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By Ken Trainor
When Dan Kill started working for Family Service and Mental Health Center of Oak Park-River Forest in 1974 as a "generic social worker," the village was tearing up Marion and Lake streets outside the offices at 101 N. Marion St. to make way for the pedestrian mall. Thirty-seven years later, as he prepares to depart the agency, now called Thrive Counseling Center, the village is tearing up the street again.
Kill, 63, officially retired on July 1, but he'll be helping out the rest of the summer with the transition to a new president and CEO, Nina Allen. On the cusp of "what comes next" (private practice, consulting and volunteering), he sat down with us for an "exit interview."
In 1996, when you took over as interim director, things were not going well for Family Service. People were wondering if the agency would even survive.
Kill: We were days away from closing our doors. That was January of '96. Our audit came in and said we were losing a thousand dollars a day. The board had to make some very difficult decisions. We had a second mortgage with First Bank of Oak Park and were able to work out a very good arrangement with them to help us with some abeyance on that second mortgage. We are part of Mike Kelly and his bank's history of helping organizations make it through tough times. We undertook an immediate, short-term fundraiser and raised enough money within a 12-month period to pay the second mortgage off, which was about $650,000.That right-sided our financial situation.
And we had to re-evaluate what we were doing with our programs, which were profitable and which were weighing us down and causing financial risk. We decided to transition out our substance abuse treatment services and were able to consolidate our space, reduce our occupancy costs to be more in line with our revenue, and rent out a floor and a half of our facility.
Our first rental partnership was with Lutheran Child and Family Services. That was the third leg of the stool, so to speak. Now we had revenue coming in that was discretionary, and we were able to cover the first mortgage. At that time, [longtime local Lutheran pastor] Dean Lueking was our board chair, and we always thought that was providential. He found us the tenant, and it was really key.
We paid off our mortgages, so occupancy costs were much more in line with our programming. Without mortgages and without renting, we have a lot of our funds going into direct services. That's the positive side of weathering the storms of ownership. Eventually the facility is your own, so that asset can be converted into service delivery.
How big is the staff?
Kill: We're about 35. The state of Illinois has not been very supportive of maintaining staffing. The last three years we have gone down in our staffing by probably 15 percent or so. State funding dropped about 20 percent. State funding makes up about half of our income. The other half comes from community contracts, agreements we have with the high school, the police department, the Community Mental Health Board, River Forest Mental Health Committee. Part of our income is through private insurance, client fees and federal grants.
Funding for mental health is available for persons with Medicaid. The state's priority is to utilize federal funds to support mental health services. For non-Medicaid people, the state has provided very, very little funding.
We are fortunate in Oak Park that the Mental Health Board pretty much covers our non-Medicaid persons. That is tax-based funding. They've been very available through the township. It's been an important safety net. I think sometimes people aren't aware of the wonderful resources that exist in this community that don't exist in many, many other communities.
Do you find yourself still battling the old stereotypes and stigmas attached to mental illness?
Kill: Stigma is a very large obstacle that interferes with people accessing services. In fact, the Village of Oak Park Health Department just did their needs assessment, and mental health and stigma came up as number 1 and 2 on their priority list. Promoting mental health wellness and promoting mental health education is also a high priority with the Mental Health Board. I think some strategies will be developed over the next few months to much, much better address that in both services to adults and youth.
Youth especially are not properly assessed for mental health difficulties, and kids who are assessed don't always access services. There is a high incidence of suicide with youth, which has been correlated with high usage of substances among kids who have co-morbidity with depression, anxiety, bipolar illnesses. So you can't separate the conversation on substance use from mental health. They go hand in hand and they need to be addressed together.
Is that the demographic that's most in need of services?
Kill: Adolescence is an important age group because if resources can be brought to bear in adolescence, you are preventing a huge number of difficulties in young adult life and full adult life.
But older adults also are at high risk for both substance abuse and mental illness, which are not assessed or addressed properly. It's a silent group. We have a special in-home counseling program for older adults, and we do a lot of work with Township Senior Services case managers to identify folks with mental health difficulties. It's a pretty lonely existence for lots of folks as they get beyond 70. Depression and anxiety go with medical complications and really don't get well addressed.
With kids, is substance abuse the cause or the effect?
Kill: It's a combination. Fifteen percent of kids have some mental health problem that is not addressed. That number was just in the Tribune recently. Depressed teens mostly struggle alone. When kids are depressed, they find ways of medicating themselves. Alcohol and other substances become a way to cope with either being overly stressed, overly anxious or depressed. For a portion of kids who get involved with substance use, mental health is a concomitant issue. Sometimes teens try it and stop it. Other times, they try it and because of some of their own chemical makeup and the fact that life isn't going well for them, it becomes much more of a serious problem.
The substance use issue is getting a lot more attention at OPRF High School lately. A lot of parents are very concerned. Would you say the problem is worse now than it has been in the past?
Kill: The data suggests it's worse now. Those surveys weren't conducted 10 years ago or during the '70s, so it's hard to compare, but the fact is that the surveys are showing a much higher rate of usage in the Oak Park community. These are national and state surveys. The community and professionals have to pay attention to the fact that there is something missing that's moving kids much more to usage. I'm ecstatic about the grassroots movement. That's something that has not happened before. This is a parent movement. In the past, it was left up to funding organizations, school or mental health, and when money dries up, programs disappear. A community strategy has the best chance for positive outcomes and for really strong community system changes.
Prevention is a critical part of it. Thrive has had ATOD — alcohol, tobacco and other drug — prevention services on a small scale through state funding since the early '90s. We have worked mostly in the grade and middle school areas, focused not only on education about substance use but also on helping kids feel better about themselves and to much more clearly verbalize not choosing drugs. Sometimes kids aren't feeling good about themselves and they're part of negative peer groups instead of something positive. That's where substance use becomes the norm. But there's not enough money in prevention to have a significant effect.
At the high school it's good that their interest is how are we going to work with kids before they use it? How do we get the best information to these kids? What communication campaign could kids be involved with, peer to peer, rather than only a parent message or a school message, which can easily be challenged in the normal stages of adolescent development. It's a much better message to be hearing from your peers than adults who [they think] don't know anything anyhow.
But sometimes we don't acknowledge how many kids make choices every day not to use and to live an abstinent life or to seek help when there is substance use.
Given that the lack of funding doesn't really allow us to attack this problem the way we should, how do we come at this?
Kill: The model of community change is called an "asset model." There are lots of organizations in town — faith communities, the YMCA, public schools, private schools. Everybody's doing something. When we talk about prevention, we're talking about how do we use the resources in existence, where everybody's on the same page as to the message, and everybody's doing something to educate and talk to kids — from your coach in Little League to your teachers to the ballet class to your recreation department. How do you bring people together to continually communicate the danger that drugs and alcohol pose in life and what the alternatives are in promoting health? My vision, instead of always looking for money, is how do communities organize.
How could we do it better?
Kill: How do we end up stopping smoking? That's a prime example of how public health created a message and the message became embedded in many, many systems of our life. Ten years ago, who would ever have thought ...
That most restaurants would be smoke-free?
Kill: Yes, if there's enough willpower behind it.
Is there enough willpower building on substance use?
Kill: I think it's building. If it's coming up on everybody's radar, this will become a serious movement, not something passing.
Why did you change the name to Thrive?
Kill: Our marketing committee did some surveys and found that even though we have been around since 1898, there wasn't clarity as to what it was that the agency did or even knowing our name. We were often confused with the state Department of Children and Family Services.
In addition to that, underway is a much stronger emphasis on wellness and not looking as much at illness symptoms, but looking at how people live their life in a quality manner. The board and the marketing committee decided that we needed to reposition the agency and look at the name as well as the mission and being able to communicate more with surrounding communities where we are serving people.
We thought Thrive was dynamic, doing more than managing your illness but living in as full a capacity as possible.
Has the mental health field changed a lot in the last 37 years?
Kill: It's changed a lot, the whole notion of recovery. In the past it was a medical model, where the professionals told you, advised you, directed you. The focus was on the management of symptoms rather than how you live your life. How are you productive as a person, and where are all the resources in the community that you can tap into?
I think the recovery model has helped extensively with families and their struggles. There's a group in town called the Fred Group. It's a parent support group for families who have children with serious mental health difficulties. But there are tremendous holes in resources for children and adolescents with serious mental health difficulties. There have been a lot of stories about families who have to give up their kids to the state because they can no longer afford care. With children and youth, medications haven't been really effective in stabilizing their illnesses. It's a tremendous struggle for families.
What were the biggest mistakes in the mental health field in the last four decades?
Kill: Well, there was a term called "schizophregenic mother."
You mean "blame mom"?
Kill: That was blame mom. In the late '60s, early '70s, theorists were very convinced that schizophrenia was caused by a mother who was unstable and wasn't giving the child all the nurturing, comfort and clear communication. The treatment during those years in some cases actually hospitalized the whole family, put the whole family under a microscope, focusing a lot on communication, mixed messages, double-bind messages.
Back in those very early days, another sad and incorrect message was that because you had this illness, you were never really going to be able to function well in life. It became a self-fulfilling prophecy. When de-institutionalization happened in the late '60s — because of better medications that stabilized hallucinations and delusions and paranoia — institutionalization just got transferred into all of the intermediate care facilities that exist throughout Chicago. People were never sorted out as to who could function on their own, and it became a business that still exists today. It's only now through lawsuits that the state is having to evaluate everybody and to give them the choice to return to the community at different levels — from supervised homes to independent living with support in permanent housing.
The mental health field has come a long way, both to the benefit and detriment of the client. The detriment side has mostly involved the state's funding crisis as well as Illinois historically being 35th or so in funding for persons with mental illness.
The state now has a pilot program in the suburban and collar county areas in which a managed care organization will be managing the care to assure that there aren't more services being provided than are absolutely necessary. So the services that have been available to persons in recovery, the funding could be there, but the services won't because someone's saying the person doesn't need them, based on a term called "medical necessity," which nobody can agree on.
Why are you retiring?
Kill: Some of my motivation has to do with the state of the state. It breaks my heart to see the organization do so well in providing services and now see so many clients who are in need without being able to access care.
Being at the agency 37 years, I'm not emotionally prepared to do another roller-coaster ride. I've been in the valley, been on the peak, been in the valley, been on the peak. It does take someone with new vision and new energies and new thoughts about where the organization can go in an environment that is extremely challenging. A lot of new ideas are needed as to how Thrive can be financially sound in the coming years.
Do you think the health care reform bill will benefit the mental health care field?
Kill: The bill will provide reimbursement for everyone who walks through the front door. There will need to be less subsidy for people if everybody has insurance. It depends on how it ends up being run. If it gets run like Medicaid as opposed to private insurance, then I think there's going to be a lot of stigma attached to it. The health care industry, because of the reimbursement part of it, may end up splitting off into the haves and have-nots. It may be that you'll have two groups of health care professionals, one that will be tuned into the more traditional insurance and one that will be maybe a nonprofit entity tuned into more of a national health care model.
What's next for you?
Kill: I have had a small clinical practice in town for the last 25 years. I hope to expand on that. If some consultation roles come up, I would be favorably disposed. I've been a volunteer with an organization called Faith and Fellowship at St. Catherine-St. Lucy in its ministry to people with serious mental illness. For many folks who were grounded in their younger years by going to church, that's not an option for them, given their illness, and the fact that not all churches have special kinds of programs so folks can have a personal experience with what spirituality or love or God or Jesus is in your life. This program offers that on a personal basis.
What are the most important elements of living a mentally healthy life?
Kill: Freud said mental health is the ability to love yourself. A mentally healthy life is the ability to be able to take care of yourself and have high regard for yourself and being close in your relationships with people around you. It's being well balanced in life. In recovery, we talk about your spiritual dimension, your recreational/leisure time dimension, and your vocational dimension, that those need to be well tuned together. When those are not in balance, then you know something is not working well for you.
And a lot of people are out of balance.
Kill: Yes. How do you know when you need to have a wellness checkup? You go to a dentist twice a year to get your teeth checked. You go to your family doctor just to make sure everything is OK. So you go for a mental health checkup. It could be two or three sessions, just like you would go to a doctor. We are here to promote wellness in your mental and emotional life.