State cuts part patients, counselors
They gathered once again in Room C10, a small windowless office where they had shared so much - Chris Jepson, the bearded state social worker, and Bruce Thiboult, the burly patient with bipolar disorder who had grown to depend on him.
They had more than two years of history between them, time enough for Thiboult to confide some of his deepest secrets: the angels who came after his suicide attempt, the allure of crack and booze, his hatred of the mother who, he says, called him a "fat pig."
But now, their weekly meetings had to end.
As a result of the state's gaping budget deficit, Jepson received a layoff notice shortly before Christmas. The Goldfarb Behavioral Health Clinic in Jamaica Plain, which serves the neediest of the needy, would be shuttered by the end of January, he was told. The two men would have to go their separate ways.
Jepson, 45, shared the news during Thiboult's visit one morning last month, keeping his own worries about his next job to himself. He searched his patient's face for a reaction.
"How do you feel about it?"
Thiboult, his face reddening, looked directly at Jepson.
When Governor Deval Patrick stood before cameras on Beacon Hill in October to announce the elimination of 1,000 jobs and scores of state services, he solemnly warned, "People will feel these cuts." Five miles away, at this mental health clinic that served some 370 poor and mentally ill patients last year alone, Jepson and Thiboult would feel the truth of those words.
Shutting down the Goldfarb clinic may, in the end, save the state only slightly more than $100,000. But the loss, for Jepson and Thiboult, isn't measured in dollars but in the rupture of a therapeutic relationship that took so long to cultivate.
Their breakup is but one of the stories behind the budget cuts, two of the countless lives upended when the state can no longer afford to deliver on the promises that it had once made.
Jepson would launch a job search, and the 49-year-old Thiboult would consider if he even wants to try to find a replacement for the no-nonsense therapist who taught him how to control his rage about life.
"You're killing my support," continued Thiboult during that session last month, while fiddling with a necklace adorned with a cross. "I only accept certain people that I feel I can trust. . . . You can't do this to people."
It was here that he first really let himself absorb the news that Goldfarb clinic was shutting down and he was losing Jepson. He remembers closing the front door behind him, lighting up a cigarette and praying: "I need your help. You're crushing me here."
Later that day, he even took a small dose of Klonopin, an antianxiety medication that he takes when needed.
Thiboult said simple things like keeping up his own apartment and tending his garden were unimaginable a decade ago. From a fractured home, he drifted from one homeless shelter to another and worked sporadically as a landscaper. Until his early 40s, he said, he was in a self-destructive spiral, focusing on getting high. But in 2002, after a suicide attempt and the intervention of some gifted clinicians, Thiboult said he began to see hope.
"That's when I felt God," he said.
Thiboult was diagnosed with bipolar disorder, diabetes, and two damaged knees, and eventually was sent to the Goldfarb clinic on a first-floor wing of the state-owned Lemuel Shattuck Hospital at the edge of Franklin Park. It was a national model for combining out-patient medical and psychological services in one place. Patients went to one side of the hallway to see mental health specialists, and the other side to receive medical attention for conditions such as diabetes, hypertension, and HIV infection.
Almost anyone who asked was seen - schizophrenics, the homeless, heroin addicts, ex-cons. To many clinicians, the center was as much a crime-prevention service as a therapeutic haven.
Through Goldfarb, Thiboult also gets prescriptions for Lamictal for his bipolar disorder, and insulin for his diabetes.
Thiboult admits that he was wary the first time he met Jepson. Before they met, he had been at a different clinic where he was assigned a couple of therapists who were "kiddies" - half his age and still in training. He refused to go back after one or two sessions.
With Jepson, however, Thiboult said he felt an "instantaneous bond."
"I just felt connected," he said. "Like he was there to help me."
Jepson never stared at the clock, their sessions often lasting an hour. Thiboult said Jepson also knows when to talk - and when not to. One day he entered Jepson's office so depressed that he just sat in his chair weeping for 15 minutes. During that entire time, Jepson sat with him in communal silence.
Thiboult said he knows the government's human services budgets swell because of patients like him. Almost every aspect of his life - housing, food, health insurance - is covered through subsidies from the government or a nonprofit agency.
But he said his volatile mood swings and knee problems prevent him from keeping a job. The "bean counters who have no clue" would think harder about slashing programs if they walked in his shoes for a few days, he said.
Thiboult said he worries that without Jepson his life may spiral downward into dark places - but he has no appointment to see someone new. "It's hitting me now," he said, his eyes welling up. "I got to start over."
It did not faze him that outside his office, he often saw security guards escort handcuffed prisoners who were brought to Shattuck Hospital for treatment. Jepson remembers fondly his past work with incarcerated adolescents, as well as with struggling families in the Department of Social Services.
Establishing trusting bonds with patients is what gives meaning to his work - and severing ties with longtime patients like Thiboult is painful when the timing is beyond his control.
"Closing with patients is difficult," he said during a lunch break a couple of weeks ago. "I've never been someone who likes to say goodbye."
Jepson has urged Thiboult to stay open to someone new, but he has faced resistance. The social worker said Thiboult wasn't his easiest patient. He could be feisty and belligerent. Jepson said he was careful when he nudged Thiboult to consider repairing relationships with his mother, or to articulate his fears about resuming life as a crack-seeking drifter.
Jepson's greatest satisfaction has come with seeing Thiboult's progress, watching him use new skills of self-relaxation and personal insight.
Jepson said some of his other patients accepted the closing of the clinic with more resignation, at least on paper. On Jepson's desk sat a homemade Christmas card from a former patient. "Chris, you're a diamond in the rough," it read. "Wishing you and yours a blessed holiday. I met you as a client, and leave you as a friend. Kevin."
Raised in Chatham, Jepson said he worked as a fisherman and carpenter before he went to a small college in Vermont. In 2006, he completed graduate school for social work at Wheelock College, and soon thereafter, took a job at Goldfarb.
After the layoff news, he and his wife considered depending on her income alone for a period. But he ultimately exercised his union "bumping rights," and is expected to start this week in a state job at a Roxbury agency that deals with severely sick children.
Jepson said the public has no clue how hard it is to keep unstable patients from hurting themselves - or others. When he sees patients in his office, he makes sure to sit by the door, an escape route if a patient becomes violent. When a patient fails to show up, Jepson often seeks that person out to make sure that patient is not on the brink of a homicidal rage or freezing to death on the Boston Common.
The clinic's closing has baffled him. "It costs the taxpayers a lot more money to incarcerate these people or to have them in-patient in a psych ward," he said.
"It's Friday morning. . . . I'm suicidal. . . . I just called the B.E.S.T. (Boston Emergency Services) Team to come and pick me up. . . . So I'm going to cancel the appointment on the 23rd with you. I don't know what's going to happen. Bye."
- Voice mail left for a clinician by a Goldfarb patient
That this relatively small out-patient clinic is a casualty of the budget crisis is a sign of just how desperate and confusing times have become. The state saved about $390,000 when it laid off four clinicians and dropped a part-time psychiatrist's slot. However, when asked by the Globe, state officials acknowledged that the clinic's shutdown also meant the loss of about $290,000 in annual patient insurance payments.
"This makes no sense," said Arletta Cioffari, a psychologist and outgoing director of the Goldfarb clinic.
In mid-January, a private vendor, Bay Cove Human Services, said it expected to take over some of Goldfarb's space rent-free, and would hire Sally Guy, a Goldfarb nurse licensed to prescribe psychotropic medications. Thiboult gets his medications from her, so he will continue that relationship. A Bay Cove official said the agency expects to provide some therapy using its own staff, though it does not anticipate staffing at the levels that had been available at the Goldfarb - two full-time social workers and one-full time psychologist.
Paul Romary, chief executive officer of the Shattuck, run by the Department of Public Health, said he faced a mandate to reduce his budget by $870,000 to help with the $1 billion budget deficit last fall - an amount now at $2.5 billion. He worked hard, he said, to avoid deeper cuts in the 255-bed hospital dedicated to quality health care for poor and vulnerable patients.
Rather than "nickel-and-dime" every department, he targeted certain areas, including closing Goldfarb and reducing his payroll by 12 positions.
"We'd never go down this path if it were not for the budget cuts," he said.
Along the Goldfarb clinic hallway, just doors away from Room C10 where Jepson and Thiboult met weekly, hangs a painted portrait of the late Dr. Jay Goldfarb.
Goldfarb had been director of Shattuck's outpatient medical clinic when he died at the age of 37 in 1989 from complications of AIDS. Officials named its medical outpatient clinic after him, and eight years later, as the demand for psychological services expanded, they created the Goldfarb Behavioral Health Clinic.
In a telephone interview from their home in Henderson, Nev., Goldfarb's parents, Esther and Keeva Goldfarb, said they had attended the ceremony dedicating the medical clinic, but they did not know a mental health unit had subsequently also carried their son's name.
"It's so sad to hear that it's closing," the 86-year-old father said, adding that he misses his son every day. He said he was happy, however, that the medical clinic will keep alive the memory of his son, a 1976 graduate of Tufts Medical School who went into medicine to help the underprivileged.
"No matter what their station in life, he took care of them," Goldfarb said.
Patricia Wen can be reached at firstname.lastname@example.org.