The Department of Mental Health will likely overshoot its roughly $174 million budget by $1.5 million in fiscal year (FY) 2013. This means that a second eight-bed facility slated for Chittenden County is being put on hold.
That’s the message department Commissioner Patrick Flood delivered to the legislative Mental Health Oversight Committee on Thursday. But under the circumstances, he said, that level of overspending is “pretty good.”
After the 54-bed Vermont State Hospital shut down in August 2011 due to devastation wrought by Tropical Storm Irene, Flood was tasked with leading an overhaul of the state’s mental health system. As he implements a new community-based, regional system, he said, the pieces continue to move.
“It is literally like we’re fixing an airplane while we’re flying,” he told the committee. “It’s going to take time. We’ve been doing business a certain way for a long period of time and now we have to change it all.”
Flood said the current budget environment he’s working through is the most difficult he’s ever encountered. The department is simultaneously revamping mental health standards, renovating community hospitals and preparing to build a new $27 million state hospital in Berlin.
One upside of shifting the mental health system to a regional model is the roughly $18 million increase in Medicaid and Medicare funds that are projected to stream into the revenue side of the budget.
This uptick is due to the fact that community hospitals now caring for many mental health patients are certified to administer these funds. The former state hospital in Waterbury, which cared for a large percentage of mental health patients, was decertified in 2003.
Despite this increase in revenue, Flood said, unforeseen costs have emerged because the state:
• Did not budget for an eight-bed acute-care unit in Morrisville. He said this was due to plans for the facility being drawn too late in the budget process.
• Used the correctional center in Springfield to treat four patients for longer than expected.
• Realized that adding 22 new residential recovery beds across the state would raise costs more than projected. Most of the costs, he said, would come from staffing needs.
• Budgeted the secure residential facility in Middlesex for five beds before the Legislature mandated that the facility should have seven beds.
FEMA funding update
The only thing certain about the status of FEMA funds for rebuilding Vermont’s mental health system is that nothing is certain.
On Thursday, Flood and Jeb Spaulding, secretary of the Shumlin administration, outlined the administration’s strategy for obtaining those funds.
Spaulding said the state is working on two main approaches for the new state hospital complex in Berlin. The first approach is to convince FEMA to fund 90 percent of the construction for the new facility by arguing that it was irreparable. Spaulding said the state is working with a team of experts and lawyers on developing this case.
The second approach is to total all of the funds necessary to flood-proof, repair and bring the damaged Waterbury facility up to code and submit that amount to FEMA for reimbursement. The hitch with that plan, said Spaulding, is that FEMA would deduct 10 percent from those funds for allocating them to a new facility on a different site.
In the meantime, Spaulding warned, the administration doesn’t want to make a hasty decision that could cut the state off from receiving higher levels of funding.
Flood and Spaulding said the Middlesex and Morrisville facilities should have no problem receiving FEMA funding for construction costs because they are temporary facilities that are being built as a result of a disaster. But, said Flood, nothing is definite.
“They usually pay for the temporary ones and not the permanent ones,” said Flood.
The harder sell, they conceded, is convincing FEMA that the Rutland and Brattleboro units are both “temporary and permanent,” as they put it.
Flood said that the two facilities are being created as a temporary fix for the current displacement of mental health patients from the state hospital, but that they won’t be taken apart.
Since the new state hospital will have fewer beds and the Rutland and Brattleboro facilities are geographically distant from Berlin, the idea is that these facilities will help shape a more regionally focused mental health system.
Mental health facility update
As the new mental health system takes shape, so too is its physical form. At the legislative committee’s meeting and in interviews after, Flood outlined the current state of Vermont’s mental health facilities.
According to Flood:
• The new 25-bed state hospital, slated for Berlin, is on track to open on Jan. 1, 2014. Although the design is not complete, he believes the state will break ground on the $27 million facility by late autumn.
• Renovations for eight temporary acute-care beds at Lamoille Community Connections in Morrisville are under way, and he expects patients to be admitted the week of Nov. 12. After the state hospital is erected, the state plans to close this facility.
• The state has selected a location for the seven-person secure residential facility on state-owned land in Middlesex. The town approved the project for the site next to the Vermont State Police barracks, and officials are now waiting out the appeal period. A neighbor has expressed concerns.
• Renovations for a six-bed, acute-care unit at Rutland Regional Medical Center are slated to begin next week. The project should be completed by early to mid March.
• Renovations at the Brattleboro Retreat to add 14 acute-care beds are under construction, and the project is on track to be completed in February.
• The state is no longer housing patients at the correctional facility in Springfield.
• A five-bed “Soteria” house in Chittenden County, which is designed to provide mental health treatment without medication, is projected to open in fall of 2013. A contract was recently awarded to the Vermont branch of the nonprofit Pathways to Housing to develop a program for the facility.
• A new eight-bed residential facility in Westminster is open.
• A new eight-bed residential home in Chittenden County’s Westford has received a certificate of approval without public opposition and is supposed to open in early winter.
• Another eight-bed Chittenden County residential home has been put on hold.
• The Second Spring residential home in Williamstown will continue running 22 beds until the aforementioned Chittenden County home comes on line at an undetermined point in the future. Second Spring was originally designed to have 16 beds.
• There are plans to open a seven-bed residential facility in Franklin County at some undetermined point in the future.