SPRINGFIELD, Vt. — Being under-resourced and making it work has been an unwavering element of George Karabakakis’ career in the mental health field — whether in Berkeley, Calif., in the late 1970s or Vermont in the 2020s.
Karabakakis, 70, recently announced he will retire from his 31-year career at Health Care and Rehabilitation Services of Southeastern Vermont next June. Karabakakis came to HCRS as a clinician in 1994 and has been the chief executive officer of the nonprofit mental health agency since 2014.
HCRS’ board of directors is in the process of forming a search committee to find his replacement.
Karabakakis started his career as a counselor in a residential treatment center in Berkeley in the late 1970s. Then-California Gov. Ronald Reagan had just de-institutionalized and closed state hospitals, forcing many people with mental health struggles onto the streets and into the care of providers like Karabakakis, he said in an interview at HCRS’ Springfield headquarters Friday.
In California, he worked in an eight-bed supported independent living program where the staff was “doing it on a dime.”
“Although we do not want institutions, we need to have funding to support the community-based services,” Karabakakis said. “Those resources weren’t there.”
It was in that role that Karabakakis first saw himself and his own struggles to “find a place in the world” reflected in his patients. This taught him that “we’re all connected.”
After five decades and a cross-country move, it is still that connection and desire to make a difference that drives Karabakakis.
“It’s just the passion and the compassion and the dedication and the commitment to really helping people live their best lives, to really be there for them without judgment,” Karabakakis said. “I think for me, being able to be part of that through all these years it’s been just really humbling, but also an honor.”
During his time at HCRS, Karabakakis has nearly doubled the agency’s budget to over $73 million and been the leader and driving force behind pivotal projects and partnerships.
“Things have changed, for the positive, but I do think that we have a ways to go,” Karabakakis said of allocating resources to mental health services.
HCRS is the state-designated agency for social services in Windsor and Windham Counties. It provides a wide range of care for children, adults and people with developmental disabilities and works closely with other service providers.
“Necessity is the mother of invention, so we figure out what we need to do,” Karabakakis said. “And we need to be both creative and innovative, but at the same time looking to the future.”
It is a constant battle for funding; applying for state and federal grants, soliciting donations and advocating at the state level for funding for new programs.
HCRS and the state’s nine other designated agencies are primarily funded by Medicaid.
In fiscal year 2024, HCRS reported that 79% of its funding, or $52 million, came from Medicaid fees while 12% came from a combination of state and federal grants and contracts.
Looking ahead, Karabakakis said HCRS is working closely with state agencies to “really monitor and really assess” the potential impacts of changes to Medicaid.
The “One Big Beautiful Bill Act” that Congress passed in July makes changes to Medicaid and Medicaid Expansion that critics argue will decrease enrollment by millions. The earliest changes go into effect in January, though many do not launch until 2027.
“We’re designated by the state of Vermont to provide a whole range of mandated services,” Karabakakis said. “So, we’re watchful and we’re not alone in that.”
As financing challenges loom, Karabakakis said it will be essential to work collaboratively. “What we can’t do as a community is go into each corner and say, okay, we’re going to protect our turf, we’re going to protect our world… Those are the times when we need to really work together.”
One of the biggest challenges is finding consistent long-term funding, Karabakakis said.
About 15 years ago, Karabakakis was the lead on a court diversion program for people with co-occurring substance use and mental health issues called the Sparrow Project.
When the program launched, HCRS had a five-year grant to fund it. The agency was able to extend the funding for a few more years until, eventually, it ran out.
“We need to advocate. We need to educate people. We need to also show the data…,” he said. “We know, and our staff know, they know it in their bones, they know it in their souls, that we are making a difference. But we also need to have the data.”
But Karabakakis still considers the Sparrow Project a success. It ultimately transformed into an ongoing driving under the influence program that has spread across Vermont courts.
Through the voluntary program, HCRS provides treatment for people in Windsor, Windham or Orange counties with substance-related driving offenses. These people then have a chance to have their charges reduced.
The intersection of mental health and justice is a cornerstone of HCRS’ work.
In addition to the DUI program, the agency runs a police social work program that embeds HCRS staff into police departments to provide mental health services to community members like outreach, de-escalation, case management and screenings and assessments for social service needs.
Karabakakis launched the program in 2003 and it is one of the projects he is “most proud of.” It has spread to law enforcement agencies across Vermont including the Hartford and Windsor police departments and the state police barracks in Royalton.
In general, Karabakakis said the work HCRS does “has to be multi-disciplinary because that’s who people are; it’s a package deal.”
In addition to police agencies, county courts and judicial employees, HCRS works with other mental health agencies, state departments, schools, housing providers and other nonprofits.
Kate Lamphere, HCRS’ chief clinical services officer and director of adult services, has worked with Karabakakis for 17 years, much of the time under his direct supervision.
“Being able to trust that your leader is going to do the right thing is the reason that I’ve been at HCRS for 17 years and what I would look for in any future leaders,” Lamphere said in an interview last week.
HCRS recently became the lead agency on a statewide mobile crisis program. Under the program, anyone can dial 988 and get supportive counseling or have crisis workers dispatched to them.
“That took George’s bravery to say, ‘OK, we will contract with all of the other designed agencies and develop that program and we’ll essentially oversee crisis services across the entire state of Vermont,’ ” Lamphere said.
Since the program launched in January 2024, Lamphere said most people who request help are able to remain in their communities and it has reduced reliance on co-response with law enforcement.
In the first six months of the program, providers responded to over 1,000 mobile crisis incidents and provided over 700 follow-up services statewide, according to Vermont Care Partners, a coalition of 16 social service agencies in Vermont including HCRS.
Chief Operating Officer Anne Bilodeau pointed to the same program as a great success, though she noted it is “in it’s early stages.”
What stands out about Karabakakis is his “humanity,” said Bilodeau, who has worked with him for six years.
“It’s not often, in my experience,” Bilodeau said, “that you see a senior leader, like a CEO, express emotion because of the connectedness as a human being to what that human being or their family, or the situation or the community is going through.”