I imagine Vermont’s psychiatric community is nervously anticipating the fallout from the horrible wrong-way crash on I-89 that killed five high school students. Lawmakers will be looking to assign blame and prevent future tragedies, and they’ve often used the psychiatric community as a whipping boy.
There are things the Legislature and administration could do, but based on past performance, I have little faith they will come to the right conclusions.
A couple of points. First, the Howard Center is in deep shit. Second, here’s the lesson I hope is drawn from this: when you have an under-resourced mental health system with a chronic shortage of inpatient beds, you foster a bias against hospitalization.
First point first. As I understand it, when a person enters the UVM Medical Center with possible psychiatric issues, a call goes to the Howard Center for initial screening. Stephen Bourgoin reportedly entered the hospital on Saturday evening not once, not twice, but three separate times.
The Howard Center was called. But it failed to perform any screening, according to the State Police report.
This is bad, really bad, and is likely to spark potentially expensive legal action. Beyond that, it should prompt a thorough review of the Howard Center’s screening procedures. If that doesn’t work properly, the mental health care system never even gets a chance to do its work.
The Center put out a curiously-worded press release, and has since refused to comment. The curious part, to me:
“Our efforts are directed towards ensuring that the facts of this case are determined and shared in a manner that is respectful of the victims’ families and others impacted by this tragedy.”
That strikes me as an attempt to change the subject: let’s not talk about our failure, we must think of the children. And “respectful of the victims’ families” is code for “let’s have no publicity, please.”
Which is the prudent course, but it would have been nice if they’d added a stock sentence about “reviewing our role in this case and our procedures more generally.”
Now on to the Legislature. Ever since Tropical Storm Irene, the mental health system has suffered with an inadequate number of inpatient beds. Governor Shumlin’s persistent stance has been that he’s creating a new, better system that emphasizes community treatment and support and de-emphasizes hospitalization.
I don’t know if the community system has been improved. What I can say is that there’s been a chronic shortage of inpatient options. This has often resulted in lengthy emergency-room stays for patients who have no business being treated in ERs.
But here’s the more subtle thing. If it’s always a scramble to find a bed somewhere in Vermont, how does that affect initial screening when a new patient appears? I’d say it almost inevitably creates a bias against admission.
Go back to the beginning of post-Irene planning, when the head of the mental health system said that we needed at least as many beds as the old Waterbury hospital had, and the Shumlin people insisted that we could get by with fewer.
Indeed, one member of the administration pooh-poohed the expert, insisting that he was merely seeking more funding for his own agency. You know, the same reasoning that conservatives use against climate-change scientists: “Ehh, they’re just publicity hounds in it for themselves.”
Over time, the administration has increased the number of inpatient beds in the system, but the waiting times are still unacceptable.
Was that part of the equation last Friday night? We don’t know. But we do know this: for years now, the system has struggled to accommodate the number of Vermonters needing hospitalization. If we want to minimize the chance of a future tragedy, we need a more robust mental health system. just like the experts were saying from Day One.
Or we need to fulfill Shumlin’s original promise of a stronger community-based component to reduce the burden on hospitals and their front-line workers.