about was follow-up with the patients once the -- residents once they went back to Alaska.
ELAINE RITSCHARD: We didn't.
BILL SCHNEIDER: You didn't?
ELAINE RITSCHARD: Huh-uh. I don't know whether -- no. See, Lynette McCoy and Helen Nye went with them, went to Valdez. They were up there until that earthquake. BILL SCHNEIDER: Did they ever talk to you about why they went to Harborview?
ELAINE RITSCHARD: I didn't ask them. I never -- no. I just assumed they went up to help them get settled, and help them get organized, and give them input of what -- how they handled -- how they handled it here at Morningside. I just assumed, but nobody told me, I just assumed they were going up to help the people organize their hospital and give them input on how Morningside did it. That's all I assumed that went on. And then I was gone. And I didn't keep any kind of correspondence with anybody. Not even with the people I worked with. KAREN BREWSTER: Now, were you the head -- head nurse on the child's ward?
ELAINE RITSCHARD: Yes. I was in charge. Uh-hum. There were no other RNs in that unit. I had nurses aides and orderlies, and they were really neat. They took such good care of those little kids. Now, remember, I was there on the day shift. They had -- they had care, but the kids were sleeping, just like your children would go to sleep. I'm sure they had to get them up to go potty, change their beds, because not all of them were well potty trained. And I'm sure the young man in that unit had to be cleaned up and taken care of. By the way, he came out of that enclosed area eventually and had his meals on the ward, and he eventually came out of that enclosed lock-up place. And he had a brother there. I'll tell you a -- his brother was about three years younger than he was. And his brother would visit with him; not inside the room, through the door, and then when he came out, he'd come out and visit with his brother. His brother was about three years younger than he was, but they looked alike. And they were Natives.
KAREN BREWSTER: So you had a day shift and a night shift?
ELAINE RITSCHARD: Three shifts.
KAREN BREWSTER: Three shifts?
ELAINE RITSCHARD: 7:00 to 3:00, 3:00 to 11:00, 11:00 to 7:00. Those were the shifts of all hospitals. By the way, they were the shifts of the policemen when dad was working, too. That's how dad and I got to baby-sit the kids. Dad would work one shift, I'd work another, and we had a baby-sitter come in and -- and sit in the house for the travel time until I got home.
KAREN BREWSTER: So you worked 7:00 to 3:00?
ELAINE RITSCHARD: I worked 7:00 to 3:00.
KAREN BREWSTER: And then other shifts, there was a nurse on staff? ELAINE RITSCHARD: There was always a nurse on staff. No. Sorry. No. I was the only RN in that unit. The others were nurses aides. But they were well trained. And they had had longer term experience with these children before I came. They kept the same staff. They hired new ones because they needed more because of the activities were increased and the driving and the visiting out in the community, they hired about six more people for that one-year period; and it wasn't a whole year, it was the period before the kids started going out into the community or back to Alaska or whatever they -- back to the families. No, they didn't go to families. Let me see, where did -- where did they go. They went to foster homes.
KAREN BREWSTER: Or halfway houses or something?
ELAINE RITSCHARD: Uh-hum. Section 10:
KAREN BREWSTER: So some -- there was some people who worked for Morningside for a very long time?
ELAINE RITSCHARD: Yes. Yeah. They were there a long time. All of those aides were there long before I came. They were there a long time. That one couple left, the one couple that were in charge of the children left. But there were long-term -- long-term help in the -- in the gardens, gardeners, and landscape people and patient care people. They were long-term. They were there a long time. And there were new ones. By the way, the young lady that contacted me that found your note on the Internet, Calnek, Sue Calnek, she was there short term, but she was there with me in that unit. Have you interviewed her?
BILL SCHNEIDER: We haven't. We haven't. We were in touch with her. We've talked with her. And she --
ELAINE RITSCHARD: She might have something to say. She was not trained before she came there in psychiatric care or even as a -- I don't -- I don't think she had any experience in hospital care, but she was good. She was very responsible.
I'm trying to think if there's anybody else. I probably could find another RN for you by calling out to somebody from my classmate getting the name of the -- it's now a former husband. See, they were divorced. But I could probably research and get you another name of another RN.
BILL SCHNEIDER: That would be great.
KAREN BREWSTER: Well, what was -- what was Morningside like as an institution to work for as an employee?
ELAINE RITSCHARD: I didn't find any problem. They paid the -- the wages that were common in the area. They did have a lot of staff meetings that I didn't attend. And I told them why I couldn't attend. If there were staff meetings on duty during my working hours, I would go to it. I'd go to the meeting. I didn't find any conflict with what I was doing.
KAREN BREWSTER: It sounds like they were very supportive of your new techniques.
ELAINE RITSCHARD: They were supportive of that -- of that children's unit. And that's the one I was mostly involved with. They were supportive, and they gave us everything we needed. Except I did question some of the private patients, but none -- none of the Alaskan, I don't remember any of those. Those children were -- were so limited and they were little babies. They were little. They just needed nurturing and loving and caring. And if they -- if they got out into a system where they didn't receive it, they'd be lost. And if they did, I don't know it and I'm sure they did.
But I didn't follow up because it wasn't my responsibility. And I couldn't have done anything about it anyway. It was all state handled, welfare system handled, foster care home handled, and -- and I wouldn't have anything to do with that. I had a special job to do and I -- I just did it. Section 11:
KAREN BREWSTER: What about the other units, the other wards? Do you know what was going on in those?
ELAINE RITSCHARD: Well, in all those other wards out there on the grounds, they were run more -- run more residential. Those people -- those patients were more active. And the ones that weren't active -- and they provided games for them, played checkers, played cards, saw movies, they provided movies for them, movie night.
You kind of had to -- to watch their behavior because they were child-like. They weren't acting as full adults either, because they weren't that kind of a patient or person. They were limited in -- in their activities, too. So they had to be treated -- say you had a house full of kids, how will you take care of them. You'd set up structure for them, see that they were fed and bathed and entertained. That's about it. Saw that they got their medicines first thing in the morning. Kept them on a strict schedule with their medication care. Then they'd be -- you could handle them then. But they were children. Those were not -- I say they were adults. I called them adults, they were children. Except the geriatrics, and then they were limited because of the former treatment. But those Alaskans were children. When you -- when you think of the type of patient they were, they weren't the ones to go out and drive a truck or -- or to go out and shop in a store alone. They weren't someone that could take the responsibility of cooking a meal. That wasn't that kind of a patient. Section 12:
BILL SCHNEIDER: There are kind of conflicting images of Morningside. There are the accounts such as you've just given, and then there's stories from the Alaskan side of people being shipped out for spurious reasons, you know. Someone didn't like the behavior of someone else, or there was an argument or something, and it would be a legal thing where the judge would make a decision and it would be -- they'd be sent off to Morningside, and the story being that they never returned. How much of that occurred, we don't know. It's --
ELAINE RITSCHARD: I don't know either.
BILL SCHNEIDER: It's certainly good to hear your accounts because it provides another angle to this -- to the story. ELAINE RITSCHARD: I don't think there was a lot of supervision or follow-up to the patients there from the Alaskan side. I don't think that was ever done.
If things happened, I don't think -- first of all, I didn't see it. First of all, I didn't -- I wasn't aware that any of these things you were telling me occurred. I don't know that that happened. If it was something that I thought was destructive to the patient, I would have said something and I wouldn't have been there. I wouldn't have even worked there if these -- if there was anything that was harmful to the patient or the patient that I didn't think was getting good care, I wouldn't be there.
The -- the part that I didn't like was in the private section when I saw the children going back into an abusive home. That, I -- that I wouldn't like. I didn't like the part of hearing the abuse of some of the Alaskan children, I didn't like that, but they had no part with what they got at Morningside. They were getting good care. They were getting the care that a child would get at that level of ability. I heard some stories of abandonment from the Alaskan parents, abuse of alcohol was number one. Birth defects from abuse and from alcohol problems. These children were damaged before we got them. And what level they rose to, able to birth -- potty train, feed themselves, dress themselves, play, do what they could do was as at a level as they could go. That was as high as they could go.
Like I say, they were -- they had a schoolhouse on the property, they had a teacher, they could learn until about the third-grade level. Even the adults over -- I called them adults, they were limited to third-grade education. They were not able to function like a fully educated or structured citizen that could take care of themselves. They were limited. And then the families, I didn't see anybody giving them any attention from Alaska. Okay.
BILL SCHNEIDER: Okay.
ELAINE RITSCHARD: Okay. KAREN BREWSTER: Have we covered everything that you had in your mind?
ELAINE RITSCHARD: I think so. I enjoyed my job. I thought those little kids were wonderful. And I did what I was supposed to do, and that's the end of it.
KAREN BREWSTER: And what did you go on to do after you left Morningside?
ELAINE RITSCHARD: Oh, I've had 45 years of nursing. I went to -- into industrial nursing. I worked for Kaiser Hospital my last ten years as a -- before an infectious disease man. Believe it or not, when we got the ranch in Central Oregon, I -- I did veterinary work, didn't I, Brad? Giving animals and cows and horses shots.
I worked at the Veterans Hospital for a couple years trying to get my responsibility for the Army that I discovered I was into. They required three years in a Veterans Hospital to pay them back for their -- they paid for my education. So I worked a couple years at the Veterans Hospital. KAREN BREWSTER: Maybe you said but why did you decide to leave Morningside?
ELAINE RITSCHARD: Well, it was closing.
KAREN BREWSTER: Closing. Okay.
ELAINE RITSCHARD: And it didn't have anything that I wanted to stay with.
BILL SCHNEIDER: Okay. Let's end.