In April, the Burlington-based alt-weekly Seven Days published the following headline: “UVM Health Network Halts Badly Needed Psychiatric Bed Project.”
The article was a news story, not a commentary, about an announcement by the University of Vermont Health Network (UVMHN) that, due to financial challenges, it would shelve its plan to build a new psychiatric unit at the Central Vermont Medical Center (CVMC) in Berlin.
Most reporters strive to uphold an ideal of journalistic objectivity, but every news story, examined closely, nevertheless betrays countless unstated opinions that inform choices about where its primary focus should lie, which words best describe what has happened, which sources warrant consultation, and which facts demand inclusion. Biases also inevitably help determine what does or doesn’t qualify as a fact in the first place.
Is it a fact, for instance, that the long-anticipated psych ward at CVMC is “badly needed”? Presumably Seven Days, like any news organization, seeks to balance the civic (and commercial) imperative to persuade readers of the urgency of its reporting with the recognition that any particular declaration of urgency inherently constitutes a value judgment. The inadequacy of Vermont’s psychiatric inpatient capacity, however, must have registered to its editor as an unassailable truth.
After all, public officials have – again and again – declared a widespread mental health crisis, and hospital physicians have offered ample testimony about psychiatric patients enduring prolonged waits in emergency rooms due to logjammed psychiatric units. At some point, expert opinion calcifies into reality.
What would a journalism professor say? A particularly fusty one might tell a reporter that, under the rubric of “objectivity,” they can write about plans for a psychiatric unit, and they can cite relevant officials’ claims or public data about the unavailability of inpatient beds as a possible basis for those plans, but the readers must figure out for themselves whether those claims or data really prove that the new unit is “badly needed.”
The purpose of this editorial isn’t to chide Seven Days for connecting the dots directly, instead of merely setting up its readership to connect them. It amounts more or less to the same thing. But the article in question – which asserts that the (possibly temporary) demise of the “desperately needed project” at CVMC “couldn’t come at a worse time for Vermont’s long-overburdened mental health care system” – reveals deeper assumptions about how mental health systems should work, and these assumptions ground coverage of mental health more broadly in the press.
A reporter seeking to use hard evidence to demonstrate the necessity for the CVMC expansion would likely run into a problem: the available statewide data on emergency room waits for psychiatric patients is not as compelling as recent testimony from physicians has been. The most recently published figures, from an Act 200 report by the Vermont Department of Mental Health (DMH), span October 1, 2020, to September 30, 2021, and therefore can’t speak to new developments, but neither do they predate the reported increase in mental health emergencies since the start of COVID-19.
According to the Vermont Association of Hospitals and Health Systems Network Services Organization’s data, the average adult psychiatric patient spent one full day in the emergency room before inpatient placement during the abovementioned calendar. The prior year’s Act 200 report shows an average of 0.85 days in the ER before admission to a psychiatric unit. The oldest available report with such data indicates an average wait of 0.9 days between 2018 and 2019, casting some doubt on the narrative of a significant increase in waits during the pandemic.
Statewide data does show that children lately have endured longer waits than adults: two days on average before placement at the Brattleboro Retreat, Vermont’s only psychiatric hospital serving youth, or at an out-of-state facility. This problem led DMH in January to issue a request for proposals for inpatient beds for children, but CVMC’s additional capacity would not serve these patients.
Wait times also are three times higher for involuntary adult psychiatric patients than for voluntary ones, but it is important to point out here that involuntary patients are not, in fact, waiting for inpatient placement. The emergency department is waiting to transfer them, but the patient is waiting simply to be released from confinement.
Per Act 79, another DMH report from January documented, in fiscal year 2021, “the lowest level of adult inpatient bed utilization” over the last eight years in Vermont’s psychiatric units. Amid staffing shortages, hospitals closed many beds, but even so, the number of open beds rose.
Now, fiscal year 2022 has nearly ended, and once DMH has tabulated its numbers, we may see that psychiatric units had few, if any, vacancies during this time. If that proves to be the case, bed closures will likely represent a big part of the problem, suggesting, perhaps, that the training and hiring of more workers, rather than the creation of more physical space for inpatient psychiatry, might alleviate the jam. But for now, we don’t know where we are.
We do know, however, that transferral to an inpatient bed doesn’t have to be the only way for an emergency department to handle someone who shows up in an extreme mental state. Unfortunately, none of Vermont’s major media outlets found time this spring to mention legislation introduced by Sen. Cheryl Hooker, which would have provided alternative care settings for mental health patients by creating seven peer respites across the state.
Outlets like Seven Days and VTDigger dedicated numerous articles to ER waits and then to the Green Mountain Care Board’s stingy refusal to grant UVMHN the right to charge insurers (including Medicaid) rates high enough to fund the construction of a new building at CVMC. DMH supported Hooker’s bill’s assertion that new peer respites would relieve pressure on emergency rooms, but this potential solution never entered the mainstream conversation about where we ought to send patients now trapped in overcrowded ERs. Nor did we see a great deal of discussion about how ending homelessness, for instance, might lead to fewer ER visits in the first place.
This is a political problem. There are all sorts of reasons why our society chooses to inflict coercive, dehumanizing “treatment” upon mental health patients inside locked facilities, but most journalists probably just don’t know that other possibilities exist, and it’s the job of activists to change that.
In other words, psychiatric survivors must make their case. Notably, in 2018, when Seven Days published a piece on the beginnings of “Vermont’s psychiatric bed crisis,” the author included a countervailing quote by Wilda White, then the executive director of Vermont Psychiatric Survivors, who apparently advocated for “housing, therapy, and community centers” instead of new investments in inpatient care. “This is not a system that needs more capacity to deal with crisis. This is a system that needs more capacity to deal with prevention and early intervention,” she reportedly stated.
By 2022, though, only one story remained about what Vermont could do to mitigate the effects upon its hospital system of its residents’ apparently increasing psychological stress. This is the way every standard solution to a social problem maintains its power within our inert culture – not by winning the public’s support in a vibrant contest of ideas but by presenting itself, with the help of a politically captured press, as the only feasible course outside of total inaction and indifference.
The artificially narrow playing field in popular political discourse affects every kind of policy debate, so naturally it has significant implications as well when it comes to progressive advocacy around “mental health awareness,” which often takes aim exclusively at a conservative tendency to ignore or minimize mental health and to underfund its treatment. When the argument does not address the character of mental health services, focusing instead only on their availability and destigmatization, well-meaning people may end up hurting those they want to help. They won’t change until the information they receive changes.
Does mainstream mental health journalism become more or less objective by incorporating the perspectives of survivors, consumers, and ex-patients? It’s the wrong question, because objectivity isn’t real and never was. But these perspectives must become powerful enough currents in mental health discourse that the point of view that journalists imagine as objectivity will always contain them.