On March 12, 2019

Rutland hospital proposes new mental health facility

By Mike Faher/VTDigger

Rutland Regional Medical Center administrators believe they may have an answer to some of Vermont’s mental health woes.

Administrators are pitching a new, eight-bed, secure residential psychiatric facility on the hospital’s campus. It would be jointly owned with a local mental health agency, with operations largely funded by the state.

The proposal comes as Vermont officials look to replace a deteriorating secure residential facility in Middlesex.

Rutland Regional leaders say they want to augment – not interfere with – the state’s plans to bolster mental health treatment.

“We think there’s merit, and we think there certainly is a need to have some of these services decentralized and have some of them in the southern part of the state,” Claudio Fort, the hospital’s president and chief executive officer, said in recent testimony before state legislators.

Vermont Mental Health Commissioner Sarah Squirrell said officials are committed to building a state-run, 16-bed secure residential facility somewhere in central Vermont. But she also said officials are interested in talking further about the Rutland proposal.

“We really appreciate Rutland coming forward as a partner, reinforcing the need for this level of care in our state,” Squirrell said.

Vermont’s mental health system is overtaxed, with large numbers of residents seeking inpatient treatment and often waiting in hospital emergency rooms for help. 

While much of the focus has been on building new psychiatric inpatient beds, intensive residential facilities are another, important part of the system – a place for some patients to go when they no longer require hospitalization but are not yet ready to return to the community.

The state’s seven-bed Middlesex Therapeutic Community Residence is supposed to serve that need for patients who are in the state’s custody under an order of nonhospitalization. But officials say the temporary Middlesex facility – which consists of two fenced-in mobile homes – is “failing” and must be replaced as soon as possible.

“We’ve got some serious issues with this building,” said Rep. Alice Emmons, D-Springfield, chair of the House Corrections and Institutions Committee. “It’s not an appropriate setting. It may not be the appropriate number of beds.”

Emmons’ remarks came at the outset of a recent meeting with Rutland Regional administrators, who came to the committee to detail their plan for new secure residential beds.

The proposal is for Rutland Regional and Rutland Mental Health Services, which is the designated provider of community mental health services in the area, to own and operate a secure residential facility on hospital property.

“We have a site already selected for this,” Fort said. “We have a conceptual site plan, and we have a program plan for that.”

The proposed treatment center would be 8,000 square feet to 10,000 square feet and employ about 24 full-time-equivalent staffers. Designing and building the facility would cost $6 million to $8 million, and annual operating costs are estimated at $2.5 million to $3 million.

In a document submitted to the Legislature, Rutland Regional administrators said they “will expect to develop a contract with the state to cover the actual costs of the program, less any third-party (insurance) reimbursement and patient contributions.”

There’s precedent for that kind of arrangement at Rutland Regional: Among the 23 adult psychiatric beds at the hospital are six state-contracted Level 1 beds that were added after Tropical Storm Irene’s flooding closed the Vermont State Hospital in 2011.

“We’ve had a very good track record and very good partnership with the Department of Mental Health in providing those services,” Fort said.

Hospital administrators also touted their proposed partnership with Rutland Mental Health Services, saying the secure residential project would draw on that agency’s expertise in helping psychiatric patients transition back into the community.

Running a residential facility “takes different training, different skill sets and a different approach than what we’re used to providing in an inpatient psychiatric unit,” said Jeff McKee, vice president of community and behavioral health services at Rutland Regional.

Dick Courcelle, chief executive officer of Rutland Mental Health Services, added that the project presents a “really unique opportunity.”

Speed is another asset of the Rutland pitch: Administrators say that, once they have a funding agreement with the state, they could open the doors of a new secure residential facility within 18 to 24 months.

That’s several years shorter than previous proposals for the 16-bed, state-run residential facility slated to replace Middlesex. But Squirrell, in an interview Friday, said the state project’s timeline since has been shortened to between two and three years.

“It is an urgent and important priority from the department’s perspective,” Squirrell said.

It’s possible that the state could support both its own project and Rutland’s. But it’s not clear whether Vermont has a need for a total of 24 new secure residential beds or the money to operate them.

Squirrell said officials have talked to Rutland administrators, and there’s “a shared commitment to support the advancement” of the state’s project.

“Potentially, Rutland’s proposal could be considered as additional capacity beyond the [state’s] 16-bed secure residential,” Squirrell said. “If there’s an agreement that that’s a need in the state, and adequate resources to support that, then as partners, we could work together on that. It’s always good to have alternative options.”

McKee said Rutland’s proposal is only a “starting point” that could be modified after consultation with the state. He noted that there are “so many moving parts” in plans to boost Vermont’s mental health services.

“At the same time, we do have a sense of urgency,” McKee said.

Emmons, whose committee will have a say in any state-funded mental health projects, said lawmakers need to grapple with how many beds Vermont needs. But she, too, said time is running out.

“There needs to be some form of a decision made, one way or another,” Emmons said.

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