The Truth of the Matter: Mental health at a crisis state


To paraphrase Winston Churchill, "Never have so few been asked to care for so many."

In Vermont, a week does not go by without hearing about another crisis. The crisis can be the overdosing on opiates, housing, climate change, domestic violence, prison overcrowding, or loss in population. But there is one crisis that seems to be continuously ignored and that is the crisis in mental health due to the lack of treatment facilities and providers. What makes the crisis more disturbing is that it pre-dates many of the recent crises that are being addressed.

To the state's credit, in 2015, it did rebuild and open a state mental health treatment hospital in Berlin, Vermont that replaced the antiquated 52-bed state facility in Waterbury – four years after the Waterbury facility closed. The previous facility only closed because it was destroyed in August 2011 by Tropical Storm Irene. Had the storm bypassed Vermont, the 19th Century facility would still be housing mental health patients. Also, in the past two years, several opiate treatment centers have been opened.

The lack of mental health treatment is even worse than what is commonly addressed. In a recent interview with the president of one of Vermont's hospitals, this writer was told that, at his hospital, of the patients discharged, almost one third have a mental health condition that the hospital is not allowed to treat. This conversation was soon after I had read that a state senator had given a statement that at the Southern Vermont Correctional Facility, in Springfield, approximately 80 percent of the inmates have some form of mental health illness.

According to the summer issue of Counterpoint, a state-wide newspaper that advocates for those with mental health challenges, Vermont has 14 community hospitals. Among the 14 hospitals, there are 1,514 inpatient beds, 58 are designated for inpatient psychiatry. If stated another way, only 3.8 percent of the total inpatient beds are available for mental health patients. This percentage does not include the 14 beds at the Brattleboro Retreat or the 25 beds at the Vermont Psychiatric Care Hospital, in Berlin.

There are two practical issues at play, when it comes to mental health treatment. One is the lack of being able to attract doctors of psychiatry as well as psychiatric nurses (recently, the state hospital had to close five of its 25 beds due to a lack of qualified nurses). The other factor is the reluctance by the state to provide meaningful Medicaid (most of the patients treated qualify for Medicaid) reimbursement to the hospitals.

In an August 30, 2016 report by Elizabeth Hewitt, of VTDigger, state government once again was forced to deal with another mental health crisis – at the above noted correctional facility. The state lost a lawsuit that pertained to an inmate's lack of mental health treatment. Hewitt's piece noted, ". . .the settlement could have an impact on many of the prisoners held in the Southern State's mental health stabilization unit, called the 'alpha unit,' which some advocates criticize. The agreement sets out changes so people who have a need for inpatient level of treatment will be better identified and more quickly addressed by the system."

Is it possible that the solution for the lack of inpatient beds and staff, throughout the state, can now be resolved by seeking treatment at any one of our state prisons? At a minimum, one would be assured of seeing a psychiatrist once a week. In the settlement, the state agreed to provide inmates who have a mental health issue a weekly visit and evaluation from a psychiatrist or an advanced nurse practitioner. At least somewhere in the state, there are not days, weeks or months of waiting for necessary treatment.

— Don Keelan writes a bi-weekly column and lives in Arlington


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