As University of Vermont Health Network administrators move forward with plans for a new inpatient psychiatric hospital, they can’t yet say how big that facility will be or how much it will cost.
But they agree on one thing: The campus of Central Vermont Medical Center in Berlin looks like an ideal location.
In a presentation Wednesday before the Green Mountain Care Board, network leaders said available space, geographic location and the expected availability of ample staffing are some of the reasons Central Vermont is a prime candidate for a new psychiatric facility.
Anna Noonan, Central Vermont’s president and chief operating officer, also said there’s been a positive reception for the project in initial community discussions.
“I’m not hearing anything negative at this point,” Noonan said. “In fact, what I am hearing is an appreciation and an awareness that this population is underserved and needs to be treated.”
Vermont’s mental health system is bursting at the seams, as evidenced by the number of mental health patients who get stuck in hospital emergency rooms due to a lack of available inpatient beds.
Earlier this year, the Vermont Association of Hospitals and Health Systems produced statistics showing that the number of days mental health patients spent in emergency rooms jumped nearly 29 percent from 2015 to 2016 and nearly 30 percent from 2016 to 2017.
On Wednesday, UVM Health Network Chief Executive Officer John Brumsted told the care board that “the crisis still exists, and we actually have some data that the situation might be worsening, particularly at Central Vermont.”
At the Berlin hospital, which is part of UVM Health Network, the total number of patients who had to wait in the emergency room for a mental health bed jumped 21 percent from fiscal year 2016 to fiscal 2017. Those patients also were waiting much longer for mental health treatment than they had in the past.
University of Vermont Medical Center – the state’s largest hospital – had 656 patients who waited in the emergency department for mental health treatment between May 1, 2017 and April 30, 2018. Several times in recent months, “half of the capacity of that emergency room has been taken up by folks … needing an acute inpatient psychiatric bed,” Brumsted said.
Earlier this year, Green Mountain Care Board members came up with a way to potentially ease some of the pressure: The board ordered UVM Health Network to set aside $21 million in excess revenue from fiscal 2017 to “measurably increase inpatient mental health capacity in Vermont.”
To fulfill that mandate, network administrators are proposing a new, acute-inpatient psychiatric hospital on Central Vermont’s property.
That’s just one aspect of a multifaceted plan. For example, the network’s new hospital could allow the state-run Vermont Psychiatric Care Hospital to become a lower-intensity secure residential facility, and the state also is funding at least a dozen new inpatient mental health beds at the Brattleboro Retreat.
But the overall goal is to create more inpatient beds in Vermont. And the health network’s Berlin facility would be the centerpiece of that effort.
Brumsted, who updated the care board on the project Wednesday, acknowledged that building more inpatient beds is not a panacea. But he believes it will get more mental health patients out of emergency departments.
“And once the emergency rooms are decompressed, we can proceed to address some of the other issues,” he said.
A report UVM Health Network submitted to the care board says the new psychiatric hospital will be “on or near the Central Vermont Medical Center campus.” It would be “right-sized, clinically appropriate and well-coordinated with existing treatment resources operated by other public and private providers,” the document says.
It’s not yet clear what “right-sized” means. Brumsted and Noonan said such details will be determined via a three-phase planning process.
The first phase, which is expected to be complete this fall, includes data analysis to try to determine the psychiatric facility’s correct size and scope. Brumsted said the health network is working with the state hospital association and the state Department of Mental Health to analyze Vermont’s needs.
“It’s my belief that this methodology … will produce an accurate count of the beds needed to serve this currently underserved population,” he said, adding that the network will build “flexibility” into the facility to accommodate future changes.
There are many others involved in the planning process. A steering committee includes top health network administrators as well as Louis Josephson, president and chief executive officer of the Brattleboro Retreat, and Robert Pierattini, psychiatry chair at the University of Vermont’s Larner College of Medicine.
The network also has hired Minnesota-based Halsa Advisors, a health care planning company that has worked on previous UVM Health Network projects. And administrators say they’ll be seeking input from a variety of interested parties including mental health clinicians, patients and families.
The focus of that discussion will be Central Vermont’s campus. As the name suggests, “we are centrally located, so it’s convenient, we think, for patients and families to reach this facility,” Noonan said.
Central Vermont already has an inpatient psychiatric unit. The hospital also is near Vermont Psychiatric Care Hospital, so it can “more easily coordinate and transfer care responsibilities between those facilities” regardless of the state facility’s future use, network administrators said.
Central Vermont Medical Center has “additional space on or very near its campus” to accommodate a new psychiatric facility, the network’s report says.
And it also has a robust workforce. Noonan said the hospital has a low turnover rate for registered nurses, and Central Vermont does not have to rely on temporary “traveling” nurses to cover shifts.
“We think that track record will enable us to continue to bring nurses into our facility to treat this (mental health) population,” Noonan said.
It’s not clear how soon that staff will be needed. Noonan on Wednesday declined to speculate on a schedule for the latter stages of the planning process, and UVM Health Network will have to get a certificate of need from the care board before building anything in Berlin.
Brumsted told board members that “I believe we still can stick with the three- to four-year time frame that I committed to earlier.”
The fact that the project is moving forward, he said, is one reason why it has been well-received among health care providers who can finally “see light at the end of the tunnel.”
Prior to this year’s mental health proposals, “what was driving people really to distraction … is that there didn’t seem to be anything that was happening,” Brumsted said.
