Firing highlights feud in mental health field

Mary L. Rives said she never saw it coming.

Rives was five months into her new job as executive director of the Western Massachusetts chapter of the National Alliance for the Mentally Ill when she got a call last September asking her to report to the organization's offices in Agawam.

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When she arrived, Rives found two executive board members waiting for her. As Rives recounts the scene, the board members told her she was being terminated, but refused to elaborate. Stunned, Rives asked to retrieve some personal information from her work station. One of the members blocked her way, then got down on his hands and knees and unplugged the computer.

Rives, an Amherst resident who said she had recently received a glowing evaluation from the board, was at a loss to understand her dismissal. After speaking privately to some other members, however, she has come to believe that she was a casualty in a philosophical feud between the alliance and a local group of mental health consumers.

"The wagons were circling around me," Rives said.

At the heart of dispute is the nature of mental illness and the use of drugs to treat it.

Medication is a major theme for the alliance. In its literature, it describes mental illness as a "brain disease," which can neither be prevented nor cured. Consumer groups have taken issue with that stance, pushing a more holistic approach, which favors therapy over medication.

Locally, the Freedom Center, which is made up of people with a history of mental illness, has clashed with the alliance over the issue. In the small world of mental health advocacy in Western Massachusetts, this has created hard feelings on both sides.

With its 20-year history of advocacy, the alliance has established itself as a loud voice for mentally ill people. In addition to soliciting funds for research and treatment, it has campaigned to remove the stigma from mental illness and deplored the "warehousing" of mentally ill people in prisons and jails.

The local chapter, by far the largest in Massachusetts, is known to be among the most active in the state, according to its vice president, Leroy Moser. Almost from its inception, Moser and his wife, Jane E. Moser, have been its most visible standard-bearers. The Mosers, who now live in Springfield, had a harsh introduction to the horrors of mental illness when their son David, who was diagnosed with paranoid disorder, broke into their Northampton home in 1988 and assaulted them.

At his trial, David Moser refused to plead insanity and, despite his parents' entreaties, would not undergo treatment for his disease. He was convicted and sentenced to 5½ years in jail. Moser served his sentence, left the area, and has not spoken with his parents since, they said. The Mosers, meanwhile, have become ardent advocates of mandated medication for people deemed incapable of making reasonable decisions about their own mental health.

Although the Freedom Center does not oppose the use of medication, it maintains that people with mental illness should be given more options for treatment and believes they are often misinformed by doctors and pharmaceutical companies, according to Northampton resident Wilton E. Hall, one of the group's members.

"They have a very narrow and outdated view of mental health treatment," he said of the alliance. "We need to come up with alternatives because the treatments now are not working the way they should be working."

The local chapter of the alliance had been going through a time of transition when Rives came aboard last March. Jane Moser, its longtime president, had retired at the end of 2003. In February 2004, the board of directors opted not to retain the chapter's previous executive director, Claire Overlander, who was still in her six-month probationary period.

Rives, 45, has been in the mental health field for more than 20 years, serving as an administrator and social worker. As an adolescent, she was also a mental health consumer and has seen the system from both sides. By her own account and that of some alliance members, she was well received when she took over as executive director.

Rives believes her star at the alliance began its swift descent when she met some members of the Freedom Center at a mental health fair in Greenfield soon after she took the job. Aware of the tension between the groups, Rives said she was careful to represent the alliance's point of view in her conversation with the Freedom Center members but felt there was room for a dialogue. She later told Jane Moser that she had received a call from the group.

"I told Jane and she got very angry they were even included in the mental health fair," Rives said.

Moser said she had a brief discussion with Rives about the Freedom Center but does not recall any mention of the mental health fair. Her advice to Rives, she said, was not to return the call.

Rives believes she fell further afoul of the board when she raised the subject of changing the part of an alliance brochure that states mental illness cannot be prevented or cured. Some mental health advocates, including members of the Freedom Center, had objected to the statement, according to Rives.

"People felt they couldn't support our support groups," she said. "I talked to the president and the vice president (of the local chapter) over lunch about the issue."

She also raised the subject at the national meeting in Washington, D.C., that she attended just before her termination. Rives said she got a mixed reaction. Still, when she returned to Massachusetts, she had no inkling that she was on her way out.

Leroy Moser, who was not on the board during Rives' tenure, returned as vice president after her departure. Moser said Rives, who was still within her six-month probationary period, was not technically fired, but that the board voted not to renew her contract. Although he would not go into detail about why Rives was let go, Moser said she created discord within the chapter.

"She played people against each other repeatedly," he said.

Whatever the reasons for Rives' dismissal, it has roiled the waters. Gina M. Selin of Springfield, who had been the only minority board member before she stepped down at the end of 2003, resigned from the organization in protest of Rives' dismissal, calling the leadership "too political and close-minded."

"I'd love to see an open dialogue," she said. "The biggest thing they all seem afraid of is their children stopping their medication."

Selin said she was also frustrated with the alliance's failure to reach out to the black and Hispanic communities.

"They haven't given it much effort," she said. "Not really. Anytime there was a black event or affair, I was there, usually, by myself."

The Freedom Center also latched onto Rives' dismissal, e-mailing an interview with her on the subject to numerous members of the mental health community. Hall, who conducted the interview, said the incident shows the alliance's resistance to other perspectives.

"They're really frightened of this issue and closed to looking at it from a broader point of view," he said.

But others in the mental health community feel it's the Freedom Center that is fanning the flames. Susan Stubbs, the director of ServiceNet, a local agency providing services for the mentally ill, calls the group "provocative."

"NAMI has differed with us, but I never once felt attacked or personally disrespected," she said. "I've got to say I've had the exact opposite experience with the Freedom Center."

Hall said Stubbs has been treating the Freedom Center like a public relations problem.

"She's dismissive of our point of view," he said, "although senior members of her agency have agreed with us there are problems that need change."

According to Stubbs, of Northampton, the Freedom Center has called for a dialogue with her agency but wants to have it on its own terms. At one point, it demanded that ServiceNet pay for a professional mediator, she said. Although she knows little about Rives' dismissal, Stubbs said NAMI has the right to protect its own interests.

"If you're paying someone to be your executive director, you'd better be comfortable with their stand on things," she said.

Waltham resident James Michael Armstrong, known as "Moe" in the mental health community, is a longtime consumer who is on the national board of the alliance. He has had his tiffs with the organization and disagreed with the local chapter's decision to let Rives go. Armstrong said he changed his mind, however, after he saw her interview with the Freedom Center.

"I think the Freedom Center has a not-so-hidden agenda," he said. "They're more responsible for inflaming the situation."

Armstrong, who suffers from post-traumatic stress disorder, has taken a variety of medications for his condition but believes "good old personal companionship" is the best medicine. He feels there are class differences within the mental health world and said the Freedom Center does not represent the whole spectrum.

Leroy Moser also draws a distinction between people with serious mental illness and what he calls "the worried well." While therapy might work for the latter, the alliance firmly believes that those with serious mental illness need medication, he said.

"NAMI is the most holistic of all because we embrace anything that works for our constituency," he said, "but there must be evidence that it works."

Moser called the suggestion that the chapter has not tried to reach out to minorities unfair, saying that its efforts have been stymied because of the stigma of mental illness in those communities.

"It's been deeply frustrating because there are deep cultural differences that exist," he said. Since Selin's departure, the local alliance chapter has added Hispanic mental health activist Manny Bernal to its board.

Rives, who was reluctant to be interviewed for this story, now works as an organization development consultant. She still believes that the alliance board, most of whom have family members with mental illness, are motivated by concern for their loved ones. However, Rives has come to the conclusion that the local chapter is a troubled organization, which has been losing membership because of its inflexibility.

"I went into the position hoping there was a comprehensive approach," she said. "I didn't have much of an agenda other than to advocate for people with mental illness and their families."