If there’s one thing just about everybody agrees on, it’s that the pair of double-wide trailers alongside the state police barracks in Middlesex just aren’t up to snuff for a mental health facility.
Lawmakers “unequivocally” agreed on that two years ago, said Rep. Bill Lippert, D-Hinesburg, chair of the House Health Care Committee.
The Middlesex Therapeutic Community Residence was constructed in 2013 as a temporary solution after Hurricane Irene washed through the state two years earlier.
But an $11.6 million replacement proposal from the Department of Mental Health has sparked an outcry from mental health providers and advocates, who argue the new home would be too large and too institutional to meet the needs of the people it’s supposed to serve.
“The idea that this residence is not a hospital, not a prison, but a mere ‘group home’ should be insulting to those who live in or run true group homes,” wrote Phoebe Wagner of Brattleboro, who said she had been a patient at the long-since-closed Vermont State Hospital in Waterbury.
Wagner was one of more than two dozen Vermonters who wrote to the House Health Care Committee opposing the proposal. Some compared mental health treatment to incarceration and contended that such approaches to mental health care disproportionately target people of color.
“All of those resources could be better used to support people in their communities,” said letter-writer and Putney psychotherapist Leigh Witzling in an interview.
Now, lawmakers have to decide whether to greenlight the $11.6 million in funding in Gov. Phil Scott’s capital budget.
Home sweet hospital?
The new “therapeutic community residence” would provide mental health care for patients who no longer need treatment at an in-patient facility such as the Brattleboro Retreat or the Vermont Psychiatric Care Hospital, but are not yet able to function in a community-based group home, according to Deputy Mental Health Commissioner Mourning Fox.
The state constructed the seven-bed Middlesex facility as a quick-fix solution to help replace the state psychiatric hospital in Waterbury, which was destroyed during Irene in 2011. The facility, constructed from two FEMA trailers, sits along Route 2, encircled by a chain-link fence.
At the time, officials vowed that it would be open for three years — just time enough to build a replacement.
Lawmakers have described the buildings as “failing.” Last summer, the union for Vermont state employees criticized officials for failing to notify employees that the water at the facility was tainted with uranium and gross alpha radiation.
The Department of Mental Health has already spent $4.5 million on siting and architecture for the replacement, which would be built in Essex, at the site of the former Woodside Juvenile Rehabilitation Center. The new home, which would cost an additional $11.6 million — for a total of about $16 million — would include 16 beds, more than double the current number.
In an interview, Fox described the proposed facility as a homey treatment center, with personal bedrooms and bathrooms, a gym, a yard and a greenhouse, as well as serenity calming rooms.
But it’s not exactly home. The facility is locked and will still be surrounded by a fence; patients cannot come and go as they please or sign themselves out of treatment. Most have been previously hospitalized involuntarily, Department of Mental Health Commissioner Sarah Squirrell told the House Health Care Committee last week. Patients typically stay for between six and 18 months at a time, Squirrell said.
Unlike a hospital, she said, the program offers a shared kitchen and allows patients to work or volunteer in the community, accompanied by staff. The state estimates it will cost $1,565 per patient per day at the home, or about $571,225 per patient per year — and $9 million a year for 16 patients.
More beds will allow patients to move from the hospital into residential care more quickly, which in turn will help shorten wait times in the emergency room for people seeking a mental health bed in the hospital, according to Fox.
He said the Middlesex facility’s seven beds have run “pretty close to 100% capacity” over the past eight years.
Mental health advocates have objected to adding more beds until state officials are sure they need them. The Department of Mental Health is relying on 2019 data and hasn’t taken into account the changes since then, or the 12 new hospital beds that will be added at the Retreat this summer.
“If we make beds, we're going to fill those beds,” said Malaika Puffer, a psychiatric survivor and mental health worker in Springfield. Building without certainty “would be a phenomenal waste of money.”
A matter of autonomy
Another point of contention: The Department of Mental Health is asking lawmakers to change existing regulations and allow use of involuntary medication and restraint at the residence. Currently, these “emergency involuntary procedures” are allowed only in inpatient hospital settings.
Witzling, who uses they/them pronouns, said they had seen the impacts of those procedures firsthand.
“I spend a lot of time helping people heal from their time in hospitals — especially from the trauma of involuntary procedures,” Witzling said.
Instead, the state should spend more time asking people with mental illness what they want and need.
“It comes down to human autonomy,” they said.
Rep. Anne Donahue, R-Northfield, pointed to a recent incident at the Brattleboro Retreat, where a patient broke a hip as a result of a restraint. State mental health officials claim to heavily regulate and oversee uses of seclusion and restraint. But “you look at this, and say, ‘Oh? Our system has intense oversight?’” Donahue said.
Fox said restraint is actually a less coercive option. Currently, if a Middlesex patient becomes violent or out of control, staff members call the police. The patient typically goes back to a hospital, starting the treatment process over.
“The idea is that if someone has that brief or episodic dysregulation, it could be managed in-house,” he said.
Ultimately, it’s up to lawmakers to decide. The House Health Care committee will take testimony on the issue next week, then will vote whether to approve the proposal as written or to make policy recommendations. The committee’s guidance will go to the House Institutions Committee, which will decide whether to approve the line item in the capital budget.
That budget will be voted on by the whole Legislature later this session.
Advocates say they hope legislators will take time to listen to the people who have been treated in the state’s mental health facilities.
After all, “the whole point of mental health care is how people are feeling,” Witzling said.
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