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By Phyllis Hanlon
Reviewers from the Centers for Medicare and Medicaid Services (CMS)
withdrew federal funding for Vermont State Hospital. The action
took place this past September, following their discovery of a number
of deficiencies at the psychiatric facility. The total annual loss
could amount to $700,000. Vermont psychologists, however, view the
situation as a prime opportunity for improvement.
According to Susan Besio, Ph.D., Vermont's commissioner of developmental
and mental health services, the problems at the hospital are "fixable."
In addition to reviewing the administrative infrastructure, she
says that strident efforts to educate the public regarding the hospital's
function are underway. "Basically, we are an ICU for people with
the most complex mental health problems," she says. Since general
and community hospitals are not equipped to serve those with intense
psychiatric illnesses, the task falls to the state facility. Besio
explains that, on average, most of the approximately 200 annual
admissions are discharged within 30 days, dispelling the notion
that long-term stays are the norm.
Besio reports that of the 29 deficiencies federal reviewers cited
in March, 23 were corrected within five months. "The remaining [deficiencies]
are in the area of active treatment," she says. "It takes time to
fix those." A new medical director, together with staff, has created
a team approach to treatment planning that includes input from clients.
Measurable goals and outcomes have been modified and a new training
and modeling strategy based on creative engagement has been devised.
While corrective measures were being implemented, however, two suicides
occurred within approximately five weeks of each other. One of the
two remaining psychologists at the state hospital - at one time
the staff boasted six psychologists and six interns - Elliott Benay,
licensed master's level psychologist and co-founder of Vermont Trauma
Institute, reports that in his 31 years at the facility, a total
of five suicides have occurred.
Involuntarily medicating patients also plays a pivotal role in
the current situation at the hospital. "Vermont is a very independent-rights
oriented state," says Besio. "If someone refuses medication, you
can only give it in certain situations." The inability to treat
pharmacologically impacts, and sometimes hinders, noticeable progress,
she says.
As Vermont has achieved a relatively successful rate of community
reintegration, Benay says that public misperceptions still promote
sequestering of the mentally ill, resulting in re-hospitalization
or incarceration. "Clearly, Vermont under Howard Dean spent a huge
amount of money on jails and corrections as opposed to continuing
to pour money into the hospital. One of the things I'd like to see
happen is more money put back into the hospital for treatment and
training of the people who work here."
Colleague Laurence Thomson, Ph.D., sees an increased workforce
and treatment options as key to the hospital's future. "By having
a larger permanent staff of quality technicians and by returning
to treatment other than simply medications, we might be able to
be more effective in working with clients here to strengthen their
skills for life in the community," he says. Benay adds, "We are
talking about the reinstitution of a psychosocial rehab model as
opposed to, or in addition to, a medical model."
Before the current situation developed at the state hospital, talks
regarding a new facility had been on the table. "Currently, we are
mixing patients with different clinical profiles and needs," says
Besio. "That makes it hard to provide state-of-the-art treatment."
Architecturally, the building presents a number of hazards as well.
Thomson points out that a new hospital would offer more space and
added capacity for the future. According to Besio, a Boston consulting
group is conducting a study to assess Vermont's imminent needs for
such action, the results of which will be ready by January.
Linda Corey, executive director of Psychiatric Survivors, a consumer
organization that provides peer support for discharged patients,
believes the problems at the hospital were reported in the past
but ignored, due to lax management and poor state oversight. Corey
indicates that a new administration as well as an advisory committee
that includes former patients, is helping restore the hospital's
standing. Psychiatric Survivors is also holding public forums to
gather input from the community.
Besio says that federal reviewers will be invited back some time
in early to mid-winter to assess the hospital's situation and determine
if funding will be reinstated.
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