Brattleboro Memorial Hospital
Brattleboro Memorial Hospital
Saturday March 30, 2013

Editor's Note: This is the first in a three-part series on the state of
Vermont's mental health care system since the closure of the Vermont State Hospital in August 2011.

BRATTLEBORO -- Finding treatment space in Vermont for a person with a serious mental illness was difficult before Tropical Storm Irene wiped out the Vermont State Hospital and its 54 beds.

Since then, it's only gotten worse.

"We are in a crisis. I cannot stress that enough," said Mary Moulton, commissioner of the Vermont Department of Mental Health. "We do not have enough capacity."

On a bad day in the Green Mountain State, there might be eight people in hospital emergency rooms around Vermont, waiting for a bed in a psychiatric facility, she said.

"We occasionally have seven- or eight-day waits, but it's not standard," said Moulton, adding it is not a problem that is exclusive to Vermont. "In New Hampshire, they've had up to 30 people waiting for up to two weeks, waiting for a psychiatric bed."

Moulton recently told WCAX that 65 percent of the patients in need of a secure treatment facility are placed within 24 hours. But for those requiring involuntary commitment, she said, the wait can take days and often requires 24/7 supervision by security or law enforcement.

"It's very stressful when someone can't get into a bed," said Moulton. "Every day, it's like a virtual hospital, and every day we have rounds. We work to move them."

Dr. Richard Meyer, emergency room director and chief medical officer at Grace Cottage Hospital in Townshend, said finding beds for psychiatric patients wasn't easy even when the state hospital was open.

Grace Cottage hasn't seen a spike in the need for acute care since the state hospital closed, said Meyer, but in the last quarter of 2012 and in the beginning of 2013, he did see an increase in need for overnight stays.

"Maybe it was a random cluster," he said. "Things seem to have petered out in terms of psychiatric patients needing admission who couldn't find a bed."

In those cases, Grace Cottage provided its own security, said Meyer.

"When we have to keep somebody overnight, we move them out of the ER and get them into a hospital bed," he said. "However, it's not the best care for the patients. If someone with a decompensating psychological condition is in an ER or a non-psychiatric hospital for a day or two, they may be getting worse, instead of getting better. They're not getting the specialty care they would get at a psychiatric hospital."

At Brattleboro Memorial Hospital, the emergency department gets, on average, 14,450 visits a year, said Steve Gordon, BMH's president and CEO. In the past two years, admissions for substance abuse or mental health issues rose 2.3 percent, not a significant increase, he said. But the number of patients needing a bed in a psychiatric facility actually increased 16 percent last year.

"And the number of patients going to the Brattleboro Retreat or the Windham Center has increased 46 percent," said Gordon. "Though the Retreat is taking the lion's share."

The Windham Center, in Bellows Falls, is a 10-bed inpatient unit of Springfield Hospital.

When a facility such as the Retreat or the Windham Center doesn't have a bed, hospitals such as BMH and Grace Cottage have to make do until one can be found, increasing demands on medical and security staff that may not be trained to respond to the mental health issues.

Grace Cottage Hospital
Grace Cottage Hospital

"We have had an increase in one-to-one staffing," said Gordon. "It depends on the patient."

The hospital has to pay out of pocket to deal with issues raised by caring for mental health patients, including training for security and medical staff, meetings to address the issues and the creation of policies, said Dr. Kathleen McGraw, BMH's chief medical officer.

"Financially, it's definitely a burden. If we didn't have to spend the money on extra security, it would be available elsewhere."

But the added costs are not stopping BMH from what it needs to do, said Gordon.

"We are adding more educational opportunities for staff to deal with psychiatric emergencies and de-escalation," he said.

The Brattleboro Retreat on Linden Street in Brattleboro. (Reformer file photo)
The Brattleboro Retreat on Linden Street in Brattleboro. (Reformer file photo)

BMH is in the process of renovating its emergency department, adding two secure rooms to address the needs of patients with acute mental health issues.

Jill Mazza Olson, the vice president of policy and legislative affairs for the Vermont Association of Hospitals and Health Systems, said until a 25-bed hospital in Berlin is open, hospitals and their ER staff will continue to be the frontline for what she called "the ongoing crisis."

"The hospitals that have inpatient psychiatric care are continuing to be very stressed," said Olson. "Some hospitals have had to reduce the total number of patients they can care for in a unit due to the complexity of the patients."

Many of those patients have medical needs in addition to their psychiatric needs, said Olson, and hospital staff also has to be aware of behavioral issues with certain patients.

"We are not going to see less stress in the system until we see more beds," she said. "And we will not know if we have the right number of beds in the system until we have those beds up and running and see how well the system is working."

In Monday's Reformer: Health Care and Rehabilitation Services, based in Springfield, staffs the front line of the battle against mental health illness in Vermont.

Bob Audette can be reached at raudette@reformer.com, or at 802-254-2311, ext. 160. Follow Bob on Twitter @audette.reformer.