Forward, Retreat
Vt. hospital taps its past to shape future of mental health
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Two people pass through the entry gate at the Brattleboro Retreat, which is celebrating its 175th anniversary as a private, nonprofit psychiatric hospital. Photo by Kevin O'Connor |
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Published: September 13, 2009
Anna Marsh stood by as doctors tried to all but drown a deranged man back to his senses by plunging him into a shockingly cold “bath of surprise,” then drugging him with a massive dose of opium.
The supposed cure instead killed him. And so Marsh, daughter of onetime Lt. Gov. Jonathan Hunt, willed nearly half her fortune in 1834 toward a kinder, gentler solution.
Some 175 years later, her brainchild, the Brattleboro Retreat — the state's first and largest mental health facility — is introducing specialized programs for uniformed officers and people of various sexual orientations, managing behavioral benefits for all Vermonters insured by MVP Health Care, and seeking to replace the troubled Vermont State Hospital with a new 16-bed psychiatric unit.
Cutting-edge? Yes and no, says Retreat President Robert Simpson Jr.
“Anna Marsh confronted denial and despair with compassion and a vision that mental illness could be treated humanely. That was pretty forward-thinking. She set the course for us.”
Historians can't report much more about Marsh's encounter with the deranged man other than, as seen in records, that it impressed upon her the need for “moral treatment.”
Few current-day residents, for their part, know much about the Retreat, even though the private nonprofit institution was one of the nation's first 10 psychiatric hospitals and, strange but true, the subject of a circa 1845 black-and-white daguerreotype that's believed to be the first photograph ever taken in Vermont.
In Robert Newton Peck's classic New England coming-of-age novel “A Day No Pigs Would Die,” his teen narrator says ignorantly of the Retreat: “That's where the crazies go … I guess when they go crazy.”
But the hospital — with 149 beds, the state's third largest after Burlington's Fletcher Allen Health Care and Rutland Regional Medical Center — helps people of all ages and backgrounds with mental illness, depression, addictions, eating disorders and other emotional and behavioral issues.
To raise awareness and money, the Retreat hosted 350 people at a 175th anniversary celebration Saturday. The crowd took in the historic brick campus (it boasts more than 50 structures on the National Register of Historic Places) and current-day celebrities such as Emmy and Tony award-winning actor Ken Howard, who spoke of a family member's struggle with addiction and depression.
People also learned how the landmark is expanding in a changing market in hopes of ensuring its future.
The psychiatric hospital is Windham County's third largest employer, with more than 500 workers and a $22 million annual payroll. It's also one of Brattleboro's largest landholders, once owning almost 10 percent of town with its campus, nine miles of public nature trails, skating and ice-fishing pond and, until 1943, nearly the entire face of Wantastiquet Mountain just across the Connecticut River in New Hampshire.
The Retreat, however, isn't as rich as statistics suggest. It survived the arrival of a competing state-sponsored mental hospital in Waterbury in the 1890s and a government push for deinstitutionalization in the 1960s. But with basic behavioral health services now available in most communities, the facility increasingly cares for patients with the most acute and costly needs.
Insurers, meanwhile, are cutting back on compensation. Companies once approved patient stays that ran months. Today the average visit for the more than 1,300 adults and 400 youth admitted annually is 10.4 days.
“Better medications, better community alternatives, shorter lengths of stay,” Simpson says. “That's a good thing.”
For the customer, not the company. A decade ago, losing several million dollars a year, the Retreat made news for labor union strife, closure of its longtime nursing home and sale of its former 380-acre, 200-head dairy farm. Then again, its annual budget was $53 million. Today it's $38 million.
Even so, the Retreat says it's on firmer economic footing. The hospital has changed its system for working with insurers — patients are covered by as many as 200 different companies — to seek more reimbursement. With 60 percent of admissions from Vermont, it's also introducing several new programs to draw more patients from more places.
The Uniformed Services Program aims to help police, firefighters, soldiers, medics and prison guards with stress, anxiety, depression and addiction. Its director, James Bastien, has firsthand knowledge: His Marine father was a World War II prisoner who, upon release, tried to drink away the trauma before dying at age 65.
“The question I had as a kid was, ‘If my dad is a hero, why is he suffering so much?'” Bastien says. “We know so much more now about treatments that can help make a difference. It's teaching people how their mind works, how to regulate difficult emotions and, once they get some relief from the suffering, how to focus time and energy on what's important to make life worth living.”
The Lesbian, Gay, Bisexual and Transgender Inpatient Program is one of the few nationally to offer specialized mental health and addiction care to people of various sexual orientations.
“There are some people who feel poorly understood by their caregivers and their peers in support groups, and that isn't a healing environment,” says Dr. Julie Praus, the program's medical director. “This program is meeting what we're finding out is a pretty substantial need.”
The Retreat, Vermont's only mental health hospital for children with an accredited grade K-12 school, just submitted a proposal to boost its adult psychiatric unit by 16 beds to replace those at the Vermont State Hospital, which has lost federal certification and funding.
The Retreat also is helping insurers. Vermonters covered by MVP Health Care — whether in Bennington, Burlington or points in between — receive mental health benefits through the hospital's PrimariLink managed service organization.
“We believe since we're in the business,” Simpson says, “we're going to be very sensitive that people get what they need.”
Finally, the hospital is marking its 175th anniversary with a new logo to complement its new programs. Then again, that's what the facility did for its 150th anniversary in 1984.
Humane care isn't the only constant, the Retreat president says. So is change.
“The Retreat's mission has always been charting the future,” Simpson concludes, “to find new ways to treat and take care. We have more capacity, and we want to do more. Our goal is to grow.”
kevin.oconnor@rutlandherald.com
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