Tag Archives: Jay Batra

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

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.