Earlier this week, VTDigger ran a story that explored the opposition to a proposed replacement for the “temporary” psychiatric treatment center in Middlesex. You know, the one that opened eight years ago and is entirely inadequate?
The story quoted people opposed to the replacement plan because it would be “too institutional.” The story didn’t quote anyone who favors the plan, aside from an official of the Department of Mental Health.
And the article framed those opposing the plan as if they represented the entire spectrum of psychiatric care. And used the language of opponents as if it was objective.
Before I go on, I must say that VTDigger is a fine organization that provides an invaluable service in our age of diminished traditional media. I’m a financial supporter. The vast majority of its coverage is thorough and fair. But when it falls short, I will point out the failure.
The trouble begins in the third paragraph, which says the plan “has sparked an outcry from mental health providers and advocates.”
The phrase “mental health providers” is very broad. It can include social workers, nurses, technicians, therapists with a variety of degrees, psychologists and psychiatrists. The article does not quote any psychologists or psychiatrists — the latter being the only mental health providers with a medical degree and specialized postgraduate training.
Those quoted include a former patient at the defunct Waterbury State Hospital, “a psychiatric survivor and mental health worker,” and a self-described psychotherapist whose training is in dance and movement therapy.
There’s nothing wrong with movement therapy. It’s part of a continuum of services, all of which are required to address the needs of all patients. But that therapist is hardly representative of the academic end of the continuum, and shouldn’t be expected to speak on behalf of, say, clinically-trained psychiatrists.
But there isn’t a single psychiatrist or psychologist in the article. If you ask any psychiatrist at the University of Vermont Medical Center or any of Vermont’s other hospitals or at the state psychiatric hospital, you’d find almost universal support for the Middlesex replacement plan. They have experienced first-hand the shortage of inpatient treatment that has plagued Vermont since Tropical Storm Irene hit in 2011 — and the negative impact on patients who need that kind of care.
The advocates’ complaints center around freedom, the idea that patients should be allowed to stay in treatment or leave as they wish. The problem is, like it or not, there’s a very small number of patients who are best treated in a secure setting. The state psychiatric hospital and the proposed Middlesex replacement target the few dozen people in direst need of intensive treatment.
The story also uses the loaded phrase “psychiatric survivors.” The plain meaning is that psychiatric care is an ordeal to be survived, not a necessary intervention for those who need it. The “survivors” are those who had bad experiences or harbor bad memories. There are a lot more people who have benefited from inpatient treatment. You rarely see those people quoted because they’re not out there making noise.
The story ends with a quote from the movement therapist: “The whole point of mental health care is how people are feeling.” That’s true for most of us, but it’s dangerously wrong for the rest. Some psychiatric problems have a medical cause and require medical treatment. That can be unpleasant at times, just like heart surgery or chemotherapy. Those patients cannot be treated in community settings or by any kind of psychoanalysis.
The anti-Middlesex advocates say the Middlesex money would be better spent on community treatment. That’s simply not true. The Middlesexes of the world provide care for those who are too sick to benefit from community treatment. Again, at any given time, that’s a few dozen out of 630,000. We need more community-based services, to be sure. But they will never completely replace inpatient care.
I suspect this article springs from a widespread discomfort with medical psychiatry in Vermont. The idea of inpatient psychiatric care evokes negative images, in part because of Waterbury’s sordid history. But psychiatric hospitalization, for the few profoundly ill, is just as necessary as any other kind.
Would anyone dare assert that hospitals should close their cardiac units so the money can go to providing group or community services for those with heart disease? I doubt it. Now, someone at high risk for heart disease or recovering from treatment can benefit from one-on-one or group counseling. But not those who are already seriously ill.
The Middlesex replacement is the cardiac wing of psychiatric treatment. It’s a service for only the most seriously ill. We need it. And you wouldn’t know that from reading the Digger piece.