Several Vermonters with complex mental health needs were transferred to a new locked residential facility in Essex last week, officials from the state Department of Mental Health told legislators.
“It’s staffed and ready to go,” Commissioner Emily Hawes told the House Health Care Committee on Wednesday. “We’re really excited for folks to be engaged in that therapeutic environment.”
The newly constructed River Valley Therapeutic Residence marks a milestone in the state’s long journey to restructure its options for secure mental health care after historic flooding from Tropical Storm Irene in August 2011 closed the Vermont State Hospital. The project adds nine additional residential beds.
Yet another shift is likely to come from S.89, a bill in the final stages of approval in the Legislature that would allow establishing a separate nine-bed “forensic” residential facility within the building that houses the Vermont Psychiatric Care Hospital in Berlin.
Also moving forward, though not for sure, is a new 12-bed inpatient psychiatric unit for youth ages 12 to 19 at Southwestern Vermont Medical Center in Bennington, which a recently completed study found would be feasible.
All three projects are part of the department’s goal “to create a comprehensive system that empowers Vermonters to receive mental health care on their terms, whenever and wherever they need it,” Hawes said in an emailed statement.
Analysts pointed to a deficit in inpatient beds as one cause of a significant increase in the number of adults and youths waiting in the state’s general hospital emergency departments for mental health treatment.
In the last six months, there has been a decrease in the average number of people waiting in emergency departments for care, as well as in the percentage of people there for more than 24 hours, according to the Vermont Association of Hospitals and Health Systems. The group represents all 14 of the state’s non-federal hospitals and collects weekly data from them.
“This is good news for those in need of care and for our emergency departments and inpatient floors,” the organization said in a written statement. “However, on any given day, we still have many Vermonters waiting for care in a therapeutic inpatient setting which is why we remain committed to continued progress in this area.”
FEMA trailers no more
The new 16-bed River Valley Therapeutic Residence opened after a low-key ribbon-cutting last Friday, Hawes told legislators. It is located off Route 15 on the former site of the state’s now-demolished youth detention center.
Five residents were there on Wednesday, according to a department spokesperson. Planning documents project people would stay an average of 18 to 24 months, with the goal of being able to return to a less restrictive community setting.
The adult-only facility is intended as a “step-down” option for people who were previously patients, most often involuntarily, at the Berlin psychiatric hospital or the state’s other two most restrictive, so-called Level One, units at Rutland Regional Medical Center and the Brattleboro Retreat.
At a cost of around $19.3 million, plus more than $5 million in estimated debt expenses, the new building replaces a seven-bed temporary facility that opened in 2013. That location, cobbled together out of two Federal Emergency Management Agency trailers alongside the state police barracks in Middlesex, was intended as a three-year stopgap solution but went on to be used for almost a decade.
In the new building, each resident has more personal space, a larger bed and their own bathroom, as well as more areas for activities indoors and outside. The residents seemed “super stoked” about the upgrade, Hawes told legislators.
“It was really nice just to see the expressions on folks’ faces when they walked in,” Hawes said.
Another secure residence on the horizon
The proposed new “forensic facility” would change the designation of nine beds in one wing of the Berlin building from being part of the inpatient hospital to a therapeutic residence. This is primarily a reduction in the type of medical equipment and staffing levels required.
The space would serve as a long-term secure residence for Vermonters involved in the criminal justice system. Specifically, it would be reserved for people who have been charged with the most serious crimes, but who either have been deemed incompetent to stand trial or were found not guilty by reason of insanity.
The bill, which is headed to Gov. Phil Scott’s desk after winning approval in the Vermont House and Senate, would exempt the project from the normal “certificate of need” review by the Green Mountain Care Board. It would also require both the Department of Mental Health and the Department of Aging and Independent Living to undertake separate and joint public rule-making processes to determine criteria and procedures for commitment to the facility.
A sticking point for advocates for Vermonters with intellectual disabilities has been whether a forensic facility is appropriate for that population. In response, the legislation now establishes a working group to assess the question and requires that, for that group, the criteria be approved by legislators.
A concern of mental health advocates is that the new facility would reduce the number of high-acuity inpatient beds by more than 15%, to 48 beds.
The department had originally requested that the River Valley facility be designed to be used by individuals who the courts might require to take medication involuntarily. An amendment that “the facility shall not use emergency involuntary procedures” originated in House Health Care and was added to the 2021 capital bill, which removed that possibility.
Hawes said, “it is inevitable that there will be some impact” from the change. However, it is needed to provide a place for people who in several cases are currently in the prison system but would be best served in a therapeutic environment.
“We must take into consideration the vulnerable population of individuals who are not competent, involved in the criminal justice system, and struggling with mental health, substance abuse or intellectual disabilities,” she said in the statement.
Also, the majority of Vermonters who need inpatient care would not be served in the high-acuity Level One hospital setting. The care system currently has 142 general inpatient beds for adults at seven different hospitals and 30 beds for children and youth at the Brattleboro Retreat only. The Bennington project would increase the latter number to 42.
The Bennington hospital recently completed a study that concluded the new youth psychiatric project would be feasible, if the state provided several layers of support. SVMC was the only respondent to a request-for-proposals initiated by the department last year.
The youth facility would require start-up operational support of $1 million and a committed $9.2 million to subsidize the renovation of a former records wing, as well as a $2,000-per-day rate for Medicaid-funded patients. The renovation funding is allocated in the latest version of the fiscal year 2024 budget bill.
Southwestern Vermont Medical Center, which recently became part of Dartmouth Health, said that psychiatric staff would be provided in partnership with Dartmouth Hitchcock Medical Center, Hawes told the committee.
Health care committee Chair Lori Houghton called the progress on the inpatient facilities as the expansion of several community-based crisis response programs “all really exciting.”
“These things should all help alleviate (pressure on) the hospitals,” she said.