VTD Social Card 102022

Ken Libertoff: The $18 Million Question About Mental Health

This commentary is by Ken Libertoff, Ph.D., who was director of the Vermont Mental Health Association in Montpelier for 30 years. He retired in 2010 but continues to serve as an advisor on health care issues.

Why is $18 million sitting unused and even ignored while Vermont’s mental health system remains in crisis?

For the past decade, empty rhetoric, endless hand-wringing, countless studies, special hearings and incompetent leadership have proven to be a case study in one of many failed responses to an overwhelmed and overworked mental health system.

One of several major problems was the lack of inpatient psychiatric beds. For a decade, Vermonters young and old who need care have sat in hospital emergency rooms for days, weeks and even longer because they lack access to appropriate care. Not only is this a tragedy for patients and their families, but it victimizes caregivers who are without options or timely clinical solutions.

The fact that these conditions continue to this day is nothing short of a disgrace.

One interesting development unfolded in 2018, when the Green Mountain Care Board drafted and endorsed a plan to allow the University of Vermont Medical Center to use $21 million in its excess revenue account to create new inpatient hospital beds.

During 2015, 2016 and 2017, UVM Medical Center was a money-making crawler with several consecutive years of net patient revenue exceeding its state-approved budget. In 2016, for example, UVM Health Network had $29 million in excess revenue and an even larger balance the year before.

The parties — the Green Mountain Care Board, which represents the state, and UVM Medical Center — have threatened to impose tighter regulations on the hospital or cut its future budgets, an unusual plan, one considered the most creative or perhaps risky. can be considered. Rather than taking punitive measures or stricter regulatory measures, the Green Mountain Care Board encouraged the UVM Medical Center to commit to investing this money in expanded access to care.

Conceptually, the proposal to involve the state’s flagship hospital was a big step in the right direction. For decades, Vermont hospitals have been reluctant to work with the state in collaborative ways, especially when dealing with patients with severe mental illness. It could be argued that the incorporation of one or more of our nonprofit hospitals could be more administratively and clinically efficient than state-run facilities in Vermont, such as the old, now-defunct State Hospital in Waterbury that was built in the 19st century, or even the relatively new 25-bed Vermont Psychiatric Care Hospital in Berlin, which has experienced complicated staffing problems since it opened in 2014.

Central Vermont Medical Center in Berlin led by UVM Medical Center, implemented a comprehensive planning process in 2018, which resulted in a plan that calls for a new 25-bed facility to be located on the main campus of the Berlin hospital. However, in early 2020, the process suffered a major setback when UVM Medical Center estimated that the 25-bed unit would cost $150 million.

This led to an angry outcry in opposition from many parties. Even John Brumsted, then CEO of the UVM Health Network, admitted that this proposal was too expensive. It can be said that despite spending several million dollars on planning, the project has lost any momentum it had.

The pandemic further slowed the process, and the effort stalled with only feeble attempts to resurrect it. UVM Medical Center’s commitment to the project lost “air” like a punctured balloon.

The handwriting was on the wall, but it took until early 2022 for UVM Medical Center to officially announce that it had scrapped plans to build this new inpatient psychiatric unit at Central Vermont Medical Center, citing large budget shortfalls and formal announced that it could no longer afford this much-needed project. UVM Medical Center did claim a total of $3 million was spent on the planning process, leaving $18 million for much-needed services.

It will soon be almost a year since the project, now referred to here as a proverbial white elephant, met its demise. With limited oversight or attention from the press, this failure is likely to cripple Vermont’s already fragmented mental health care system for years.

That means the Green Mountain Care Board, the governor, or state agency leaders, or the Legislature must be responsible for the remaining $18 million that remains in limbo. These funds are dedicated to expanding access to mental health care. There is no excuse for further delay.

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