Category Archives: Mental health care

Vermont’s new mental health system will have more inpatient beds than the old one

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I wouldn’t blame Jay Batra if he felt personally vindicated today. Maybe even a little bit smug. VTDigger’s Morgan True: 

The state wants to replace a temporary psychiatric facility in Middlesex with a permanent structure twice the size, officials told lawmakers last week.

… Last June Vermont opened the doors of the Vermont Psychiatric Care Hospital in Berlin, but the system still lacks the capacity to keep people with acute psychiatric needs out of emergency departments.

How about that. “…the system still lacks the capacity…”

Vermont’s new, decentralized, community-oriented system currently has 45 beds: 25 at VPCH, 14 at the struggling Brattleboro Retreat, and six at Rutland Regional Medical Center. If/when the Middlesex facility is built, the system will have 59 beds.

Before Tropical Storm Irene, the Vermont State Hospital had 54 beds. After Irene, the Shumlin administration insisted, repeatedly, that if we had a more robust community-based system, we wouldn’t need that many inpatient beds. In the process, it ignored the counsel of psychiatric professionals, who said that 50 was the bare minimum.

What’s happened since then? The administration has slowly, quietly, built the system back up. And it has found that, yes indeed, those professionals knew what they were talking about.

Let’s take a trip in the Wayback Machine to Tuesday, December 13, 2011…

Gov. Peter Shumlin announced on Tuesday that his administration plans to replace the Vermont State Hospital in Waterbury with a decentralized, “community-based” plan with 40 inpatient beds in four locations around the state. …

The unveiling of Shumlin’s proposal came on the same day a top mental health psychiatrist called for almost the exact opposite of what the governor proposed. Dr. Jay Batra, medical director of the state hospital since 2009 and a professor at UVM, told lawmakers at a hearing on Tuesday that the state should have one central mental health facility serving 48 to 50 patients in order to provide the best clinical treatment and best staffing model.

That, from a lengthy VTDigger account of Shumlin’s announcement, which was made in the conspicuous absence of Dr. Batra. At the time, Shumlin was planning on a central hospital with as few as 16 beds. It was a well-intentioned effort to avoid the serious problems that had plagued VSH in the past. But it was a misdirected effort, pursued against the advice of those actually in the field.

At the time, I wrote some highly critical stuff about the administration’s plan, and I got some active pushback from administration officials who basically accused the psychiatric community of professional puffery — overstating the need for their own expertise.

Now, it’s safe to say that the administration was wrong.

Assuming the Legislature approves the $11.4 million Middlesex facility, the mental health system will have more beds than before Irene, and those beds will cost more than a similar number at a single, central State Hospital. How much more, I don’t know. But the system has had persistent problems hiring and maintaining the staff it needs for the specialized care its patients require. Those problems are exacerbated when the beds are spread among four separate facilities.

Also unknown is how much money was [mis]spent on the long and winding road to get exactly where the experts thought we should go in the first place. Plus, we are left with a system that’s almost certainly more expensive to operate and harder to administer because of its geographic spread.

One of Governor Shumlin’s great strengths is his decisiveness. He can assess a situation quickly, make a decision, and carry it through. Well, it’s a strength when he’s right. When he’s wrong, and he stubbornly insists on staying the course, that same decisiveness is one of his great weaknesses.

So it was a push, not a jump

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Media reports posted after my initial VPO piece on Doug Racine’s departure make it clear that Racine was fired as Human Services Secretary; he did not resign. And he was fired in a sudden and coldblooded way. The best reporting comes from Paul “The Huntsman” Heintz, who got the skinny from the firee himself.

In a phone interview, he said he was summoned to the 5th floor of the Pavilion State Office building at 4 p.m. Monday for a meeting with Shumlin chief of staff Liz Miller and Secretary of Administration Jeb Spaulding.

“I went in and sat down. They said, ‘The governor wants to make a change at your agency.’ I said, ‘Who would that be?’ Jeb looked at me and said, ‘You,’” Racine recalled. “We talked about it for a few minutes and then I went to the office and cleaned out my desk.”

So now we know who wields the hatchet in the corner office. Shumlin did give Racine a call about an hour after the meeting, and it was relatively cordial; but hell, couldn’t he do the actual deed himself? Especially since Racine had handled the hardest and most thankless job in state government for three and a half years?

There was also a Profiles In Courage moment Tuesday afternoon, when Shumlin went kinda wishy-washy on the nature of Racine’s departure, i.e. voluntary or not:

Asked what, specifically, prompted Racine’s exit, Shumlin said, “Specifically answering your question is exactly what I’m not going to do.”

Well, at least it was a head-on refusal to answer instead of the usual “bury ’em in bullshit” routine.

When I call AHS Secretary the “hardest and most thankless job,” here’s what I mean. It handles a whole lot of disparate programs aimed at helping our most unfortunate. It’s a huge agency by Vermont standards. As I noted earlier, it was hit hard by the Douglas Administration’s ill-fated Challenges for Change initiative, not to mention its misadventures with technology contracts (which were at least as bad as Shumlin’s). And it was ground zero for the health care reform effort and all the attendant troubles.

In addition, AHS’ challenges were compounded by Tropical Storm Irene, which left a whole lot of people in need of help — and which scattered the agency’s personnel to rented spaces in multiple communities because of the flooding in Waterbury. And they are still scattered today. Not to mention the flooding and forced closure of the Vermont State Hospital and the ensuing years of chaos in the mental health care system. 

Doug Racine handled all of that with grace and dignity. He kept his nose to the grindstone and almost never uttered a discouraging word in public. I’d think that was a good thing, but apparently he was too quiet for Shumlin’s taste:

According to Racine, the governor wanted a secretary more willing to engage with the news media and interest groups.

“If anything, it was perhaps not being out there enough,” Racine said.

I always thought Racine’s quiet style was perhaps exactly what Shumlin wanted from his longtime political rival. Either that, or Racine himself opted for the low-profile approach because he didn’t want to come across as bitter or as a potential political threat.

As I said in my previous post, I understand the need for a sacrificial lamb. And between the problems with health care and DCYF, I can see why Racine got the axe. But the way it was done? I think Racine deserved better.