Our mental health sandcastle, part 2

And every one that heareth these sayings of mine, and doeth them not, shall be likened unto a foolish man, which built his house upon the sand:

— Matthew 7:26

A few months ago I was chatting, off the record, with a former Shumlin administration functionary. The subject turned to post-Irene mental health care, on which I have been very critical of the administration. This person expressed pride in the new Vermont Psychiatric Care Hospital, calling it a “showplace” and urging me to take a tour.

And perhaps I will. But here’s the thing.

Building a building is the easy part. You can usually rustle up the necessary funds, with or without auctioning the naming rights. Government money, grant funding, foundation support, private donors — all are attracted to flashy new things.

It’s a lot less flashy to operate the building once the ribbon has been cut. Management, maintenance, operating costs; attracting and maintaining quality staff and motivating them to excel; creating the systems that will ensure performance equal to the bright shiny promise of the new edifice.

Am I talking about the new state psychiatric hospital here? You betcha.

The hospital has never been fully and properly staffed. Hard work and low pay — and a dangerous work environment — have proven to be strong disincentives to recruitment, and VPCH has suffered from a high attrition rate.

I’ve been hearing background chatter about this, but recently we’ve seen two stories documenting VPCH’s troubles.

First came an August 10 piece on VTDigger, reporting that one wing of VPCH had been closed because of a nursing shortage. The cause, reports VTDigger: uncompetitive wages.

State officials acknowledge it’s a problem, and are working on ways to address it. But that’s only half the story.

In addition to low pay, working conditions are also a major concern. There have been injuries to nurses and other staff at the hands of psychiatric patients, creating an unsafe work environment. That contributes to staff turnover, which contributes to the nursing shortage. One source, being perhaps a bit hyperbolic, talks of a system “imploding on itself.”

Or perhaps it’s not so hyperbolic. In January, VTDigger reported on a disturbing trend of violent attacks at VPCH. At the time, there had been 59 attacks by patients on VPCH staff — in roughly six months. Dr. Marvin Malek, who works as a consulting physician at VPCH, said there were two to three violent incidents a week, a number he says is “abnormal” for such a facility. He said there’s “a palpable atmosphere of fear” in the hospital.

Hmm. The pay sucks, and there’s a good chance you’ll get clocked by a patient. Not a recipe for a contented workforce.

The second news item came earlier this week, as VPR’s Taylor Dobbs provided more information on the shortage. Which is far from a recent phenomenon.

When VPCH finally reached its full 25-bed capacity in February, it was only because “we were using a substantial amount of traveling nurses,” according to hospital chief Jeff Rothenberg. But when summer hit, the number of available Kelly Nurses dwindled, causing VPCH to close a wing.

Neither article addresses a very real concern: VPCH needs highly-trained people to work with our most troubled (and often dangerous) Vermonters. But we’re relying on traveling nurses with who knows what kind of experience and training. Are they psychiatric nurses? Have they worked inpatient psychiatry before? I don’t know.

And, of course, traveling nurses come and go, putting VPCH on a vicious cycle of understaffing, turnover, low retention, lather, rinse, repeat.

How long has this been going on? Well, almost certainly since VPCH opened in the summer of 2014. VTDigger quoted State Rep. Anne Donahue, a real birddog on mental health issues, as saying the problem was apparent as early as last September, when she and her colleagues “were urging that there be aggressive action.”

I don’t think she meant “wait till next summer when it’s become a perpetual crisis.”

So here we are with a shiny new well-designed building that’s failing to deliver its promise. We still have psychiatric patients waiting in emergency rooms; we have an underpaid and demoralized workforce; and after a full year in service, we can’t hire and retain enough nurses to keep the beds open.

If the problems continue, or if — God forbid — there is an implosion, Rothenberg and/or his bosses at the Department of Mental Health are likely to get the blame. Maybe they deserve some of it, but this particular defeat has many fathers. The Shumlin administration, while promising a new, top-flight mental health care system, has been trying to do it on the cheap since day one. The Legislature has persistently tried to cut the already inadequate Shumlin proposals.

Even if a crisis is averted, through sheer luck perhaps, the system remains a mess. And there seems to be little political or administrative will to clean it up.

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