BRATTLEBORO — Brattleboro needs a better way to handle the mentally ill in crisis and people picked up for public intoxication, and, with some state money, local organizations can provide just that.
That's what members of the Vermont Legislature's Mental Health Oversight Committee heard repeatedly on June 15 at a special hearing held at the Brattleboro Retreat.
At present, the emergency room at Brattleboro Memorial Hospital is the first stop for the mentally ill and substance abusers in trouble.
“It's a big, big problem, people going into the emergency room who don't really need that kind of service, and it ties up the police, it ties up the emergency room and it's not good for the people who go there ... because it's a very frightening experience,” said Judith Hayward, director of Health Care and Rehabilitation Services of Southeastern Vermont (HCRS).
The oversight committee, which serves in an advisory capacity to other committees in the legislature, is making stops around the the state to solicit public input from communities about their mental health and substance abuse treatment needs.
State Sens. Kevin Mullin, R-Rutland, and Jeanette White, D-Windham, along with state Reps. Mike Fisher, D-Lincoln, Tom Koch, R-Barre Town, John Moran, D-Wardsboro, and Mike Mrowicki, D-Putney, met with about 50 mental health service providers, public officials and administrators and others gathered to give testimony and hear the proceedings.
White remarked that she was impressed by the size and composition of the meeting, which was quite different, she said, from the crowds of lobbyists that similar meetings in Montpelier attract.
Brattleboro Selectboard member Daryl Pillsbury spoke based on his long experience as a BMH maintenance worker.
Because the nighttime staff at BMH is just 16 to 24 people, most of whose duties prevent them from leaving their regular posts, Pillsbury said, he is often called away from maintenance work to assist with mental health patients in the ER.
“I have seen, in my 24 years here, a huge increase in the ER being used as a mental-health facility,” he said. “And although we have a wonderfully trained staff on medical problems, we are not trained for the stuff we are seeing now.”
“And I can guarantee you the maintenance guy definitely isn't. It's unfair for that person who comes into the ER and for me as a worker,” Pillsbury added.
Pillsbury described long waits while staff attempt to find beds for people in need of psychiatric inpatient services or detox.
He cited one patient who arrived at the hospital at 8 p.m., and whom he began monitoring when he came in at 11 p.m. The patient was still waiting when Pillsbury finished his shift at 7 a.m. the next morning.
When Pillsbury asked about the patient upon returning to work that night, he learned that eventually the patient was simply sent home, because there was no place else to send him.
'Inefficient and ineffective'
Brattleboro Town Manager Barbara Sontag also lamented the present system.
“Our current method of handling both public intoxication and mental illness is both inefficient and ineffective,” she said. “We are bouncing people between the hospital ER, HCRS and a jail cell, with no real service being delivered.”
“In one evening, we can have a person transferred to the emergency room by Rescue, Inc., and at the hospital, this person, who is there for public intoxication, is utilizing the services of skilled medical professionals.
“Hospital staff will then contact HCRS to come assess the person. They may then request that this person be taken into protective custody. With no place else to send the person, the Brattleboro police are called to transport to the Springfield correction center.”
Sondag told the panel that on most nights, Brattleboro has three to four police officers on duty, typically three.
“When our officers have to transport, it takes two officers,” she continued. “We are then left in the town with one officer on duty, and these two officers have left town for something that is really not a police matter.”
“This is not safe for the individual; it is not safe for the town, for the citizens who expect that when they call 911 a police officer will come; it is not safe for the single police officer left, who has to go into a building, who has to respond to a domestic violence call, to be by himself without any backup,” Sondag said.
The legislature has set a July 2012 deadline beyond which towns may no longer use state correctional facilities for housing public inebriates, leaving towns to figure out alternate plans.
“The legislature has acknowledged that the Department of Corrections is not the place for these people,” Sontag said. “However, you have failed to acknowledge that a local lockup cell is also not the place.”
Sontag noted that in Brattleboro, the local lockup is monitored only by a busy dispatcher.
Difficult since 1973
One of the most impassioned speakers before the committee was Ben Copeland, who has been associated with the Retreat and HCRS for 25 years and is in charge of Brattleboro's Public Inebriate Program.
Copeland said Brattleboro's Alliance for Building Community identified substance abuse as one of the area's leading health-care issues 15 years ago. But substance abuse services remain scarce, and there are no publicly funded social workers to help people obtain what services there are.
“Of the people in Brattleboro with serious mental illnesses and substance abuse problems, most receive no treatment at all. Access to behavioral health treatment is very difficult,” he said.
“Every legislative committee that has studied the substance abuse treatment system in Vermont has labeled the system as broken and totally inadequate,” Copeland said.
Koch said the legislature is well aware of the shortcomings in this area, but given the current financial difficulties, the state finds it difficult to fund the needed services.
Koch suggested that if a community-based detox center could first be established, then the legislature might have an easier time helping to support it.
“The legislature has found it difficult to fund detox centers or changes to the process for substance abuse since 1973,” Copeland replied, with evident frustration.
He said he had attended “probably 40 meetings” on this topic over the years, with the state repeatedly turning responsibility for the problem back to the towns, with little sign that towns are able to handle it on their own.
Crisis-care center
The heads of BMH, the Retreat, and HCRS reported to the committee that they have been collaborating to find solutions to the current reliance on the hospital's emergency room, and hope to establish a crisis-care center housed at the Retreat and operated by HCRS that will divert mental health and substance abuse patients from BMH and provide more appropriate care in a less stressful setting.
The Retreat has already agreed to provide 16 inpatient beds of the 54 that will be lost when the Vermont State Hospital in Waterbury is closed, which will provide more local longer-term care to patients with serious psychiatric problems.
Hayward said her agency has already created such a facility at its headquarters in Springfield and has been handling about 60 patients per month. Police can bring people there directly, and the agency has staff able to determine if there is a medical problem that requires a hospital visit.
Because of the high cost of the present system, diverting just 40 patients annually from the emergency room would justify the cost of creating the crisis center. She estimated such a center could be run for $150,000 a year, assuming the Retreat provides a space for it.
Other points
Among other points made before the committee:
• Christine Hart of the Brattleboro Housing Authority called for more supportive services for those with special needs living in low-cost housing.
• Michelle Bos-Lun of Youth Services decried the gaps in supportive services for youth created by eligibility requirements that require a history of multiple hospitalizations or other signs of extreme distress.
• Youth Services Executive Director Allyson Villars observed that while the region seems to have a norm of acknowledging and getting treatment for problems such as bipolar disorder or attention deficit/hyperactivity disorder, the difficulty of getting substance abuse treatment has led to a culture of disregarding drug problems.
Several speakers stressed that Brattleboro area organizations are ready and able to take on the challenges of handling the community's mental health and substance abuse issues, and to have the necessary structures in place speedily - if the state can put some money on the table to help.
The Mental Health Oversight Committee will hold other meetings to gather public input in Rutland on July 15 and in Burlington on Aug. 19.
When the Legislature reconvenes in January, members will report to the other, related committees on which they serve.