[T]he state’s largest facility for treating patients with acute mental health needs closed one of its four units earlier this summer due to understaffing.
The Vermont Psychiatric Care Hospital (VPCH) has been operating at limited capacity for three weeks because of a shortage of nurses, interim Commissioner of the Department of Mental Health Frank Reed said in a phone interview Friday.
Reed estimated that, depending on the acuity of patients being treated at VPCH, the facility currently has a maximum capacity of 21 beds — down from the total capacity of 25.
“If you don’t have the nurses to staff all those beds even though they exist, you can’t bring people in,” Reed said.
The decision to temporarily close the unit was based on concerns about the ability to provide good services to patients, along with the safety of staff and patients.
The closure of the unit does have the potential to impact the length of time that someone may be kept in a hospital emergency room while awaiting care in a psychiatric facility, Reed said.
However, DMH has been monitoring emergency room wait times and has not seen a large uptick since the unit was closed three weeks ago, Reed said. He said that there have not been many court-ordered inpatient evaluations in recent weeks, and there have not been many patients waiting for involuntary care.
The staffing shortage is due in part to workers’ summer vacation schedules, along with a shortage of staff available through traveling nurse companies.
The psychiatric hospital relies on services that arrange for temporary contracts with nurses from out of state, who may stay for a month or longer. Reed said that the state is currently working with three traveling nurse companies.
He expects the facility will be returned to full capacity in the next month.
Following the closure of the 54-bed Vermont State Hospital in Waterbury due to damage sustained by flooding during Tropical Storm Irene, the state opted for a decentralized system that includes beds at Rutland Regional Medical Center and the Brattleboro Retreat.
To complement the beds at the existing hospitals, the state built a 25-bed facility in Berlin. At full capacity, the system now has nine fewer beds available to Vermonters with acute mental health treatment needs than before Irene.
Sen. Claire Ayer, D-Addison, said that because of the persistent staffing problems at the hospital, the state is falling short in its obligation to treat Vermonters.
“We made a promise to Vermonters. We said we’re going to open this much smaller hospital but it’s going to be enough because we’ll provide this level of care,” Ayer said. “We’re not doing it because we’re not staffing it.”
Meanwhile, Ayer said, the state is expending resources on hiring traveling nurses instead of investing in getting Vermont nurses trained and putting them in permanent positions.
Ayer and Rep. Ann Pugh, D-South Burlington, who chairs the House Human Services Committee, sent a letter to the Department of Human Resources last September requesting that the administration look into shifting away from the use of temporary nursing staff and instead invest in training and retaining permanent staff members.
DHR Commissioner Maribeth Spellman responded with a letter the following month outlining joint efforts with DMH to address issues with nurse recruitment and pay disparities. The departments planned to run an ad campaign to try to bring in fresh candidates.
Spellman also cited DHR’s state government-wide analysis of nursing positions regarding market factor adjustments — supplements to base pay to make salaries in state government more competitive with those in the private sector.
Reed said that a working group run by the DHR and the Agency of Human Services has been looking into the reclassification of nursing positions and working on market factor analysis for the last several months. He expects the results will be completed shortly.
The staff shortage at the psychiatric facility is part of a lack of qualified nurses on a much wider stage, Reed said.
“It’s a national shortage,” Reed said, noting that other state facilities are facing a similar staffing pressure. “All of the facilities are struggling to have nurses available.”
Steve Howard, executive director of the Vermont State Employees’ Association, said that the union probably would not bargain for nurses at VPCH alone to receive a pay bump.
“We are unlikely to do that because the nursing shortage at the state psychiatric facility is not any different than the nursing shortage at the Vet’s Home,” Howard said Friday.
The discrepancy of pay between private and public sector jobs is another problem, said Howard. Nurses working for the state should be paid “at least” what nurses in the private sector are paid, he said.
Howard urged the administration to “step up” and complete the market adjustment process.
“There are certain populations that the people of Vermont expect the state to take care of,” Howard said.
According to Rep. Anne Donahue, R-Northfield, who works for Vermont Psychiatric Survivors, there is a need to address the nursing shortage at VPCH more swiftly than the statewide issues with understaffing.
“It’s only inpatient psychiatry where we have people waiting for days in emergency rooms,” Donahue said by phone Friday. “Singling it out and addressing it as a crisis is valid because of the level of lack of service for people who [are in] need.”
Donahue said that she and other lawmakers on the Mental Health Oversight Committee, which has since been reorganized into the Health Reform Oversight Committee, identified the problems with staffing at VPCH last September.
“We were urging that there be aggressive action,” she said. Now, almost a year later, she is frustrated that the staffing issue has not been addressed.
The issues at the psychiatric facility with staffing, along with emergency room wait times and other factors indicate that it may be time for the state to assess whether the new psychiatric care system is sufficient, Donahue said.
“I think we have enough indicators now that we have to start planning for what we do when it’s not adequate,” Donahue said.
