Hospital to expand ER to address increased mental health demands


BENNINGTON -- Despite the emergency room being no place to deliver psychiatric care, at times the local hospital's ER is half-filled with people in need of mental health care, some of whom have been there for weeks at a time awaiting placement in a more appropriate facility.

The problem is not expected to go away, said William Hall, director of engineering at Southwestern Vermont Medical Center, and so the plan is to renovate existing storage space near the ER into a three-bed area specially designed to house patients suffering a mental health crisis.

Hall expects the renovation will cost between $120,000 and $140,000. A building permit will be submitted to the Town of Bennington this week, and construction should begin in the first week of March. The space will have an office for nurses and security staff who can monitor patients via closed-circuit television to allow them solitude. It will be handicap accessible and there will be a bathroom with a shower.

The Vermont State Hospital in Waterbury, formerly the state's primary mental health facility, closed in 2011 when it was flooded by Tropical Storm Irene. While the state plans to open its replacement this summer, not only have hospitals statewide been struggling to place their psychiatric patients in the meantime, but some worry the pressure on their ERs will not be completely alleviated.

The Vermont State Hospital had 54 beds, while the new one under construction in Berlin is expected to have 25. "We believe that we are building a state mental health facility in Vermont that's going to be an example for the rest of the country, that's our plan," said Gov. Peter Shumlin Monday in an interview. "You have to remember that we lost our state hospital in the middle of the night, we still don't have it back, and we believe that the additional 25 beds along with the enhanced community-based care, which is what we're really beefing up, is going to reduce the need for acute care when prevention in the local community works better, is more cost-effective, and better for patients."

He said the state is still in crisis in the meantime, and the hospitals have handled things well.

Locally, there is skepticism the new facility will alleviate the pressure on the ER.

"The long and short of it is that in total by the end of the summer it's anticipated that they will have increased the capacity of the system by 10 beds, and I don't think anyone realistically thinks that's going to fix the problem," said Dr. Adam Cohen, medical director of SVMC Emergency Department.

Cohen spoke to the Banner in early January and said that during the previous week, seven of the ER's 16 beds were occupied by patients in need of psychiatric care, two of whom had been there for over a week.

"They are very resource-intensive patients to take care of," he said. "In many cases we need a sheriff and a full-time one-on-one provider to take care of these patients."

An emergency room is not a good place for someone in need of psychiatric care, according to Cohen.

"It's bad for them, they're in a high-stimulus environment that usually makes them worse. It's bad for the other patients in the ER," said Cohen. "Imagine you're next door with your 3-year-old and there's a violent, out of control, psychotic patient in the room next to you screaming profanities the whole time you're there. That's not good for anyone else in the ER."

These new rooms will allow patients in mental health crisis to be away from the noise and hustle of the ER while they can still be monitored to make sure the do not harm themselves or others.

Hall said these rooms are an extension of the ER, not a new department. No new services will be provided by the hospital, which does not offer psychiatric care.

This problem is not unique to SVMC.

"There is very poor access to psychiatric treatment in the state," said Cohen. "Again, not a local problem, not a Vermont problem, but a problem nationwide, but if you come to the emergency department there is a likelihood that your wait times will be longer because we are treating a large population of psychiatric patients in a system that is designed, at this point, to offer them no recourse but to go to the emergency department and wait there for a long time for treatment to be available."

People in need of emergency care cannot be turned away, and when a patient has nowhere to go, Cohen said, emergency rooms end up being a catch-all place to put people.

"We've had to develop training programs to handle these kinds of things, and it's been a lengthy process," said Cohen. "I feel that we have the training and the policies in place now to help us handle this population as best we can under the circumstances, but this is not the purpose of an emergency department."

He noted that providers have been assaulted by patients numerous times, which adds to the rate of staff turnover.

Contact Keith Whitcomb Jr. at or follow him on Twitter @KWhitcombjr.


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