Shumlin’s mental health care system still kind of a mess

Very interesting article by VTDigger’s Morgan True, which will get buried under today’s good news about Vermont Health Connect. The story details a plan to build a 16-bed secure inpatient facility for the severely mentally ill.

This specific plan comes from Northeast Kingdom Human Services, which proposes the hospital as part of a multipurpose “social service campus” in the distant hamlet of Bloomfield, pop. 262. How distant? It’s more than an hour northeast of Saint Johnsbury.

That seems like a bad idea for a number of reasons. It’s awfully far away from any sizeable hospital; proximity to a full-scale medical center is considered prudent for a secure inpatient facility. It’s a hell of a drive for the vast majority of those wanting to visit a patient. And there’s the problem of attracting qualified staff to such a remote locale.

This may be nothing more than a fever dream by NKHS; the state is nosing around for a new facility but has made no commitments to the Kingdom. But it does point out something I hadn’t realized: the administration is again looking to expand the system because it is still overstressed.

It’s almost a year since the new hospital in Berlin opened its doors, and there are still severely mentally ill patients waiting in emergency rooms for days at a time because there aren’t enough secure beds. And the state faces a looming, if somewhat unofficial, deadline to close a “temporary” seven-bed facility in Middlesex by 2018. Remember the fall of 2011, when the Shumlin administration unveiled plans to decentralize the system in the wake of Tropical Storm Irene?

The details of the administration’s proposal call for replacing the 54-bed state hospital with a new 15-bed state-managed facility near Central Vermont Medical Center; 14 inpatient beds at the Brattleboro Retreat; six at the Rutland Regional Medical Center; and up to 5 beds at the Windsor Correctional Facility to handle patients under court jurisdiction.

That’s 40 beds at four different facilities. Administration officials insisted that would be enough, although the then-head of the State Hospital was lobbying for a new, central state hospital at least as large as the old one.

In 2012, the state opened the seven-bed facility in Middlesex as a stopgap. The new Vermont Psychiatric Care Hospital in Berlin was still two years away from opening. At the time, officials were planning for 16 beds in Berlin; that was later ramped up to 24.

VPCH has now been open for almost a year. Middlesex is still operating. The system now has 45 secure inpatient beds. And there are still people waiting in ERs. If the planned Northeast Kingdom facility were built, it would add 16 beds, seven of which would supplant Middlesex. That’d bring the system-wide total to 54, if my math doesn’t fail me. That’s more beds than the old Waterbury hospital.

So what happened to “we only need 40 beds”? Inoperative, I guess.

The main rationale for the decentralized plan was money: a smaller inpatient facility would allow the state to leverage federal dollars, which would enable the state to allocate its own resources to a more robust community-based system.

Somehow I doubt the numbers have worked out that way. The system has grown incrementally since 2011. I don’t know how much new money has been invested in community programs, but the construction and staffing costs for the system have risen and are still rising.

Back in 2011, administration officials projected a $15 million cost for building a 15-bed secure hospital in Berlin. The final construction cost of VPCH, expanded to 24 beds, was $38 million — more than twice as much. Staffing and operating costs are roughly equivalent to those of the old Waterbury hospital, which had more than twice as many beds. (You can’t cut corners on staffing a secure mental health facility. By building smaller, the state chose to forego potential economies of scale.)

The optimistic NKHS projection for the Bloomfield facility’s cost is $7 million. The Department of Mental Health is projecting an $11 million price tag for a hypothetical 14-bed facility. Care to place a bet that the ultimate cost will be higher than that?

And then there will be operating and staffing costs. If the new state hospital costs as much to run as the old one, any new expense will be on top of that. A lot of the money has been leveraged from federal sources.

But how much, exactly? How much was extra state expenditure at a time of tight budgets? How much more expensive will the new system be when it’s fully operational? How much new money was really invested in community-based care?

And could we have avoided a five-year-long (and counting) crisis if we’d made an early commitment to a single, centralized facility?

I suspect the answers to those questions would be disappointing to those of us who want the best for our most vulnerable and/or most dangerous citizens, and for those of us who want to believe the Shumlin administration knows what it’s doing.

Maybe this is why the Mental Health commissionership has been a slow-motion game of musical chairs. Shumlin’s original appointee, Christine Oliver, survived less than a year. Her replacement, Patrick Flood, announced his departure less than a year after that. His replacement, interim Commissioner Mary Moulton, was on board for six months. Her successor, Paul Dupre, plans to leave this month after less than two years on the job. With his departure scheduled for June 12, another interim commissioner will most likely be needed. And then there will be another new hire.

The job is a thankless one at the best of times. The rapid and continuing turnover at DMH — and the general reliance on internal candidates — would seem to indicate a doubly thankless job that nobody wants, and nobody can handle for very long.

So tell me again. How’s the system working?

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One thought on “Shumlin’s mental health care system still kind of a mess

  1. Cynthia Browning

    Just so you know, many in the legislature supported Dr. Batra’s recommendation for rebuilding a larger facility in Berlin, but the Administration refused to consider that. More and better community services are useful and I support them, but folks in acute crisis need a hospital bed and there are not enough of them. I think that the Shumlin Administration and the Legislative majority blew the best chance in 50 years to do right by Vermonters who need this kind of care.
    Rep. Cynthia Browning, Arlngton

    Reply

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