Health Care

Human services chief promises review of mental health system

Al Gobeille
​Al Gobeille is secretary of the Agency of Human Services. File photo by Erin Mansfield/VTDigger
The secretary of the Agency of Human Services said his staff and other stakeholders will do a “deep dive” into systemic issues in how Vermont delivers mental health treatment.

Al Gobeille told the Senate Appropriations Committee on Feb. 9 that he and his staff would begin working with others this week to look at how to improve treatment.

Gobeille has scheduled a meeting Friday with hospitals, mental health providers, independent doctors and others with a stake in the system. He will divide the work into four categories — flow, workforce, facilities and funding — and ask groups to report back with potential solutions.

Gobeille said the meeting will require all stakeholders to get in a room and agree on what problems are plaguing mental health care before they solve them. He said the full review will need to be complete within a few weeks, but he warned there is no “silver bullet” to fix mental health care.

“My take on it is that a long time ago we deinstitutionalized mental health, but we have never properly funded where we expected them to go to,” Gobeille said Feb. 9. “They have to go somewhere, and where do they go? Is that properly funded? And I would say no.”

The Agency of Human Services spends more than $300 million annually funding 11 nonprofit organizations dedicated to treating mental health and providing disability services, according to Gobeille. Those so-called designated agencies consistently report that they’re underfunded.

In a 2016 report, the designated mental health agencies reported an annual staff turnover rate of 27 percent. The same year, the Green Mountain Care Board, with Gobeille as chair, said the state’s largest designated agency did not have enough money to “adequately fund the institution’s desire to accomplish” its goals.

Gobeille told the committee that the issue goes back to the law that created the designated agencies. The agencies are not funded as an entitlement — a social service program that requires the state to pay for services for any eligible person who needs them.

Instead, the law tells the Department of Mental Health and the Department of Disabilities, Aging and Independent Living to ensure services for people with mental health issues and disabilities “within the limits of funding designated by the Legislature for this purpose.”

“It doesn’t say that it’s going to take all comers or anything,” Gobeille said. “And so the designated agencies have responded by sort of taking the money and taking all comers and trying to cover everyone but have not come back and said, ‘This is the specific issue where I’m struggling with money that’s causing us to not have enough here or over there.’”

Sen. Richard Westman, R-Lamoille, listens to a colleague in the Senate. Photo by Roger Crowley/for VTDigger
Sen. Richard Westman, R-Lamoille, listens to a colleague in the Senate. File photo by Roger Crowley/VTDigger
Gobeille said the review would force all stakeholders to come up with specific solutions. He said those could include “step-down” beds to replace the Middlesex secure mental health facility, transitional housing for patients who need to leave hospitals, or psychiatric beds for elderly patients waiting in emergency rooms.

Lawmakers asked Gobeille to move swiftly. Sen. Richard Westman, R-Lamoille, referenced workers who said at a joint hearing Feb. 8 that they were in danger of being assaulted by patients who were being held involuntarily because they represent a danger to themselves or others.

“The first time somebody really gets hurt or something like that happens, we’ll rush to do something in a way that might not be the best thing to do,” Westman said. “So I want a plan. I want us to move. But this is something that — something bad’s going to happen.”

“We have patients in the emergency room assaulting sheriffs,” said Sen. Jane Kitchel, D-Caledonia, the chair of Senate Appropriations and a former human services secretary. “This is not a new problem. It’s just a problem that hasn’t been solved.”

Gobeille said: “It’s a multifaceted, community-based problem that is not going to be solved by just one thing. If you had 25 more Level 1 psych beds” — such as the ones at the Vermont Psychiatric Care Hospital that serve the most acute patients — “you would do that and you would still have a whole host of problems.”

Kitchel agreed: “I can’t decide how to spend that first dollar or redistribute what we have in the system without that examination of the entire system.”

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Erin Mansfield

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  • “Gobeille said the meeting will require all stakeholders to get in a room
    and agree on what problems are plaguing mental health care before they
    solve them. He said the full review will need to be complete within a
    few weeks, but he warned there is no “silver bullet” to fix mental
    health care.”
    Really? Are you kidding me? Big Al is going to require all stakeholders to get in a room and dream up solutions. Who are the stakeholder, all Vermonters, all immigrants, federal employees…?

  • Louis Meyers, M.D.

    Al Gobeille and Donald Trump are both professional businessmen and are now engaged in creating public policy. But the differences between them could not be greater. Gobeille is thoughtful, both serious and open-minded, and respectful of others. He does not seek to simplify or trivialize complex social problems. He works diligently toward solutions and does not personalize disagreements. Donald Trump…enough said.

  • Barry Kade

    Referencing the current system whereby mental health patients often spend weeks in regular hospital emergency rooms awaiting beds space at a mental health facility, ” Westman said. “So I want a plan. I want us to move. But this is something that — something bad’s going to happen.” This appears to be a lack of empathy for the mental torture presently occurring. For those patients, something very very bad is happening now.

  • Lisa Nicholson

    I appreciate the perspective that it needs to be approached from many directions. It bears thoughtful careful analysis not snap overly simplistic problem solving. Ideally it seems like It needs to work as a system instead of funding stream silos and regulations/structures that inadvertently create competition for dollars and leave consumers lost in the gaps.