Amid emergency department logjams across Vermont, the Department of Mental Health (DMH) issued a request for proposals (RFP) for a new inpatient psychiatric unit for children and adolescents on Jan. 28.

The Brattleboro Retreat is the only hospital in the state that has such a unit currently. When children show up to other hospitals with mental health crises, they often spend days in an emergency department before a bed in Brattleboro (or, in some cases, New York or New Hampshire) becomes available.

A year ago, the General Assembly solicited testimony on the increasing wait times for inpatient treatment among these youth, which DMH labeled “completely unacceptable” before the House Committee on Health Care. This winter, COVID-19 outbreaks, including one at the Retreat that reportedly put 30 staffers on sick leave at once, worsened the situation significantly by many accounts.

Now, DMH wants “qualified health care organizations connected or affiliated with a general medical facility” to consider entering a contract with the state for the provision of up to 10 beds at “the most intensive level of care.” The unit would process voluntary and involuntary admissions 24 hours a day, seven days a week, for psychiatric patients under the age of 18.

Patients would receive “psychiatric evaluation, service, medication management and consultation” and “daily therapeutic care and intervention following best practices for acute stabilization” from the contractor.

According to the RFP, DMH intends to use federal dollars for the contract, which will distribute start-up funding for hiring, training and, if necessary, the lease of physical space. Based on costs, it will also establish a per diem rate for services provided within the unit, for which DMH will bill Medicaid, commercial insurers, and families.

Dr. Haley McGowan, a pediatric psychiatrist at the UVM Medical Center Emergency Department, testified before the Senate Committee on Health and Welfare on Feb. 2, reporting a 111% increase in “patients seen by my service in the emergency room” in 2021.

“To give you an idea of where we are now, this Monday morning, there were 11 youth in the UVM Medical Center Emergency Department for mental health needs, and their average length of stay at that point was 11.2 days,” she revealed. “If we include children waiting elsewhere in the hospital, for whom we do not have appropriate placement, the average wait extends to 15 days.”

“This doesn’t happen for medical patients. What does unfortunately happen for medical patients is that their care can be delayed because of the strain that mental health patients place on an emergency department that is not designed to care for them,” she continued. “What’s worse is that we actually have to get children get worse before our eyes and before their parents’ eyes because they’re trapped in the counter-therapeutic environment that is the emergency room.”

Responses to DMH’s RFP were due by Feb. 22.

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