A report issued recently by the Department of Mental Health re-emphasizes why our state’s mental health system needs reform. But measurable progress is being made.
The 60-page report is a report to the Legislature on the implementation of Act 79, which was passed in 2012. It was designed to “strengthen a well-respected community mental health system by bolstering supports and filling gaps to assist people living and receiving treatment in their communities.”
The problem is, demand exceeds supply.
In 2017, the latest reported data to the National Outcome Measures indicates, Vermont service providers assisted approximately 37,550 people. Readmission rates in Vermont for 2017 were about 7 percent — 1.3 percent below the national average.
“The landscape of the (mental health system in Vermont) has been changing and evolving as a new system of resources are implemented within community-based care or inpatient care settings,” the authors of the report concluded. “We have seen an ongoing demand for the limited number of inpatient beds to serve individuals with acute mental health needs.”
While Vermont communities do provide help, the number of people in need of services has exceeded the number of available beds (and providers) statewide.
But that trend appears to be slowing.
The demand had become so acute that the Department of Public Safety has been working with mental health providers to integrate mobile outreach — sometimes staff on hand at law enforcement agencies — to offer help. This approach makes sense, as police are often the first individuals on the scene of a problem. But, even with proper training, and someone on staff to assist, the wraparound service is mostly available to larger agencies, and it still does not meet the need for placing individuals in serious crisis.
Much of that burden ends up falling on emergency rooms and hospitals, creating another level of strain and sometimes safety concerns. There have also been reports of individuals staying in emergency rooms for days at a stretch, as well as a handful of claims of abuse and mishandling.
Hospitals are reporting double-digit annual increases in the number of mental health patients entering emergency facilities. According to published reports, the Vermont Association of Hospitals and Health Systems showed that the number of days psychiatric patients spent in emergency departments climbed from 3,138 in 2015 to 5,237 in 2017 — a 67-percent jump.
“Training throughout the community and hospital systems is an ongoing need,” the report states.
The need is being met in a meaningful way, however.
Vermont has a decentralized system of adult inpatient care, where people in need of hospitalization are provided treatment at either the state-run inpatient facility or six designated hospitals. (There are 45 beds between three facilities — Rutland Regional Medical Center, Brattleboro Retreat and the Vermont Psychiatric Care Hospital in Berlin — for the most severe cases, or Level 1 involuntary. Statewide, there are an additional 156 beds for Non-Level 1 Involuntary and voluntary inpatient stays.
Fortunately, while demand is high across Vermont, adult inpatient bed occupancy decreased slightly in 2018. Similarly, involuntary patient lengths of stays was relatively unchanged. Readmission rates were also unchanged — a trend that remains well below the national readmission-rate trends. Additionally, the report states, more adults were being referred to involuntary inpatient care than in previous years.
Conversely, there were spikes in the first and last quarter of 2018 for people with involuntary admissions — the highest levels in several years. (No reason for the sharp increases is given.)
In addition to a plea to lawmakers to maintain funding levels in order to meet the need already in place, the report offers some steps aimed at improving services for 2019.
First and foremost, it calls for additional inpatient bed capacity. It also asks for the replacement of the Middlesex Secure Residential Recovery Program; renovations at the Brattleboro Retreat; progress in transporting patients for mental health care; a review of rates and payments; and “integration, coordination and overall parity for mental health services as a component of health care.”
In the past, there also have been calls to improve mental health services in the state’s prison system, as well as offering more opportunities for outreach and community partnering with social workers and service providers.
The state’s mental health crisis is one that requires attention and care. Lawmakers face another tight budget this year, but within our dwindling population, there are Vermonters who need a level of help no one else can provide. And that service needs to be sustained.