Last year, the state set aside more than $9 million for a new inpatient psychiatric unit for youth at Southwestern Vermont Medical Center in Bennington.
The expenditure is a sign of rising concern about the mental health of Vermont’s young people, and the shortage of resources to address it. With few other places to go, youth in mental health crises often end up in hospital emergency departments, where they sometimes stay for days.
But as the hospital moves towards standing up the facility, which would serve youth aged 12 to 17, other organizations are raising questions about whether it is truly needed — and whether the state’s money might be better spent elsewhere.
In filings with the Green Mountain Care Board, the Brattleboro Retreat, a psychiatric hospital located in Brattleboro, and the nonprofit advocacy group Disability Rights Vermont argued that the need for the new 12-bed unit was not supported by evidence.
Southwestern Vermont Medical Center “proposes a service that the Retreat believes is duplicative, and therefore an improper use of health care resources within the system and an unnecessary use of taxpayer dollars,” Elizabeth Wohl, the general counsel at the Brattleboro Retreat, wrote to the Green Mountain Care Board last month.
Wohl acknowledged in the filing that one reason for concern is that the proposed unit could draw patients away from the Retreat and cut into its revenue.
But the Retreat also argued that the state does not need more in-patient beds for youths, and should instead invest in lower-level residential and outpatient services.
That argument is similar to the one made by the advocacy group Disability Rights Vermont, which also opposes the expansion.
“Since I’ve been here, so for the last dozen years, the department (of mental health) continues to put such a heavy emphasis on the most restrictive and the most expensive settings for people,” Lindsey Owen, the group’s executive director, said in an interview. “And now they’re attempting to do that with our youth. And really this approach is absolutely setting up our kids for failure.”
Those concerns raise a crucial question: where should the state invest its limited resources to best help young people struggling with their mental health?
Youth in hospitals
State officials requested the funds for the new unit last year, amid growing concern about young people with mental health needs and their impact on the state’s hospitals.
Between January of 2023 and January of 2024, hospitals reported nearly 1,600 instances of youths seeking mental health help at emergency departments. In roughly a quarter of those visits, young people stayed at the department for 24 hours or more, according to data collected by the Vermont Association of Hospitals and Health Systems.
State officials and administrators at the Southwestern Vermont Medical Center say that there is high demand for inpatient beds. Last month, the Bennington hospital filed an application with the Green Mountain Care Board for a certificate of need, a necessary approval to move ahead with the renovation for the facility.
The hospital, which became part of the Dartmouth Health Network last year, proposes to pay roughly $300,000 towards the renovation. The state will foot the rest of the bill, according to the GMCB filing.
“Adolescents are not receiving optimal healing treatment and potentially being exposed to additional emotional and mental harm as they wait for inpatient placement in emergency departments across the state,” hospital administrators said in that application.
State officials say that the new unit would also help youth who need hospital-level treatment for both mental health and other medical conditions.
How many beds are needed?
The actual demand for more beds is difficult to quantify. A feasibility study completed last spring did not land on a hard number of needed beds; instead, the study estimated only that the state needed anywhere between zero to 12 additional inpatient beds, or possibly more.
“The actual math around figuring that out is super, super complicated,” said James Trimarchi, director of planning for Southwestern Vermont Medical Center. But, he said, the demand is plain to see in hospital rooms around the state.
“Kids are in our emergency department for days waiting for placement,” Trimarchi said. “We know that’s a problem. And we also know that, as good as Brattleboro Retreat is, it’s not the right treatment approach for all kids. Kids need choice.”
Steve Cummings, the interim CEO of the Brattleboro Retreat, said that the institution had weighed in on the project in hopes of sussing out the actual need for mental health facilities.
The Retreat is currently working to reopen a youth residential treatment program, a lower-level facility than a hospital inpatient unit, with a capacity of roughly 15.
“You look at wait times in emergency rooms for adolescents,” Cummings said. “But the hard part about that is, if an adolescent is waiting, the statistics don’t always show — are they waiting for an inpatient bed? Are they waiting for a residential location? Are they really medically complex patients that we couldn’t take?”
‘To the point that they’re in crisis’
Owen, the executive director of Disability Rights Vermont, said that the $9 million would better be invested in shoring up less intensive mental health care: counseling, school resources, community-based services.
That way, kids struggling with their mental health could get help earlier and more easily, and not escalate into something more serious, she said.
“If we paid direct service providers appropriately, then we would be able to have people in those positions, and we’d be able to provide Vermont residents with proactive health care,” Owen said. “And not allow for a system where the only thing that happens is people deteriorate to the point that they’re in crisis, and they wind up in these more restrictive settings.”
Emily Hawes, the commissioner of the Vermont Department of Mental Health, declined to talk specifically about the Southwestern Vermont Medical Center project, as it is currently under review by the Green Mountain Care Board.
But, Hawes said that the state has already made investments in many areas of the mental health ecosystem.
She pointed to funding for psychiatric urgent care initiatives for youth and adults across Vermont, as well as a new Mobile Crisis program that can respond to people experiencing mental health crises around the state. The department also operates the 988 suicide and crisis hotline, she noted.
“We strategically invest in multiple levels across the system,” Hawes said. “That’s ultimately our full commitment, is that folks are able to get care when and where they need to.”