A comprehensive bill that replaces the Vermont State Hospital and creates a broad new spectrum of community mental health treatment won near-unanimous backing Thursday in a preliminary vote in the Vermont House.
“This is a historic moment,” said Rep. Ann Pugh, D-S. Burlington, as she spelled out to House lawmakers details of the sweeping bill drafted to respond to the loss of the 54-bed state hospital in Waterbury, which was flooded and closed by Tropical Storm Irene.
By a 124-3 vote, legislators agreed with Pugh, chairwoman of the House Human Services Committee, that it was time to seize “this tremendous opportunity growing out of the crisis Irene gave us.”
“We’ve been talking about transforming the mental health system in Vermont ever since I’ve been a legislator,” said Pugh, noting the state’s extensive and futile effort in the past decade to plan and fund a replacement for the antiquated buildings that comprise the state hospital.
Lawmakers have been working feverishly for weeks with the administration of Gov. Peter Shumlin to draft legislation that addresses the mental health treatment crisis caused when the acute-care state hospital beds were removed from the system.
The governor launched the process in December when he declared patients would never go back to the Waterbury facility and set out a plan to trim acute-care beds, arguing for a comprehensive proposal that stresses treating mental illnesses in a spectrum of community settings instead.
Lawmakers in the House tweaked Shumlin’s plan and together with Mental Health Commissioner Patrick Flood filled in innumerable blanks on funding to come up with the consensus bill that won backing Thursday.
Flood said Thursday that the pricetag for the proposed system is around $174 million, roughly $20 million more than the fiscal 2012 mental health budget. However whether there is any actual cost increase to the state is unclear because of the complexities of extensive federal Medicaid reimbursements.
The one major dispute over the bill involved the size of Shumlin’s proposed new state hospital in central Vermont, which lawmakers decided needed to be bigger than the 16 acute-care beds proposed. The bill, H.630, proposes a 25-bed facility instead. Those beds are paired with a six-bed facility at Rutland Regional Medical Center and 14 beds at the Brattleboro Retreat.
The bill also calls for a secure five-bed acute-care facility for patients under department of corrections control.
Rep. Alice Emmons, chairwoman of the House Institutions and Corrections Committee, told House lawmakers her panel struggled with the complexities of deciding the right size for the new state-run hospital since Vermont doesn’t know how much FEMA and insurance money will be available for the $25 million facility. But she also said because the hospital won’t be built for “anywhere from two to three years,” stakeholders in mental health will have to time to make sure the 25-bed hospital is right-sized for the needs of Vermonters.
Pugh noted more than 70 individuals from psychiatrists and clinicians to mental health experts and consumers came before her panel, some urging no state hospital beds at all and others as many as 100.
“We spent over a month trying to weigh those different perspectives,” she said. Her committee eventually concluded by a 9-1 vote last Friday that a 25-bed facility was needed in the northern part of the state and formed the best “backstop” to meet the needs of Vermonters and provide a professional “staff to promote recovery.”
“We were not able to receive sufficient data that a 16-bed facility could do that,” she said.
The overhaul bill includes a range of other beds outside of the acute-care facilities: four short-term crisis beds designed to avert hospitalization, a five-bed voluntary non-coercive residence with peer support; and one 15-bed and two eight-bed facilities around the state providing for intensive recovery.
A wide variety of peer services provided by those who have had experience in the mental health system, crisis intervention teams, housing subsidies and mobile support teams are also provided in the bill. The community services, housing and the four-bed and five-bed beds facility are estimated to cost $8 million annually.
The bill that reached the floor included a provision to ensure that the 240 state hospital workers, who were dispersed to work at facilities around the state, will have extended and preferential rights for jobs when the new state hospital is built. Emmons said those provisions were agreed to by the Vermont State Employees Union and the administration.
Rep. Thomas Koch, R-Barre Town, rose to support the bill, humorously saying he felt like a member of the audience throwing flowers on the ice at the national skating championships. Noting he had “become extremely frustrated by the lack of progress” during the last nine years in reforming mental health, he praised the committees that slogged through the complex process and found consensus.
While he had his own concerns about letting private institutions handle some of the former state hospital patients, he said lawmakers should be “extremely proud” of the bill.
“There’s been a lot of inaction, a lot of talk. We’ve done more in the last five months than we had done in the last eight and a half years,” he said.
The bill will have its final reading Friday and upon passage move over to the Senate for that body’s review.
Rep. Pugh was elated with the large margin for passage.
“I think a vote of 124-3 is incredible,” she said, especially considering how “controversial” replacement of the state hospital has been in the past.
Asked what is likely to happen in the Senate, she said she didn’t know and was just going to let the process work.
Emmons had the same response, calling the vote “terrific.”
“Now we’ll see where it goes,” she said.
