Health Care

Senate backs bill to examine, better fund mental health system

Claire Ayer
​Sen. Claire Ayer, D-Addison, the chair of the Senate Health and Welfare Committee. Photo by Erin Mansfield/VTDigger
The Vermont Senate unanimously approved a comprehensive mental health bill Thursday that calls for increased pay for mental health workers and a broader look at how to improve the system.

The Senate endorsed the bill, S.133, in a voice vote after senators raised concerns about the number of psychiatric patients waiting in emergency rooms to get proper care. The bill could get final approval in the Senate as early as Friday before moving to the House.

At the time the bill was being discussed on the floor, the Department of Mental Health said it was aware of five adults and one adolescent waiting in emergency rooms for treatment, but that there might be more.

The University of Vermont Medical Center, which has the largest emergency room in the state, reported having five patients waiting, and it’s unclear if those are the same patients in the Department of Mental Health tally.

Sen. Claire Ayer, D-Addison, said the number of psychiatric patients being held in emergency rooms has gone up since flooding from Tropical Storm Irene closed the state hospital in Waterbury in 2011 and the state built a new facility in Berlin.

“It’s a very ‘slight’ rise, but what people are telling us is that they’re seeing an increased intensity” in the patients, Ayer said. “It seems that there’s more trauma coming in with the patients.”

She pointed to testimony from an expert who described some of the patients waiting for placement as “a homicidal 6-year-old, a 9-year-old too scary to leave at home with his parents, a young man who wanted to cannibalize his family, and several geriatric patients” who cannot get placed in a nursing home.

Ayer said that while so many psychiatric patients are waiting in emergency room beds and being guarded by sheriffs, the publicly funded designated mental health agencies have crisis beds that are empty because the agencies don’t have the money to hire nurses to staff them.

Ayer said low pay is the main reason nurses and other workers aren’t choosing to work at the designated mental health agencies. She said there may also be licensing requirements stopping workers from coming to Vermont, and a national shortage of people going into mental health fields.

S.133 would require the Agency of Human Services to provide the Legislature with an action plan by Sept. 1 on about a half-dozen issues that are contributing to inadequate mental health treatment.

Those issues include how adults and children move through the mental health system; how much it would cost for the state to implement a better system for patients to navigate through the system; and how to make sure patients who arrive at hospitals are treated the same, “regardless of whether (they have) a psychiatric or a physical condition.”

The Senate temporarily stripped a provision in S.133 that would have allocated $30.2 million to increase pay for workers. They also amended the previous version of the bill, which would have increased pay at designated mental health agencies to $15 an hour for front-line workers and 85 percent of market rate for salaried workers.

Jane Kitchel
Sen. Jane Kitchel, D-Caledonia, the chair of the Senate Appropriations Committee. Photo by Erin Mansfield/VTDigger​
Sen. Jane Kitchel, D-Caledonia, the chair of the Appropriations Committee, said the committee’s practice at this point in the budget process is to take money requests out of policy bills until members can look at all the requested spending increases throughout the state budget.

The amendment would create a three-year process for increasing pay for mental health workers. Front-line workers would get $14 an hour starting July 1, and $15 an hour starting July 1, 2018.

The amendment also calls for giving salaried workers 85 percent of market rate starting July 1 and increasing their pay again for the following two fiscal years.

Kitchel said the committee wants to book savings in other areas of the health care system — such as spending on psychiatric patients in emergency rooms or on hiring sheriff’s departments to watch the patients — to help fund a multimillion-dollar appropriation this year to increase pay.

“We have been looking very carefully at where expenditures are being experienced right now because of the performance of the designated agencies for lack of staff,” she said. “We are trying to identify areas of spending as potential resources, and that gets into a pretty elaborate, political and financial analysis.”

“There is no question, and there has been extensive testimony on the performance of our system as it exists today,” Kitchel said. “The Appropriations Committee is in concurrence that the staffing difficulty is creating collateral impacts throughout the treatment system.”

Sen. Dick Sears, D-Bennington, the chair of the Judiciary Committee, who also sits on Appropriations, asked senators to think about whether they would seek to build the current mental health system if they had the chance to do it all over again.

“I hope that we will take that fundamental look at the basic structure of the system, if you can call it a system,” Sears said. “I think it’s broken. I think it’s been broken for years. Nationally it’s broken, not just Vermont.”

He said: “I actually have to question, are the designated agencies the best source of dealing with our local community mental health problems. Are we overburdening them? Should we be looking at a better way of dealing with them?”

“We know that what’s going on with our emergency rooms is horrific,” Sears said. “I’m not picking the designated agencies. But fundamentally, we have a system that’s flawed, and I’m hopeful that in 2018, we will begin to fix the system. But is it fixable, or should it be completely revamped?”

Ayer, who spoke about S.133 on the floor, said pay increases for mental health workers will likely be funded this year. She said the bill has so far done better than she expected.

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