Saturday March 30, 2013

BRATTLEBORO -- The Vermont State Hospital was opened in 1890 in Waterbury. It was built to relieve overcrowding of the Vermont Asylum for the Insane, now known as the Brattleboro Retreat, which was opened in 1849.

At one time, the state hospital complex in Waterbury grew in size to 40 buildings, with a patient population peaking in the 1930s at more than 1,700. But by the 1980s, it had shrunk to one building, with the remainder being used for state offices, many of which were also flooded by the rains deposited by Irene in August 2011.

Since the state hospital was closed following the storm, Gov. Peter Shumlin has proposed spending $45 million on new mental health facilities around the state, including $20 million for a 25-bed state hospital in Berlin.

Vermont was hoping to get 90 percent of its funding from FEMA, but the federal agency initially denied the application, concluding the buildings in Waterbury were not destroyed by the flooding and therefore the state did not deserve emergency funds for rebuilding them. In January, the state was notified that it would be receiving $30 million in combined insurance payments and funding from FEMA to build the hospital in Berlin.

The state’s new plan calls for care facilities in communities around the state.

According to a December 2012 report from the Mental Health Oversight Committee of the Vermont State Legislature, the state’s mental health system provides services to more than 28,000 adults and children every year. Care ranges from acute inpatient hospitalization to case management and peer services.

Prior to the closure of the state hospital, acute mental health care was provided at the centralized location in Waterbury.

"The General Assembly used the devastation of VSH as an opportunity to transition from a centralized system of care to a decentralized system that emphasizes community supports and services over institutionalized treatment," wrote the eight members of the oversight committee.

Since the state hospital’s closure, the rate of inpatient placement being delayed in Vermont has increased over time, though the number of involuntary applications has remained stable, according to a January 2013 report from the Department of Mental Health to the Vermont State Legislature.

"This is due to the overall reduction in inpatient beds and the intensity of services required," stated the report. "Of the 252 waits identified during this time frame, 63 percent (158) were placed within 24 hours of presenting to the (emergency department). Over the 35-week period, on average, only one wait per week exceeded 24 hours."

The state converted a former nursing home in Morrisville to the Green Mountain Psychiatric Center with eight beds. It also approved the creation of a six-bed unity at Rutland Regional Medical Center and a unit at Fletcher Allen in Burlington. Also on tap is a seven-bed secure unit in Middlesex, that is expected to open sometime this month. In addition, inpatient and outpatient care is being provided by Central Vermont Medical Center in Berlin and the Windham Center in Bellows Falls.

In Williamstown, Second Spring has made room for eight temporary residential intensive care beds and in Westminster, Hilltop Recovery Residence, an intensive transitional residential facility, opened in June 2012.

The Brattleboro Retreat, which was in discussions to take some of the state hospital’s patients prior to its closing, added 14 beds to meet the deficit caused by Irene. It is in the process of $5-million renovation project, which will result in a secure 14-bed unit in one of the Retreat’s buildings. That unit is expected to open in early April.

During the 2012 Legislative Session, Act 79 was passed to reform the state’s mental health care system. It called for a strengthening of "a well-respected community mental health system, bolstering supports and filling gaps to assist people living in and receiving treatment in their communities."

Act 79 supports an increase in case management services for designated agency outpatient clients and emergency outreach services in every community. Peer support programs have expanded and a statewide inter-disciplinary training program between police and mobile crisis responders was developed.

Act 79 also calls for a reduction in law-enforcement interventions through mobile crisis outreach teams.

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