More Vermont children are in need of mental health services but treatment options close to home are hard to find, lawmakers were told Wednesday. With the mental health system for adults in transition, government officials decided it was time to look into possible reform of children’s services as well.
At a meeting with the Legislature’s Mental Health Oversight Committee in Montpelier on Wednesday, health care officials and individuals who have been exposed to the mental health care system gave testimony on issues such as decentralizing acute mental health care, creating a peer system in which friends are part of the recovery process and increasing funding for outpatient care.
When the Vermont State Hospital in Waterbury flooded and was closed in 2011, Gov. Peter Shumlin decided to restructure and decentralize the mental health system through legislation called Act 79. .
The unfinished task has left the mental health system in Vermont with fewer beds and has put added pressure on hospitals and correctional facilities to house patients in need of acute care. But the reform has also put more focus on outpatient care, something that will benefit patients in the long run, officials say.
For children with acute mental health problems, there has been no Act 79 and the committee heard from advocates for the mentally ill and from the children themselves.
A recurring theme was that children and adolescents with acute mental illness need to stay close to family and friends to speed their recovery.
“Even though there wasn’t an Irene to create the crisis, there are all the same system problems,” said Rep. Anne Donahue, R-Northfield, who sits on the oversight panel. Donahue has worked on mental health policy since the mid-1990s, when she was emerging from her own struggle with mental illness.
One of the systemic problems with children’s mental health services is the lack of community programs, which results in children ending up in the hospital unnecessarily, Donahue said. Then there are the truly acute cases that need immediate beds, but because beds were given to people who don’t need them, children often are forced to wait for treatment, she said.
Kelly Deforge of Essex Junction spoke about the difficulties she and her family experienced when her now 15-year-old son was voluntarily admitted to the Brattleboro Retreat, a private psychiatric hospital. Deforge had to wait 10 days before there was an open bed, and she told the committee about the constant 24-hour stress it put on the family to be around her acutely ill son while they waited.
Deforge also called for a more localized system to care for acutely mentally ill children.
“I have nothing bad to say about Brattleboro,” she said. “I just wish there was something closer up north.”
The Brattleboro Retreat is the only mental health institution in Vermont to admit children. The facility has 12 beds for acute crisis stabilization of children aged 5 to 13, and 21 beds for children aged 13 to 18. In addition, the hospital keeps a total of 30 residential beds for children aged 6-18, according to Peter Albert, director of government affairs at the Retreat. It also treats patients from outside Vermont, he said.
Several witnesses emphasized the importance of keeping crisis treatment close to home, saying long hospital stays can create mistrust in young individuals suffering from mental illness.
Aimee Powers, mother of a 9-year-old boy in need of acute mental care, told the committee that stays at the Retreat instilled a lack of family trust in her son.
Powers called for a better way to treat children closer to their home and to include parents as part of the recovery process. When the Retreat is the only option for parents of acute mentally ill children, many parents choose to quit their jobs and stay at home rather than be separated from them for long periods of time, she said. And when the care at the hospital didn’t work out for her son, that’s what Powers did. She quit her job and took care of her son on a full-time basis.
Health care officials are looking to improve the system. Frank Reed, Commissioner of the Department of Mental Health, and Albert both stressed the need for localized beds for the acutely ill as well as beds in a transitional facility for recovering patients. The issue is always funding, Reed said.
“I think children’s hospitals should only be there as a last resort,” Albert said. “Children should sleep in their own beds at night.”
Good child psychiatrists are sparse and a scenario in which they have to commute between two hospitals is difficult to imagine, Donahue said. A better option would be to start a wing for children at Fletcher Allen Health Care in Burlington, she said.
“To have only one specialized hospital has been a persistent problem for decades,” said Donahue. “But that’s the institutional reality — you don’t want to create a specialized program in several places.”
As of now, Brattleboro is the place where the resources exist, she said. The problem with the governor’s decision to make the adult mental care system more regional is that when you start spreading out cases there are staffing and budget issues because the level of care cannot be maintained in all of the facilities, Donahue said.
However, a localized system with more “diversion beds” might be a cheaper option, Reed said.
For example, a $1,000-a-day bed in the hospital, with care that in some cases is superfluous, might only be $250-a-day in a diversion bed, Reed said. But, again, money is the issue.
“The problem is that the hospital bed has to be kept,” Reed said. “How do you set up the new beds while not infusing more money in the system?“
The Department of Vermont Health Access (DVHA), which is paying for the Medicaid beds at Brattleboro, is looking into such a restructuring, Reed said.
The local beds would be called crisis beds and would be diverted from the hospital. They would be short-term beds, two or so, and would be local or regional, Reed said.
“Right now, we have many places with two beds for adults,” he said. “There’s times when you need to be in a hospital. But from an intuitive point of view, I would say that if we had more diversion beds many of these children would probably not have to go to the hospital.”
Designated agencies (DA), which are mental health clinics in each geographic region of the state, would be the preferred partner, Reed said. But it is too early to tell what such an arrangement might look like, he added.
The infrastructure is already in place and the problem lies in funding, said Charles Biss, director of the Children, Adolescent and Family Unit at the Department of Mental Health.
“The DA system already knows what they need to do,” Biss said. “But we need to get some more funding toward that.”
In the past year more Vermont children than ever were admitted for acute mental care. For 2012 there were 370 admitted cases in ages 5-18, a number that’s usually around 290-300, Biss said.
From 2011 to 2012, children and adolescents treated at Brattleboro through Medicaid went up 56 percent. Including other pay sources and out of state patients, the number of children and adolescents went up with another 23 percent, and the current year to date indicates the trend will continue, according to Albert.
The demand for service has seen an increase and to accommodate this surge a diversion of resources from hospitalization as well as developing aftercare resources to hasten return to community is needed, Albert said.
But Reed is careful not to come to any conclusions. “It’s not a trend if it’s just a year,” he said. “All I hear is that there’s been a high need and acuity this year. It’s something we really need to watch, but it’s too premature to say — it’s only been one year,” he said.
Another point brought up at the meeting was the importance of peers for recovery.
“Kids with mental health problems don’t always trust adults,” said Justin Lambert, 17, from Big Picture South Burlington, a student support group at South Burlington High School. Lambert was admitted to the Brattleboro Retreat several times after attempted suicides.
The Children, Adolescent and Family unit is serving 9,000 to 10,000 children through schools, homes, child care, pediatric offices, mental health agencies and other community agencies, said Biss. But he’s worried about the future of some of the programs.
Through a federal “Youth in transition” grant, the Children, Adolescent and Family unit has been running a community program to support young adults with mental health services and to stimulate peer-to-peer support as children transit to adulthood. But the grant expires next year and Biss told the committee he’s concerned about how about how such initiatives should be funded in the future.
“One of the things that I would advocate for is that inpatient care should be the last resort and we really need more community crisis options,” said Biss. “Often times what patient needs is just a place of extra support, both in and out of homes.”
The next step for the Mental Health Oversight Committee is to write a report and bring the report to other committees of the House and Senate. Donahue will bring the report back to the Human Services Committee.
“This is something that has to develop through a committee,” she said. “It’s not something that you can just think of a precise solution without a lot of dialogue, and we’re going to need to do that legwork this session and make sure this has committee attention.”
While there has been no decision whether to draft a bill on a reform of children’s mental health system for the next session, it will be brought to the Appropriations committees in both bodies, Donahue said.
“There are really critical things we need to address,” she said. “And from what we heard today, children’s services is definitely one of them.”