This commentary is by Nat Mulkey of Burlington. He is a writer and a child and adolescent psychiatry fellow at the University of Vermont Medical Center.
Recently, drastic cuts were announced to the services that University of Vermont Health Network can provide to our Vermont community. There is, and has been, a lot of finger-pointing about who is to blame.
I am no economics expert, so much of this debate is beyond me. However, I am an expert in a few things — the first is reality TV. And the beef between the UVM Health Network and the Green Mountain Care Board is some serious season-five-of-Selling-Sunset-Chrishell-vs-Christine stuff. In other words, a longstanding, sometimes shallow, animosity. All this is despite being on, in theory, the same team.
As a psychiatrist, I am also an expert in sitting in a room with desperate, suicidal, psychotic, manic, anxious and hopeless people and telling them I have little to offer them. The GMCB and those in charge of this state, have made sure of that.
Compared to my veteran colleagues, I am a rookie. I have been practicing here in Vermont as a resident and fellow psychiatrist for three-and-a-half years. Yet even in that short amount of time, the number of mental health services that have vanished is astounding. Extremely limited crisis counselors available both in the community and the hospitals, the loss of step-down units, the loss of substance use treatment facilities, the loss of adolescent treatment facilities — and with this new announcement, a huge cut to the psychiatric services in central Vermont.
The GMCB continues to issue a number of disappointing responses in reaction to the UVM Health Network’s announcements. The continued effort to give UVMHN the “villain edit” is both cringe and misleading. It remains challenging to watch the dehumanization and demonization of health care “administrative costs” without recognition that these are real people, with real jobs.
Truthfully, I also am over hearing red-herring blame related to executive pay — those salaries are drops in the bucket compared to the cuts the GMCB has now required. Not to mention these salaries are fairly standard for academic hospital executive pay. Sure, there are lofty equitable pay structures that can be discussed all around, but to put it simply, UVMHN and those that run it are fulfilling their roles in this state to the best of their abilities within increasingly restrictive regulations.
It would be at this time in a therapy session that a good counselor would call attention to some clear defensiveness, really on both parties’ ends. But one party in the room is the regulator, and does have more power than the other. I get it — I too feel defensive in the face of being told I am not doing a good job. (Which happens all the time, when I face misplaced outrage at our system and sit in rooms with patients as they, or their families, yell at me).
I was able to find and review the GMCB’s vision statement on its website. Luckily for me, it actually is not my job to create or curate resources in our system to meet the needs of Vermonters. But it is theirs, in part, or at least it is their job to, as I’ll paraphrase from their website, work closely with other agencies and providers to enhance the quality of our care. I fail to see how a longstanding, oddly targeted campaign against the hospital system responsible for the bulk of care in this state fits into that mission.
I will reiterate, I am not a health care economist, but clearly something is not working. From the short time I have been at UVMHN, I’ve seen this hospital system invest in subsidized housing in the area, invest in diversity, equity and inclusion leadership, work with community partners to establish a mental health urgent care, and work with various unions representing different work forces in the hospital.
Should a health care system be doing some of these things at baseline? Absolutely. But are the vast majority of similarly resourced academic medical centers in this nation making these same efforts? Absolutely not. With the dire landscape of Vermont housing and elder care, hospital systems like those in the UVMHN end up filling these gaps.
I do know the GMCB is aware of these increased challenges because they have mentioned it in their statements. It’s one thing to dedicate a sentence to it in a press release, it’s another to sit face-to-face with these “challenges” in a room and be forced to coldly level with them about the limits of a health care system.
So team, what is the vision here? Right now it looks like stacked emergency departments and embarrassingly poor and highly inequitable care for Vermonters. I am clearly biased, but it seems far past time for GMCB to take seriously UVMHN’s stated limits on its ability to integrate the board’s restrictions without compromising patient care.
Mental health care will continue to get the short end of the stick. My colleagues and I will continue to sit in rooms with desperate people and apologize for things we have no control over. And we will continue to absorb the anger and hurt that Vermonters justifiably feel about being the actual victims of this situation.
