At Vermont State Hospital after Irene, drama – and many questions

Vermont State Hospital. VTD/Josh Larkin

Vermonters have been transfixed – and transformed – by the devastation tropical storm Irene wrought on the state’s roads, bridges, buildings and facilities, upending innumerable lives in the process.

But the damage inflicted goes beyond the realm of bricks and clapboards, asphalt and concrete, to major parts of state government.

Nowhere is the impact being felt more than in Vermont’s mental health system.

It is no exaggeration to say that Irene tore through that system as suddenly and damagingly as it wiped out covered bridges and Vermont villages. Ten days after Irene hit, state officials confront a gaping hole in mental health care and a debris field of vexing questions.

The crisis stems from the loss of the inundated and antiquated Vermont State Hospital, part of the Waterbury state office complex. Located in the floodplain of the Winooski River, it served as the state’s top facility for treating the most severely ill and those under court order for evaluation or treatment.

Not only has its staff of 240 found their work lives thrown into turmoil, but mental health providers and administrators, the judicial system and those providing legal and advocacy services have all felt the impacts, along with those who need the hospital’s services.

Because of extensive infrastructure damage to the Waterbury complex, state officials are now estimating it won’t be used again for at least several months, in the best scenario.

In a state riveted by tales of flooding, how the hospital was evacuated remains another remarkable story, and one that underscores the mess left behind for mental health treatment.

As the muddy churning floodwaters of the swollen Winooski surged into the state complex, they inundated the ground floor of the hospital, whose red-brick buildings and 54 beds are at the east side of the complex. A rough contingency plan had been mapped out, but when the emergency generators that were supposed to provide power were swamped, hospital staffers suddenly found themselves coping with 51 anxious clients, no electrical power or way to provide food, along with increasingly dire warnings that the floodwaters, already creeping into the first floor, could rise into the second of the hospital’s three floors.

So began a hectic evacuation that challenged those treating some of the state’s most mentally ill, including seven people who were under court supervision.

Staffer Kris Martin worked his regular shift Sunday until 3:30 p.m. and at that point says there were warnings but initially the river didn’t seem threatening.

“When I left work, it didn’t really seem all that bad,” he says. Staffing was the normal reduced weekend shift, which does not include administration or activities personnel, he says. He went home to hang out with his mom, who was visiting, and watched TV until the power went out in the evening around 7 o’clock and he got an inkling things were taking a dramatic turn.

Julie Young, a psych technician who has worked at the hospital for 16 years, says the change happened quickly.

“It went from, were we going to flood? to we’re flooding and everybody’s out,” she says.

The Canteen at the Vermont State Hospital

Arriving early Monday morning for her shift via a back road because the main access to the hospital was flooded, Young says she was stunned by what she saw in Waterbury.

“On my drive, I just saw upheaval. Trash everywhere, cars floating, trees down, just a mess, an absolute mess,” she says.

The whole back of the state hospital was flooded, and when she went inside, it was dark and staff and clients were using flashlights to find their way around. The overnight staff was “exhausted” but “the patients were calm, they were great,” she says.

The Red Cross brought in food and supervisors began what she calls the “orderly chaos” of evacuation, a complex and difficult process of finding space for 51 people in an already tight care system. Buses had to be ordered, sheriffs called to transport patients hospitalized under court supervision, facilities phoned to find out who had space and which clients would fit.

For Commissioner of Mental Health Christine Oliver, it was a night she will not soon forget — including discussions at one point that looked at whether “inflatable boats” might be needed to get people out of the hospital.

Arriving on site Monday morning with Human Services Secretary Douglas Racine and medical staff, within a few hours all 51 clients at the hospital were placed by the administration.

”The system stepped up in a phenomenal way, and we’re very grateful for that,” says Oliver, who receives high praise from staffers for her on-scene effort.

According to Oliver, 16 clients went to the Brattleboro Retreat, seven to the southern state correctional center in Springfield, seven to Fletcher Allen Medical Center in Burlington, eight to Second Spring in Williamstown, and smaller numbers to other mental health facilities around the state.

Rep. Anne Donahue, R-Northfield, is considered the state’s most knowledgeable lawmaker on mental health issues and often a critic of the system and mental health planning. But she has nothing but praise for the way the evacuation was handled and how mental health facilities around Vermont responded.

“That just speaks volumes about the kind of work and relationships within the system, that within two hours they were able to find a match for every patient in the hospital,” she says.

“You have to keep in mind, nobody ends up at the state hospital unless they are in a stage of illness that they are too severely ill to be admitted to any other hospital,” she says.

Donahue says the flood left her with many indelible images. When she arrived early Monday afternoon to see if she could help out, she was struck by the sea of slimy “half mud, half goop” around and in the hospital.

“I slipped before I even got in the front door,” she says.

On the swamped ground floor, she saw staff lockers flipped on their side and ceiling tiles soiled and hanging, indicating water had risen totally filling the space. The normally bustling state complex grounds were deserted.

Looking at the damage, she says, “That’s when it really hit me, this is comparable to the 1927 flood, this is a major disaster we’re facing,” she says.

In fact, the situation was historic.

“Remember, this is the first evacuation of the state hospital ever,” she says. Even in the famous 1927 flood, some 2,000 patients remained at the hospital, albeit marooned in a sea of water, she says.

Along with the mess she also found staffers from top to bottom pulling together, relating how Medical Director Dr. Jay Batra showed up with bagels and other food at 6 a.m. and staffers from other facilities came to Waterbury to pick up patients and their records.

“Everybody has really pulled together. This has been really galvanizing,” she says.

Now the hard part begins: Sorting out what the future holds for VSH staffers and clients who underwent a sudden diaspora around the state, and dealing with the much larger question of how the system will work in light of the hospital’s closure for at least an extended period.

That starts today with a meeting between Oliver and human resource officials with VSH employees whose work lives have been turned upside down. VSH staff are commuting to all the facilities where clients were transferred, including the Springfield correctional facility, where a unit was set aside for the patients. All are working 12-hour instead of eight-hour shifts and some are being put up in motels overnight and working in prisons, where they have little experience. And they are concerned that their VSH jobs may not exist down the road.

Young says some staffers are still taking shifts even though they lost their homes in the flooding.”

Conor Casey, of the Vermont State Employees Association, says the state has wide contract latitude in emergency situations but at some point many issues will come to the fore for VSH employees.

“You can imagine there’s a lot of anxiety there,” he says.

“I think a lot of people are concerned about the future of the Vermont State Hospital at this point,” he adds.

Martin, who has had several shifts at the Brattleboro Retreat, says staffers understand it’s an emergency situation and are “willingly pulling together” to care for clients.

“It was good to know that everybody was OK,” he says of his first visit to Brattleboro, where officials say the Retreat has bent over backwards to accommodate VSH clients.

But Martin says there’s also worry about the future.

“Everybody is scratching their heads wondering if they’re going to get their salaries and get their hours to keep their apartments and cars and all that,” he says. He had signed up for a Community College of Vermont course this fall and because his work schedule was radically changed, he’s had to put that on hold, “a huge inconvenience in my life.”

Fellow staffer Young echoes Martin.

“It’s a learning process every day,” she says, calling the upheaval and longer shifts “exhausting.”

Young says some staffers are still taking shifts even though they lost their homes in the flooding. “I have utmost respect for my co-workers at the state hospital who are tirelessly doing the job with very few complaints,” she says.

“Hopefully we’re going to get some answers this week,” she says of the meeting today with Commissioner Oliver. “I have to give kudos to the commissioner, ” she adds, noting Oliver has worked hard under difficult circumstances to try and keep everyone informed.

Oliver says it hasn’t been easy.

“Email has been up and down at least 12 times,” she notes, calling communication with staff about schedules and care “very very difficult.”

“There’s a lot of HR (human resources) issue we have to sort out.”

And a lot of treatment issues as well. Oliver says the state remains in “emergency mode” right now but is already looking at “mid-term options” for care. Taking up 51 beds in an already stressed system will have considerable impact on mental health care.

“We’re trying to shore up the system that we have as it exists now,” she explains, which includes looking at everything from “mobile hospital units” to renovating some structures as temporary facilities as the state looks at longer term options.
Meanwhile, new clients are entering the state hospital system, increasing stress. Rep. Donahue notes that the 51 beds used when the state hospital clients were transferred is fully a third of all the general psychiatric beds in the entire state.

“What happens with the very next patient at the door?” she asks. “How is the system going to function when it’s already stretched?”

“There are some very big questions” she says.

According to Oliver, new patients have already entered the system and been taken in at Fletcher Allen and the Brattleboro Retreat. She is in agreement with Donahue that the closing of the VSH will force major changes.

“What the bureaucrats and the administrators and lawmakers couldn’t do, maybe a tropical storm could,” says Zeigler, referring to the hospital’s closure — for now.”

The 800-pound gorilla in the mental health room is whether to renovate the damaged state hospital building or move in another direction such as a new facility, or several regional ones – all solutions the state has been unsuccessfully wrestling with for a decade now and which bring impassioned arguments from mental health advocates such as Donahue and Laura Zeigler of Plainfield.

“What the bureaucrats and the administrators and lawmakers couldn’t do, maybe a tropical storm could,” says Zeigler, referring to the hospital’s closure — for now.

“It’s still a big dangerous mess as to what will come out of this,” she says. “I hope the state can pull it off and come in for a landing.”

Ironically, the “Vermont State Hospital for the Insane” was built in 1890 in Waterbury in response to overcrowded conditions at the Vermont Asylum for the Insane in Brattleboro, which later became the Brattleboro Retreat in 1898. Now with the emergency closing of the VSH, some of its clients are back at the site of the original facility.

Despite its troubled history – federal sanctions nine years ago, suicides and a loss of federal dollars as a result – prolonged state efforts to develop a viable alternative to VSH have hit numerous roadblocks. Though a “Mental Health Futures” plan was drafted back in 2004 under Gov. James Douglas, wrangling over cost and how the system should be reformed have persistently stalled any progress.

Oliver, who retains her sense of humor in all the adversity, says state officials have been working on a new Futures plan since January.

For now, “It remains there, on steroids.”

In light of what the state faces, “We’d like to be yesterday’s plan,” she quips.

Among options the state is considering are several smaller facilities, more transient mental health beds and the idea of a few “secure” beds for those in the judicial system, she says.

Considering the state hospital’s 54 beds have been largely filled in recent years, she does not think the state can go without a facility for intensive mental health treatment, though she guesses the number of beds would be less, maybe 30 instead of 54.

Donahue, along with many mental health advocates, says closing VSH at Waterbury is long overdue. She notes she fought past plans to spend $50 million to build a new facility in Waterbury — in a floodplain.

“The sheer idiocy of it was unbelievable,” she declares. While some advocates support a new slimmed down modern facility, or facilities, for critical care, others such as mental health blogger Morgan Brown advocate not replacing the hospital at all, but building “a robust community-based system” instead.

On one thing there is unanimous agreement. After years of debate, the muddy waters that closed the hospital have made it perfectly clear that the state has no choice now but to confront the issue and finally adopt a plan.
Ahead lies both opportunity and risk, especially when state and federal finances are tight.

“The biggest hope is that it finally forces something to happen. The biggest fear is that it forces the wrong thing to happen,” says Rep. Donahue.