Advocates, employees and former patients are outraged by Douglas administration’s decision to close the Canteen at the Vermont State Hospital. They say it’s the only place left for patients to get a break from the hospital’s locked down wards. In order of appearance: Malcolm Sawyer, former VSH patient; Joe Yoder, a psychiatric technician for VSH; Sarah Lunderville, executive director of the Vermont Center for Independent Living; Curtis Sinclair, Canteen coordinator; and Michael Sabourin, a patient advocate.
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The state should be cutting where the fat truly exists, not to the bone as had been its inclination: i.e., there is no need or justification for many departments or agencies across state government — most particularly within VT AHS — to retain and have so many top and middle management positions that have grown since the current adminstration came into office: e.g., deputy commissioners.
As specifically concerns VT DMH, one of the positions that should be cut is the Deputy Commissioner position as this would result in cost savings and sparing much more needed positions further down the food chain.
While the DMH commissioner and others within the department may depend on the deputy commissioner quite a bit, it would seem that when one measure priorities about what is truly most important and what gets the taxpayers the most for their dollars as well as provides the most to those the DMH is supposed to serve, this and other such high level positions should be cut instead.
I suppose one can make the argument that if the conditions get worse at VSH, it will expedite closing it down. The past five years of history suggest that the criteria for “quality” is strictly based on external accrediting organizations; there has been an ongoing trade-off of reducing supportive, esteen-building, recovery-oriented care in favor of regimentation and top-down policies. Case in point, the most recent overreaction to a situation where one patient, just prior to discharge, horded some cereal and Tylenol in his room for use later. Now, patients assessed as being safe and trustworthy enough to reach a status of freedom off the unit must be searched before reentry. What message does that give the individual about having built trustworthiness?
Closing the canteen is likely being seen as one more “risk reducer” by the administration — not a worsening of conditions. Ironically, that is contrary not just to what line staff recognize, but also to the VSH Medical Director. He spoke Friday to the NAMI conference on the topic of the interplay between genes and the environment, and how now that we understand that the environment can help actually change the brain (neuroplasticity) to overcome illness, we can effect change by, in effect, “exercising” the brain — and the most effective of all such excerises is socializing. He said closing of the canteen will have “a huge clinical impact” by taking away “the most obvious socialization” environment and “the most normalizing experience they [patients] have.”
I think there are more fundamental budget issues; this is just a symptom. We are in a revenue crisis — so how do we decide how to “share the burden?” We are making decisions with a process that includes three truly grievous and unjust aspects:
1. Whatever happenned to “nothing about us without us?” Advocates and consumers may disagree on best outcomes (case in point, this dialogue), but the state’s pledge used to include having them at the table. That can be the source of alternative ideas, as well as potential compromises, rather than bureaucratic decision-making that is oblivious to what programs are recognized as most critical by those who actually use them. The new approach has been exclusion.
2. The state and taxpayers have benefitted for years by our practice of maximizing federal money to support essential state programs. Now, those programs, not the state general fund, are expected to make up that full difference. Any cut in any other department is therefore multiplied by 3.1 for human services for an “even impact” on the general fund — rather than based upon on even impact on state programs. That is why the canteen was targeted: it uses all general fund, so it gave the administration a better bang for the buck in savings.
3. Lip service has been given to restructuring services for efficiency. Instead, cuts continue to be made by arbitary “head count” targets, instead of a serious look at specific priorities and most efficient and effective programs.
The first writer suggests the need to move more rapidly to close VSH, and I couldn’t agree more. However, moving faster on a bad plan is even worse than no movement. Under the current administration’s plan, $25 million in services today would be replaced by $90 million in costs in five years. The added cost to the state will not be greater than health care inflation, because it will all rely upon federal matching funds. (Free money…just your federal taxes instead of state.)
The first two stages planned will be the most expensive, raising doubts about the ability to ever close the other half of VSH: step one, a new, $15 million+ 15-bed locked “residence” at Waterbury for long-term treatment-resistant and forensic patients; step two, a $25+ million, 28-bed inpatient wing at Rutland that will give Rutland free replacement of its 16 existing beds and create 12 (of the 24 needed) VSH inpatient replacement beds. That construction will be funded by an Enron-type shell corporation (which means double the interest on the loan over 20 years), all paid by Medicaid bed rates (which will be double the rate than for all other payers.) They will be the most expensive 12 beds ever build in the state — maybe the country; and it smells like Medicaid fraud to me. If we follow this path, two years from now, when BISHCA rejects the CON, we will still be at ground zero.
So Paul, don’t hold out hopes of closing VSH any time soon under the present plans — with or without the canteen. For most folks, the canteen isn’t a false carrot to make institionalization acceptable; it simply made institutionalization a tiny bit more tolerable.
Although I am among those who have long been working to have VSH closed down as well as at the same time working to have built and putting into place a very different system of providing for the actual needs of those either currently or previously as well as in the future who could be incarcerated there and, will not shy away from continuing to do so at all; while it does remain open, I have come down on the side of opposing the closure of the VSH canteen out of respect for each and every one of those currently as well as formerly incarcerated at VSH who it is reported have indicated the canteen is needed for the time being as their one small bright light at the end of the tunnel, even if only a glimmer of hope is provided by such.
These needs include real, safe, decent and affordable housing, income, training, employment, transportation and other such supports and services that allow one to live independently where and how they may choose to reside.
This is of course versus what has basically been the sole focus of the commissioner and his supporters to chiefly replace the role of VSH and merely moving what is done there in the form of institutionalization elsewhere in one form or another, while mostly providing poor lip service to providing truly community-based opportunities and real inclusion for people that too many within our society would rather keep out of sight out of mind, unless the plan is to allow them to rot on the street or in jails and prisons, etc., which already happens often enough already.
The fact is that dumping people without their being offered basic housing as well as independent living opportunities and supports or services they can freely choose from when they are without such is no solution either. Not everyone has the means to provide for and support themselves after being released from such incarceration, particularly right away or so easily.
The current administration in office and the commissioner of mental health and his supporters have their priorities mixed up and have been headed in the wrong direction for quite some time.
Even though closing VSH and, not merely moving its functions elsewhere, is highly desirable and sorely needed in order to move ahead with what will be required, the closure of the canteen while the facility remains open is not, certainly not by those who are incarcerated there, nor those of us who stand in solidarity with them anyway.
I completely support mental health commissioner Michael Hartman’s decision to close the canteen at the Vermont State Hospital. It is a good start on actually closing the $22,000,000 monstrosity that is the Vermont State Hospital. The canteen has always seemed to me to be the way patients are duped into accepting institutionalization. Closing it is cutting off the head of the monster.