March 1st, 2013

Vermont grapples with budgetary priorities

The Vermont Department of Mental Health’s current fiscal year $174 million budget represented a 15 percent increase to enhance community services in the only state which until recently had no government-operated psychiatric beds.

It wasn’t enough.

Developing a strong community mental health system will require another $20 million, Finance and Management Commissioner Jim Reardon informed lawmakers during January mid-year budget adjustment discussions. Expenditures included mobile crisis teams to monitor patients at risk and new beds in transitional housing.

Much of that increase is offset by decreases in other departments so the general fund impact is about $4.5 million. “If we don’t get the money, then we have to make the appropriate adjustments, but I don’t think that will happen in the Department of Mental Health because Act 79 was passed,” Reardon says.

He was referring to the 2012 legislation establishing a new regionalized 45-bed acute-care system to replace the 54 beds lost when Tropical Storm Irene flooding closed the Vermont State Hospital in late August 2011. The net loss of nine beds coincides with plans to expand residential and outpatient services.

“It’s all about setting priorities in the budget and this is one of the governor’s priorities to roll out this system of care,” Reardon says.

A new 25-bed, intensive care mental health hospital to be built adjacent to the Central Vermont Medical Center in Berlin is projected to open in early 2014. About $17.5 million of the $28.5 million facility’s construction cost will be covered by insurance and FEMA. Other beds will be at Rutland Regional Medical Center and Brattleboro Retreat.

The new Berlin facility will enable the state to become eligible for annual reimbursements for Medicaid patients lost in 2003 when regulators took issue with the Vermont State Hospital’s deteriorating condition. Restoring that aid will pay for the state’s portion of the cost of building the new hospital in under two years, Gov. Peter Shumlin said at the Jan. 8 groundbreaking ceremony.

“We had what I think was unprecedented legislative support in building a system that would be community-based, strengthening the community base so we wouldn’t need as many hospital beds,” Acting Mental Health Commissioner Mary Moulton says. “We’re confident that the system we’re putting in place is going to meet the inpatient needs.”

Moulton stepped into her role when Patrick Flood resigned in November. She agreed to run the department until July when she plans to return to Washington Mental Health Services Inc., where she was chief of operations.

“What we’re working on is a lot of cooperation among hospitals and communities and we’re going to need another year to see how we’re doing, but we’re confident that it’s going to work and that capacity we’re building will work,” Moulton says.

“We do have days where we have our needs exceeding our capacity for inpatient beds. Actually, we place people out of the emergency room 64 percent of the time within 24 hours into an inpatient bed.”

Vermont currently has 35 acute care beds available, including eight temporary beds at the Green Mountain Psychiatric Care Center in Morrisville.

State Rep. Anne Donahue, (R-Northfield) who co-chairs the Joint Mental Health Oversight Committee, believes the goals of transitioning to a community-based, geographically dispersed model may be overly optimistic.

“I think it remains completely premature to judge whether the extent to which Vermont hopes to push the envelope on community rather than inpatient care will prove to be sustainable from a program and treatment perspective,” Donahue says. “If the program and treatment impact is not substantial enough, the financial investments will not be sustainable. Shortfalls in the budget to achieve the initial community plan, so early on, reduce the overall likelihood of success.”

By Janine Weisman

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