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mental health

    MENTAL HEALTH

    With Clinicians Overbooked, Agencies Try to ‘Triage’ the Delays

    When access to therapists is months away, nonclinical care can help, leaders say

    By

    WELLFLEET — When Dikke Hansen decided to “semi-retire,” giving up her position as director of behavioral health at Outer Cape Health Services in 2021 and taking up part-time work as a private-practice therapist, she created a profile on Psychology Today to find new patients.

    Almost immediately, she was fully booked.

    “I would get calls every single day, often multiple times a day, from people asking for help,” she said.

    Hansen was quickly forced to turn people away. But there was nowhere to send them: every other clinician she knew on the Outer Cape was also booked solid.

    “I felt so helpless,” she added. “These were real people with genuine needs. I couldn’t help them, and I couldn’t refer them to anyone else.”

    Hansen’s experience is far from unique. There is a shortage of practicing mental health clinicians on the Outer Cape, she said, that is particularly severe for families looking for therapists for their children.

    At Outer Cape Health Services — the only provider of medical and behavioral health services here — the wait to be matched with a clinician for long-term care is at least nine months, according to Brianne Smith, who succeeded Hansen as director of behavioral health.

    Barbara Dominic, who leads the Barnstable County Children’s Behavioral Health Work Group, which is in the process of conducting a Cape-wide behavioral health needs assessment, said it is rare to find a therapist with a wait time of less than six months.

    “Sometimes with these kids it gets so bad that we tell them to just go to the emergency room and sit there until they find help,” said Cindy Horgan, director of family support services at the Cape Cod Children’s Place, an Eastham nonprofit that offers family support and group counseling services but not clinical, one-on-one therapy. Horgan said she receives calls daily from families who don’t know where else to go.

    There is definitely a need for more clinical services here, according to Smith, but she said nonclinical measures such as parenting classes, grief support groups, and peer counselors play an important role. Not only are they more accessible, but they can be more helpful, she said.

    “If we’re only looking at a wait list and how many clinicians there are, then what we’re missing is the upstream work that can be done around prevention and collaboration,” Smith said. “It’s important to ask if there are other needs that can be addressed in the meantime while families wait for a therapist.”

    Bridging the Gap

    In the months while families wait to see a clinician, Outer Cape Health Services offers the help of a “community resources navigator” who tries to direct families to other kinds of support.

    At the Children’s Place, family support services become a kind of “triage” program to help families bridge the gap between the moment they decide their child needs mental health care and the time they’re actually able to meet with a clinician, Horgan said.

    Roughly 3,000 families access support services at the Children’s Place each year, Horgan said. A fifth of them — roughly 600 families a year — first encounter the organization because they are seeking mental health care.

    The Children’s Place offers parenting workshops, one-on-one counseling for parents with histories of opioid addiction, and support groups for parents, among other services.

    “Sometimes a family will be going through a divorce, and they’ll be really concerned for their kids and want to get them in some kind of therapy,” Horgan said. “We’re not able to provide the therapy, but we can work with them on healthy co-parenting.”

    Bay Cove, a community behavioral health center in Hyannis that serves the entire Cape, also uses a “triage” model offering nonclinical services to help ease the wait period for clinical help, according to Diane Santoro, Bay Cove’s vice president of behavioral health-care integration.

    There are roughly 10 mental health clinicians on Bay Cove’s staff, Santoro said, but it typically takes months for someone seeking help to secure a spot with one of them.

    Santoro said that most people waiting for therapists become involved in other Bay Cove services, including a popular peer support program that matches struggling families with “family partners” — not experts, but peers who have gone through similar experiences.

    Before a Crisis

    While organizations like Bay Cove and the Children’s Place work with families who are already seeking clinical help, other groups aim to reach young people before they reach a crisis point — or help them manage their grief after one.

    The organization Sharing Kindness operates suicide awareness programming and grief support groups for people of all ages across the Cape.

    Sharing Kindness coordinates 15 independently licensed clinicians — all of whom have “day jobs” as working therapists or social workers — to lead “grief groups” in schools, said the organization’s co-founder, Kimberly Mead-Walters.

    It’s not traditional one-on-one therapy, but clinician-led peer groups are also in short supply, Mead-Walters said, and the informal grief groups help to reach more students.

    Calmer Choice, a nonprofit based in Osterville, tries to get ahead of crisis-level mental health problems by teaching mindfulness practices to children.

    Sarah Manion, Calmer Choice’s executive director, said that mindfulness education is not a crisis intervention resource but that “building a foundation for lifelong well-being” can help families before a crisis hits.

    Manion said that children start to become aware of their emotions in elementary school, so Calmer Choice focuses on teaching emotional self-regulation to students in kindergarten through fifth grade.

    “I’m not going to say this is a silver bullet solution,” Manion said, adding that mindfulness is a “tool in the toolkit” that kids can fall back on “if and when things do get bad.”

    Hansen, Smith, Dominic, Horgan, Santoro, Mead-Walters, and Manion all emphasized how mental and community health organizations on the Cape work together to try to manage the crisis of limited access to mental health care here.

    “I don’t think having such a long wait list is necessarily unique to this area at all,” said Smith. There are nationwide problems with access to mental health care, and Cape Cod is not unusual in that respect, she said.

    “What is unique to our area is how well all of us work together,” Smith said. “When you’re able to put all of those pieces together around somebody, you have a healthier community.”

    MENTAL HEALTH

    Bridges Granted Pretrial Probation After 4 Months of Incarceration

    A case evolves from prosecution to treatment and recovery

    By

    PROVINCETOWN — Jonathan Bridges, the man detained in last winter’s West End barricade incident, has been granted pretrial probation for two years, after which all charges will be dropped if he adheres to certain conditions.

    According to the recording of an Oct. 10 hearing at Orleans District Court, those conditions include attending regular therapy sessions and taking medication, living at his family home in Yarmouth, and remaining employed or looking for employment.

    Bridges had been facing two counts of kidnapping and one of assault and battery with a dangerous weapon after barricading himself and two roommates inside his house and expressing suicidal thoughts.

    A fourth charge, possession of a firearm, was dropped on Aug. 29, according to court records. The Provincetown Police Dept. had brought that charge despite recordings of law enforcement communications from the Feb. 28 incident that made it clear that Bridges was in possession of a pellet gun, not an actual firearm.

    At the Oct. 10 hearing, Assistant District Attorney Robert Hoffman told presiding Judge Robert A. Welsh III that the mental health crisis Bridges experienced that day posed a “significant hurdle” for prosecution. The Commonwealth sought to support continued mental health treatment for Bridges in lieu of pursuing criminal charges.

    Bridges’s attorney, Matthew Kelley, told Welsh that Bridges’s roommate Michael Goff has been “quite the advocate” for Bridges and “doesn’t believe this should be a criminal prosecution.”

    Kelley said that Bridges’s health has improved since receiving treatment after his arrest. “This is the best he has been doing in years,” Kelley said.

    Bridges had been in pretrial detention for four months, during which he was shuttled back and forth between Bridgewater State Hospital and Barnstable County Jail before being released on June 26.

    Solitary at the County Jail

    Police arrested Bridges on Feb. 28 following a seven-hour standoff that brought about 40 Cape Cod SWAT team members in full riot gear to the scene. In the following months, he was taken to Cape Cod and Falmouth hospitals, transferred to the Barnstable County Correctional Facility twice, and taken to Bridgewater State Hospital twice.

    Bridges told the Independent that the severity of his mental illness stemmed from an untreated hypothyroidism diagnosis, which caused severe depression. When Bridges was first detained at Barnstable County Jail, he was placed under suicide watch.

    Suicide watch at the jail, Bridges said, consisted of 24-hour surveillance, known as “eyeball watch,” in a solitary confinement cell. Bridges said that the overhead lights were kept on all night, and he was naked except for what he described as a straitjacket with Velcro on the sides.

    “I wouldn’t talk; I wouldn’t eat; I just lay there using my straitjacket as a blanket because it was freezing in there,” Bridges said. A correctional officer always was sitting outside his cell, he said. “Some would play music for me, some would talk to me, but most wouldn’t say or do anything.”

    Every day, he said, a mental health clinician would stop by to ask if he was feeling better. “I wouldn’t say anything,” Bridges said.

    Barnstable County Sheriff Donna Buckley wrote to the Independent saying that the jail’s suicide prevention protocol “is not to punish an inmate, demean, or dehumanize them. It is to keep them alive.”

    Buckley stated that the “solitary-type cell” Bridges was in is called a health services observation cell and is reserved for inmates who are most at risk.

    The garment that Bridges wore, Buckley said, “is not a straitjacket,” but an “armless kaftan that can only be closed with Velcro.” In it, she said, the inmate’s arms and hands are free.

    Buckley stated that correctional officers have responded to 68 suicide attempts at Barnstable County Jail in the last five years; there have been two suicides in that time.

    According to Michael Horrell, a senior staff attorney at Prisoners’ Legal Services of Massachusetts, mental health watch “is not a long-term solution to treating someone’s mental health issues.” In fact, he said, “Being subjected to those conditions over a long period of time can lead to severe decompensation and can exacerbate someone’s mental health crisis.”

    The pro forma check-ins common in jails, he added, do not serve a purpose. “You need to have actual, substantive engagement to figure out the root causes of the crisis and work to resolve them,” Horrell said.

    Bridges was being held at the jail under the care of a private health-care provider called Wellpath. In late August, Buckley ended Barnstable County’s contract with the company after it proved unable to meet its staffing obligations, with only 20 percent of positions filled.

    “I don’t know how they thought that locking me up in solitary with lights on all day and someone watching me but not talking to me was going to make me feel any better,” Bridges said.

    In December 2022, the Mass. Dept. of Corrections reached a settlement with the federal Dept. of Justice after a 2020 DOJ report accused the Dept. of Corrections of civil rights violations for failing to provide adequate treatment for prisoners with mental health needs. The DOC’s “use of prolonged mental health watch under restrictive housing conditions, including its failure to provide adequate mental health care, violates the constitutional rights of prisoners in mental health crisis,” the report said.

    At Bridgewater Hospital

    On the fifth day of his incarceration at the jail, Bridges became unconscious and was taken to Falmouth Hospital, where doctors diagnosed him with hypothyroidism. According to Bridges, he began medication there before being transferred to Bridgewater State Hospital, a state-run medium-security facility for men suffering from mental illness.

    There, he said, “at least I could read books.”

    Bridges said at Bridgewater he was able to undergo extensive treatment and medication for his mental and physical health.

    According to the Mass.gov website, the state Dept. of Corrections, which oversees Bridgewater, still outsources its health-care services to Wellpath, but the contract is set to expire next July.

    Efforts are underway in the state legislature to transfer the operation of Bridgewater from the Dept. of Corrections to the Dept. of Mental Health.

    The idea arose after a February 2022 report conducted by the Disability Law Center raised health and safety concerns about the facility, including “harmful levels of mold growth,” “illegal chemical and physical restraint,” and a “pervasive culture of punishment and intimidation.”

    After Bridges was released from Bridgewater in late June, he said, his family welcomed him back home in Yarmouth. He is currently working at a restaurant there.

    He said he feels better than he has in a long time. “I may not agree with the way the police handled the situation, but getting me into the hospital and on medication did help me,” Bridges said.

    Editor’s note: An earlier version of this article, published in print on Nov. 16, misspelled the last name of Michael Horrell, senior staff attorney at Prisoners’ Legal Services of Massachusetts.

    HEALTH CARE

    Mental Health Program May Become a Three-Town Effort

    Provincetown, Truro, and Wellfleet consider a combined program

    By

    PROVINCETOWN — The boards of health of Provincetown, Truro, and Wellfleet will meet jointly in December to hear about the health-care needs of the three towns and to consider a combined effort to improve access to mental health services.

    The lack of mental health practitioners here — in particular, therapists who accept insurance — is so severe that the towns are considering how to use public money to make mental health and substance abuse care more available.

    The three-town meeting is currently set for Wednesday, Dec. 7, according to Provincetown Health Agent Lezli Rowell, who briefed the Provincetown Select Board on Monday.

    Provincetown already has its own five-year mental health plan, which officially began in July of 2021. That year’s programming included a barrier elimination fund, which helps people access mental health and substance abuse programs by paying for transportation or child care, and a youth activity fund that pays for transportation or course fees for camps and classes, based on a theory pioneered in Iceland that social engagement helps prevent depression and substance abuse in young people.

    The plan is designed to build year over year, and the crux of the plan, both financially and operationally, is the two crisis counselors that were to be funded in the second and third year of the program. They are meant to help address the acute shortage of therapists and mental health practitioners on the Outer Cape.

    “This person would be able to see locals, regardless of their insurance status or ability to pay,” then-health director Morgan Clark told the select board in January 2021. “It would be like a stopgap — you could see them until you could get into a relationship with a longer-term mental health clinician.”

    In the 2021 plan, the crisis counselors would be paid for by the town but hired and managed by a nonprofit health-care provider on a contract basis. The cost would be $132,000 per year per clinician.

    That part of the program has been on hold, however, partly because Clark resigned as health director last October and partly because Town Manager Alex Morse told the select board he wanted to explore regionalizing both the crisis counselor program and the town’s health director position itself.

    The health needs assessment that the three towns conducted this summer supports the notion that their mental health needs are similar and acute and could be approached regionally, Rowell said on Monday.

    How Is It Paid For?

    Select board Chair Dave Abramson asked if the marijuana revenues that were coming to the town were being collated against the mental health expenditures that were going out. Morse said that marijuana revenues go to the town’s general fund, and mental health expenses come from there.

    Town staff including Clark and Assistant Town Manager David Gardner have acknowledged the potential connection between the revenue from “community impact fees” on marijuana dispensaries and the town’s new mental health and substance abuse programs. Towns were supposed to demonstrate that they were spending community impact fees on costs related to the presence of marijuana dispensaries — which could include mental health and substance abuse programming, Gardner told the select board last year.

    Those community impact fees, however, have now been dramatically curtailed by a new state law (follow this link to see related story by Paul Benson).

    Rowell told the select board that the towns are exploring grant programs that could help fund the shared mental health programs. Morse mentioned the possibility of support from a foundation, or from American Rescue Plan Act funds from the county government, that could supplement the town’s resources.

    The local option tax on marijuana still exists — and Wellfleet receives local option taxes on marijuana sales as well — but Morse said that a detailed discussion of marijuana revenues would take place at an upcoming meeting.

    HEALTH CARE

    New Mental Health Law Aims to Expand Access to Treatment

    Rules apply to insurance companies, which have evaded parity laws for years

    By

    PROVINCETOWN — The mental health bill that became state law on Aug. 10 includes a dizzying array of provisions. There are titles that improve mental health access in schools and in prisons, programs that make it easier for mental health practitioners to begin work in Massachusetts, and a new rule that allows people with disabilities to continue to be covered by their parents’ health insurance even after they turn 26.

    At the core of the law, however, is an effort to enforce the state’s 22-year-old promise of “parity” in mental health — that is, the idea that mental health care should be available and paid for in the same way that physical health care is.

    The state’s first parity law was passed in 2000 and updated in 2008. The federal government passed parity laws in 1996 and 2008, and mental health is one of the 10 “essential health benefits” under the Affordable Care Act of 2010.

    Nonetheless, the devil is in the details when it comes to health insurance. Low reimbursement rates for mental health care means that few providers actually accept insurance. Hospitals get reimbursed poorly for the care they give in their emergency rooms. In other words, access to care is a persistent problem because insurers have not been paying for it.

    “The core foundation of this is enforcement of federal and state parity,” said state Sen. Julian Cyr, who was the Senate’s lead negotiator on the bill. “Even though we’ve had state laws related to parity on the books for almost two decades, it’s just been unenforced.

    “This law clearly states all the requirements that insurers must have,” Cyr continued. “It establishes oversight and penalties. This is going to force a real change, particularly in the reimbursement rates.”

    Massachusetts has one of the highest per capita rates of mental health practitioners in the country, Cyr said, but many of them do not accept insurance at all. “You may theoretically have insurance coverage,” he said, “but if there’s no therapist taking that care, how are you going to get access?”

    The problem exists across the spectrum of mental health needs — from ordinary appointments with a therapist to emergency treatment for acute psychotic episodes.

    “Reimbursement rates are so low that there’s no incentive for health-care providers to have a psych unit,” Cyr said. “A number of hospitals have closed those units. Cape Cod Healthcare closed their pediatric psych unit maybe a decade ago.”

    As things stand now, it can take days or weeks to find an inpatient bed for psychiatric care, especially for minors. At a youth suicide-prevention forum held this spring in Truro, parent Beth Cook described her daughter’s long wait for an inpatient psychiatric bed at Cape Cod Hospital, according to a story about the forum in this newspaper. After six days, the family gave up on inpatient care and opted to drive daily to Pembroke, 80 miles away, for outpatient care.

    “The emergency boarding crisis is catastrophic,” Cyr said. “You can be boarding in the emergency room for 14 days, waiting to get a bed” in a psychiatric unit.

    The cost of the time spent waiting in the E.R. is not reimbursed. “The hospital doesn’t get paid for the days you’re there waiting to get care,” Cyr said.

    The state’s latest attempt to undo these perverse incentives was largely due to Senate President Karen Spilka, Cyr said. Spilka has been open about her father’s acute psychotic episodes and the fear she and her brother felt as children, and she made this bill her “number one personal priority” after she became Senate president in 2018, according to Cyr.

    “The senate president set the agenda here, and I think it really shows what’s possible when leadership shifts,” Cyr added.

    Cyr also said that people are more open now about mental health challenges than they were in the past, and that many legislators have struggled to access care. Cyr pointed to his own history with depression and anxiety, which became acute when he was in college.

    “I was lucky — there were pretty robust student health services at N.Y.U. — and that care helped me manage my anxiety and do things I never dreamed I could do,” Cyr said. “Even so, as a 30-something health policy wonk and state senator, it took me years to get my insurance to cover my mental health care. And even today it’s a bizarre reimbursement process that I don’t quite understand.”

    ‘Alternative Response’

    The new law also contains some measures to amplify an approach called “alternative response,” which envisions a system for responding to mental health emergencies that is less centered on law enforcement than the current system. Currently, Bay Cove Human Services provides some emergency service programs on Cape Cod, but it is funded only for patients on MassHealth. The new law forces all insurance companies to help pay for emergency service programs, Cyr said.

    Federal legislation recently turned the national suicide hotline into a new emergency phone number: 988. Massachusetts is hoping to expand its 988 line into a “one-stop shop” to help people access mental health resources of all kinds, including clinicians trained in emergency response.

    “On Cape Cod, 70 to 75 percent of 911 calls are related to mental health, addiction, and domestic issues,” Cyr said. “You look at 911 response, and there isn’t even a call script for someone in an acute mental health crisis.”

    Police will still be the first responders, especially in rural places like Cape Cod, Cyr said. But an expansion of emergency service programs means the police should have much easier access to mental health professionals who can help them respond to crises.

    Wellfleet Police Chief Michael Hurley confirmed that mental health calls were a large part of police work now. He said he welcomes the newly enacted law, but he would like to see more resources devoted to prevention in addition to crisis intervention.

    “When people are calling us they’re in crisis,” said Hurley. “We’re past prevention. The only tool in our box is to send the person to Cape Cod Hospital. If we could tackle prevention a lot more, with the support of clinicians and navigators, that would make a big difference. We need to come up with funding for that.”

    IT TAKES A VILLAGE

    At Womencrafts, Michelle Axelson Listens

    A landmark of Provincetown’s Women’s Week stays creative

    By

    PROVINCETOWN — Michelle Axelson came to town in November 2010, for a break.

    A Boston-based social worker by training, she had loved working at Mass. Correctional Institution — Framingham, a women’s prison, as well as with substance abuse patients at a gay community health center. But she felt burnt out by the disease of addiction, and she was grappling with the end of a relationship.

    In short: she felt as if her life was falling apart. So, she allowed herself a winter season in Provincetown to put herself back together. That was 9 years, 11 months ago. Axelson’s still here.

    “I absolutely fell in love with Provincetown,” she told the Independent. “Living here is a lot about letting go — about not measuring yourself and comparing yourself to others and living life on life’s terms. Who wouldn’t want to live on the ocean, in response to the tides?”

    But it wasn’t just about a new way of living: Axelson fell in love with her stopover gig.

    “In the mental health and substance abuse fields,” she said, “if you have reason to take a break, you call your next job your ‘get well job.’ ” For Axelson, that “get well job” was at Womencrafts, a lesbian-owned landmark at 376 Commercial St. that is one of just 13 remaining feminist bookstores in the U.S. and, since 1976, has been promoting female creators of all kinds — authors, artisans, and musicians. Working there, Axelson immediately felt at home.

    Michelle Axelson at Womencrafts. (Photo Nancy Bloom)

    “Womencrafts basically is a community center,” she said. “In here, you’re at home and you’re safe, and we see you. I realized really quickly that it was a lot more than a retail job. I felt like a social worker.”

    Axelson used Womencrafts to host protest planning sessions, a feminist fight club, and a book club of feminist titles. She used it to do what she does best: listen.

    “I’ve always been very attuned to bearing witness,” she said. “I grew up in an alcoholic household — I don’t mind sharing that — and, from a young age, I have focused on trying to help and take care of others. I think listening to others’ stories is in me, and that’s a lot of what I do here at Womencrafts.”

    Born in 1977, Axelson is a year younger than the establishment, and she was conscious, she said, of her worldview as an out lesbian being affected by the same forces that had shaped the shop, originally a lesbian-separatist space.

    When customers come in, Axelson urges them to share their memories of the store, and what it means to them. She hears the same themes over and over: Womencrafts as a cultural touchstone, as a safe space, as a place where lesbians come to proclaim and celebrate their sexuality out loud.

    “The stories longtime customers share are so important,” Axelson said. “It’s so important to connect intergenerational communities.”

    Kathryn Livelli and Wendy Hinden, the couple that owned Womencrafts and hired her, agreed. And so, three years after she started her “get well job,” they approached Axelson, a generation younger than they were, with an idea: she loved the store — did she want to buy it?

    Axelson was floored. “I thought people who owned stores were all wealthy,” she said. But Livelli and Hinden mentored her through the process. And in buying the store, Axelson bought herself a way to stay in the place she loved — a way “to make sense here,” to continue bearing witness and shape Provincetown’s lesbian community.

    One of the highlights of Axelson’s time at Womencrafts? No question: Women’s Week.

    That one week usually generates as much income for the store each year as the entire month of July. “People buy books to last them a year,” Axelson said. “They’re upfront with me that they could get the books cheaper online, but it’s important to buy it here. For a long time, it was one of the only places you could find lesbian titles on the shelf.”

    Though the financial boost is important (“We’re not a nonprofit — we’re a barely profit,” she said), Women’s Week offers much more.

    “It breaks my heart when people come in and ask where all of Provincetown’s women are,” she said. “Provincetown is male-dominated, and Women’s Week is just a special time. It’s a place where underrepresented, unappreciated people are rock stars.” And where stars often mingle. “So many of the women who come have been central to so many of our coming-out stories and our experiences — living legends, really, like Cris Williamson,” Axelson said. “It’s an opportunity to understand why getting together in women’s spaces is so important to the older generation.”

    And, thanks to Covid, there’s not a lot of getting-together happening right now. Only five customers are allowed into Womencrafts at a time. For Axelson, whose “favorite thing” is seeing her store packed with people reading, the situation just “sucks.”

    As she spoke, a customer was ready to be rung up. Axelson processed the transaction and handed a bag across the counter.

    “Thank you,” the customer said. “You’re a true goddess among women.”

    Women’s Week 2020

    Friday, Oct. 9, through Sunday, Oct. 18

    Whale Watch Dolphin Fleet:

    MacMillan Pier; daily, 9:30 a.m. & 1:30 p.m.; $55; whalewatch.com or 508-240-3636

    Art’s Dune Tours:

    Off-road tour through the dunes of the National Seashore; daily, 10 & 11:30 a.m., 1:15, 2:45 & 4 p.m.; 800-894-1951

    Truro Vineyards & South Hollow Spirits:

    11 Shore Road, Truro; daily, 11 a.m. to 5 p.m., trurovineyardsofcapecod.com

    Bay Lady II:

    MacMillan Pier; sails daily, 12:30 p.m.; $40; or at sunset, 4:30 p.m.; $45; sailcapecod.com or 508.487.9308

    Suede in concert:

    Crown & Anchor poolside, 247 Commercial St.; 4 p.m., sold out; 8 p.m., $65; onlyatthecrown.com

    Virtual events: Screenings, performance: womensweekprovincetown.com

    BODY/MIND

    Rest Can Be Part of Your Resistance

    Restorative yoga is not a nap, but a complement to all the action

    By

    It feels like just yesterday that we were all holed up, arguing on Facebook about opening up for the summer season and wondering what would happen. And then it did.

    It’s hard for me every autumn when the frenetic energy of summer, with its overlapping work schedules and social obligations, comes crashing to a stop, as if I blew a fuse to turn the lights off instead of using the dimmer. Every summer season ends with a surge of anxious questions about the winter: “Did I make enough money to make it through?” “How will I stay sane?”

    A quiet place, a blanket, a pillow make a difference in stimulating the relaxation response. (Photo Emma Doyle)

    This pandemic summer and strange political moment are making that seasonal uncertainty more intense for many people. It may feel a bit counterintuitive to lie down and snuggle up during a time of such upheaval, but real rest will make you stronger.

    Chronic stress is harmful to our physical and psychological health. Its impact spreads through the body as adrenal hormones act on our autonomic nervous system, preparing the body for “fight, flight, or freeze.”

    While this bodily response may be appropriate for a singular stressful event, like a natural disaster or a big presentation at work, it isn’t necessary for our everyday lives. How do we switch out of a maladaptive stress response?

    Researchers agree on one thing that helps — stimulating the relaxation response. David Spiegel, M.D., director of the Stanford Center on Stress, explains, “In medicine we are learning that physical problems such as high blood pressure and heart disease can be influenced by psychological intervention such as relaxation training.”

    Active yoga practices like pranayama (breathwork) and asana (physical poses) are what we focus on most in yoga studios together. But restorative yoga is the magic ticket to countering chronic stress.

    The practice itself is simple — though not necessarily easy. The first step is to create a quiet place to relax. This can be the bedroom or a corner of a room that you know won’t be occupied for the duration of your practice. If you live with others, create an agreement with them that you need a space to yourself for 30 minutes with no interruption. You could do this in even less time, but getting truly comfortable and feeling supported is important.

    Creating conditions for relaxation is just as important as creating conditions for action. We are primed to favor productivity. That’s why lowering the lights, having a small towel or eye covering, and using as many blankets as possible are musts.

    Yoga props are used in restorative yoga classes, but it’s OK if you don’t have them at home. For a faux bolster, roll up a large beach towel or stuff a pillowcase with laundry. Wear warm, comfortable clothing. Dress a bit warmer than usual because when you begin to fully relax, you’ll start to feel cooler.

    Take your bolster and place it underneath the backs of your knees. Make sure your heels touch the ground or place something else underneath them. Place a towel or blanket underneath your head to keep your neck neutral. Pull a blanket over your body, cover your eyes, and make all the micro-adjustments you need to be truly comfortable.

    This all leads up to the finale — rest. If I’m especially agitated, I’ll systematically tense areas of my body as much as possible and then let go. Squeeze eyes, clench jaw and throat, and release. Tense shoulders, arms, make hands into fists, and release. Once I’ve moved through my whole body, I’ll usually count the length of my breath, trying to coax it a bit longer and smoother. It is way too easy to let this be a time to wander around with your mind, but restorative yoga is an embodied rest practice. That is, you’ve got to stay with it and with yourself.

    When it feels like we must act on everything because our lives depend on it — we must sign the petition, march in that rally, and keep up to date on all the news — it can be hard to allow for rest. But restorative yoga is a complement to all the action, the inundation of information, the swift change of summer to fall. Think of your rest as part of your resistance. Not a nap, but something more.

    For more on breathing and relaxation, online readers might refer to one of my past columns, “A Time to Voo,” or, for a full-fledged book on restorative yoga, I suggest Relax and Renew by Judith Hanson Lasater.

    HELP LINES

    Wellfleet, Taking Cue from Provincetown, Dials In on Mental Health

    Community members are on call, so no one has to go it alone

    By

    Editor’s note: In the Aug. 6 print edition of the Independent the Well Line’s phone number was incorrect. The correct number has been substituted below.

    WELLFLEET — “We all have to go through this pandemic, and my feeling is no one is going through it alone,” said Dale Rheault, one of the founding members of Wellfleet’s new mental health phone line.

    For the past two weeks, a group of health-care professionals in Wellfleet has operated a phone line for residents to call if they are dealing with anxiety, loneliness, or any other mental health issues.

    Dubbed the “Well Line” after the “well” in wellness and Wellfleet, the phone line is manned by clinical social worker Dale Rheault, pediatrician Susan Spear, who specializes in adolescent medicine, and registered nurses Dennis Cunningham, Karen Friedman, and Kristen Shantz.

    The phone number is 508-514-1633. The line is staffed Monday through Friday from 9 a.m. to 5 p.m. After-hours messages get callbacks on the next weekday.

    The service is not clinical, but instead serves as a resource for people to reach out to if they need assistance in finding professional help or they just need someone to talk to.

    Wellfleet Police Chief Mike Hurley first pitched the idea of a Wellfleet mental health phone line two months ago.

    “What you are seeing overall is an uptick in everybody’s stress and anxiety, mine included,” he said. “It just seems like, every day, mental health is woven into whatever we deal with.”

    Hurley added that he got the idea for the line from Provincetown, which had already set up a mental health support phone number.

    “We called the Provincetown group, and they already adopted Truro, so they couldn’t take on Wellfleet, too,” he said.

    From there, Cunningham and Spear took Hurley’s idea and formed a team to get Wellfleet its own service.

    Although the salient piece of the program is the phone line, the Well Line is three-pronged.

    The service also includes a buddy system, where two callers can be paired up to check in with each other every day, week, or few weeks, depending on their needs.

    “If someone is home alone, or home and lonely, and they would like to touch base with someone, they can,” Spear said.

    The team also holds weekly group therapy sessions on Zoom, led by Rheault. The meetings take place every Monday from 3 to 4 p.m.

    Rheault, a former clinical social worker, is the only member of the group who is qualified to lead a clinical session. She practiced her profession in Provincetown for 15 years, retiring last year.

    “I missed the work, but I felt a real calling, because people were experiencing such stress with the exasperation of isolation,” she said. “I wanted to be helpful.”

    Planning happens outdoors for the Well Line team; from left: Susan Spear, Dale Rheault, Dennis Cunningham, Kristen Schantz, and Karen Friedman. (Photo Teresa Parker)

    Then the Well Line group asked her to join in their effort.

    “I am sadly happy to be doing this,” she said.

    On July 27, Rheault had her first call from an elderly resident who, along with her husband, is immunocompromised and was concerned about the risks that summer tourists bring to the community.

    The former therapist spoke with the resident for most of the day and offered her resources for getting advice on safety.

    “The line has been pretty quiet,” said Rheault. “But we are ready and willing to help people.”

    The Provincetown Warm Line is at 508-309-5848 and operates from noon to 7 p.m. daily. Similar to Wellfleet’s, the line is manned by a group of current and retired medical professionals who are part of Provincetown’s Covid-19 Task Force. They also offer the buddy system service.

    currents

    This Week in Wellfleet

    By

    Meetings Ahead

    Go to wellfleet-ma.gov and click on the meeting you are interested in for instructions on how to participate.

    Thursday, June 11

    • Cape Cod Commission, 3 p.m.
    • Nauset Regional School Committee, 6 p.m.
    • Zoning Board of Appeals, 7 p.m.

    Tuesday, June 16

    • Select Board Meeting with Emergency Management Team, 10 a.m.

    Wednesday, June 17

    • Barnstable County Assembly of Delegates, 4 p.m.
    • Conservation Commission, 5 p.m.

    Conversation Starters

    Covid-19 Update

    As of June 8, Wellfleet had two active cases of Covid-19, four cleared cases, and one death as a result of the coronavirus.

    Visitor Sticker Sales

    The select board voted unanimously on Tuesday to move the start date for visitor beach sticker sales up seven days, from June 20 to June 13. The three-day, one-week, two-week, and seasonal stickers will still be sold online only, and one-day passes remain banned for the rest of 2020.

    No Short-Term Rental Minimum

    Wellfleet will not adopt a minimum stay rule for short-term rentals. The select board decided Tuesday that such a restriction is not practical for the town’s economy and that a discrepancy in such restrictions from town to town would cause difficulty for visitors. “If people have to stay in Eastham instead of Wellfleet, they will stay in Eastham, and all we will do is hurt our own businesses and rental market,” board member Michael DeVasto said.

    A Listening Ear

    An independent group in Wellfleet and the police are hoping to set up a mental health phone line for residents. “We see it not as a clinical model but as a listening ear,” said Dennis Cunningham, who spoke at Tuesday’s Covid Task Force meeting to introduce his program. The phone line, which is in the process of being set up and staffed by volunteers, aims to provide a place for people to call if they are feeling anxious, stressed, or overwhelmed with isolation or any other mental health issues.

    In the meantime, residents who need someone to talk to are encouraged to contact Wellfleet Police Chief Mike Hurley at [email protected], who will pass the message to the phone line team.

    Virtual Mayo Concert

    The Wellfleet Recreation Dept.’s Mayo Beach Concerts will take place virtually during phase two of Gov. Charlie Baker’s reopening plan. The department will live stream performances from the Mayo Beach tent over Google Meet and Facebook Live.

    “This is a way to support our talented local musicians,” said Health Dept. Director Hillary Greenberg-Lemos. —Devin Sean Martin

    MENTAL HEALTH

    Professionals Tell Parents, ‘Learn to Let Go’

    Families and caregivers need to prepare for a marathon, not a sprint

    By

    Four weeks into school closures, parents and kids are struggling with disrupted routines, financial stress, and health concerns, and there are no easy answers.

    “We are all in uncharted territory,” said Leah Booth, a speech-language pathologist at the Yale Child Study Center. “There is no blueprint for what families are experiencing right now.”

    Take exercise breaks with your kids
    Kids (like the author’s, pictured here) may complain when parents organize outings, but ultimately family exercise helps keep everyone in better spirits. (Photo Elspeth Hay)

    While the initial weeks of no school may have felt like an extended spring break, said Booth, it’s become clear we are in for a marathon, not a sprint.

    “Part of what families might be struggling with is the idea of letting things go,” she said, pointing out that many schools and organized children’s activities are offering remote ways to engage. “Many of us had this ‘Go, go, go’ schedule with sports and school, and it all came to a full stop. I think there are many families out there who are still frantically trying to keep all these same balls in the air.”

    If it works to engage remotely with all those activities, that’s great, said Dr. David Grodberg, medical director of the Yale Child Study Center Outpatient Clinic. “But if there are a lot of barriers to maintaining that intensity,” he said, “I worry about the resulting stress on the family.”

    “If you find yourself fighting with a third grader over math facts, maybe you opt to snuggle or read a book,” Booth suggested. “My hope is that parents can let go of the guilt of not creating a fourth-grade classroom in their living room.”

    Talking With Kids

    All of the mental health professionals contacted for this article advise being honest with kids. Casey Hammond is a licensed clinical social worker in Orleans.

    “Speaking in hushed tones, acting secretive, not sharing information — kids are attuned to that,” she said. Instead, invite questions. “Ask them, ‘What are you hearing? What are you worried about?’ In most cases it won’t be as big as we think, and it will get bigger the more secretive and panicked we act.”

    Dr. Grodberg advised balancing honesty with the child’s age and maturity, what psychologists call “developmentally appropriate transparency.”

    “Parents can convey calm without trying to protect children from reality,” he said.

    Jonathan Runge, a clinical psychologist who practices in Provincetown and Boston, offered an example: “Say something like, ‘For a little while,’ — provide a realistic time frame — ‘we are going to have to make some sacrifices, just so that there is enough not only for us but for everyone, including your friends. But won’t it be fun to plant and tend a vegetable garden!’ ”

    Don’t over-explain. “Sometimes parents’ own anxieties result in them offering more or different information from what the child is asking,” Booth said. “Try to simply answer the question you’re asked.”

    Getting Help

    Statewide, an estimated 17 percent of schoolchildren are on individualized education plans. “These are students with developmental delays, autism spectrum disorder, behavioral, or emotional problems,” said Dr. Grodberg. In many cases these kids are getting what they need through their schools; suddenly, these services have been interrupted, placing a huge burden on families.

    “There’s a growing demand for telehealth services for kids who both have chronic, long-standing behavioral health needs, and kids who are now developing difficulties coping,” said Dr. Grodberg.

    The good news, said Newton psychotherapist Stuart Simon, is that research shows that teletherapy, or virtual online therapy, is almost if not equally as effective as face-to-face counseling. Simon, who works with Wellfleet’s Gestalt International Study Center, added that, while in the past therapists and insurance companies have had privacy concerns about virtual counseling, in this time of disconnect and crisis, “Most folks I know are saying, ‘Let’s just get the help out to people.’ ”

    Physical activity is crucial for keeping kids and adults mentally healthy, said Dr. Grodberg. Getting outside as a family most days for a walk or a bike ride is one of the best ways to keep everyone in good spirits.

    Hammond also recommended calming anxiety with what’s known as Emotional Freedom Technique (EFT) tapping. Tapping on acupressure points is said to help eliminate the stress response, or “fight or flight” reaction.

    “It’s really simple,” said Hammond. “We tap on the same spots acupuncturists would stick a needle into.”

    “This is such a novel circumstance,” said Booth. “The truth is that we don’t know the long-term impact.” The best thing parents and families can do, she advised, is to keep learning day by day and do their best to manage in the moment.

    One silver lining of this experience for both kids and adults, said Simon, is awareness of our shared humanity.

    “I’m 69 years old,” he said, “and this is the first time in my life when everyone in the world is experiencing the same thing at once. This creates a different kind of connection. I hope that doesn’t fade.”

     

    HEALTH

    Navigators Help Police Deal With Crisis Calls

    Mental health and substance abuse are most pressing issues

    By

    Last year, 600 to 700 calls to the Wellfleet Police Dept. resulted in police reports. Of those, half involved mental health or substance abuse issues.

    Providing crisis intervention is now something officers prepare for, and in Truro, Wellfleet, and Eastham, they look to the community resource navigator program to provide follow up. (Provincetown no longer participates in the program, choosing to focus on housing and homelessness.) The navigator program appears to be helping, with the percentage of clients judged to be at high risk going down in the last quarter.

    Behind the large number of calls, at least in part, is a cultural shift, said Wellfleet Police Chief Michael Hurley, who joined the force 25 years ago. “If you were worried about someone 10 or 15 years ago, you wouldn’t call us to check on them,” Hurley said. “Today, no one hesitates to do it.”

    The opioid epidemic and climbing suicide rates have also likely upped the number of calls. In 2016, 78 people in Barnstable County died from opioid overdoses, compared to 12 in 2000. From 2000 to 2016, 512 people died from opioid-related overdoses. The age-adjusted suicide rate on the Cape and Islands doubled from 2000 to 2011, from 6.2 per 100,000 to 12.1 per 100,000, and according to the suicide awareness group SharedKindness, the county’s suicide rate is more than twice the state’s overall.

    Brianne Smith and Michael Hurley
    Community Resource Navigator Brianne Smith confers with Wellfleet Police Chief Michael Hurley. (Photo Molly Newman)

    Providing support to people suffering from mental health crises is now central to police work. “As a department, we’re dealing with it on a daily basis,” Hurley said.

    Eastham Officer Josh Adams said that although police are often the first to respond to mental health or substance abuse-related situations, until recently, they were not trained in how to deal with them. “We knew the law and made sure the law was met,” Adams said. “We were never trained as social workers, and we didn’t know what resources were out there.”

    Police officers have long conducted “well-being checks” after receiving calls from people concerned about themselves or about a friend or loved one. These days, however, they’re trained in crisis intervention. “Our new guys know how to handle themselves differently,” Adams said. “They’re trained differently — to be less robotic, softer.”

    Since July 2017, when Eastham, Wellfleet, and Truro agreed to pool their resources, police in the three towns have relied on community resource navigators to provide follow up. Each town pays Outer Cape Health Services (OCHS) $25,000 annually to maintain the program.

    After receiving a call for help, officers can refer the person in need to the navigators — social workers who visit that person in the days following the well-being check.

    “We see most folks at home, regardless of insurance,” said Brianne Smith, who runs the program along with Paula Erickson. Meeting people at home offsets barriers, like transportation or the formal setting of an office, which Smith said might discourage people from getting support.

    After evaluating the client’s needs, a navigator refers him or her to resources and programs that might help address specific concerns. The navigators meet regularly with Cape Cod Hospital, Bay Cove, and first responders. They also participate in police officers’ crisis intervention trainings and meet with guidance counselors at Nauset middle and high schools.

    Police in Wellfleet, Eastham, and Truro say that the navigator program is helping.

    Truro Officer Tom Roda worked as an emergency medic for years before joining the force. “You’re bringing the care to them, rather than saying, ‘Hey, there’s this program, if you go to this place, if you call this number….’ ” Roda said. “Almost everyone I’ve spoken with has agreed to meet with them.” He thought the likelihood of follow up with the navigators is high and added that the number of repeat calls coming in about the same individual is going down.

    According to its most recent quarterly report, the navigator program received 61 total referrals from the three towns in the last quarter (October to December 2019), up from 43 in the previous quarter. The table below shows which services navigators most frequently referred their clients to over the past two quarters across all three towns:

     

    Service Clients referred
    Community involvement* 40 %
    Mental health 30 %
    Housing 28 %
    Health 28 %
    Income 20 %
    Substance abuse 19 %
    Family / social relationships 18 %

    *The navigators define “community involvement” as services geared toward decreasing isolation.

    The navigators track their clients’ progress, and their numbers confirm that the program is working. The percentage of clients deemed “high risk” has dropped from 49.1 to 27.3, while the number of “medium risk” and “low risk” clients has increased. These numbers reflect an assessment of the same people who regularly engaged with the program over a three-month period.

    Still, the number of calls coming is high, from a first responder’s point of view. “Some days, it feels like Wellfleet could have its own navigator,” Hurley said.

    “It’s unclear if it’s solving the problem,” Hurley added, because the program does not address the root causes of mental illness and substance use disorder.

    OCHS has secured funding for a substance use disorder recovery coach, in the hopes that it will lighten the burden on navigators and nurses and will lead to a higher rate of successful recovery. They are currently searching for a suitable candidate.

    To close more loops, the navigator program helped form Outer Cape Community Solutions, a group composed of police officers, navigators, and other organizations involved in mental illness and substance use disorder. The group meets monthly.

    “It’s really opened up lines of communication,” Adams said. Hurley, too, said collaboration between various groups is cause for optimism. Ensuring that people know about the program’s existence is also important, he said. “It’s working. But there are still steps we can take.”

    Navigators’ Drop-in Office Hours

    Tuesdays, 11 a.m.-2 p.m., Wellfleet Police Dept.

    Wednesdays, 11 a.m.-2 p.m., Truro Council on Aging

    Thursdays, 11 a.m.-2 p.m., Eastham Public Library, except second Thursday of the month at the Children’s Place in Eastham.

    THE HOMELESS

    ‘When Are We Going Home?’ Rocha Still Asks

    David Chick says he is near giving up trying to help a homeless man

    By

    HYANNIS — Freddie Rocha greeted David Chick with his usual questions: “When are we going home?” and “Did you come to take me home?”

    Chick smiled and asked if he had been smoking cigarettes.

    Rocha said, “No, I quit.”

    Chick had arrived on Oct. 31 at 75 Pleasant St., the Larry Doughty House, a tired-looking state Dept. of Mental Health (DMH) rooming house in Hyannis where Rocha, 68, had been staying for three weeks. He has a private room there with a rubber mattress and a bed skirt for a sheet.

    Freddie Rocha photo
    Rocha and David Chick in Rocha’s room at the Larry Doughty House in Hyannis. (Photo K.C. Myers)

    It’s the latest in a list of temporary addresses where Rocha has lived since he was evicted from his family home in Provincetown in September 2018 because his siblings wanted to sell the home. Mary Welles, of Yarmouth Port, and Dennis Rocha, of Connecticut, have both said they cannot afford to maintain it and allow their older brother to live there.

    Diagnosed with schizophrenia, Rocha has been homeless ever since. Chick has taken on himself the dismaying work of trying to help Rocha find a permanent stable home.

    More than a year later Chick admits he is close to giving up.

    “[Freddie] wants to be in Provincetown and he deserves to be in Provincetown,” Chick said, but, he added, he doesn’t think the DMH employees care if Rocha has housing in Provincetown or not, and he and the family do not agree on what should happen next.

    Homeless for the Summer

    Last winter Rocha lived with Chick, who has kept Rocha connected to a maze of services. The goal has been to prevent Freddie’s having to leave Provincetown, his home of more than 40 years. But last summer Rocha slept on the streets.

    Chick explained when their winter rental was up in May 2019, and an off-season hotel stay at the Cape Colony Inn ended in June, Chick found a summer rental for himself, but not for Rocha. Chick, an artist, also had a studio space, but the landlord would not allow Rocha to sleep there.

    Chick recalled seeing Rocha in such bad shape on Aug. 2 that he knew he had to do something.

    Rocha wore a black sweatshirt and “heat was radiating off of him,” Chick said. “If he went a few more days he probably would’ve had a heart attack. He was living on the streets. He was staying outside Cumberland Farms until two in the morning…. He was expiring from dehydration and exhaustion.”

    As exhausted and miserable as he was, Rocha still didn’t want to get into a car, which is typical; he balks at the idea of going to the hospital.

    When a DMH caseworker came to Chick’s studio to discuss Rocha’s case, they decided Rocha needed to be involuntarily committed under Section 12 of the Mass. General Laws, which allows mentally ill people to be committed for their own safety or the safety of others.

    Chick said he told Rocha they were going to look at Harbor Hill, where Chick has submitted an application for an apartment on Rocha’s behalf. Last Friday, Rocha’s name was picked 134th out of 153 names for 11 available housing units in Provincetown, Chick said. Harbor Hill may still be an option for Rocha.

    Chick then told Rocha they were driving to P.B. Boulangerie in South Wellfleet. Rocha, who had not slept soundly in weeks, conked out in the car. Chick drove him to a DMH facility in Hyannis. When Rocha refused to stay, they placed him under a Section 12 order, Chick said.

    At Cape Cod Hospital, doctors treated him for dehydration, Chick said.

    A psychiatrist adjusted his medications. The result is that Rocha is now healthier and more mentally clear, Chick said.

    “So it was a blessing in disguise,” Chick said.

    What Are the Rules?

    Freddy Rocha photo
    Rocha at the Larry Doughty House, a place for clients of the state Dept. of Mental Health on Pleasant Street in Hyannis. (Photo David Chick)

    After that, Rocha stayed temporarily at the state-owned Pocasset Mental Health Center and then in a respite program at Falmouth Hospital, Chick said.

    That is where Chick ran into Dennis Rocha, Freddie’s brother from Connecticut.

    Chick and Dennis had strong disagreements in the past — Chick went to court, unsuccessfully, charging that Dennis and his sister had Freddie evicted illegally — but they spoke amiably at the hospital, Chick said.

    “I think we just started trying to work together and come together for this common goal of helping Freddie,” Chick said.

    But since then relations have gotten worse again. Mary Welles, Rocha’s sister, stated by email that she and Dennis would like the DMH to control her brother’s care.

    Both Welles and Dennis Rocha are currently arguing with Chick about whether Freddie should be brought back to Provincetown to live in a place that Chick has rented for him on Conant Street. Chick and Rocha stayed there last winter, and the landlord has invited them back, Chick said.

    Rocha’s DMH caseworker informed the siblings that renting the Conant Street apartment will jeopardize Rocha’s state voucher and his ability to get into Harbor Hill, Welles wrote.

    Chick, however, said that’s not correct. The voucher is usable at Conant Street because this time it is a year-round lease, he said. And it will not hurt Rocha’s chances to get into Harbor Hill should one of those apartments become available, Chick added.

    The back and forth illustrates the difficulty in understanding the rules that govern the region’s complex social services net. In addition to the Hyannis-based Housing Assistance Corp. and the state DMH, Chick is currently working with ARC of Greater Plymouth, which operates a program that pays a live-in assistant to care for mentally challenged people. Chick is willing to be Rocha’s “live-in assist” temporarily but he needs someone to be his backup and would like someone else to eventually take over.

    “David has put his life on hold to help Freddie,” said Julie Wheeler, who started a GoFundMe account to provide money for Chick to help Rocha.

    Wheeler said she trusts Chick completely.

    “He does everything for Freddie,” Wheeler said.

    Still in Hyannis

    Three weeks ago the DMH moved Rocha to his present group home on Pleasant Street. It’s called “a residential treatment center” for DMH clients. On Oct. 31, Rocha was alone in an upstairs room with a single bed.

    Chick does not like this place and that is why he used the last of the GoFundMe account set up for Chick to pay Rocha’s housing expenses — the account originally had $15,765 — to pay for the Conant Street apartment.

    Chick said Rocha will be able to afford the rent going forward if he uses his state housing voucher for $2,000 a month. Because Rocha spends his Social Security income on lottery tickets, Chick added, his money could in future be handled by a representative payee through the Society Security Administration, which the DMH is arranging.

    As of Monday, however, Chick said he had decided not to take Rocha out of the Larry Doughty House, even though he believes it’s the wrong place for him, because he does not want to alienate DMH or the family.

    Few people understand why Chick is so involved in Rocha’s life. Rocha’s siblings do not trust him. In addition, Chick faces persistent skepticism from the various agencies he has pulled in to help Rocha.

    “I’m not family, I’m not the guardian, I’m not anything,” Chick said. “The one thing I get out of this is my connection with Freddie.”

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