A new “forensic” psychiatric unit is scheduled to begin operating next fiscal year, potentially easing pressures on Vermont’s oversubscribed mental health system.
Department of Mental Health Commissioner Melissa Bailey told lawmakers on Wednesday that she wants an additional $1.5 million in fiscal 2019 for initial operations at a 12-bed facility housing those who have entered the treatment system via the courts.
The unit, to be located at Northwest Regional Correctional Facility in Swanton, is considered temporary and eventually will be replaced by a larger structure with more beds.
But officials say it’s a much-needed first step toward addressing a patient population that, at any given moment, occupies about half the beds at the Vermont Psychiatric Care Hospital in Berlin.
“We have definitely felt the pressures of our forensic population,” Bailey told members of the House Appropriations Committee.
The Mental Health Department’s fiscal 2019 budget proposal is $240.5 million, up nearly $8.6 million from the current fiscal year. Bailey said a level-funding approach won’t work given the strain on a system that’s operating at or near capacity.
“We did go through the exercise of what that would look like, and the administration made a determination to not do that in the Department of Mental Health given the crisis that we’re facing,” Bailey said.
Some of the proposed budgetary increase can be accounted for by salary and benefit increases; federal grant funding; and obligations transferred from other agencies.
But Bailey zeroed in on two “calculated increases” – $1.5 million for the new temporary forensic unit, and $400,000 for a new “street outreach” program aimed at keeping mental health patients out of emergency rooms.
Those are “the two areas where we are seeking increases in order to create additional capacity for our system,” she said.
The forensic mental health population includes defendants who have been referred for competency or sanity evaluations. It also includes those who have been found incompetent to stand trial or not guilty by reason of insanity.
Such patients now are scattered throughout the state’s mental health inpatient beds. At the Vermont Psychiatric Hospital, which has 25 beds, there are 12 to 14 forensic patients at any given time, Bailey said.
Forensic patients also tend to have “a significantly longer stay than someone who’s coming into the hospital from a civil commitment process because of the legal system and the legal processes that are involved with that care,” Deputy Mental Health Commissioner Mourning Fox said.
Additionally, officials said the forensic population contributes to an ongoing problem with mental health patients getting stuck in Vermont’s hospital emergency rooms.
The department’s new, 12-bed facility dedicated to forensic patients will be housed in an existing building at the Northwest State Correctional Facility in Swanton.
Bailey expects the unit to be operational for a portion of fiscal 2019. The department’s $1.5 million request would cover “operations for three months, with the anticipation that there will be some construction needs at the facility before we’re able to move people in there,” she said.
That equates to a full-year operating budget of $6 million. That fact that didn’t go unnoticed at Wednesday’s Appropriations Committee meeting: Rep. Catherine Toll, D-Danville and the committee’s chairwoman, said the department will have to come up with a detailed plan for future operations.
“We’ll have $6 million in the (fiscal 2020) budget going forward,” Toll said. “Where is the other $4.5 (million) coming from, so that we don’t have a hole in next year’s budget?”
Bailey said all of the unit’s operational money will have to come from the state’s general fund because of regulatory difficulties in drawing on Medicaid for the forensic population.
“Having it be 100 percent general fund, and having a facility that’s completely dedicated to that population, is the best approach,” she said. “Otherwise, we’re constantly sort of walking a very gray line around that.”
Long-term, the department wants to create a 20-bed forensic facility as part of a much larger prison/mental health complex proposed by Gov. Phil Scott’s administration.
Rep. Matt Trieber, D-Bellows Falls and an Appropriations Committee member, asked Bailey whether 20 forensic beds will be enough.
“I don’t know that I could say, ‘Yes, absolutely,’” she said “But I think it’s a really good number – a solid number.”
Fox added that, with other initiatives within the department, officials are trying to lower the number of forensic patients entering the system.
One of those initiatives is the new “street outreach” program.
First announced in December, street outreach is a joint venture between state and municipal officials. They’ll share the cost of counselors who will try to intervene before a person experiencing mental health issues ends up in police custody or in an emergency room.
The idea is to “engage with folks that are really challenging to engage and won’t necessarily show up at a community mental health center looking for help,” Bailey said.
The program is launching in Chittenden County, and Bailey said officials are having conversations about whether it could work in the Rutland, Barre/Montpelier and Brattleboro areas. The department has budgeted for roughly three positions in each area.
“In each region, it’s looking a little different given the region’s need,” Bailey said. The aim is to answer, “What do we need to do to help divert people from emergency departments and get them to the right level of care?” she said.
