Editor’s note: This commentary is by Dillon Burns, who is Mental Health Services director at Vermont Care Partners.
[E]xcellent reporting on both trauma and recovery in Vermont’s mental health system of care this week has reignited the public conversation about solutions. Last month, UVM Health Network proposed building 29 to 35 new inpatient psychiatric beds to address the crisis of long waits in emergency departments for people in mental health crisis – waits that are not only grueling for all involved, but also inconsistent with parity laws and simply inhumane. UVM Health Network had landed on this number range by analyzing emergency department and inpatient psychiatric bed usage data from hospitals across the state – no small feat given that this data comes from multiple hospitals.
UVM’s analysis of hospital data provides a good start to the conversation. But, just as the acute care side is only one part of the complex landscape of mental health services in the state, so is the hospital data only part of the picture. The next step should be a deeper conversation and full system analysis. Here are three questions that mental health policy stakeholders should be asking before moving forward on a 35-bed plan:
Has the system adequately quantified the cost of care for the small number of people experiencing barriers to discharge — people who are ready to leave the hospital but have lengthy stays because they don’t have a place to go? This small cohort represents hundreds of bed days that could be used by others in need. What investments in specialized nursing home care and supported housing could open up these beds? Could these investments provide more return than dollars invested in inpatient capacity?
What are the consequences to the broader mental health care system of increased inpatient spending? The cost of a 35-bed build doesn’t include the ongoing costs of hospital level care, which is currently between $1,425 and $2,537 per bed/day – equivalent to what it costs to treat the average outpatient therapy client for a year in the community mental health system. Currently, hospital social worker salaries can be twice the salary of clinician with the same degree in the community mental health system. Will the gap in pay continue to grow? What will be the consequences for the cost and effectiveness of community-based mental health services? Will the workforce shortage on the community mental health side further diminish preventative community-based services?
What if Vermont invested in predictive data modeling and analytics, not just focused on hospital usage but also on the flow through the whole mental health system, including outpatient mental health providers, primary care providers and even school-based and early childhood clinicians? What could we learn if we analyzed both the spending and the health outcomes for people with significant hospital stays versus those with wraparound community supports? With collective investment and political will, use of predictive analytic models is not only possible, but one of the most promising untapped resources for addressing our mental health crisis.
Hospitals, community providers, advocates and stakeholders in state government all share the goal of helping people who need mental health services, particularly those in crisis, access the right level of care at the right time. If we continue these hard conversations and dig deeper into what the data can tell us about the return on investment for community-based care, there are opportunities to continue Vermont’s heralded traditions of fiscal responsibility and social responsibility. Let’s get this right.
