Our still-broken inpatient psychiatric system

One of journalism’s highest purposes is to lance the boils of society — to expose unpleasant truths that everybody is doing their best to ignore.

A prime example appears on VTDigger today: a story by Morgan True about the continuing problems in the state’s psychiatric care system, and particularly the brand shiny new state hospital in Berlin.

Among the key points:

— Even after the facility’s opening, some psychiatric patients have found themselves parked in emergency rooms for days or even weeks.

— There have been 59 documented attacks by patients on hospital staff, some resulting in significant injuries.

— The hospital houses a couple dozen of the most severely ill people in Vermont. Many have been convicted of violent felonies. One doctor told True that the hospital is “one of the most dangerous workplaces in Vermont.”

— State law strictly limits the restraint or medication of patients against their will. Even the most violent.

— In part because of this dangerous work environment, the hospital has been consistently understaffed since its opening. As a result, it has yet to operate at full capacity.

Which brings us back to point one: several months after the hospital’s opening, severely mentally ill people are still being warehoused in ERs.

This is a whole lotta bad stuff. It shows a mental health care system that’s still functioning poorly even after the Shumlin Administration’s entire plan has been put in place.

The Department of Mental Health, for its part, seems to be taking a remarkably lax and unforthcoming attitude toward the situation. DMH knows the total number of attacks on staff, but it won’t release any information on staff injuries.

And according to DMH Deputy Commissioner Frank Reed, the department “has not tried to compare the number of violent incidents at VPCH to other psychiatric hospitals.”

Well, why the hell not? I’d think you’d want to know whether our problems are unique, or simply the natural consequence of caring for the most severely mentally ill.

Reed also flunks the transparency test when it comes to waiting times in hospital emergency rooms. He says average wait times have decreased, but…

Reed was unable to provide documentation of average wait times, saying those figures are still being “pulled together.” The numbers will be presented to a legislative oversight committee in January.

Perhaps Mr. True should apologize for inquiring at an inopportune time. But it shouldn’t be that hard to assemble those numbers. Indeed, I’d expect a Department that’s doing its job to compile those figures on an ongoing basis.

In fact, I’d be very surprised if DMH doesn’t have the numbers already. It’s Management 101, isn’t it? Keep track of your most important statistical markers?

True’s report raises all kinds of questions about state law, the Shumlin Administration’s concept of a mental health care system, and how many resources were spent trying to develop a system that was undersized from the start. DMH officials are talking about supplementing the system with a new 14-bed secure residential facility, but acknowledge that it’ll be a tough sell when lawmakers are under the gun to cut the budget. DMH may have already squandered its best opportunity to create a good system.

And please don’t insult me with the “No one could have foreseen” excuse. The people responsible for inpatient care were all saying the same thing after Irene: the Shumlin Administration’s plan was so bare-bones that it was almost doomed to fail. While their advice was ignored, how many millions did the Administration spend on inadequate plans, patchwork facilities, and extra costs? (One example: according to True, the state has paid more than $1 million since 2012 for sheriff’s deputies to monitor psychiatric patients in hospital ERs.)

And it turns out, to the surprise of no one who works in the field, that a 24-bed hospital costs nearly as much to run as the old 50-bed facility, and costs more on a per-bed basis because the foundational staffing needs are so high.

And, given that the new hospital has some of the same kinds of problems as the old one, I have to ask if our laws are out of whack. I mean, look: We’re talking about the two dozen  sickest people in Vermont, many of them violently, dangerously sick. The restrictions on restraint or medication without patient approval may be the best thing for the vast majority of patients; I believe different standards should apply to the very sickest. They are the ones least capable of exercising sound judgment, and most capable of inflicting harm on staff or fellow patients.

One commonality between the old hospital and the new is our strongly patient-centric laws. It seems clear to me that those laws are on point for the vast majority of patients, but that there should be a different standard for patients in the state hospital.

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