April 1st, 2010

VA could get psychiatric facility

There’s no dispute that Vermont needs to replace Vermont State Hospital. At 120 years of age, it’s antiquated and has been denied recertification. The governor knows it and the legislature knows it and Vermont Mental Health Commissioner Michael Hartman is hoping that the political forces will approve a plan, now evolving, to care for Vermont’s mentally ill in a combination of community and hospital settings.

Since 2004, Vermont has been looking at new ways to deliver mental health care. “There is a responsibility not just to replace 54 beds with 54 more, but to create a variety of new programming,” says Hartman.

Although he says it is only “in discussion” for now, during a recent interview, Hartman detailed a proposal that would also involve the Veterans Affairs Medical Center and Dartmouth-Hitchcock Medical Center. The plan is for the VA to donate land to the state of Vermont, which would construct a new building adjacent to the VA’s White River campus. Vermont would then contract with Dartmouth-Hitchcock to provide medical services and with the VA to provide “hotel services” such as laundry and food.

Initially, the idea was for the new facility to house 16 beds, but efforts are currently underway to see if 33 beds would be feasible. (Legally and administratively, 33 beds place the project in another category and some details need to be addressed).

Dartmouth-Hitchcock has extensive experience in providing psychiatric services and has in the past worked with the VA. And, the VA has a small psychiatric unit; Hartman predicts that patients could, when necessary, be transferred from there to the new unit. He states that the new plan, however, would be more a “series of complementary relationships” than a collaboration between Vermont, the VA and Dartmouth-Hitchcock. He describes a new 33-bed facility as “an extension of care” offered by Dartmouth-Hitchcock at its nearby Lebanon campus.

Hartman is also hoping the final plan will include, at the other end of the state, 12 more psychiatric beds at Rutland Regional Medical Center, to furnish intensive care at the level of a state hospital. In community settings, the hope is for new crisis and longer term rehabilitation/recovery beds as well. These resources would provide “an ability to deal with folks outside of the hospital setting.” Additionally, there is a proposal for a new secure 15-bed unit in Waterbury, separate from the state hospital, for those found not guilty by reason of insanity, not competent to stand trial or at risk to themselves or others.

According to Hartman, in recent years, Vermont has worked at providing care in community settings. Now, the state is scrutinizing inpatient care and those patients who are held or taking medication involuntarily. The entire plan, including inpatient and outpatient services, amounts to 60 beds and is estimated to cost $60 million. Hartman projects that by 2014, the facilities in Waterbury, Rutland, and at the White River VA could be open and operating.

By Elinor Nelson

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