Commissioner says new community mental health system is “becoming a cohesive whole”

Vermont’s mental health system post-Irene, in patient terms, is still sick but shows signs of getting better.

That was the optimistic assessment of Mental Health Commissioner Patrick Flood, speaking to a special panel of legislators at the state capital Wednesday.

“Basically, things are going pretty well,” said Flood, who is overseeing a dramatic overhaul of mental health care approved by the Legislature this past session. At the same time, stresses and strains on the system remain, he said, and it will be January before the new system begins to “really turn the corner.”

“We literally spend hours every day making sure somebody can get a bed and we don’t always succeed,” said Flood, with the result that sometimes patients end up being parked in emergency rooms until space is available.

Flood reported to the legislative Health Access Oversight Committee Wednesday on the implementation of Act 79, which refocused mental health care toward more community based treatment and pre-emptive emergency care that will keep people from ending up in acute mental health crisis.

The comprehensive overhaul, proposed by the administration of Gov. Peter Shumlin and signed into law in April, was prompted by the flooding closure of the antiquated Vermont State Hospital in Waterbury, taking 54-acute care beds out of the treatment system on Aug. 29.

Flood said one of the unheralded accomplishments as the overhaul begins to get traction is that Vermont’s mental health care is becoming a cohesive whole instead of a bunch of treatment parts, with patients’ needs and care addressed in a comprehensive way through increasing coordination and communication.

“What had been a collection of services is slowly turning into to a system,” said Flood, calling the impact of that on those in the system “remarkable.”

Flood said the state is also trying to address “the lack of consistency” across the state in responses by hospitals, other mental health agencies and law enforcement in how they handle patients.

He said the state’s new care management system, an essential aspect of coordinating and tracking people in the state’s more dispersed new community based treatment model, is “in is infancy” but is already producing benefits.

That will greatly improve “with another six months of experience,” he said.

“That’s what I want to hear,” said Sen. Claire Ayer, D-Addison, one of a handful of lawmakers who played a major role in drafting the state’s new mental health system as chairwoman of the Senate Committee on Health and Welfare. A key concern for lawmakers was keeping tabs on how the beefed-up community treatment system was working and identifying what programs were succeeding or not.

Flood presented lawmakers with a proposed “dashboard” of data his department is now collecting as part of the new law, intended to provide lawmakers and mental health officials with a better picture of the new system. It includes a wide range of data points, such as acute in-patient and crisis bed occupancy, emergency room holds, adverse events, restraint and seclusion figures and other metrics.

Flood asked lawmakers to weigh in on what other data they wanted and Rep. Chris Pearson, a Burlington progressive, said he wanted geographic data indicating where patients come from.

The fact the state’s major population base is around Chittenden County and the state’s acute-care facilities were located away from the county in central and southern Vermont was a contentious issue during debate on the mental health overhaul.

“At some level I think it would be valuable to see how out of whack we are given that our facilities are not concentrated where our people are,” he said.

The departments’ director of operations, Frank Reed, brought lawmakers up to date on the status of a wide array of bricks-and-mortar changes approved in the new legislation.

  • Three qualified bidders delivered proposals Wednesday on construction of a temporary eight-bed acute care hospital wing in Morrisville in the local mental health agency’s existing offices. The opening is targeted for Sept. 1, Reed said. Flood said those beds would be a big step to easing the crisis in acute care that exists now. He also said depending on the need, the state may decide to house 10 or 12 patients at the facility by reworking the space.
  • Construction contracts have been signed for the spaces that will house six acute care beds at Rutland Regional Medical Center and 14 at Brattleboro Retreat as authorized by Act 79. Required state “certificate of need” permits are expected by the end of this week, Reed said. The designs for those two facilities, which are part of the legislative package to replace the beds at the former state hospital, are being finalized, he said.
  • Having selected a site adjacent to Central Vermont Medical Center in Berlin for the new 25-bed state hospital authorized in the bill, the state is now working with advocates and mental health officials to complete a design for the facility off Fisher Road, Reed said. The state allocated $5 million in the next fiscal year for the three acute-care facilities in Brattleboro, Rutland and Berlin for design and construction. Flood insurance and FEMA funding is expected to help defray some of the costs.
  • A new eight-bed intensive residential recovery facility opened in Westminster this month and a new site has been identified for another eight-bed facility for Chittenden County. A seven-bed facility is still planned in Franklin County but no site has been selected.
  • Plans for a seven-bed high-level secure facility in Waterbury for patients under court jurisdiction are proceeding, with consideration of a modular unit design. The state is aiming to have it open by Nov. 1 on the flea market property north of the village on Route 2.

Flood said that finding a place for those patients, who are currently housed at a correctional facility in Springfield that he has said is an inappropriate setting, would make “a big difference.” He added that he was hopeful that some of the five patients at Springfield may be able to be moved to a more appropriate setting in the interim, but called the legal issues “very complicated.”

According to Flood, the mental health treatment system remains stressed and full with between 230 and 240 patients under his custody. Patients continue to find themselves stuck in emergency rooms waiting for placement, he said. In April that happened 14 times, and in May the number jumped, he said.

On the positive said, new crisis teams created under the legislation show signs of helping people stay in their homes and preventing them from needing more costly acute care, said Mary Moulton, deputy commissioner of mental health.

Moulton also said the state is seeing progress on working with law enforcement to revamp procedures on moving mental health patients, who in the past have complained about feeling humiliated at being transported in metal shackles. She praised Vermont sheriffs for adjusting their views and trying to find ways to move patients in unmarked cars with plainclothes officers to avoid the stigma that goes with transport.

Flood called the willingness of sheriffs in law enforcement to look at the issue an “amazing and refreshing” development.

He also said 31 patients had been served with a $600,000 legislative appropriation for temporary housing, which advocates said is a big need for those in acute mental health crisis, since lack of housing can often precipitate a crisis.

Comments

  1. David Dempsey :

    Senator Ayer said of Commissioner Floods report “that’s what I want to hear”. Did she think he was going to tell her something that she didn’t want to hear, like how bad things really are and what a terrible job he is doing. I don’t think she would hear what she wants to hear if she talks to the employees working for him. They know what is really going on.

  2. Check out todays (6/24/12) issue of the New York Time Magazines front page article on “Love and Commitment” Vermont’s system is quoted in a discussion of mental hospital closings. It really shows how important family support is in protecting their loved ones.

  3. NICOLE LEBLANC :

    In FY 13 The State Needs to GIVE THE DA SYSTEM 20 MILLION for community based services.

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