A majority of members of the House Human Services Committee expressed support on Wednesday for a 25-bed facility in Central Vermont that would replace the Vermont State Hospital.
The Waterbury facility, which was damaged in the Tropical Storm Irene flooding that devastated the town of Waterbury, had enough capacity for 54 patients.
The committee has been asked to fast track passage of a plan to provide treatment for patients with severe psychiatric problems. House Speaker Shap Smith set the deadline for the bill to emerge from House Human Services at end of this week. House Corrections and Institutions is working on a financing plan concurrently. The bill would then be up for passage on the House floor before it goes on to the Senate. The governor wants the legislation on his desk by Feb. 17.
Gov. Peter Shumlin has proposed a 16-bed facility, and at a press conference on Wednesday, reiterated his stance that the state doesn’t need a larger psychiatric hospital. His administration has advocated for a community-based support system for the severely mentally ill and a four decentralized institutional settings for care. In all, his plan includes 41 beds — 14 at Brattleboro Retreat, six at Rutland Regional Medical Center and four secure placements at the Windsor correctional compound.
Lawmakers and the Shumlin administration are expediting the standalone bill so that the state can move ahead with plans to create new capacity at two regional hospitals, a prison compound and a proposed new facility in central Vermont as soon as possible. Patients who were displaced at the end of August and new patients who need acute psychiatric care have been sent to treatment facilities around the state. State officials are anxious to finalize plans so that permanent “no refusal” psychiatric beds can be made available to patients as needed.
In discussions on Wednesday, 7 out of 10 lawmakers on the Human Services committee, including the chair, agreed that the state needs a state-run facility with at least 25 beds. Most also said the structure should be designed in such a way that wings can be added on to it in future if the community mental health system plans and placements at regional hospitals don’t work out.
After each of her committee members voiced their opinions on the key issue in the draft legislation, Rep. Ann Pugh, D-S. Burlington, said she struggled to make a decision.
“I came at this wanting to come to yes with the governor’s proposal,” Pugh said. “I’m three-quarters of the way to yes.”
Pugh said she believes it’s important to have a geographically dispersed system for acute care and she “fully supports” placements at Rutland Regional and Brattleboro Retreat. A facility in Central Vermont, she said, will have to serve as the main facility in northern part of the state, and given the larger size of the population, she believes a 16-bed facility is too small.
A new facility, she said, won’t be enough to guarantee quality care.
“We need to do things differently,” Pugh said. “We’re not just talking about building beds. The kind of care and treatment needs to be different. We need to discuss what recovery means and flesh that out if we want a recovery-oriented system.”
Rep. Anne Donahue, R-Northfield, supported a 25- to 30-bed facility in Central Vermont along with units in Rutland and Brattleboro. She wants the state facility to be large enough to accommodate the spikes in patient population. The 16-bed plan would create a situation in which there would be no excess capacity in the system for patients for about 20 days a year, she said.
“This is not a hospital patient level that stays the same — it’s very much in flux,” Donahue said.
The Shumlin administration is using an average patient count to drive its patient capacity model. A more accurate picture of the daily need, she said, is an actuarial analysis in the 2006 Milliman report to the Legislature that projects psychiatric patient load through 2016. In a chart produced by the firm, there should be an additional bed capacity of 10 for erratic changes in patient population.
“What we don’t know is how many community services have to go into place to absorb unmet need to reduce inpatient beds,” Donahue said.
The question, Donahue said, is what happens on each side of the gamble.
“If you build it too big, you have the potential of filling it with people who didn’t need that level of care,” Donahue said. “The risk of making it too small is catastrophic. Making it too small means death. Sometime along the line more than once. We will have many days when we will not have the capacity.”
Most of the committee members also agreed that the Brattleboro Retreat and Rutland Regional Medical Center contracts should be for four years, rather than 10 years, as originally proposed. Committee members said the Legislature should have an opportunity to evaluate the effectiveness of care provided by the facilities at that juncture.
“We can’t have any of those (short-term contracts) without evaluations, without being clear about what it is we’re looking for,” Pugh said.
Pugh said the state will be covering capital improvements for the two facilities to accommodate psychiatric patients and these permanent structural improvements will continue to be an asset into the future. “I don’t think it’s a loss for them,” she said.
The draft legislation (as of Wednesday) would also shore up community-based treatment programs ($1 million, for example, would be set aside for peer services; $8 million for regional nonprofit mental health centers; and $600,000 for housing subsidies); and funding to support patient care in treatment centers in Brattleboro, Rutland and Windsor.
House Human Services also debated a set of principles that would be used as a framework for reforming the mental health care system in Vermont. A few of those tenets: Protecting the legal rights of patients; a commitment to oversight, accountability and transparency; alignment with future health care reforms; geographic and financial accessibility; long-term planning; high standards of care; and coordination of a continuum of care within the most integrated and least restrictive settings available.
Editor’s note: This story was updated at 6:15 a.m. and again at 6:34 a.m. on Jan. 26. Correction: Seven members, not eight, supported the 25 bed or more option.
