Yesterday’s happy-smiley ribbon cutting at the new State Hospital in Berlin was, indeed, a happy occasion. The post-Irene period — almost three years — has been extremely tough on seriously ill patients, their caregivers, and the entire mental health care system. Long waits, days spent in emergency rooms, endless shuffling of patients from one facility to another, constant searching for even a single empty bed. It’s been damn tough, and the interregnum has been longer than it should have been.

But nobody should confuse this milestone with the finish line. There are still a lot of questions to answer and issues to address. (Many of these were covered in Pete “Mr. Microphone” Hirschfeld’s fine piece for VPR, which went above and beyond the pro forma coverage of a ceremonial event and actually addressed the meat of the issue.) First and foremost: is this new hospital big enough?

After Irene, the experts were insisting that a new hospital needed to be at least as large as the old one. Instead, it’s half as big. I realize we’re trying to deemphasize hospitalization and move to a multifaceted, community-based system. But we’re talking about the sickest of the sick: even at 54 beds, that’s one bed per 11,593 residents. A central hospital isn’t for patients who might be better served in outpatient or community settings; it’s for the very, very small number of people who are too ill to function, too dangerous to themselves or others.

It remains to be seen whether 25 beds are really enough. It’ll definitely ease some of the intense pressure on the system, and it should prevent the widespread warehousing of patients in ERs or other unsuitable locations.

And there’s still widespread legislative dissatisfaction with the cost of the new facility, which makes me fear that the hospital will be nickel-and-dimed by lawmakers more concerned with the bottom line than with adequate patient care. Sen. Jane Kitchel, for one: she was more than pleased to take part in the ribbon-cutting, but she’d really like to see the hospital run more cheaply. 

Many lawmakers are complaining that the new hospital’s per-patient costs are substantially higher than the old one’s. That’s true, but I’d point out a couple of obvious items:

— The old hospital was inadequate. Everyone says so. It lost its federal certification, which meant it did not qualify for Medicaid funding. If the old hospital wasn’t up to snuff, well, of course the new hospital will cost more.

— Many of the costs are fixed. So when the Legislature happily signed off on a smaller facility, it tacitly agreed to much higher per-patient costs. A brand-new 54-bed state hospital would have had higher operating costs than the old one, but it would have cost a lot less per patient than the new 25-bed facility. This shouldn’t be a surprise to anyone in the legislature.

— Many of the costs of the old state hospital are now redistributed across multiple locations, and helping to fund new community-based programs. (Or at least that’s the way it’s supposed to work.) This very intensive kind of psychiatric care requires staffers with special training and expertise; in a single central facility, you can have a more concentrated level of expertise. In the new system, we’ll have to spread those people around. And almost certainly hire more of them.

So I don’t want to hear any whingeing from the legislature about the new hospital’s cost. This was their idea.

But it must raise serious questions about the legislature’s willingness to fund the community-based facilities that are supposed to undergird the whole system and prevent a whole lot of hospitalizations. <a href=”http://digital.vpr.net/post/after-long-wait-mental-health-hospital-ready-first-patients”>Via Hirschfeld: </a>

Northfield Rep. Ann Donahue is a mental health advocate who has spent years advocating for a new state mental hospital. Impressive as the new facility is, Donahue says the system won’t function properly unless the community-based facilities are actually built. And she said much of the bed space and treatment capacity called for in the reform plan have yet to be constructed.

“Some of them are still in development, some of them are on budget hold. And we need to really enhance that aspect or we won’t reduce the need for inpatient care,” Donahue said.

At the ribbon-cutting, Human Services Secretary Doug Racine trumpeted the claim that Vermont “has the best mental health services in the U.S.” As of today, that claim is one step closer to reality but, fundamentally, it remains in the realm of political blather. The truth is, Vermont may well have the best mental health care system in the country ON PAPER. But a long struggle remains to turn it into reality. And penny-pinching Democrats are, sad to say, the biggest obstacle in our path.