A conversation with Peggy Bailey

Peggy Bailey is the Director of Clinical Services at Connecticut Mental Health Center (CMHC). She oversees all aspects of care at CMHC and its satellite clinics. A licensed clinical social worker since 1982, she has worked at the Center for most of her 30-year career. Over the years she has helped to implement many changes in the way services are delivered at CMHC. This spring, I caught up with Ms. Bailey to learn more about her work and her vision for clinical care at CMHC.

LB: You came to CMHC in 1978, right after college. What was your first job here?

PB: I worked as a “psychiatric aid” on the 4th floor. It was an unlocked unit at the time and accepted only voluntary patients.

LB: What was it like?

PB: It was a great learning environment. Several of us were fresh out of college, and we were all learning together. We were taught to do full clinical assessments and mental status exams. At first we had help from more experienced staff; then we were allowed to work more independently. Some famous doctors from the Yale Department of Psychiatry would come to the unit for admission conferences. We would present our assessments and they would interview the patients. Afterwards, we’d have team discussion about the diagnosis, formulation and treatment plan. During that time period, I also learned to interview family members. The environment was incredibly interesting, and I really enjoyed working with the patients.

LB: When did you return as a full-fledged social worker?

PB: In 1983 I returned to the 4th floor as a social worker. During that time, the unit went from being unlocked to locked. That was an interesting period in the history of CMHC.

LB: What happened?

PB: There were a number of changes taking place throughout the state mental health system, including a downsizing initiative at CVH (Connecticut Valley Hospital), and the closing of Fairfield Hills Hospital. There was a shift in focus towards treating people within their own communities rather than sending them to more remote state hospitals. There was also an emphasis on returning patients to their communities more quickly, rather than keeping them in the hospital for prolonged periods of time. The decentralized approach to inpatient treatment made it easier to keep patients connected to their families and communities, and it also facilitated good discharge planning.

There were some tensions, though, as we made these changes. We weren’t accustomed to managing patients who didn’t necessarily want to be in the hospital. At the time it was difficult for the staff.

LB: When did you begin working in outpatient services?

PB: After working as an inpatient social worker for about three years, I moved to the outpatient department—the Psychosocial Rehabilitation Unit, something that doesn’t exist in the same way now. I oversaw the case management program, which developed as part of the downsizing initiative at CVH. Similar programs had been set up throughout the state. We all spent a couple of days per week at CVH, working with patients identified for discharge to our respective communities. We got to know our patients and brought them to New Haven to see the various resources available and to help them identify where they wanted to live. I also had responsibility for housing and entitlement coordination. In the mid 1980s, I became director of this unit.

LB: Today we have “treatment teams.” When did that start?

PB: In the mid- to late-1980s, we moved to a team structure. The Outpatient Division, as it was called, had individual, group, and family modality coordinators; all outpatient staff had caseloads that included each of those modalities. In an effort to more effectively integrate CMHC’s research mission into our work, we moved to a team model, which was similar to the “firm” model that had been introduced at the West Haven VA Hospital. Initially the teams at CMHC were generic in nature, but we fairly quickly transitioned to a diagnosis-based team model.

LB: Are CMHC teams still diagnosis-based?

PB: Actually, we changed it again.

LB: Why so many changes?

PB: Well, essentially we moved back to a generic team structure to equalize the team sizes. The Psychotic Disorders team had grown to be much larger than our other teams. We tried to match the staffing levels with the number of clients on each team, but in the end we found that there were just too many challenges inherent in managing a very large team.

LB: When did you become Director of Clinical Services?

PB: About eight years ago.

LB: What are your responsibilities today?

PB: I oversee clinical services throughout CMHC. I have two deputies: Avon Johnson, who manages inpatient services, and Edwin Renaud, who manages most of the ambulatory treatment teams in this building. I’ve continued with some of the newer programs and also the satellite clinics.

LB: How would you describe your role?

PB: I work with the Director’s Group to oversee the delivery of services throughout CMHC. I help develop new programs in response to changes that are occurring within CMHC or at the State level. I attend to risk and safety issues with our agency Risk Manager and other clinical leaders, and I collaborate with Human Resources in the hiring of new staff. Many of the new initiatives in recent years have been related to the CT Department of Mental Health & Addiction Services Recovery Initiative, including the Person-Centered Planning Initiative and the development of the Community Support and Recovery Pathways Programs.

LB: You mentioned the “recovery initiative”—how do you define that?

PB: I think recovery means different things to different people, but at its core, it speaks to an emphasis on working collaboratively with clients to assist them in developing meaningful lives in the community, including safe, affordable housing, valued roles, social networks, etc.

LB: Do you see that happening for our clients?

PB: I think we are making good progress. We’re fortunate to have a well-developed array of housing, social and employment programs in New Haven. The growth in our peer support services has been important to building recovery-oriented care here. In addition, the Citizenship Project, our new pilot program, will lead to further advancements in clinical care at CMHC. The Citizenship Project focuses on the rights, responsibilities, roles, resources, and relationships and serves as a framework for full community inclusion.

LB: What are some of the highs and lows of your career?

PB: CMHC has been part of the fabric of my life for over thirty years. The place is important to me, as are the people I work with here. The low points are probably related to times when we have hiring freezes. I see what the stress is like for people who are working hard, with fewer staffing resources.

As for the high points…I enjoy strategizing with my co-workers about challenging cases. I enjoy the planning that’s necessary to make changes in our service system, or to launch new programs. I have many mentors here and I’ve had many opportunities to grow and develop professionally over the course of time. I’m very thankful for that.

LB: Thank you very much, Peggy, for talking with me.

PB: You are welcome.

This article was submitted by Shane Seger on August 13, 2013.

Peggy Bailey, LCSW

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Margaret Bailey

Clinical Instructor (Social Work) in Psychiatry