[T]he House is backing a new plan to expand Vermont’s mental health treatment capacity, including creation of a new psychiatric hospital in Berlin.
Representatives on Tuesday gave preliminary approval to a revised version of S.203, a wide-ranging mental health bill that includes several initiatives aimed at improving a system plagued by increasing demands and a lack of capacity.
The bill’s newest language may be its most notable: The House is endorsing the University of Vermont Health Network’s proposal to develop a new inpatient psychiatric facility at Central Vermont Medical Center.
The legislation also calls for a new, 16-bed secure residential mental health facility. And it says development of additional psychiatric beds at the Brattleboro Retreat should be allowed to go forward without the usual permitting process for new health care facilities.
The intent of the language is clear – to boost the state’s psychiatric facilities, and to get started as soon as possible.
“I don’t think there’s anyone here who is not aware of our crisis in delivery services for mental health care in the state,” said Rep. Anne Donahue, R-Northfield and vice chair of the House Health Care Committee.
Vermont has sought to rebuild and enhance its mental health capacity after flooding from Tropical Storm Irene forced the closure of the Vermont State Hospital in 2011.
The state has returned to pre-Irene levels in the number of inpatient beds, but increasing demand is overtaxing the state mental health system.
One symptom of the stress on the system is the number of mental health patients who are forced to wait in hospital emergency departments because there are no inpatient psychiatric beds to accommodate them. The Vermont Association of Hospitals and Health Systems recently presented statistics showing the number of days those patients spent in emergency rooms jumped by 28.6 percent from 2015 to 2016 and by another 29.7 percent from 2016 to 2017.
The new, multifaceted plan to revamp the state’s mental health system could ease some of those pressures. It consists of four primary elements:
• University of Vermont Health Network would develop a new, acute inpatient psychiatric facility at Central Vermont Medical Center, which is an member hospital of the network. The House bill says the new secure residential facility would have 16 beds.
• The state’s current psychiatric hospital, also in Berlin, would be transformed into a lower-intensity “secure residential” facility, for those who are ready to be discharged from a psychiatric hospital but still require support and supervision.
• Increased capacity elsewhere would allow the state to close the seven-bed Middlesex Therapeutic Community Residence.
“That was built purely on an emergency basis after Tropical Storm Irene and is in urgent need of replacement,” Donahue said.
• Because all of the projects would take several years, the state also is seeking a more immediate increase its mental health capacity. It appears that the favored option is adding 12 temporary inpatient beds at the Retreat, with the state footing part of that bill.
Taken as a whole, the mental health proposal is still in its infancy. For example, UVM Health Network has not committed to a bed number for the new psychiatric hospital. A lengthy permitting process will be required for the project.
But plans are taking shape. Earlier this month, the Green Mountain Care Board ordered UVM Medical Center to set aside $21 million in excess revenue earned in fiscal year 2017 to “measurably increase inpatient mental health capacity in Vermont.”
This was seen as a signal that UVM should move forward with planning its new psychiatric facility at Central Vermont Medical Center.
The Senate Appropriations Committee also is discussing inserting funding for additional inpatient beds into the fiscal 2019 budget. Those beds may be at the Retreat.
The House’s Tuesday vote on S.203 is another sign that the plan has backing.
Donahue said the support expressed for the new psychiatric facility is “an important statement of intent, because if the University of Vermont Health System is going to begin the work on planning and designing such a facility, it does need some indication that it would be (aligned with) the direction the Legislature would like to go.”
That direction, Donahue said, is toward linking psychiatric facilities with hospitals.
She pointed to the House Health Care Committee’s fiscal 2019 budget recommendations issued earlier this session. In that memo, the committee noted “the need to ensure that the state’s hospital system, including community hospitals and the academic medical center, increasingly takes responsibility for access to inpatient care regardless of whether that care is for psychiatric or other inpatient care needs; and the importance of integrating inpatient psychiatric care within an inpatient medical center.”
In that sense, UVM’s psychiatric facility proposal “would exactly correlate” with the committee’s policy goals, Donahue said.
S.203 directs the state Agency of Human Services to “assist the University of Vermont Health Network in identifying the appropriate number and type of additional inpatient psychiatric beds needed in the state.”
The agency also should “plan the increased number of inpatient psychiatric beds in a manner that maximizes the state’s ability to leverage Medicaid dollars,” the bill says.
Donahue also highlighted a provision of the bill allowing the Retreat, for the purposes of developing short-term mental health beds, to bypass the Green Mountain Care Board’s certificate of need permitting process as long as the state allocates money for that project.
That’s in recognition of the fact that “it’s urgent to be able to go forward as rapidly as possible on the planning” for those beds, Donahue said.
S.203 doesn’t focus exclusively on psychiatric facilities.
There are other provisions in the bill including a study of “nonhospitalization orders,” which require a mental health care regimen for individuals who are not receiving inpatient care. Those orders have come under scrutiny in recent years.
“This study would look at whether those (orders) are actually effective and meet their purpose,” Donahue said.
The bill also seeks more data from hospitals on the number of “voluntary” patients who have been admitted to inpatient psychiatric units, as well as the lengths of their stay in such units or in emergency rooms.
That would fill a gap in the state’s statistics and in lawmakers’ understanding of Vermont’s mental health problem. The state has not been accounting for patients who seek and undergo treatment of their own free will.
“We thought we were getting all the data,” Donahue said. “It turned out that we were only getting data collected about people who were in the custody of the (state).”
Mental health parity is another part of S.203. The bill inserts language into existing law to try and ensure “equal access to mental health care in a manner equivalent to other aspects of health care as part of an integrated, holistic system of care.”
“Mental illness is a social construction,” said Rep. Brian Cina, P-Burlington and a House Health Care Committee member. “The concept of mental illness arises out of the belief that the mind and the body are separate. The more than we learn about ourselves as human beings through science, the more that we recognize that the mind and the body are interconnected – one and the same.”
The House is scheduled for a final vote on S.203 Wednesday. The bill then would go back to the Senate, since the House has added many amendments.
Clarification: This article has been updated to reflect that Central Vermont Medical Center is a member hospital of the University of Vermont Health Network, rather than being owned by the network.