Southwestern Vermont Medical Center to expand ER to meet increased mental health demands

Editor’s note: This article is by Keith Whitcomb Jr. of the Bennington Banner, in which a longer version was first published on Feb. 5, 2014.

BENNINGTON — Despite the emergency room being no place to deliver psychiatric care, at times the local hospital’s ER is half-filled with people in need of mental health care, some of whom have been there for weeks awaiting placement in a more appropriate facility.

William Hall, director of engineering at Southwestern Vermont Medical Center, shows the space near the hospital’s emergency room that will be converted into a three-bed area designed to house patients having a mental health crisis. Photo by Keith Whitcomb Jr./Bennington Banner

William Hall, director of engineering at Southwestern Vermont Medical Center, shows the space near the hospital’s emergency room that will be converted into a three-bed area designed to house patients who are having a mental health crisis. Photo by Keith Whitcomb Jr./Bennington Banner

The problem is not expected to go away, said William Hall, director of engineering at Southwestern Vermont Medical Center, and so the hospital plans to renovate existing storage space near the ER into a three-bed area specially designed to house patients suffering a mental health crisis.

Hall expects the renovation will cost between $120,000 and $140,000. Construction is expected to begin the first week of March. The space will have an office for nurses and security staff who can monitor patients via closed-circuit television to allow them solitude. It will be handicapped accessible and there will be a bathroom with a shower.

The Vermont State Hospital in Waterbury, formerly the state’s primary mental health facility, closed in 2011 when it was flooded by Tropical Storm Irene. Its replacement in Berlin is expected to open this summer. But hospitals statewide have been struggling to place their psychiatric patients, and some worry the pressure on their ERs will not be completely alleviated.

The Vermont State Hospital had 54 beds; the new one is expected to have 25.

“We believe that we are building a state mental health facility in Vermont that’s going to be an example for the rest of the country, that’s our plan,” said Gov. Peter Shumlin Monday in an interview. “You have to remember that we lost our state hospital in the middle of the night, we still don’t have it back, and we believe that the additional 25 beds along with the enhanced community-based care, which is what we’re really beefing up, is going to reduce the need for acute care when prevention in the local community works better, is more cost-effective, and better for patients.”

He said the state is still in crisis in the meantime, and hospitals have handled things well.

Locally, there is skepticism the new facility will alleviate the pressure on the ER.

“The long and short of it is that in total by the end of the summer it’s anticipated that they will have increased the capacity of the system by 10 beds, and I don’t think anyone realistically thinks that’s going to fix the problem,” said Dr. Adam Cohen, medical director of SVMC Emergency Department.

Cohen spoke to the Banner in early January and said that during the previous week, seven of the ER’s 16 beds were occupied by patients in need of psychiatric care, two of whom had been there for over a week.

“They are very resource-intensive patients to take care of,” he said. “In many cases we need a sheriff and a full-time one-on-one provider to take care of these patients.”

An emergency room is not a good place for someone in need of psychiatric care, Cohen said.

“It’s bad for them, they’re in a high-stimulus environment that usually makes them worse. It’s bad for the other patients in the ER,” said Cohen. “Imagine you’re next door with your 3-year-old and there’s a violent, out-of-control, psychotic patient in the room next to you screaming profanities the whole time you’re there. That’s not good for anyone else in the ER.”

The new rooms will allow patients in mental health crisis to be away from the noise and hustle of the ER, but they can still be monitored to make sure they do not harm themselves or others.

Hall said the rooms are an extension of the ER, not a new department. No new services will be provided by the hospital, which does not offer psychiatric care.

This problem is not unique to SVMC.

“There is very poor access to psychiatric treatment in the state,” said Cohen. “Again, not a local problem, not a Vermont problem, but a problem nationwide, but if you come to the emergency department there is a likelihood that your wait times will be longer because we are treating a large population of psychiatric patients in a system that is designed, at this point, to offer them no recourse but to go to the emergency department and wait there for a long time for treatment to be available.”

People in need of emergency care cannot be turned away, and when a patient has nowhere to go, Cohen said, emergency rooms end up being a catch-all place to put people.

“We’ve had to develop training programs to handle these kinds of things, and it’s been a lengthy process,” said Cohen. “I feel that we have the training and the policies in place now to help us handle this population as best we can under the circumstances, but this is not the purpose of an emergency department.”

He noted that providers have been assaulted by patients numerous times, which adds to the rate of staff turnover.

Contact Keith Whitcomb Jr. at [email protected] or follow him on Twitter @KWhitcombjr.

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  • Anne donahue

    How unfortunate that it took until now. BEFORE the CON was granted for the comprehensive new ED, I met with and urged the hospital to include planning for psychiatric emergency care. Now that those in psychiatric crisis are interfering with care for other, storage space will be retrofit for them. Left out of the planning process and last in line for meeting these health care needs: psychiatry is still the afterthought. We still have a long, long way to go to achieve parity in access in mental health care integrated with the rest of health care.

  • rosemarie jackowski

    The public has had major concerns about the ER for a long time. They are still waiting for an explanation as to how someone could go to the ER with a backache and be found sometime later, ‘by non-medical personnel’. The patient was dead. It appears that the ER lost a patient.

    There must be a way to release some information, without revealing the identity of the patient and still complying with HIPAA rules. The community has a need to know.

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