Mental health system faces major overhaul

BRISTOL — The restructuring of the state’s mental health system post-Irene was the hot topic at Monday’s legislative breakfast in Bristol, a timely discussion that gave lawmakers some food for thought as they weigh options on how to replace the Vermont State Hospital.
Tropical Storm Irene flooded the 54-bed state hospital in Waterbury last August, leaving state officials with the challenge of maintaining services for some of Vermont’s most vulnerable mentally ill patients. At the same time, the flooding presented the Shumlin Administration and human services providers with the opportunity to replace the Waterbury facility — which state officials acknowledge has been deficient on many levels.
“There is a broad consensus that the old way we (administered mental health services) was not working,” said Rep. Willem Jewett, D-Ripton, and House majority leader, at Monday’s breakfast. “The care wasn’t something we could be proud of, in a number of respects, nor were the bricks and mortar. The people who delivered that care did it earnestly and with the best intentions and they were trying. But the system they were working with just wasn’t up to the task.”
Gov. Peter Shumlin has proposed replacing the state hospital with a 16-bed facility in Berlin, along with six acute-care beds at the Rutland Regional Medical Center and 14 at the Brattleboro Retreat, along with five additional beds for the Corrections Department at a site not yet determined.
The broad intent, Shumlin has said, is to provide a more de-centralized, community-based mental health care system in Vermont.
Jewett agreed with the administration’s philosophy.
“We in Montpelier have to absorb the crisis and say … ‘What is going to work in the long run?’” Jewett said. “We need to make sure people are safe during this crisis period, but it is going to take some time to build our capacity back up.”
Jewett said it will take time to build a new facility, so community-based solutions will be imperative during the months ahead.
The Vermont House recently approved Shumlin’s plan, with one significant change — the Berlin facility would have 25 beds, not 16. That vote is not sitting well with some lawmakers, including Rep. David Sharpe, a Bristol Democrat and a longtime member of the House Ways and Means Committee.
“The federal government will pay for a 16-bed hospital; they will not pay for a 25-bed hospital,” Sharpe said. “It seems to be a no-brainer that we build a 16-bed facility that has the infrastructure in it … so that if we need 10 more beds in five or 10 years, we add 10 beds at that time. But to forego federal support for a mental health facility at this point in time is foolishness.”
Sen. Claire Ayer, D-Addison, is chairwoman of the Senate Health and Welfare Committee. She said she is more supportive of the original proposal for a 16-bed facility on Berlin because it is “not irreversible,” but warns that it will cost millions of dollars each year to manage the beds once they are in place. She explained the state hospital patients are currently being served in certified hospitals and are therefore eligible for federal Medicaid reimbursement. That will no longer be the case when they move into the new state facility with more than 16 beds, she said.
Ayer on Wednesday noted an offer by the Central Vermont Medical Center and Burlington’s Fletcher Allen Health Care to jointly operate a new mental health facility on CVMC grounds in Berlin. But Ayer said the plan calls for the state to help bankroll a new mental health facility over which it would not have oversight of patients. That, among other things, has prompted the Shumlin Administration to pan the proposal.
Robert Thorn is executive director of the Counseling Service of Addison County (CSAC). He — as well as the Vermont Council of Developmental and Mental Health Services (VCDMHS) — favors the notion of a 16-bed hospital for patients with acute mental health needs, while increasing support for community-based services.
According to Thorn, Vermont Mental Health Commissioner Patrick Flood hopes to secure around $8 million through this year’s budget adjustment act and the fiscal year 2013 general fund budget to help regional mental health agencies adapt to Shumlin’s proposal for a more decentralized mental health system. That number is somewhat smaller than the VCDMHS believes will be necessary to do the job, but Thorn is optimistic a plan can be worked out. He said CSAC estimates it will need at least $500,000 in additional state funding each year to adapt to the Shumlin plan, money that would be used for such purposes as hiring more staff to oversee local crisis beds and bringing on more case managers to keep track of an increased client load.
“The commissioner has been providing very strong leadership on this,” Thorn said.
Ayer said the Senate could vote on the mental health bill as soon as this week.
Reporter John Flowers is at [email protected].

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