Retreat begins to take state patients

By LISA RATHKE
Associated Press

BRATTLEBORO -- When the governor demanded the state accelerate plans to close the troubled Vermont State Hospital, officials turned to the Brattleboro Retreat for help.

Within weeks, three state patients were moved to Brattleboro. Within a month, more will follow.

"The state needs the Retreat," Health Commissioner Paul Jarris said this past week.

The Brattleboro Retreat is one of the 10 oldest psychiatric hospitals in the country. The nonprofit hospital was founded in 1834 when Anna Marsh of Hinsdale, N.H., a physician's wife, bequeathed $10,000 to open a hospital for the insane, one of the first in country, and named the four trustees who would start it.

The collection of historic brick buildings at the edge of town now known as Retreat Healthcare has grown to include two inpatient psychiatric units for adults, the only psychiatric hospital for children in the state, a K-12 school, facilities for substance abuse treatment and other therapy, a continuing education program and the area's largest daycare center.

"We basically see ourselves as having the most psychiatric resources in the region and we would be the logical people to help them (state hospital) out, so we want to that," said Dr. Fred Engstrom, the Retreat's senior vice president of medical affairs.

Engstrom has been working with state officials since news broke in the beginning of this month that the state hospital had lost its federal certification and access to millions of dollars in federal funding for a second time after two patients escaped from supervision.

"It's a stark contrast," Engstrom said after touring the state hospital last week.

"They have a staff right now that's been put through the wringer, whether that's fair or unfair and I'm not there to judge. But needless to say, they feel very discouraged," he said.

The state hospital is also limited by an outdated facility, Engstrom said.

The Retreat has invested millions of dollars to renovate its buildings and update them for safety, he said.

"They (state hospital) have a lot more difficulties with their environment in terms of places where you can't see patients, places where potentially you could harm yourself; it's the sort of thing where the facility's been neglected," he said.

Retreat officials say they sympathize with the state hospital staff who have complained about inadequate staffing and poor working conditions for years and don't want to have an adversarial relationship with the state hospital.

They face the same tough challenges the state hospital does in treating severely mentally ill patients, many of whom are suicidal and ambivalent about whether or not they want to get better. Patients try to run away, Engstrom said. They've committed suicide and harmed themselves.

"I don't want to hold us out as perfect," he said. "We have some people who feel so horrible about themselves, might someone commit suicide here? It might happen. We had two in 1997. We've had suicide attempts since then."

The Retreat, however, has never been decertified.

The state hospital had just regained its federal certification in November, 14 months after losing it in 2003 after two patients committed suicide within six weeks of each other. Among the problems, inspectors found a shortage of staff, that the sickest patients were being locked in their rooms at night and there was inadequate documentation to show all patients were receiving treatment.

The Retreat has had its share of financial troubles in recent years. A series of consecutive annual operating losses prompted it to shut down its Linden Lodge nursing home, and in 2001 to sell its 450-acre dairy farm, which in the early years provided most of the milk, cheese, beef, vegetables and fruit eaten at the Retreat. An increase in Medicaid reimbursement rates in 2003 and internal changes have helped to stabilize the Retreat, said spokeswoman Maria Basescu.

"The motivation for responding to the state's need for help is not about bailing out the Retreat financially; it's about maximizing what the Retreat can do," said Basescu.

The Retreat has 175 mental health professionals with various degrees, the greatest concentration in northern New England, and is able to tailor treatments to individuals, said Engstrom. The hospital specializes in dual diagnoses such as substance abuse and mental health and serves as the state's psychiatric hospital for children.

Half the patients come from out of state and many have been in and out of hospitals.

"We have a reputation for being able to help some people who are the hardest to treat," said Engstrom.

Safety of its patients is paramount, said Basescu. For that reason it has made clear to the state hospital that it will not treat violent or disruptive patients.

How many patients the Retreat will eventually take depends on the number of vacant beds and the type of treatment a patient requires. The two inpatient facilities for adults together have 46 beds. "They indicated they could take 15," Jarris said.

The goal is to reduce the population at the state hospital from 50 to 35 within a month, to decrease the workload on staff. The state is also looking to other hospitals and community based agencies to accommodate patients. The long-term plan is to build a 16- to 28-bed hospital that would be attached to one of the state's medical centers.

In the meantime, officials with the division of licensing and protection for the Department of Aging and Disabilities, one of the groups that decertified the state hospital earlier this month, and the hospital's medical director have traveled to Brattleboro to inspect the Retreat.

"We've been satisfied that the facility is a quality facility and it can handle our patients," Jarris said.

Engstrom and state officials are weighing all the issues, legal and otherwise, surrounding moving patients to Brattleboro, he said.

They say they want to be sure any move will not disrupt a patient's care.

"We wanted to make sure that we take patients where we can be helpful and the patients want to come here," Engstrom said. "We also wanted to make sure that when they came here it would be a thoughtful process; it wouldn't be exodus in which people were put on buses."

A look at the Retreat:

  • Brattleboro Retreat, a nonprofit psychiatric and addictions treatment center, part of Retreat Healthcare, founded 1834, one of the 10 oldest psychiatric hospitals in the country
  • Treats dual diagnosis, eating disorders, mood disorders, severe depression, anxiety disorders, post traumatic stress disorders, personality disorders and addictions
  • Employs 175 mental health professionals, including 12 psychiatrists, three internists, one pediatrician, one neurologist, three anesthesiologists and six nurse practitioners.

Copyright 2005, Brattleboro Reformer. Used with permission.