(cross-posted from Beyond VSH blog, here)
Jointly Signed Letter from Members of Vermont Mental Health Advocacy Community to Legislators re: Relooking at Mental Health ‘Futures’ Project:
Vermont Protection & Advocacy, Inc.
141 Main Street, Suite 7
Montpelier, VT 05602VP&A is the Protection & Advocacy System for Vermont(800) 834-7890 (Toll-Free)
(802) 229-1355 (Voice)
(802) 229-2603 (TTY)
(802) 229-1359 (Fax)[… (e-mail address omitted)]
Date: April 15, 2009
To: Members of the Vermont General Assembly
From: Vermonters concerned with mental health services.
Regarding: We need a new look at the “Futures Project”!
A number of advocates for mental health issues have expressed very serious reservations about certain parts of the “Futures” project proposal to replace the various services that are currently delivered at the Vermont State Hospital, with the ultimate goal of closing the facility.
Doubts have been expressed about the expense involved in the proposal to build a new facility as part of Rutland Regional Medical Center because of its complex financing scheme that replaces capacity for VSH and replaces their current unit for RRMC. There is also concern that making it, in effect, the initial ‘triage’ point of the system is not consistent with progress towards a community-based system and will also discourage deeper participation by other community hospitals, making the closure of VSH a more distant possibility. This is especially true since the other local hospitals will still need to serve patients NOT served at Rutland when the beds there are filled – and they need to be filled to make the financing package viable. We will be left needing VSH for the foreseeable future!
There has been considerable support for the development of community residential recovery resources and peer-run alternatives as well as support for the development of secure residential capacity, though without consensus on location and the final form a facility might take. There is also considerable concern that current planning has not accounted for such factors as the stress that the community mental health system is under and the particular need for housing options for people with mental health issues.
Yet most would agree that the state hospital should close sooner rather than later and ask what is the answer or answers to the replacement of its functions! Here are some thoughts that may be of some use.
The Futures project started with a large number of interested individuals with a broad range of interests and experience being brought together to devise a solution. Five years later VSH is still operating with a 54 bed capacity.
With all that has happened since the process began it seems clear that if we are to close the facility several things need to occur:
- Whatever plan is adopted needs to have the clear goal of closing VSH, with a target date!
- There needs to be leadership that is willing to put together a plan based on the values expressed in the early “Futures” legislation that include being community based, Recovery oriented, and trauma informed,
- That plan should be presented to and discussed with a broad range of “interests” and leadership should be willing to work WITH the community to refine and modify when appropriate,
- Under-served areas and a reasonable geographic distribution of services should be considered,
- The mental health needs of inmates who currently lack meaningful access to inpatient services require greater consideration,
- The plan should not hinge on diminishing civil rights or due process for people facing involuntary treatment.
Is such a course of action possible? We believe it is if there is an understanding of the goals and if it is clear that solutions rely on the broad community and not just the willingness of one particular player to participate. All of the designated hospitals, and in all likelihood some other community hospitals, need to be involved in meeting the needs of their local areas. We need to rethink the idea of responsibility at the local level. This means that some new version of a “no-reject” policy needs to be worked out so that evaluation and clinically appropriate services can be delivered without the VSH as a “safety-valve”. And solutions need to be developed for individuals with long term needs.
There are a number of possibilities for partnerships that ought to be considered, that could lead to closing VSH and that may, together, create a more promising system in Vermont. Some of these have been discussed and cursorily rejected; some of them have not received serious consideration. All of them present challenges, but none should be rejected without further consideration with a problem-solving orientation:
- St. Johnsbury – in an area of the state underserved in psychiatric inpatient services a unit could be developed either by the hospital or the state that could serve up to 16 patients,
- St. Albans – the Northwest Medical Center has potential for developing 3-4 beds within their facility, if they could do so with support of the state,
- Bennington – the Southwest Medical Center used to have a facility that could serve 12, perhaps that could be redeveloped without great capital expense,
- Springfield – the beds closed at the Windham Center could be re-opened adding 6-10 new beds, again without capital expense,
- Burlington – could FAHC develop a small, specialized unit within its current footprint to serve medically complex patients, adding 6-12 beds of capacity to the system?
- Rutland – could the Medical Center utilize some of their current licensed capacity or develop a unit less reliant on the state than the current plan and serve 6-12 new patients?
- Berlin – locating a state facility near the Central Vermont Medical Center has been proposed. This could be a potentially better choice than the VSH “campus” for a secure residential facility serving 15 clients,
- Brattleboro – The Retreat is likely a willing partner with the state and could possibly increase capacity by 6 beds without great capital expense.
This list has the potential for 70 or 80 beds to assist in the closure of the 54 bed VSH and, in the case of units that may be developed by the state, meet the needs of people with serious mental illness who are currently spending shameful amounts of time in segregation in our correctional institutions.
No one of these possibilities is the be all and end all solution.
No one of these could happen without a real consideration of obstacles like corporate structures, IMD rules, staffing challenges, and re-imbursement hurdles.
None of these suggestions will occur without active engagement with community players, respecting their financial challenges and their view of the local community’s needs.
No one community should provide such a significant part of the solution that the state concentrates so much of its resources that other parts of the plan becomes impractical.
What is “the community” and who needs to be part of the solution?
- Individuals who have lived with mental health issues,
- their families,
- local hospital leaders,
- designated mental health agencies,
- advocates,
- the state administration,
- experts in Medicaid and Medicare,
- the medical profession, and
- the public at large!
Vermont is capable of developing services that respond to our citizens’ needs. We would never have closed Brandon without the imagination to build a community based system different from what went before.
We have developed Second Spring and are in the process of developing Meadowview in Brattleboro, as well as a peer run respite center. We now need to look at our larger institutional partners, the community hospitals, across the whole of the state, as part of a coherent delivery system. Our system for physical health has evolved in that way and we should consider no less for individuals with mental health issues.
Respectfully Yours,
Laura Ziegler, Plainfield
Morgan W. Brown, Montpelier
David Fassler, M.D., Charlotte
Michael Sabourin, Marshfield
Ed Paquin, Executive Director,
Vermont Protection & Advocacy, Inc.Sally Parrish, South Burlington
Bethany G. Knight, Northern Knights Consulting, Glover
Xenia Williams, Barre Town
Marty Roberts, Montpelier, Vermont Psychiatric Survivors,
Adult State Mental Health Standing CommitteeLarry Lewack, Executive Director,
National Alliance on Mental Illness of VermontGwen Budd, Montpelier
Jack McCullough, Project Director,
Mental Health Law Project, Vermont Legal Aid