When people in crisis show up at Montpelier’s Another Way Community Center, they’ve often tried other things first — calling their case workers or therapists, or leaving messages at their psychiatrist’s office.
Ericka Reil, a trained peer specialist who has a history of homelessness and schizophrenia, supports them one conversation at a time.
Sometimes patients have taken a bus or taxi straight from the ER, where it can be hard to get treatment for acute mental health needs, the Vermont native said. One man told her he was discharged because staff told him he wasn’t sick enough to be hospitalized, but he felt he couldn’t handle his crisis alone.
“What do I have to do?” Reil recalls him asking her. “Do I have to get violent for them to hold me?”
Many have almost nowhere else to go: As of Monday, all but five of Vermont’s 138 adult psychiatric beds were in use.
Now, state officials are planning to increase its psychiatric capacity. But staffing shortages may complicate that.
Mike Smith, secretary of the Vermont Agency of Human Services, said during a press conference last week that the state would bring back nine adult beds, five of which would re-open by mid-September.
The private Brattleboro Retreat would add 12 adult beds and four pediatric beds. Smith said he expects the Retreat would reopen six of these beds by mid-September.
Leaders at the Retreat and the state’s hospital in Berlin, Smith said, are “actively seeking more staff” to make that goal.
Mental health needs on the rise
Vermonters’ mental health needs loom large outside of Another Way, a community center that helps people with mental health needs. Reil said the agency sees as many 27 walk-ins on an average day.
Among the issues: opioid addiction, anxiety and depression. And they’re concerns that can be found across the state.
Opioid overdoses made up a larger portion of Vermont’s emergency department and urgent care visits in 2021, at 31.9 visits per 10,000, up from a previous three-year average of 23.7 visits per 10,000, according to an Aug. 9 report from the Vermont Department of Health.
Although the report suggests that this trend may be temporary, Kelly Dougherty, deputy commissioner at the Vermont Department of Health, noted in a press conference Tuesday that the uptick is concerning.
Unaddressed anxiety and depression symptoms have also gone up. At the height of the pandemic in April 2021, almost 40% of adults with anxiety and depression in Vermont needed therapy they did not receive, according to a Kaiser Family Foundation study. As the state lifted all of its emergency restrictions in June, that number declined to 16%.
The foundation has yet to release its August metrics, but Alison Krompf, deputy commissioner of the Vermont Department of Mental Health, noted a “worrisome” increase in the number of adults with mental health needs this summer even as the number of children needing psychiatric support stabilized.
Reil can’t always see the conditions that bring residents to the community center. The outcomes are easier to see, especially in people who are experiencing homelessness and mental illness. Some come back to the center for years and make lasting impressions, she said.
“And there are some people I’ll probably never see again,” she said. “But I hope I do.”
A deepening staffing shortage
In the world of health care, beds are more than mattresses on a metal frame. The nurses, doctors, technicians and other workers who care for patients in those beds are also part of the equation.
It can be tricky to determine exactly how many staff members are needed per bed, but in general, patients with more serious conditions demand more staff. Federal guidelines say inpatient psychiatric facilities require a certain number of medical staff to be on the premises at all times, but facilities also have to balance patient needs with the cost of staffing.
The Brattleboro Retreat, which serves as the state’s largest psychiatric hospital, had its share of staffing challenges before the pandemic. But layoffs, budget cuts and resignations throughout the pandemic have only made the task of recruiting and retaining nurses and technicians more challenging.
Alluding last week to similar challenges at the state psychiatric facility, Smith said the state plans to fill staffing gaps with contractors, also known as travelers. Travelers often fill positions temporarily, albeit at much higher salaries than full-time staff. Because of that cost, health systems turn to temporary staff as a last resort, but provider burnout and vacancies across the health care system have increased reliance on these travelers.
Krompf, however, said the state department of mental health would likely succeed in recruiting full-time staff because Vermont’s high vaccination rate — more than 86% of eligible residents to date — has made the state “a safe haven” for workers from areas with more cases.
Hiring staff for additional beds in the middle of a pandemic would likely be more difficult even for Vermont, and especially in the mental health field, said Davis Patterson, who studies the nationwide provider shortage at the University of Washington in Seattle.
Psychiatric staff, especially nurses and mental health workers, have been hard to hire even before the pandemic. With some health care workers leaving the market for higher-paying and safer and easier jobs, that staffing pool shrunk even more, Patterson said.
“In the short term, [workforce reductions that] seem good often end up being, in the long term, sort of a short-sighted thing,” he said.
Retreat leaders also hinted that there may be challenges ahead. The Retreat has some beds for patients and “is anxious to help alleviate” the bed shortage,” spokesperson Jeff Kelliher wrote in an email Monday.
“However, like so many other healthcare facilities in rural areas like Vermont, the lack of a fully-staffed workforce is a primary challenge,” he added. “We are working with our state partners to address this issue and identify steps we can take to remove this barrier.”
