The Vermont State Hospital in Waterbury, an integral - and controversial - part of the state's mental health system for well over a century, has treated its last patient.
Last week, Gov. Peter Shumlin pronounced the antiquated facility, built in 1890 and flooded out by Tropical Storm Irene, finished as a treatment site for Vermonters in mental health crisis. “It is old, it is decrepit,” he said, and it does not serve Vermonters well.
“It is my intention to never to go back to Waterbury for the state hospital,” he said.
Speaking at a press conference, the governor also outlined four steps the state is taking to provide a continuum of treatment options for those needing different levels of care as the state restructures the entire mental health delivery system in Irene's aftermath.
He said the proposed interim system embraces improvements that should provide more and better treatment options. It will also “take the pressure off” hospitals that have had to take in patients they are not well-suited to treat after the state hospital was evacuated Aug. 28.
The plan outlined should also make the state eligible for Medicaid and Medicare dollars the state has forfeited for nearly a decade at the state hospital because of quality or care issues, he said. He said Vermont has been out $10 million a year and should recoup some of that money, as well as be able to use FEMA funds to implement changes.
Mental health advocates and agencies unanimously welcomed closure of the state hospital, but some, such as Rep. Anne Donahue, R-Northfield, worried the interim plan would become the de facto future and jettison years of discussion on how best to deliver mental health care. Others said it still did not go far enough toward a community-based system.
Julie Tessler, executive director of the group representing mental health service agencies, said she liked the increased emphasis on expansion of community-based services in the proposals Shumlin announced.
The state has been scrambling in the last eight weeks to find alternative facilities to house those in acute mental health crisis following the emergency evacuation of 51 patients from the state hospital's Brooks Building.
The governor's comments put to rest a controversial stop-gap plan to fix up the unflooded floors of Brooks as a treatment site for up to 30 patients while better options are developed. A cost estimate was around $1.3 million, but money was not the issue, he said.
“It was my belief that the state hospital was not a facility that dignified the treatment that we should give to our most vulnerable citizens in this state,” he declared.
In its place, Shumlin said human services staff working “24/7” have developed alternatives that will ease the crisis created when VSH patients were spread around the state to other facilities, filling up a third of all mental health care beds in the state and leading to limited treatment options.
Under the interim plan outlined by Shumlin, Deputy Human Services Commissioner Patrick Flood and Mental Health Commissioner Christine Oliver, the state envisions around 30 acute-care beds at two different facilities.
Shumlin said the Brattleboro Retreat had agreed to provide 14 of those to handle patients such as those formerly treated at the state hospital. While the Retreat is already providing 15 slots, it will make renovations and changes to take on more difficult clients, officials said. Those beds should be available “in a very short time,” Shumlin said.
The state is also trying to create 15 more acute-care beds at the site of the bankrupt Pine Ridge School in Williston, near Central Vermont Hospital, in conjunction with Washington County Mental Health, or potential other sites, the governor said. Those will take more time to develop, Shumlin said.
Thirdly, the state is working to fund two additional “step-down” facilities such as Second Spring in Williamstown, where patients can go to transition from acute hospital care as they prepare to go back into the community. Second Spring took a number of patients from the state hospital when it was flooded, and its model was praised as effective by officials Thursday.
Fourth, the state is working to set up so-called intensive “wraparound” services. Flood said the state has been using these successfully for more than two decades and will add services for another 20 people, who would be treated at home or in special apartments. He called it “more of a home-based model of service” that offers intensive care and is an option for those who don't do well in a hospital setting.
Shumlin, who noted the state is now moving “from crisis management” to a 3- to 5-year transition period, said these steps together will ease stress on the system and that the state will evaluate which of these services works best as it works to solidify what a future system will look like.
Asked whether 14 beds at Brattleboro Retreat were sufficient for those in acute crisis, Flood said it depended on the rest of the system. He noted a “very close analysis” of the 51 patients at the state hospital before Irene found that “about half were there because they could not find an alternative.”
Flood said the new “enhanced services” being set up, coupled with an effort to improve emergency services to identify those in crisis earlier and forestall their ending up in the hospital, should ease pressure on the system.
The goal, he said, “is to make sure the right person is in the right bed at the right time.”
Oliver said the state was going to phase out its use of the correctional facility in Springfield for mental health patients who are under court-ordered supervision. Six patients are being housed there now, but no more will be added, she said, observing that other options will be used. She has called the prison a problematic place for mental health treatment.