Vermont's Mental Health Safety Net Needs Attention

(February 22, 2017) Retreat President and CEO Dr. Louis Josephson recently wrote an Op-Ed that addresses the gaps in care and coordination of Vermont's mental health and addiction services and suggests the possibility of creating a true system that largely consists of Vermont's existing mental health and addiction assets.

Josephson's Op-Ed was published by the VT Digger on February 21, 2017. Here is a link to the published piece.

Here is the text:

Louis Josephson, Ph.D.: Fragile Safety Net Needs Attention


Recent news of the closure of Maple Leaf Treatment Center in Underhill took many of us in the field of mental health and addiction by surprise. Too many Vermonters in need of addiction treatment are already underserved. And the sudden loss of Maple Leaf's 41 beds along with its outpatient program for people battling opioid addiction is an unfortunate blow that will further strain our state's loosely stitched patchwork of mental health and addiction services.

The closing of a facility like Maple Leaf certainly gets people's attention. It makes the news. Lost in the headlines, however, is a larger, more complex, and more troubling story about our state's desperate need for a more thoughtful, well-coordinated approach to caring for some of Vermont's most vulnerable citizens.

Regulatory challenges, staffing shortages, financial constraints and service closures have become an unfortunate and almost daily fact of life for just about every mental health and addiction care provider in Vermont. But the truth is we will never be able to resolve these issues with a piecemeal approach. Yes, the loss of 41 beds in a small state like ours is not insignificant. But Vermont actually had more total bed capacity in 2016 than it did in 2011 before Tropical Storm Irene closed the state hospital in Waterbury. So where is the problem? And more important, what's to be done?

My view is that our top priority should be to address obvious gaps in care and coordination by creating a true system that's designed to make the best, most efficient use of Vermont's existing mental health and addiction care assets. If for no other reason, we should do this in order to stem the growing tide of people who, for lack of far less expensive and far more effective alternatives, are compelled to turn to the their local emergency departments during a mental health crisis.

As a hospital CEO, I will say without hesitation that adequately funding our state's designated agencies (community mental health centers) is an investment Vermont can't afford not to make. So many outpatient providers, hospitals and government agencies throughout the state are already doing amazing work with too few resources. It is these community-based services that, when properly resourced, will keep people suffering from mental health and addiction issues out of our emergency departments. They will also help keep people out of hospitals like mine, and that's a good thing.

The rightful role of a resource like the Brattleboro Retreat should be to care for those patients who require inpatient treatment as a last resort — not because they weren't able to obtain services in the weeks and months prior to being admitted. Don't get me wrong — plenty of people are ideally served by inpatient psychiatric care. But we also know that plenty of others could likely have avoided hospitalization if they had access to treatment options beforehand. The "system" we want to create in Vermont starts with a strong, adequately funded network of community mental health services.

It also ends with strong community-based services in the sense that people who are ready to step down from hospital-level care both need and deserve adequate outpatient services, and sometimes residential care, that will allow them to reintegrate into everyday life at a level that is safe for both the patient and the community. This is a significant gap in our current delivery model that must be addressed if we are to benefit from a true system of mental health and addiction care.

At the Retreat we have too many hospitalized patients who no longer meet the requirements for inpatient care, but are not ready to live independently. They're stuck in beds they don't need, while others who are desperately ill wait to be admitted.

Decisions about health care in Vermont and across the country always seem to boil down to a debate about money. I understand and respect the need to be cost conscious, and I am not suggesting that simply spending more money on mental health and addiction services will solve Vermont's problems.

I am suggesting that by working together to reinvent our approach, and by prioritizing the needs of certain populations including children and adolescents who are seriously emotionally disturbed and adults with severe and persistent mental illness, we could easily offset the many unnecessary costs incurred through the lack of coordination between and among care providers, government agencies and other stakeholders. We could also transform our delivery of mental health and addiction services into a true system that puts patients first.

It's clear to me that everyone who cares about the problems faced by Vermont's mental health system means well. But at some point we also have to do well, and that requires our collective will to act. I think the solutions to our problems are within reach, and I look forward to working with our new partners at the Statehouse, the Agency of Human Services, and Department of Mental Health whose fresh eyes and new perspectives can go a long way in helping us turn Vermont's considerable mental health and addiction treatment assets into a true system of care.