BENNINGTON – Vermont could have ten to 12 new inpatient psychiatric beds for adolescents by 2024 if a proposal by Southwestern Vermont Medical Center comes to fruition.
Direct input from psychiatric survivors or family members has yet to be brought into discussion on the idea, and some have questions about whether it is an appropriate plan.
Hospital officials have stressed the uncertain nature of the plan thus far. The first step will be a feasibility study, which was scheduled to begin by late fall and is due for completion by March 31.
SVMC has targeted a 4,500-square-foot area within its main hospital building in Bennington for a potential renovation that would create a private room for each patient, as well as an “education space” for schoolwork and a common area for “visits with family, peers and support persons.”
Its preliminary cost calculation for the project estimates a price tag as high $10.425 million from pre-construction to launch.
Prolonged delays in emergency departments across the state for kids awaiting inpatient psychiatric placements — sometimes for a week or more — led the Department of Mental Health to issue a request for proposals for a new highacuity pediatric psychiatric unit last January.
It called for “up to 10 beds” to supplement Vermont’s only children’s psych ward at the Brattleboro Retreat.
But DMH initially received just one response, which the University of Vermont Medical Center subsequently withdrew, citing a budgetary shortfall. DMH reissued the request for proposals in June, and this time, SVMC decided to throw its hat in the ring.
“The first time they offered the RFP, we started to pull together a proposal and really started looking at this and realized that it was just really a significant lift for SVMC,” Director of Planning James Trimarchi recalled.
“We didn’t submit a proposal in that first round, but we had good conversation with the Department of Mental Health about a kind of shared vision of what the need is in the community and what we might be able to do. “When the proposal that they did receive got withdrawn,” Trimarchi continued, “they reached back out to us and they said, ‘Is there a possibility that we could do a joint feasibility study and see whether or not this makes sense?’”
SVMC signed a contract for $25,000 with DMH in late October to examine the statewide demand for inpatient psychiatric beds for children between the ages of 12 and 17, and the potential cost of construction and operations at SVMC. The contract commits DMH to “share perspective and concerns from other Vermont agencies and departments in order to ensure that collateral impacts are considered in the design of the unit and its operations.”
SWMC is also required to “obtain feedback on the design and operations from [United Counselling Services, Bennington’s community mental health center], mental health advocacy organization such as Disability Rights Vermont and persons with lived experience.”
However, the resulting report, which must include “reflective anticipated impact on state agencies and departments,” does not require any similar assessment of impact on children and families.
Trimarchi, the SWMC planning director, said they’ll solicit input from “organizations that can speak to lived experience, to make sure that we have the design right and the model right and the programming right.”
“We haven’t had the kickoff for the feasibility study, so there has been no firm commitment to engage any specific group. What I can tell you is we will engage groups,” he clarified.
The contract doesn’t compel SVMC to build the unit.
“We’re a medical facility, not historically an inpatient psychiatric facility,” Trimarchi acknowledged. “We’re exploring the idea.”
In doing so, SVMC expects to get a better understanding of several potential roadblocks.
“There’s a lot of challenges from the space constraints, from the regulatory constraints,” Trimarchi noted. “There’s staffing challenges, in terms of recruitment of the right providers to staff it… If we’re going to do this, we want to do this right, and the right way to do it is trauma-informed, in the least restrictive way,” he said.
Vermont Psychiatric Survivors Executive Director Karim Chapman expressed hope that VPS could offer peer support at the facility if SVMC’s proposal pans out.
“For various reasons, such as liability issues, VPS traditionally hasn’t had a history of doing that kind of work with adolescents,” he said. “I would love to see VPS in a position where we are supporting young people.”
Disability Rights Vermont Executive Director Lindsey Owen’s first reaction to SVMC’s plan was unenthusiastic.
“I haven’t had a chance to look at that exact proposal, but to the extent it’s constructing another locked facility to serve youth, I think that that might be not what Vermont really needs right now,” she commented. “There needs to be a lot more work done in Vermont to provide better, proactive, and progressive treatment options in the communities.”
Counterpoint asked DMH whether any input was solicited from psychiatric survivors in the lead-up to or writing of the request for proposals for this or other new projects it is pursuing.
A spokesperson said that the state “made a reasonable assumption that some peer communities and providers may likely be bidders” on the projects, and allowing direct participation in drafting an RPF would exclude them from bidding.
But soliciting input and questions has been a consistent part of all the planning, DMH said, including through the adult and children’s mental health standing committees.
“Many stakeholders, including peers, have identified the need for expanding the options for care offered in a diversity of settings, rather than relying on the Brattleboro Retreat,” it said in a written response. The RFP was developed “to gauge the interest and feasibility” for an increase in child and adolescent inpatient beds and if it goes forward, “it will begin the process of diversifying available choices for care.”
The DMH statement said that with the feasibility report from SWMC, it “anticipates being able to work collaboratively to develop a project plan that best meets the needs of Vermonters, which will include stakeholder engagement at that time.”