The mental health care overhaul springs another leak

With a new legislative session just around the corner, little signs of budget distress are popping up all over. Here’s the latest: According to VTDigger, Department of Mental Health officials have told lawmakers that this year’s expenditures are $1.15 million over budget — and next year’s spending is expected to be $20 million above that. Which is a hell of a lot, considering that this year’s budget for the mental health system was just under $40 million.

In other words, the projected cost will rise by 50% next year.

And that doesn’t include construction costs for new facilities.

The major annual operating cost increases stem from the $9 million needed to run the new state hospital [in Berlin] and the roughly $3.6 million to operate facilities in Chittenden and Rutland counties. Other cost increases are spread out across the board, according to a department spreadsheet.

I’ve been saying all along that advocates of community-based care may come to regret backing the Shumlin plan: the administration has promised better care for all in exchange for reduced inpatient space. With the costs of inpatient care on the rise, it remains to be seen whether that promise will ever be fulfilled. .  

Another factor unaccounted for: how much cost shifting has there been since the Vermont State Hospital closed? Presumably, the state has saved some money by not having a VSH. On the other hand, hospital emergency rooms have seen higher costs because they’ve served as holding pens when there are no available mental health beds. Which is frequently the case. And, presumably, community mental health systems have been under pressure to treat sicker people and keep them out of hospitals. Also, in the constant search for beds, there’s been a lot of patient-shifting around the state. Has the state been covering some of those costs?

Those are questions that would help us more fairly evaluate the system’s financial straits.

However, there’s one unknown that is really, in the immortal words of Donald Rumsfeld, “a known unknown.”

Legislators and officials in the statehouse on Monday discussed the difficulty of budgeting for psychiatric care.

“Trying to pinpoint the number (of psychiatric patients) is almost impossible,” said Sen. Jeanette White, D-Putney. “We have no idea how many of our 620,000 residents will need inpatient or outpatient care.”

With respect, Senator, I hope you don’t really believe that. And I especially hope you’re not laying the groundwork for cutting the budget because “we don’t really know.” Senator White is using the same rationalization employed by President Bush for keeping the Iraq and Afghanistan wars out of his budgets.

It’s actually not that hard to project future needs. In fact, it’s standard operating practice. How do you know how much snow will fall this winter? How many crimes will be committed, or how many defendants will be sent to prison? How do you know exactly how much tax revenue will come in?

The answer, in all cases, is you can’t “pinpoint” the future cost of anything. But you have a damn good idea based on past experience and expert planning, and you have contingency plans in case things go sideways.

And when the projection for next year goes up by 50%, well, it’s a pretty strong indication of trouble on the horizon.  

2 thoughts on “The mental health care overhaul springs another leak

  1. of $10 million annually from 2003-11 due to failure to receive certification for at least eight years, those overruns look like a bargain.

    VSH was found to be plagued with gross mismanagement & incompetence on an ongoing basis-there is no reason to believe this will change, which is why the legislature as well as the professionals involved made the decision to move to a different model rather than imprisoning the mentally ill in long term institutions unless absolutely necessary.

  2. Those in favor of the new system are always positing it against the old VSH, which isn’t coming back anytime anywhere. The choice is between a spread-out system and one containing a central hub. IMO, the spread-out system is going to have significant problems.

    And you lose all credibility with me when you refer to psychiatric hospitalization as “imprisonment.” For some people — for a very tiny number of the most mentally ill people — confinement is the best option. And for all but the tiniest minority of that tiny number, it would be confinement for a brief period of time. The days when we locked people up and threw away the keys are long gone.

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