LOCALmatters
Vermont’s Psychiatric Bed Crisis Befuddles Policymakers BY AL I C I A FRE E S E
V
built the 25-bed Vermont Psychiatric Care Hospital in Berlin, contracted with Rutland Regional Medical Center to provide seven beds, and made a deal with the Brattleboro Retreat, a private psychiatric facility, to provide another 14 beds. Those 46 beds are reserved for the highest-need patients, who have been hospitalized against their will and placed in the Department of Mental Health’s custody. Many policymakers, and even more hospital staff, are convinced that effort isn’t enough, especially as the need grows. Private hospitals recorded 1,920
who have entered through the criminal justice system. They could include individuals who have been charged with a crime and are awaiting a psychiatric assessment, defendants who have been deemed incompetent to stand trial or found not guilty by reason of insanity, and inmates who experience a psychiatric crisis while in prison. About half of the patients at the Vermont Psychiatric Care Hospital fit one of those descriptions. They tend to stay longer because of the complexity of their legal cases, creating a bottleneck that clogs up the state’s entire inpatient treatment system, according to Gobeille.
16 LOCAL MATTERS
SEVEN DAYS
03.07.18-03.14.18
SEVENDAYSVT.COM
HEALTH CARE
inpatient mental health admissions in 2012. That number rose to 2,104 in 2017, according to data from the Vermont Association of Hospitals and Health Systems. The figure does not include admissions to the Brattleboro Retreat and the Vermont Psychiatric Care Hospital, data for which wasn’t readily available, according to the Department of Mental Health. The doctors’ desperate gesture last summer made an impression on Gobeille, who concluded that the quickest way to reduce pressure on emergency rooms would be to build a 3,000- to 5,000-square-foot addition at the Swanton prison. The temporary forensic psych unit would house patients
In an interview, Emmons explained that she has reservations about investing money in a temporary facility. She suggested that it would be more prudent to add beds to an existing hospital and provide more housing for patients after they’re released. Josephson came away from the committee meeting with a different impression. As he left the room, he said to no one in particular, “Now I get it. They don’t want to pay for it.” Gobeille’s long-term solution centers on a permanent 50-bed forensic facility, but it’s part of a 10-year plan to construct a 925-bed prison complex in St. Albans — an idea that lawmakers and advocates have panned. In a report to the legislature earlier this year, the secretary also recommended creating more state beds at private hospitals and contracting with nursing homes to provide psychiatric care to older patients. Not everyone believes more beds is the answer. “This is not a system that needs more capacity to deal with crisis,” said Wilda White, executive director of Vermont Psychiatric Survivors, a Rutland-based advocacy organization. “This is a system that needs more capacity to deal with prevention and early intervention.” White said Vermont should instead invest in more housing, therapy and community centers that could support people with mental illnesses. The temporary forensic unit proposal didn’t fare better in the House Health Care Committee, which formally rejected the idea in a memo released February 28. Those lawmakers shared Emmons’ concern about spending millions on a temporary building, but they also raised a philosophical objection to segregating patients who have been charged with a crime. “We have never distinguished in Vermont and said, ‘Because you’re coming through the door of the criminal justice system, even though you have the same clinical need, we’re going to THOMAS JAMES
ermont Human Services Secretary Al Gobeille has said his top budget priority this year is creating more beds for psychiatric patients. But last week, some key state lawmakers balked at his plan to locate those beds in a prison complex. Gobeille’s proposal attempts to address a crisis in the state’s mental health system that’s left patients waiting weeks for one of 188 beds in Vermont’s six public and private hospitals. The secretary has asked for $2.9 million to build a temporary 12-bed psychiatric wing at the Northwest State Correctional Facility that would cost $6.5 million annually to operate. The House Health Care Committee formally declared its opposition last week, on financial and policy grounds. While most lawmakers agree on the need for more beds, there’s no consensus on the best solution. That doesn’t bode well for a larger challenge that policymakers have yet to confront: Vermont is three years away from losing millions of federal dollars that help pay for a large portion of inpatient beds in the state system. “We’ve gotta get this moving now,” Gobeille said. The bed shortage reached such a crisis that, last August, emergency room doctors and nurses from Central Vermont Medical Center showed up unannounced at Gov. Phil Scott’s office in Montpelier and demanded to meet with him. The governor wasn’t available, but he sent Gobeille to talk with the group the next day. What the hospital staff told the human services secretary wasn’t news to him: Patients are languishing in emergency rooms, where they occupy badly needed beds without receiving the treatment they require. Officials tend to trace the problem back to Tropical Storm Irene, which flooded the 54-bed Vermont State Hospital in Waterbury and prompted officials to replace it with a decentralized mental health system. The state
Some patients accused or convicted of crimes end up at the Brattleboro Retreat, where they’ve threatened and occasionally injured staff, according to CEO Louis Josephson. On March 1, he told the House Corrections and Institutions Committee about an incident in which two such patients “jumped” an employee as she brought them coffee. Calling Gobeille’s forensic unit a “nobrainer,” Josephson stressed to lawmakers: “I want to be crystal clear that this is an urgent, immediate need in the state.” Committee chair Alice Emmons (D-Springfield) wasn’t buying it. A “forensic [unit], I think, is being seen as a silver bullet, and I’m not convinced it is a silver bullet,” she said.