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Strategies examined
to replace Vermont Hospital
(February
2008 Issue)
By Pamela Berard
Two recent reports review strategies for how best to replace the
aging Vermont State Hospital, an issue at the forefront for the
Vermont Legislature and the Gov. Jim Douglas administration in 2008.
The Ethan Allen Institute, an independent free-market public policy
group, in November released a report asserting that Vermont shouldn't
build a new state hospital for its mentally ill residents, but rather,
the state should establish a series of community-based services.
Also in November, the Vermont Legislature's Consulting Group on
the Future of the Vermont State Hospital and Systems of Care recommended
replacing the state hospital with a new smaller rehabilitation treatment
center for long-term care with other services moved into community-based
facilities or community hospitals.
The legislators directed the consultants to review existing plans
for replacing the more than 100-year-old state hospital. The consultants
included Richard Surles, the former state mental health commissioner;
Con Hogan, former human services commissioner; and Thomas Moore,
former deputy of the Department of Social and Rehabilitative Services.
"Our intention in asking for the report was to step back from the
discussion that had become one really focused on bricks and mortar
and where is this building going to be built, to put the discussion
back in the context of the whole community mental health system,"
says Vermont House Speaker Gaye Symington, (D) one of the legislators
who commissioned the study.
"We thought a new set of eyes could help us sort through all the
different voices and help us chart our way forward," Symington says.
"The report was helpful and has given us a new framework for doing
just that, in the context of looking at the state hospital in the
context of our whole community mental health system." The consultants
proposed a "modified position," noting the "difficulties in financing
a total non-state system and the need for some level of state controlled
long term, secure residential care," according to the report.
One of the issues that needs a closer look is the subject of why
hospitals in the state aren't treating more mental health patients
and what those barriers might be - whether it's staffing, infrastructure,
legal issues, etc., says Symington. "We also need to start the process
of building a new smaller secure residential facility for a population
that is not as large as the 50 beds of our current state hospital
but that we believe represents a permanent need for long-term residential
care," she says.
The Ethan Allen Institute report, "Don't Send Me to Waterbury!"
asserts that building an expensive new replacement facility for
the state hospital will both burden taxpayers and provide inadequate
services for the mentally ill.
The report recommends the state's mental health system focus on
community-based services. It also recommends the state Department
of Mental Health abandon the idea of "high-cost state-owned mini-VSH
facilities" and recommends the DMH and other agencies welcome private
providers of services, "such as residential recovery housing, and
faith-based and peer-run drop-in centers." It also recommends community
hospitals "address the issue of forced medication as a serious question
of medical ethics." The report offers examples of community-based
recover programs and also opposes the use of physical restraints
on patients.
The report's principal author, Bethany Knight of Glover, was formerly
executive director of the state Nursing Home Association and worked
as a volunteer in free peoples' clinics in India. She was in India
last month and unavailable for comment, but John McClaughry, Ethan
Allen Institute president, says patient advocates were excited and
positive about the report. He notes the issue forces a policy choice
between recreating a large institution or adopting a "recovery in
a caring community model" to help people trying to recover from
mental illness.
In addition to the quality of care, a major issue is the "enormous
cost of trying to build a new state institution, almost certainly
more than $100 million, to accommodate some 53 patients," he says.
"Even with federal participation, our calculation is $276,000 in
Vermont tax dollars per patient year."
Both reports are available online. The Ethan Allen Institute report
is available at www.Ethanallen.org under "Publications" while the
consultants' report can be found on the state Web site, www.leg.state.vt.us
under "Reports."
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