Maybe We’re Finally On Our Way to a Functioning Mental Health System

“Temporary facility,” well beyond its sell-by date.

Congratulations to the Scott administration for finally making a long-overdue commitment to the state’s mental health system. Its FY22 capital budget includes $11.6 million to build a replacement to the rattletrap pictured above. That, in all its prefab glory, is the Middlesex Therapeutic Community Residence, which houses people who are transitioning from psychiatric hospitalization to independent living.

The MTCR was built in the aftermath of Tropical Storm Irene, which flooded the old state psychiatric hospital in Waterbury. It was thrown up quickly using a pair of modular units, and opened in 2013 as a stopgap. Its time has come and gone.

It’s also too small for demand. Its seven beds are almost always full. The new digs would have 16 beds. The idea is that a larger step-down facility would allow more patients to be discharged from hospitals sooner, freeing up those beds and (hopefully) eliminating the constant issue of severely ill patients being parked in emergency rooms for lack of psychiatric beds.

This all sends me down Memory Lane. I’ve been following the state’s woeful efforts to rebuild the system since 2011. In the wake of Irene, the Shumlin administration announced plans to craft a new, much more community-oriented system. Such a system would theoretically require fewer inpatient beds because more people would get treatment sooner, before they got really sick.

Shumlin’s original plan for a new psychiatric hospital called for 16 beds. At the same time, embarrassingly, the then-medical director for the mental health department Dr. Jay Batra was saying the new hospital should be at least as large as Waterbury’s 50-plus beds.

At the time, administration officials pooh-poohed Batra.

They depicted him as biased, and implied that he was just engaged in empire-building. Well, turned out Batra was pretty much dead-on. Over the years, the new hospital was upsized to 24 beds; 14 more were created at the Brattleboro Retreat, plus MTCR’s seven. If the new step-down facility is built, that’ll add up to, gosh, whadya know, 54 beds.

Dr. Batra could be forgiven for saying “I told you so.”

The Scott administration’s proposal got an initial hearing Friday before the House Corrections and Institutions Committee, which passes muster on the capital bill. It was a brief hearing; more will follow on Wednesday afternoon.

A few details: The full price tag is $16.1 million, including $4.5 million already appropriated in previous capital bills. It would be a secure facility for patients who don’t need full hospitalization anymore, but aren’t yet ready to come and go as they wish. The proposed site is the former location of the Woodside Juvenile Rehabilitation Center in Essex Junction. If all goes on schedule, the new place would open in late 2022 or early 2023.

Mental Health Commissioner Sarah Squirrell made it clear that MTCR needs to be ditched. “It’s a temporary structure in service for more than five years,” she said, although it’s actually eight years and counting. “The site has poor drainage, there’s no permanent foundation. Constant repair is needed.”

Besides that, it’s fine.

Her presentation was questioned by two legislative newbies, Reps. Karen Dolan and Michelle Bos-Lun. Dolan asked why Vermont needs more secure beds. “Our [inpatient] beds are pretty much at 100% all the time,” Squirrell replied. “We did an analysis of residential bed needs. It clearly indicated the capacity in the system is inadequate.”

Hence, patients getting stockpiled in emergency rooms — putting stress on ER staff and delaying full treatment for the patients.

Bos-Lun asked if an alternative model might be better. She mentioned the Soteria House in Burlington as a “less intrusive peer therapy model. Have you considered more beds in the least restrictive setting?”

“Expanding peer services is a top priority. The answer to your question is ‘Yes, and’,” Squirrell said. “For some individuals, a Soteria type of facility would be unsuitable. A more secure residence is more in their clinical interest.”

Dolan and Bos-Lun were speaking the language of many in the mental health advocacy community. The committee received written testimony from WIlda White, founder of MadFreedom, an organization seeking to end the “oppression of people based on perceived mental state.” She opposes what she calls the “carceral” approach to psychiatric treatment, i.e. locking people up. “Vermont’s mental health system has many needs but not among them is a second, state-run psychiatric hospital,” she wrote in her testimony. She calls for more community-based options — which Peter Shumlin never did deliver.

White is far from alone in her view. But with all due respect, I know people who work in the mental health sphere. The inpatient system is designed for the most critically mentally ill Vermonters. These people are way beyond community-based treatment or peer counseling or any of that. Now, if we were to commit ourselves to truly beefing up the community-based system, we might eventually see a drop in serious mental illness.

But in the meantime, there are always a few dozen Vermonters who pose an immediate danger to themselves or others. That’s less than one-tenth of one percent of the state’s population. In truth, no one in the system wants to restrain patients any more than is absolutely necessary. To the contrary, inpatient staff often put themselves at risk to provide the least intrusive treatment possible.

I don’t expect to convince anyone who feels otherwise, but I’m on the administration’s side here. It’s well past time for Vermont to return to full inpatient capacity — while also making the long-overdue investment in community-based solutions. I’d love for there to be no need for psychiatric hospitalization, but we aren’t there yet.

So, from this vantage point, here’s hoping the $11.6 million is approved, and Vermont gets a step-down facility that’s well-built, clean, safe, and up to date. We should have done this years ago.

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