Editor’s note: This commentary is by Ken Libertoff, Ph.D., who was director of the Vermont Association for Mental Health in Montpelier for 30 years. Since retiring in 2010, he has served as a consultant on mental health and general health care policy issues.
With the announcement that the proposed construction of a new inpatient psychiatric unit at Central Vermont Medical Center is significantly delayed, it signals a setback and a new level of crisis in our state’s inadequate and troubled mental health system.
Despite measured,calming words and well tuned bureaucratic public relations responses by many, it is time for the governor to step in and call for dramatic action and leadership. In recent years, there have been endless stories about the crisis in mental health treatment and access to care. The crisis will continue and it will build and it will be particularly devastating not only to Vermonters who need access to quality mental health care but to many in the practitioner community who try week after week and year after year to provide excellence in a troubled and often dysfunctional system.
Gov. Phil Scott should appoint a mental health czar to advise and coordinate policy because it is unacceptable to have years of crisis without solutions, timely, credible and appropriate solutions. It is way beyond time to accept a business-as-usual posture. The atmosphere of crisis has led to some questionable and perhaps bad decisions in recent years, and despite study committees, 10-year plans and a diverse group of state leaders engaged, there is little tangible progress in this vital sector of health care.
It is a disgrace to have Vermont citizens sitting in hospital emergency rooms, waiting for days or weeks for a inpatient psychiatric hospital bed. This has been the reality in our state for more than five years and despite tons of rhetoric and endless hand-wringing, the situation is reflective of failure. Certainly members of the Legislature and the Green Mountain Care Board and the secretary of the Agency of Human Services know that if Vermont patients with heart conditions or cancer or strokes or broken bones were waiting for days in emergency rooms throughout the state, there would be a declared state of emergency and a outraged public outcry.
A mental health czar should be charged with sorting out fact from fiction, and add a badly needed dose of transparency and leadership directly to the governor and to the aforementioned bodies. Obviously the mental health czar must consider the recent delay in plans for a proposed new inpatient psychiatric facility in central Vermont and figure out whether to accept an additional two-year delay or consider other options. With so much focus on the demand for new inpatient beds, there has been an absence of discussion about the critical need for building more acute care options and a variety of community based “step-down” programs which might in fact lessen the pressure on hospitals throughout the state by either reducing hospitalizations or by making it possible for patients to leave with a path to recovery. Attention must also be devoted to strengthening Vermont’s designated mental health agencies where demand always exceeds funding.
Another pending question, and it greatly impacts the mental health budget, is deciding on the proper role for the Brattleboro Retreat which has significant financial and clinical challenges.
And the fact that Vermont still relies on a seven-bed facility in Middlesex is troubling since it was created in 2013, and meant to be a stopgap program for two or three years. It was the past Human Services secretary who accurately characterized this austere program as not offering a proper treatment environment.
It cannot go unnoticed that just six years ago, Vermont opened the new $38 million Psychiatric Care Hospital in Berlin. Seemingly, it has struggled to clearly define its mission while facing a number shortcomings in care, in staff recruitment and in the lack of adequate staff training. It is past time for an independent assessment of this facility.
๏ปฟPatience may be a virtue but it has its limits. Patience has no place when crisis, year after year, denies both the mental health patient and mental health practitioner dignity, appropriate care and true parity with all other health care conditions.
