Department of Mental Health Commissioner Patrick Flood. VTD/Josh Larkin
MONTPELIER – The Vermont State Employees Association has thrown up a major roadblock to the state’s newly announced decision to decentralize acute mental health care.
VSEA President John Reese said VSEA will use “any and all means at our disposal” to oppose Gov. Peter Shumlin’s proposal to replace the state’s 50-bed hospital, which was damaged in the Tropical Storm Irene flood, with a 15-bed facility in Central Vermont.
Shumlin announced on Dec. 13 that he wants to spin off care for severely ill mental health patients from one facility to a handful of private regional hospital facilities on Dec. 13.
“We are not confident that the plan put forth by the administration is going to provide the necessary level of care for individuals around the state,” Reese said Thursday.
Reese said the administration didn’t consult with mental health professionals in drafting the plan, and he suggested the smaller facility may be driven more by cost considerations than an obligation to provide the best care. That point was pungently made when Dr. Jay Batra, the medical director at the now-flooded out state hospital in Waterbury and a psychiatric professor, testified in the Legislature endorsing a 48-50 bed state hospital replacement the same day Gov. Shumlin announced his plan to move in the opposite direction.
Dr. Batra has since said he was not consulted on the governor’s proposal.
Reese said he’s “confused as to why the administration has come up with this plan,” especially considering the administration itself had previously announced its support for one centralized hospital for treatment with 40-50 beds, a view he said was also taken by Shumlin when he was running for governor.
Administration Secretary Jeb Spaulding said the state simply disagrees with the union on the best way to treat patients with acute mental illness.
State officials decided in the “long view” a community-based care system was the best method for treatment. Spaulding said the state had to move quickly to deal with a stressed system following the closure of the Vermont State Hospital.
“I think you’ll find the vast majority of those interested in mental services all agree as well,” he said, adding “it doesn’t mean it’s unanimous.”
Buildings at the Waterbury State Office complex. Photo by Don Shall.
Conor Casey, the VSEA legislative coordinator, said the VSEA will consider what legal options it has in light of contract provisions that cover situations when the state seeks to “privatize” care.
He said the organization will vigorously oppose the proposal in the Legislature.
“We’re going to fight this thing every way we can,” Casey said. “We feel it’s a very bad policy decision. We feel a central facility is the best option.”
Some 240 employees were at the state hospital when it was flooded out Aug. 29 by tropical storm Irene and they are now working at facilities around the state under a cobbled together system created after the state hospital closed.
Casey said a larger facility would provide patients with access to higher quality care and preserve a highly trained work force attuned to the needs of patients who need acute mental health care.
The VSEA’s vocal opposition comes after an emotional and disputatious meeting Friday at the Montpelier VFW hall that drew around 100 state hospital employees to talk with Spaulding and then-Mental Health Commissioner Christine Oliver. (Oliver this week switched her post to become Deputy Secretary of the Human Services Agency and Patrick Flood, who has been the administration’s point man on the state hospital, left that post to take Oliver’s position.)
VSEA staffer Doug Gibson attended and said some staffers were in tears and others were frustrated though civil. He said among front-line state hospital staffers there is “unanimous” agreement that the plan is a “travesty” and the state is going in the wrong direction – and not just because jobs are at stake.
“People are seeing what this privatized system will look like,” he said. “In some instances, they’re not liking what they’re seeing,” he said.
VSEA plans to present an alternative proposal.
The administration’s proposal calls for replacing the 54-bed state hospital with a new 15-bed state-managed facility near Central Vermont Medical Center; 14 inpatient beds at the privately run Brattleboro Retreat; six at the Rutland Regional Medical Center; and up to 5 beds at the Windsor Correctional Facility to handle patients under court jurisdiction.
Mental Health Commissioner Flood has indicated that beyond those 40 beds, a raft of new community care beds will be added providing more mental health beds in the system than were at the state hospital. Mental Health officials have testified in the Legislature that as many as 20 of the 51 patients at the state hospital when it was flooded didn’t need to be there but were awaiting other placements, part of their argument that a larger new state hospital isn’t needed.
Shumlin’s plan also relies on a broad continuum of additional community services, including transitional beds for people moving off acute care, improved emergency services, housing vouchers and peer support, as well as an expanded case management system.
Some lawmakers appear to agree with the VSEA view that one central hospital is the best option for treatment of severely ill patients, while others have indicated they are open to what the governor has proposed. Flood indicated Wednesday that the administration intends to come in with a specific bill that will outline programmatic and financial steps the Legislature must approve.
Casey asked why the drafting of the plan was done in secrecy without reaching out to VSH staff. He said the union was “caught completely off guard” by the governor’s proposal and only learned about it in media reports after the announcement.
VSEA officials are not critical of all aspects of Shumlin’s proposal. They praise the beefed-up community care aspects but insist the most acutely ill need to be treated in a specialized facility with staff trained to deal with them. Dr. Batra has testified that the state needs the mental health equivalent of a “level I trauma center,” making the analogy that a broken leg can be treated at the local emergency room but major trauma needs to be treated in a specialized facility.
Dr. Batra’s assessment is correct, according to Gibson, who said VSH employees have reported that the private facilities can’t handle abusive patients.
“The hospital staff has years and years of training. They have the techniques to handle the situation,” he said. In a post on the VSEA website, Gibson wrote that the Shumlin plan will “throw away a century-plus of caregiving expertise down the drain.”
Casey said the governor’s proposal also underestimates the numbers of mentally ill patients who are now being sent to corrections facilities who need to be taken care of in a central state hospital. He said VSEA officials are hearing from corrections employees that they are being forced to deal with mentally ill prisoners who should not be in the jails and need treatment.
“They don’t have the training they need” to deal with them, he said. The state’s proposal to have up to five beds at the Windsor prison facility for people under corrections department control is “absolutely insufficient,” he said.
One of the issues disputed between VSH staff and Spaulding at Friday’s meeting was Spaulding’s contention that the state is limited to building 15 beds or less for any new mental health facility if it wants Medicaid funding participation. Spaulding said he remains convinced that is the case, though he was challenged about it the meeting.
Spaulding said a number of issues remain to be decided in the governor’s proposal, including who will pay for any new construction or physical alterations at the Brattleboro Retreat and Rutland Regional Hospital and details of a state contract with those institutions on how they will handle Vermonters in mental health crisis.
Spaulding said he understood the anguish of VSH employees who are commuting long distances to their jobs now and facing uncertainty about their jobs. He said the state would make every effort to try and keep them in the mental health system or in other state employee positions.
“I realize it’s a very emotional issue,” he said.
For his part, Reese said the VSEA is urging VSH employees to speak up and voice their concerns to lawmakers. He predicted the governor’s proposal faces “a long bumpy ride.”
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The Governor probably changed his mind about building a new 40- 50 bed state run hospital after he took a good look at what was going on at VSH. Until he got all the facts he had probably believed that the VSH decertification was only due to the building being so old. But the fact is that CMS found that staff were not documenting problems properly and were often not aware of what was going on. The VSH administration was not doing anything to deal with some problems brought up by CMS.
I worked in food service there and I can tell you about how badly that was handled. CMS found that the Director of Dietary Services failed to ensure all dietary staff adhered to accepted standards of safe food handling practices. The VSH administration did nothing to address that issue. The hospital dietician came in at noon every day for the last four years even though she was a full time employee. When I reported that to the administration they claimed they had no idea it had been going on. I found that hard to believe and I told them so. The food service was inadequate and they never checked to see that the dietician was doing anything for FOUR whole years.
That is just one of many problems at VSH that were not handled properly. Now VSEA wants to waste tens of millions of dollars of taxpayer money to build a new hospital that will certainly be run just as poorly. I’m not sure the state could even properly run a small 15 bed facility that has been proposed. It might be better to have Fletcher Allen in Burlington take on 15 beds so the proposed state run hospital won’t be needed.
More money needs to go into community services so that people don’t get to the point where they need hospitalization. The state hospital has been taking up too much money that could be put to better use. I urge everyone to write to their representatives in support of the Governor’s plan.
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Just because you didn’t like the dietician doesn’t mean that others didn’t (don’t) care about the quality of service they provided to patients there. I’d also like to point out how far away the cafeteria was from the hospital area and you would never have seen what we do on behalf of our patients on the units. Cafeteria business in NOT hospital business anyway. What are you even saying here? Your boss should have been harder on you guys, because you and your crew “failed to ensure all dietary staff adhered to accepted standards of safe food handling practices?” Personally, I feel VSH compromised quite a bit to get their CMS certification. I feel the level of training improved, the quality of care improved along with it, and the amount of restraints and seclusions declined as well. Things were steadily improving before the flood, if you don’t take the mandatory overtime into considerration. Staff at VSH should be very proud of their accomplishments. I’m sorry if you’re bitter for whatever reason, but VSH employees provide a thankless and noble public service, that few outsiders will truly know or understand. We owe it to the mentally ill of Vermont to continue providing this care, and we owe it to the staff to provide an adequate facility to provide that care in.
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VSEA Its time to look back and remember how the state closed Brandon Trining school for the developmental disability community back in 93, Largen state hospitals / Institutions are Not Cheaper they are far more Expensive $$$$!! VSH needs to stay closed and we need to reinvest our tax dollars into buliding a robust commubity based mental health system!!!!
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Given how Nicole Leblanc within her above comment has brought up the closing of the former Brandon Training School as an example of Vermont closing such institutions as well as how there is a lot to compare in what some were saying then and what is being said now along the same lines by those who try to suggest these institutions need to be kept in place, here is the link to a report about such:
http://thechp.syr.edu/brandon.htm
In addition, another report, this one about VSH authored and published back in 2007 yet still very timely and also relevant might prove helpful as well (via PDF version):
http://www.ethanallen.org/publications/specialreports/VSH.pdf
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I am glad that the state has included those who have a diagnosis of mental health issues in the planning. I am thankful to the alternatives which come in a community based system like the excellent work of Vermont Psychiatric Survivors http://vermontrecovery.com/vps.html, Another Way http://www.anotherwayvt.ning.com and Alyssum.
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Did anyone pay less taxes after these places closed? Saving the State money doesn’t mean it’s saving you any. They just reallocate the funds so they don’t have to raise your taxes during election season. As these institutions close, the crime rate rises and overall quality of living in Vermont declines. The real kicker is, the average Vermonter will pay just as much if not more, even as their level of hardship increases.
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The push for deinstitutionalization in the 1960′s and 1970′s was a good idea in its day. Policy makers got carried away with it and never adequately funded the community side of the equation. Leaving this up to politicians has us where we are today. Planning? No, government doesn’t plan. Government delays, defers, postpones, studies, forms committees, looks into, has a dialogue, has a summer study, does whatever it has to in order to avoid making decisions.
It’s also hard to argue with those who say VSH has been mismanaged. Employees are not supposed to be punching bags:
From May 18 VT Digger Article:
“It’s common for patients to punch, kick or spit at state employees who work at the hospital. Over a two-year period, nearly 200 workers were injured at the facility.”
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As a VSH employee, I’ve BEEN kicked, spit on, etc. The reason why we have to endure such abuse is largely because of the laws our state have approved to ensure that prisoners and instituionalized patients aren’t abused by workers within the facities they’re stuck in. If they’re exhibiting dangerous behavior, we literally have to wait to until someone is hit until we can seclude or restrain them.
It sounds pretty reasonable, unless you’re the one getting hit. well, as you said, it’s all politics! Now a patient can harass or disrupt others, abuse them verbally, even threaten someone, and all we can do is tell them to stop unless they physically assault someone. I love my job though. We provide a high level of care for some of the most troubled people in our state. Many of these people with issues such as severe depression or bipolar disorder can be stabilised with proper treatment, but in the interim have been deemed by the state to be too dangerous to themselves or others to live in a community setting. We help them in their most acute stages of mental illness, and get them on the right track to re-enter the community so they can try to enjoy life again. And for those that can’t leave, at least we can provide some comaraderie and a sense of community. I’ll admit it doesn’t work for everyone, but we try our best.
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Fletcher Allen is not the answer. The patients at VSH received specialized care from skilled and trained employees, care that is not possible in the long term at acute inpatient psychiatric units. Pts and staff suffer when patient populations are mixed like this. FAHC and VSH employees are still providing safe and quality care, but it is incredibly stressful, and unsustainable. Acute care psychiatric patients don’t receive the care they need, and may not seek the help they need because they are aware of the current conditions in the inpatient FAHC unit.
Vermont absolutely needs a centralized psychiatric hospital for this highly specialized patient population.
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“If they’re exhibiting dangerous behavior, we literally have to wait to until someone is hit until we can seclude or restrain them.”
THIS is another failing of VSH. Staff were never properly trained and it appears that they still have not been properly trained. The US Department of Justice found VSH guilty of violating the civil rights of patients for using too many seclusions and restraints.
Staff are supposed to take preventative actions when they see a patient is having problems and not simply wait for them to hit someone before doing something. One of the factors that leads to patient’s discontent is that they are locked up against their will. That is why the community treatment model is a better option that building another 50 bed institution.
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Curtis, are you suggesting patients who do not wish to be locked up should be released so as to avoid aggressive/assaultive behaviors on locked units? I suppose that would work for the locked units, but it might be a bit risky for the public. Of course we could probably cure the problems in correctional facilities the same way…
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Yes Curtis, DOJ found that too be true over 5 years ago. Now DOJ ranks VSH in the TOP 15% State Hospitals in the United States. Facts are facts and living in the past instead of the present is wrong. VSH had been recertified for over a year by DOJ and commended on the type of care that staff provides. People can lie, but facts are truth. Were a couple of days from 2012, if you have negative statements you need to find something from within the last year, not well beyond that. The times and culture have changed at vSH and DOJ’s fact findings prove that.
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DOJ only investigates hospitals when the level of care gets so bad that they have been accused of violating patient’s civil rights. They only investigate the WORST hospitals.
Issues with patients barricading rooms with beds existed in 1995. That was only one of the problems that was never dealt with properly according to CMS. If problems have not been fixed in a fifteen year period between 1995 and 2010 why do you expect anyone to believe they have been fixed since then?
When I worked there and started reporting problems to outside agencies I was put on paid administrative leave. It wasn’t lifted until they day my department was shut down and I was laid off. The message was clear that people would be punished for reporting problems. Anyone willing to report impropriety has probably been kicked out of VSH.
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Your right about DOJ. However you are still living off of old reports. Once again for you to read. The last DOJ report states that VSH is in the TOP 15 % of State Hospitals in the United States! FYI, there is only 1 state in the United States who does not have at least 1 State Hospital and that state’s mental health system is one of the worst in the country. That report was done after 2010 which is where you are trying to use your data from. It is 2 years later now. When was the last time you were on a unit? The barricading issue you talked about was fixed over a year and a half ago! CMS had not been back in over a year so how do you know what they would of found now. There was a plan for them to come in the fall before irene was hit. The Govenor hired someone to specifically see if there was a chance for VSH to pass. If this gentleman felt it wouldn’t then it was to be recommened for CMS not to come. The fact that CMS was indeed suppose to come in September or October proves that this gentleman found that VSH had a great opportunity to pass. Yes you worked at the Waterbury Complex, but not on the units and it has been close or over 2 years since you had, so stop making comments you can back up. Once you can come up with facts more recent than March of 2010, bring them up, but to keep saying the level of care that has been issued in the last year plus is just ignorant when DOJ reports otherwise. What happened in 1995 does not reflect what care was given in 2011. DOJ has been in 2-3 times since CMS’s last visit and both reports were very good alas TOP 15% in the country. VSH has also been recertified for over a year by DOJ. That is what the public fails to see. DOJ certification is a better standard on patient care than CMS is. CMS is about the chance tio recieve Federal monies and the biggest issue with CMS whose surveyors were hand picked by Gov Douglas who wanted VSH to fail was building conditions. Another thing that is being overlooked is even if Vermont went with Patrick Flood’s plan there is no guarentee for Federal money. There is going to be major cuts coming up at the Federal level and gee, where do they cut from 1st? Mental health. Also saying that having more than 15 beds to recieve Federal Funding is a lie. Massachuseets just built a CMS structured 220 bed State hospital and recieves Federal Funding. It also did not cost the State 220 million or 1 million per bed as Mr. Flood claims it will cost to build in Vermont.It was in fact studied with in the past couple of years to be a cost of between 40 and 48 million to build a 72 bed unit. It also is claimed that Mr. Flood’s plan would save the state money when in fact it is being reported that it will cost 22.6 million yearly for the new plan and the cost to run VSH was 21 million per year. No I may not be a math major, but anyone can see that it will cost the State and taxpayers more with this plan. As a taxpayer this is a ridiculous plan as 1 it will cost me more and 2 Vermont’s most vulnerable will not recieve the care they need and deserve. Facts are facts and it’s time to live in the present, not more than 2 years ago.
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The eighth and last compliance report by DOJ was made on October 8, 2010. It only found that VSH was in compliance with civil rights laws: “We acknowledge the sustained efforts of the staff of VSH in working towards meeting the requirements of the Settlement Agreement. Progress has been significant since our last visit and VSH is in compliance with a substantial percentage of items and those items that are in the significant compliance (none are lower) should be able to be successfully addressed in a timely manner with resources already in VSH’s possession.” http://mentalhealth.vermont.gov/sites/dmh/files/report/vsh/DMH-DOJ_Compliance_Report_8.pdf
DOJ does not certify hospitals. It only investigates hospitals that have been accused of violating patient’s civil rights. The DOJ website only lists eighteen other state hospitals it has investigated since 2003:
•Mississippi Mental Health and Developmental Disabilities Systems (12/22/2011)
•New Hampshire Mental Health System (04/07/2011)
•Delaware Psychiatric Center (Findings Letter) (11/9/2010)
•State Psychiatric Hospitals in Georgia (12/08/2009)
•Ancora Psychiatric Hospital in Winslow, New Jersey (08/24/2009)
•Kings County Hospital Center in New York, New York (01/30/2009)
•Northwest Georgia Regional Hospital in Rome, Georgia (01/15/09)
•Georgia Regional Hospital in Atlanta, Georgia (05/30/08)
•Oregon State Hospital, Salem and Portland, Oregon (01/09/08)
•Connecticut Valley Hospital, Middletown, Connecticut (8/06/07)
•St. Elizabeth’s Hospital in Washington, D.C. (05/30/06)
•Patton State Hospital in Patton, California (05/02/2006)
•Alascadero State Hospital in Atascadero, California (05/02/2006)
•Vermont State Hospital in Waterbury, Vermont (07/05/05)
•Napa State Hospital in Napa, California (06/27/05)
•North Carolina’s Public Mental Health Hospitals, Dorothea Dix Hospital in Raleigh, Broughton Hospital in Morganton, Cherry Hospital in Goldsboro, and John Umstead Hospital in Butner (03/17/04)
•Metropolitan State Hospital, Norwalk, California (02/19/04)
•Metropolitan State Hospital, Norwalk, California (05/13/03)
It looks like VSH was one of the worst 18 institutions in the US according to DOJ. CMS would not certify VSH even after millions of dollars were spent on it.
I was there and I could see how badly the VSH administration was dealing with the situation. The executive director was replaced after I left, but some of the same incompetent administrators were still at VSH. If they and their cronies are transferred to a new state hospital it would also be poorly run. Hopefully, by building a smaller state run facility, the Schumlin administration will be able to weed out the incompetents and only transfer the good employees to the new facility.
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Curtis, DOJ does in fact certify. There was a big old letter of certification hanging right outside admissions. I work there as well and know what is going on. I am not someone from the outside. DOJ was last at VSH in early 2011 and that is when the report of VSH being in the TOP 15% of State Hospitals in the U.S. I work the units and am an instructor in our crisis management, so I know the positive results that is being done. Since we went to our new sytem almost 3 years ago, seclusions and restraints have gone down almost 2/3 as to what it was with the system we used before. Staff at VSH is the best trained staff in the use of crisis communication to avoid seclusion/restraint and the numbers that we get monthly in our news letters show that. Facts are facts. DOJ was back after you last reported, they come once a year, so 2010 was not the last visit made by them, and even that report did show that we were moving in the right direction in quality of care and 2011 shows it even more.
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The working conditions at VSH got so dangerous in early 2011 that some staff talked to the press about it. Staff were being forced to work 16 hour double shifts. I recall a letter to the Times Argus asking for an investigation. Here are two articles:
http://www.wcax.com/story/14527825/forced-overtime-fight-at-vt-state-hospital
http://www.stowetoday.com/waterbury_record/news/article_4c928c78-6b7e-11e0-928a-001cc4c03286.html
This is at the same time you say DOJ came by and rated VSH is the top 15%. Maybe it was in the top 15% of the worst hospitals – the 18 that DOJ had found guilty of violating patient’s civil rights.
Citing the DOJ investigation of VSH as a positive is ludicrous. The hospital administration and staff BROKE THE LAW by violating patient’s civil rights. Now you say all those problems have been fixed. I have heard that year after year. The VSH administration was calling VSH one of the best hospitals back in the 90s at the same time that they were violating patients civil rights and then again just before it lost certification by CMS. Why should anyone believe what they are saying now?
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It seems that everyone is focused on shutting down the state hospial to rid the mental health system of history associated with the state hospital.The overall assumption is that the funds used to run the state hospital will be diverted to run and enhance community programs. So, I asked myself what indeed does happen when states close down thier instuitions?A short trip on the internet revealed that things are not so rosy, and promises rarely kept when it comes to bolstering commuity programs. In fact most states that reveal relevant information, claim a reduced ability to deal with their menalty ill citizens. Some exerpts;
Unfortunately, over the last ten years the capacity of our community support system has failed to keep pace with community needs. The funds available have not matched the increasing need for services or the increasing expenses of providing effective services. We all share in the human cost of a critical-care health system that is structurally underfunded, struggling daily to meet the needs of some of our communities’ most vulnerable people.
This above comment was from Pennsylvania from a discussion on the events after closing Harrisburg State Hospital.
The comments below are from Kanas;
While integration of individuals into mainstream society is an admirable goal, service providers are failing to meet many significant needs. Community hospitals are closing inpatient psychiatric units, and the three remaining state hospitals are currently at or near capacity. The number of beds at state mental hospitals has decreased by 456 since 1991, while the state’s population grew 10.6% between 1990 and 2005. Even persons admitted for psychiatric care in community hospitals are limited to stays of three to five days, with 45 days per year being the maximum paid by insurance companies
In 2005, the League of Women Voters of Kansas (LWVK) adopted a study of mental health care in Kansas to evaluate the significant shifting of care from state mental hospitals to community based mental health centers. This study confirms that the inadequacy of the current system has contributed to an increase in the population of the homeless mentally ill, to the incarceration of adult and juvenile offenders with mental illness, to preventable deaths among individuals with mental illness, and to the inability of service providers both to deal appropriately with individuals in crisis and to treat the physical and mental problems of individuals with severe and persistent mental illness.
This is what I fear will be happening in the near future if the current plans go forward. Alas, it already has happened in the recent past;
The trend toward deinstitutionalization took over in the late 1990s and early 2000s, drastically reducing the number of state hospital beds for persons with severe mental illnesses and greatly changing the mental health services system. Excluding government-owned facilities, in 1995, there were 433 psychiatric hospitals compared to 315 in 1999. The number of beds shrank from 43,497 in 1995 to 29,937 in 1999. As nursing homes took over a bigger role in the delivery of mental health services, controversy arose as to the appropriateness of the mentally ill living in and seeking treatment in nursing homes. The situation worsened for the mentally ill during the recession in 2002 and 2003, when many mental health programs were being targeted for cuts nationwide. Private insurers were not filling the gap left by government programs, with one study noting that the amount of resources devoted to psychiatric care among private insurers had dropped 54 percent in the 10-year period ending in 1998. Due to these reasons, several state mental hospitals closed and private hospitals filed for bankruptcy protection in the mid 2000s. Community mental health centers, a less costly alternative to inpatient psychiatric care, were overrun, and more hospital emergency rooms began taking on the care of patients with no other alternatives. When a psychiatric patient enters an emergency room, often uninsured and unable to pay out-of-pocket costs, he or she must be held until the hospital can find a bed in a psychiatric facility, taking hours or even days. As a result, many hospitals and universities began to expand their mental health facilities.
This does not seem so unfamiliar to us who are in the field.
Coming from a state who closed down a large state hospital(CT), I witnessed people living under bridges and in cardboard boxes in alleyways who were expatients of that hospital. A few years later, when the state was going through a recession, I remember speakng with someone who was involved with communtiy based mental health services and on the extent that critical funds were being cut by the state. While everyone hopes only for the best for our patients, for fullfilling lives in the community, we need o be aware of reality of the situation. The truth of the matter is that without a adequate number of beds in a state faciltiy, those people who are in the most need will find themselves in conditions far less therapuetic.
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Federal law requires that people with mental health disabilities be treated and housed in the least restrictive way possible. DOJ issued a scathing assessment of New Hampshire’s mental health system describing it as “broken” and “failing.” The report said the state was violating the Americans with Disabilities Act by unnecessarily institutionalizing mental health patients instead of spending money on less restrictive community care.
This is what will happen in Vermont if we keep pouring money into a failed state run hospital.