Category Archives: Mental health care

Here’s Half of a Good Article on a Proposed Mental Health Facility

Not An Artist’s Rendering of the New Psychiatric Facility, Though Some Would Say So

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.

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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.

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When Pigs Fly

In the wake of George Floyd’s murder and the wave of ensuing protests, Vermont’s political leadership is united in calling for criminal justice reform.

They are also united in minimizing expectations for actual, y’know, results.

This shouldn’t be surprising. Law enforcement has always gotten a full, respectful, sometimes dreamy-eyed reception in legislative committees. Police chiefs, sheriffs and state’s attorneys always wield strong influence when it comes to any issue that touches on their work, from criminal justice to substance abuse to cannabis to the deadly perils of Happy Hour.

(This post concerns our top Democratic and Progressive leaders, not Republican Gov. Phil Scott. He has made all the right noises, and I’m sure he will endorse modest reforms. But the expectations ought to be higher for the D’s and P’s.)

No surprise then, that Dem/Prog Senate President Pro Tem Tim Ashe and Dem House Speaker Mitzi Johnson have already put the kibosh on any talk of cutting the Vermont State Police budget. Ashe, who believes it’s time for him to move up the ladder to the lieutenant governorship, offered this in lieu of leadership: “It’s one thing to say that, to communicate as part of this national discussion, but how you actually implement such a proposal is not a one size fits all.”

Spoken like a politician fleeing a hot-button issue.

Johnson asserted that Vermont has “a very different law enforcement structure than a lot of other states,” so those notorious one-size-fits-all solutions just won’t work here.

Well, I’d like to know more about how Vermont’s structure of state police, county sheriffs and municipal police departments, whose officers are armed with lethal weapons and who are primarily responsible for responding to a variety of public safety situations, is so dramatically different from the police structure elsewhere.

And whose officers have a track record of disproportionately stopping or arresting people of color and of using deadly force in dealing with the mentally ill.

Eh, I don’t think out “structure” is so different. Johnson is simply making another meaningless callout to Vermont exceptionalism.

As for Attorney General T.J. Donovan, he has tweeted that America’s criminal justice system is “broken,” and the time to fix it is “now.” But his proposed fixes are from the lipstick-on-a-pig bargain bin.

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Let’s Not Fix the Mental Health System and Say We Did

Oh, great. The state’s Department of Mental Health is finalizing a ten-year plan to improve the state’s inadequate mental health care system. The highlights, errrrr lowlights, include:

  • It doesn’t appear to address the system’s biggest shortfall, i.e. the lack of resources for the worst cases.
  • It echoes the approach promulgated by the Shumlin administration and legislature after Tropical Storm Irene. Which, for those just joining us, failed to do what it promised.
  • There seems to be nothing about the lack of resources in the prison system.
  • There’s nothing about providing more funding to put the plan into action.

So there’s that.

The report focuses on linking treatment of mental and physical illness, “eliminating stigma around mental health and expanding community-based treatment programs.” That’s nice. But meanwhile, people with profound mental illnesses continue to be stuck in hospital emergency rooms in greater numbers and for longer periods.

That has nothing to do with “stigma” or “community-based treatment programs.” It has everything to do with Vermont’s lack of capacity to treat our severely mentally ill. That’s been a problem since Irene damaged the state hospital at Waterbury.

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Magical Thinking vs. Entrenched Racism

Big news from VTDigger:

The Vermont Psychiatric Care Hospital is finally set to educate employees about diversity nearly two years after the state Human Rights Commission found discrimination against workers of color.

Seems like an awfully long time. One thing’s for sure, though: If they put that much thought into creating an anti-bias program, it must be a really good one.

The state Department of Mental Health is hiring ReGeneration Resources of Brattleboro to offer a one-time training to its 200 hospital employees on bullying and harassment, such terms as “implicit bias,” and how to report and respond to problems and “contribute to the creation and maintenance of a healthy, cohesive workplace culture.”

Oh, um. “A one-time training” meant to cover such a wide range of issues? That seems problematic. Unless the racist culture isn’t very deeply rooted?

The Human Rights Commission called for training after releasing a January 2018 report that found more than a decade of “repeated hostile, offensive and racist comments and actions” at the Berlin facility. There, one employee faced calls of “chocolate boy” and found the N-word scrawled on his car windshield, a second was told she commuted on “the welfare bus” and still others were tagged “nappy” and offered a stereotypical spread of fried chicken and watermelon.

“More than a decade,” eh? And we’re going to fix all of this with “a one-time training”?

I got two words for ya: Bull and Shit.

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The Narrow Parameters of Acceptable Debate

So how many political parties do we have in Vermont? Two? Three? Umpteen, if you count Liberty Union and whatever Cris Ericson and Emily Peyton have going on and the Mad Hatter of #vtpoli, H. Brooke Paige?

(I know, he’s a Republican. But any day I can mention Mr. Paige is a good day.)

Well, looking at recent policy debates in the Statehouse, you might just conclude that we have a grand total of one: The Moosh Party. Because on a whole range of issues, there’s little disagreement on the fundamentals; the discussion is confined to the details. At a time when Vermont faces some huge challenges, there’s a complete lack of bold thinking in the executive and legislative branches. We’re All In The Box.

The most basic area of consensus is on state finances. There’s no serious talk of raising taxes, cutting taxes or even significantly reforming our tax system. There’s no serious talk of raising or cutting spending. Streamlining or reforming government seems as unattainable as ever.

(When Phil Scott was running for governor in 2016, he talked a lot about “Lean management” as a way to make government more efficient and free up money to pay for new programs without raising taxes. He rarely, if ever, brings up that idea anymore. His state website touts his PIVOT program (Program to Improve Vermont Outcomes Together, and someone was paid taxpayer dollars to come up with that pukey acronym) but — deep into the third year of the Scott Era — doesn’t cite any cost savings. It does boast of 44 PIVOT projects underway and the training of hundreds of state managers and employees in Lean practices. Which makes me suspect that spending on PIVOT has outweighed any actual savings.)

When times are good and the state is enjoying unexpected revenue, the broad consensus is that we shouldn’t spend it — or at least not very much of it. The Republican governor and the four Democratic money committee chairs are in agreement on that. Except perhaps at the margins.

There’s also broad agreement that the state shouldn’t be borrowing any more money. Remember Sen. Michael Sirotkin’s ill-fated proposal to launch another $35 million housing bond this year? He’s a powerful committee chair, and his idea went nowhere. One of the loudest voices in opposition: Democratic Treasurer Beth Pearce, who’s fiercely protective of the state’s bond rating.

All this broad consensus leaves room only for piecemeal action. Take, for example, the legislature finding $6 million in this year’s budget to boost child-care subsidies. Nothing to sneeze at, but advocates will tell you that it’s a drop in the bucket compared to the actual need — for parents trying to keep their jobs and for child-care workers trying to make a living.

And it’s one-time money. That’s what passes for significant accomplishment in 2019.

Here’s another. Universal broadband is widely seen as a necessity for rural Vermont to become economically competitive. This year, the state enacted Act 79, which produces $1.2-1.4 million per year for broadband grants and creates a revolving loan fund for existing and startup internet service providers. A nice step, but nothing like a game-changer.

Meanwhile, the overwhelmingly Democratic legislature whiffed on three signature issues: paid family leave, minimum wage and a tax-and-regulate system for cannabis. What’s notable about those three, besides the whiffing, is that none of them would have cost the state much money. Paid leave? A new tax. Minimum wage? Employers would foot the bill. Cannabis? Would have brought new revenue to state coffers.

Not even on the table: Climate change, housing, education, the tattered mental health system, economic development, seriously addressing income inequality and health care reform, among others. No effort, through increased state aid or some sort of student debt forgiveness, to confront our affordability crisis in higher education. Nothing to address Vermont’s demographic crisis — except for the Scott administration’s dink-and-doink grant programs that only benefit a handful of employers and workers. On climate change, leaders of both parties acknowledge the crisis and our lack of progress toward established climate goals. But propose or approve a truly game-changing agenda? Not on your life.

Literally.

For years, politicians on all sides have talked about ending our reliance on out-of-state prisons. But actually doing something about it? Spending money on facilities or enacting new programs to reduce the inmate population? Nah.

Any effort to close the ridiculously large and still growing wealth gap, either through boosting benefits or job training or education affordability — or through increasing taxes on top earners? All talk, no action.

Health care reform would seem to be a critical need, considering that the Green Mountain Care Board just approved whopping insurance-rate premiums. But do you hear anything besides the gentle shuff-shuff of hand-wringing? Nope. I think elected officials of all stripes are still scarred by then-governor Peter Shumlin’s disastrous reform efforts. Nobody wants to call that monster out from under the bed.

The biggest exception to this depressing parade of cromulence was Act 76, which establishes a revenue source and administrative structure for waterways cleanup. Nice. But it only came after years of ducking the issue as long as humanly possible — even as toxic algae blooms make an annual joke of our alleged commitment to environmental purity, not to mention killing dogs and maybe causing Lou Gehrig’s Disease.

And action only came under threat of federal intervention. Yep, we can thank the Trump EPA for forcing Vermont to clean up its water.

This around-the-middle consensus isn’t only frustrating for those on the left. It’s got to be just as galling for conservatives, who believe the answer to Vermont’s problems lies in cutting taxes, spending and regulation. You’re not getting any of that from Team Scott, much less the legislature.

It’s funny. Vermont is widely seen as bluer-than-blue Bernie Country. But our current crop of elected leaders is comfortably at home in a narrow band of non-threatening incrementalism.

 

 

The Bourgoin reverberations

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.

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Incoherent Rifle-Wielding Man, Blah Blah Blah

In a time when America is averaging more than one mass shooting per day*, the good people of Burlington just suffered through several weeks of a homeless man riding his bike around town with a rifle strapped to his back.

*FBI definition: four or more people shot in a single incident, not including the shooter. We’ve had 29 in July so far. 

Per Seven Days’ Mark Davis, police “found [Malcolm Tanner] to be ‘incoherent,’ and he insisted that laws do not apply to him.” But they did nothing about him because “he did not seem to be breaking any laws.”

Tra la la.

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Fighting with both hands tied behind their backs

My pageview stats for the past several days tell a stark tale: I should stop writing about mental health, and go back to renewable energy*. So naturally, here I go with another piece about mental health. Ever the contrarian.

*Of course, if I really wanted to make clickbait, I’d probably write about nothing but Bernie Sanders.

The mental health care system has often come under attack in Vermont for mistreatment or overtreatment of patients, for alleged forced hospitalization, restraint, or medication. Indeed, the practice of psychiatry in general has few friends in the state. There’s a simple reason for this, and it has nothing to do with the quality of care.

It has everything to do with privacy.

Medical practitioners are legally bound to guard patient confidentiality. This is a very good thing, and I would not seek to change it. However, one of the unintended effects is that when a doctor or nurse or hospital is accused of harming a patient, only one side of the story is heard: the patient’s. If providers tell their story, they are breaking federal law and the ethical standards of their profession.

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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.

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