[S]tate officials and hospital administrators have begun moving forward with a major expansion of Vermont’s mental health system, less than a month after Gov. Phil Scott signed two bills supporting the projects.
Officials say planning is “well under way” for the upgrade’s centerpiece – an acute inpatient psychiatric facility to be built at the University of Vermont Health Network in Berlin.
The state also is laying groundwork for a more immediate project – the addition of at least a dozen new inpatient beds at the Brattleboro Retreat that are expected to be ready by the end of 2019.
Al Gobeille, secretary of the Agency of Human Services, visited the Retreat last week to discuss the project, which is supported by $4.5 million in state money allocated for fiscal 2019.
“We had a very productive meeting and site visit,” Gobeille said. “But there’s a lot of work to do.”
The changes are the result of intensifying pressure on the state’s overtaxed mental health system. One symptom of the overload is an increasing number of mental health patients stranded in hospital emergency rooms, forcing hospitals to upgrade their facilities and add staff.
To try to address the need, officials have proposed a multifaceted plan.
- UVM Health Network would create a new inpatient psychiatric hospital on the grounds of Central Vermont Medical Center, which is part of the network. The Green Mountain Care Board has ordered the network to set aside $21 million in 2017 surpluses from patient revenue for the project.
- The state’s current inpatient facility – Vermont Psychiatric Care Hospital in Berlin – may be converted to a lower-intensity “secure residential” facility for those who are ready to be discharged from a psychiatric hospital but still require support and supervision.
- The seven-bed Middlesex Therapeutic Community Residence – which is the state’s current secure residential facility – would close. Middlesex was built as a temporary facility after Tropical Storm Irene’s flooding in 2011.
- A minimum of 12 temporary beds will be added at the Retreat to provide interim inpatient resources while the aforementioned projects are underway.
The plans could change. Legislative language in Act 200 – a miscellaneous mental health statute – says Vermont Psychiatric Care Hospital might still be maintained as a state-owned, acute inpatient facility. It is unclear whether the federal government will continue to provide Medicaid funds for the hospital, which puts the future of the facility in doubt.
The expansion will take several years and will be subject to ongoing debate. But UVM Health Network administrators already have gotten started: They’re working with the state and the Vermont Association of Hospitals and Health Systems “on an analysis of the number and type of inpatient beds needed to best serve Vermont.”
The network also is looking at financials and clinical programs and “making certain we coordinate with key stakeholders,” UVM Health Network spokesperson Michael Carrese said.
Health network administrators are scheduled to appear before the Green Mountain Care Board next month to provide an update on the project.
“Our first report to the [care board] will necessarily be preliminary in nature, but each future report will show additional substantial progress on the milestones the board has set for the project,” said Dr. John Brumsted, the health network’s president and chief executive officer. “We’re pleased to be under way with planning and to be having productive discussions and look forward to updating the board.”
Retreat renovations to be expedited
At this point, though, state officials are placing greater emphasis on the Retreat project because it promises a faster return.
The recently signed capital bill sets aside $4.5 million next fiscal year for “renovation and fit-up” of the Brattleboro mental health beds. There’s been another $1 million for the project included in fiscal 2019 budget bills, though a budget has not yet been finalized.
Gobeille said the Retreat is not expected to help foot the bill for the project. “We would put up the capital, and then they would operate it, and we would pay them a contracted rate for the treatment,” he said.
That rate will be part of an agreement that’s in the works between the state and the Retreat. Money allocated by the state cannot be spent without that agreement, which is supposed to include “terms and conditions that ensure the protection of state investment.”
Gobeille said that deal is in “rough draft” and will be finalized by October. “We’re in alignment with what we’re doing, and now it’s about the details of the legal agreement,” he said.
Louis Josephson, the Retreat’s president and chief executive officer, said state officials will be monitoring expenditures and will be “intimately involved in everything that we’re doing.”
As part of the project, crews will be relocating other beds at the Retreat, Josephson said.
“We actually started initial planning with our architects even before the ink was dry (on state legislation),” he said. “But it’s a big project.”
Act 200 says the Retreat is not required to ask the Green Mountain Care Board for a certificate of need for the project. That will shorten the schedule, but Josephson said the nature of the work – renovating mental health units in historic buildings, without taking beds offline during construction – means the project will take time.
Gobeille said it’s still cheaper and much quicker than starting from scratch. “If you were going to build a hospital, it would take four or five years,” he said.
Once the Retreat’s new beds are ready, both Josephson and Gobeille said they expect the facility to have a significant, positive impact.
“It’s not just 12 beds,” Gobeille said. “It’s how many people we can treat per year at these facilities.”