Editor’s note: This op-ed is by Rhett Williams of Roxbury.
I work for the Vermont State Hospital and am part of the Therapeutic and Recovery Services department. This letter is the opinion of a citizen who hopes for the best possible services for Vermont’s acutely mentally ill. It does not attempt to represent the perspective of other VSH staff.
Tropical Storm Irene inflicted a heavy toll on the state of Vermont. Nowhere was the damage greater than at the state hospital in Waterbury.
Many buildings, roads and bridges were destroyed by the storm. Most of those buildings, roads and bridges have been repaired by now.
The damage to the state hospital in Waterbury, effectively shutting it down, and the state mental health system continues to take a heavy toll on those who suffer from severe mental health challenges. Taking approximately 50 beds out of the system has left some of the state’s most vulnerable without a safety net in times of crisis.
The state’s most severely mentally ill are obviously difficult to treat in times of crisis. This is why the staff of the state hospital are spread around the state assisting other facilities.
Many of the most ill in the state are well known to VSH staff. Staff at other facilities are less prepared to handle patients when they become violent or threaten violence.
When patients become violent or pose a threat of violence facilities in the community, such as Second Spring in Williamstown, usually call screeners and have patients transferred to emergency rooms. This creates a tremendous burden on emergency rooms and hospital psych units across the state.
VSH staff are used to dealing with such behavior and can often de-escalate these situations without resorting to physically restraining or secluding patients. This is why it is absolutely necessary that VSH staff continue to be part of the treatment of these patients.
This is also why this situation is so difficult. VSH staff are working 12 hour shifts for three or four days at a time in locations far from their families. Separation from families, and typical routines is extremely stressful for staff. This stress, over time, will affect the quality of care provided.
A centrally located facility would reduce this stress and allow workers to return to their lives. The cheapest option, though incredibly unpopular, would be to return to the two undamaged floors of the Brooks building in Waterbury. This would improve the quality of care and increase the number of beds in the state to ensure that all those in need have a safe place to begin to recover.
While you may be aware of the perspective I have shared above there is something else I would like to point out. I am an activities therapist for VSH. My department, Therapeutic and Recovery Services, provides groups designed to facilitate psychosocial rehabilitation. TRS is pivotal in providing an environment and a framework where patients can improve.
Before Irene some groups occurred on the units where patients rooms, a dining hall, recreation rooms and showers are. The majority of the work we did took place in the treatment mall. The treatment mall was a very different space from the units. There were carpets, new tables and furniture. Patient art adorned the walls.
When patients were granted permission to attend groups in the treatment mall by their doctors it was a sign that their symptoms were becoming more manageable and that they were taking a step toward leaving the VSH. We engage patients in conversations about their experiences with mental illness, hope, self esteem, triggers, warning signs and goals. Group topics include, Wellness Recovery Action Plans, exercise, knitting, defining recovery, yoga, sensory modification groups, a hospital wide work program, transition to the community, cooking, and many others. Some groups occurred on the units where patients rooms, cafeteria, recreation rooms and showers are.
A patient’s ability to participate in these groups helped hospital staff measure the progress toward goals and their readiness to return to the community. There was a correlation between the creation of the treatment mall and decreased average length of patient stay. There was also a correlation between the creation of the treatment mall and a decreased likelihood that discharged patients would be admitted again. Every morning TRS staff met to discuss patients who were expected to have treatment plans that day. One TRS staff attended each treatment plan with a Social Worker, a Doctor and one Nursing staff. Our feedback helped the treatment team gauge a patient’s progress toward goals. Patient goals often included rates of participation in groups and the work program.
The treatment team, as we knew it, appears to have been a casualty of the storm. Treatment has suffered in innumerable ways. Many community facilities have neither a structure nor an economy of patients that enables TRS staff to provide substantive groups as we did in the treatment mall. We need a centralized location where psychosocial rehabilitation can occur again.
If the state is truly committed to serving the most vulnerable Vermonters we have to provide a safe space for those who are the most acutely ill to begin the process of sustained recovery. We have to utilize the staff of VSH in a congruous way in which we can pool our skills in one facility and act as a team once again.
VSH Therapeutic Recovery Services staff provide the most dynamic psychosocial education in the state and it is our goal to provide services on par with the best in the northeast and the country.
I urge you to support a return to undamaged portions of the Brooks building in Waterbury for the time being, while a new facility is built or retrofitted. This storm has given us a chance to create a world class space where we can provide world class services. The mentally ill of this state can not afford to watch Vermonters let this opportunity go to waste.
