Editor’s note: This op-ed is by Floyd Nease, executive director of the Vermont Association for Mental Health and Addiction Recovery.
When Tropical Storm Irene flooded the Vermont State Hospital, it accomplished in one night what legislatures and administrations have been trying to do for decades. It closed the hospital.
The fact that VSH is closed and that the administration has firmly said it will not reopen is only the beginning of the story. The resulting pressure on the rest of the mental health and health care systems is enormous. As others have said, the flood has receded, but for Vermonters needing mental health care’s equivalent of intensive care, the emergency has not.
The challenge is not just the 51 patients who were evacuated (many of whom are back in their home communities now), but the (on average) five new patients every week who come into the system needing acute care.
The flood of water has been replaced by a flood of need. Hospital emergency departments all over Vermont are managing very difficult situations with patients who, prior to Irene, would have been admitted to VSH. It has even stretched the judiciary. With the loss of the centralized location at VSH for hearings, the distribution of patients all over the state has demanded an unsustainable distribution of justices. Something needs to be done, and it needs to be done quickly.
The result has been an extraordinary series of meetings organized by the Shumlin administration with mental health providers, hospitals, advocates, peers and other interested parties to discuss the future of Vermont’s mental health system. There have been meetings about the future of the mental health system for years. The difference now is that everyone in attendance knows that this time, the decisions that are made will be implemented. That makes the stakes for people with mental illness very high, indeed.
What has made these meetings extraordinary is that in a process that must by necessity be fast-tracked, the administration has worked hard to have as many perspectives at the table as possible. It would be much easier to sit in a room by themselves and make decisions. The result is that creative and alternative ideas that might never have been considered before are being taken very seriously. These meetings require everyone in the room to assume that everyone else in the room – even those with competing agendas – is acting in good faith. Some of the discussions have been difficult. All have been productive.
When Irene hit, the governor said that he didn’t want simply to rebuild our roads and bridges as they were before, but to rebuild better and smarter. So far, that principle is being applied in this effort, as well.
Even with much still undecided, it is clear that when all is said and done, Vermont’s mental health system will look very different. Current ideas for the long-term plan, still very much in development, would add acute inpatient care capacity at Brattleboro Retreat, strengthen the community crisis and long-term care system so that it can effectively work with patients who need higher levels of care, add to the capacity of community-based facilities, increase peer services and alternatives, increase community hospital capacity and beef up crisis and outpatient care at the community level.
It is still unclear whether or not there will be a new state hospital, though there appears to be general agreement that if there is, it will be significantly smaller.
It is a tall order. We at the Vermont Association for Mental Health and Addiction Recovery have had a close-up perspective on these events and have participated in many of the meetings. We have stayed in touch with advocates, the administration and those in the mental health system, and we applaud the hard work that everyone is doing.
It is not a straight line from the current crisis to what the system will ultimately look like. We can expect bumps in the road. In the end, it’s likely that no one will be entirely satisfied with the results. But I am increasingly confident that if we continue on the current course, even with all its bumps, this population of vulnerable Vermonters will be well served for many years to come.
