Despite pressure from the Shumlin administration, the House Corrections and Institutions and House Appropriations committees passed a bill this week that would expand the size of the replacement facility for the Vermont State Hospital from 16 beds to 25 beds.
Some mental health advocates and psychiatrists testified in hearings that it would be difficult for the state to create a therapeutic environment with 16 patients.
The federal government doesn’t like to fund institutions of mental disease, or residential psychiatric treatment programs that are larger than 16 beds. Though Vermont has a special waiver through 2013 that allows the state to operate a so-called IMD with 17 or more beds, if the government doesn’t renew the waiver operating costs associated with nine additional beds could be appreciable. A 25-bed facility under this scenario could be significantly more costly.
The political ramifications of House Dems backing a change to the bill that the governor, also a Democrat, appeared to be borne out in House Appropriations late Wednesday afternoon. The majority of members of the budget-writing committee grudgingly supported the bill with the caveat that they preferred a 16-bed option with room to expand if needed. Lawmakers said they were worried about the long-term budget impacts of a larger hospital.
Rep. Mitzi Johnson, vice chair of House Appropriations, said she preferred a 16-bed facility. The Democrat from Grand Isle said she is comfortable with the idea of going from a total of 54 beds (the capacity of the now-defunct Vermont State Hospital) to 41, including placements at regional hospitals. Under the new system, the state would create an additional 40 placements at other residential facilities that she said would help to take pressure off the institutional, acute care system.
“I’m frustrated that we have a plan we know is going to cost a chunk more money as soon as the doors open,” Johnson said.
Rep. Kitty Toll, also a Democrat and a member of House Appropriations, said she wanted a larger psychiatric facility. “For me, I’m committed to taking money within our budget,” Toll said. “We have to look across state government and have priorities.”
Other lawmakers worried that a larger hospital and accompanying costs would pull money away from the community mental health system, which they also view as crucial.
Anxiety over whether lawmakers were making an ideal decision under emergency circumstances in the wake of Tropical Storm Irene, were overridden, however, by a sense of relief that at least they were moving on after years of wrangling over what to do with the Vermont State Hospital, which given its difficult history had long been a source of angst for the Legislature.
“I think it’s high time we moved on this thing,” said Rep. Bob Helm, R-Fair Haven, and a member of House Appropriations. “If we don’t get the FEMA money we’ll be the first to know. I’m not afraid. I’m glad we’re finally getting this thing off the shelf.”
Conor Casey of the Vermont State Employees Association said a 25 bed facility is a step in the right direction and “it’s an improvement from the governor’s plan.”
“What’s regrettable is this debate is about community mental health versus in-patient beds, when really we need to fund both properly for an effective mental health system,” Casey said.
The bill, H.630, passed House Appropriations on a 10-1 vote. Rep. Philip Winters, R-Williamstown, was the sole dissenter. The bill has already advanced through the Corrections and House Human Services Committees, and the GOP has agreed to suspend the rules. The House will take up the bill on Thursday.
Editor’s note: This story was updated at 6:38 a.m. and again at 7:20 a.m. Feb. 2.
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The legislature is going to have a lot to answer for when the new 25 bed state run hospital fails to get certified. CMS would not certify the old VSH after eight years because it was run so poorly. The state poured millions of dollars into that place and it still could not get certified. Now the legislature wants to pour millions more into another Vermont State Hospital. We should call it the Vermont State Albatross.
The argument about creating a more therapeutic environment by making the hospital bigger is a joke. You cannot create a therapeutic environment with the kind of authoritarian coercive treatment that was practiced at VSH. Nearly all ‘patients’ at VSH were involuntary. The existence of places like VSH with its involuntary treatment procedures actually keep people from seeking help because they are afraid of being locked up against their will.
A Scandinavian study showed the unfavorable psychological treatment outcomes of involuntary treatment (Kaltiala-Reino, Laippala, & Salokangas, 1997). The authors conclude that “coercive treatment arouses negative feelings in the patient, creates negative expectations about the outcome of treatment, and fails to result in a trusting relationship between the patient and the professionals.”
Studies have repeatedly shown that when persons with even the most serious mental illnesses are provided with appropriate and comprehensive community mental health services, they succeed (White House Conference on Mental Health Fact Sheet, 1999). Most often, the crisis that results in commitment does not arise instantaneously. Before the crisis, the individual had mounting problems, for which the mental health system offered little or no help, and the involuntary admission could have been avoided by early and effective interventions. Involuntary and acute care admissions should be viewed as failures of community services. Building a responsive mental health system with services like mobile crisis teams, assertive community treatment teams (ACT), and supported housing is the best strategy for ensuring that people receive needed treated.