WATERBURY – The Vermont Department of Mental Health expects to launch a unified statewide mobile crisis response service this year. It follows a 13-month pilot program in Rutland which had to limit operations due to challenges recruiting workforce.

DMH selected Healthcare & Rehabilitation Services, the community mental health center for Windham and Windsor counties, as its vendor. HCRS will subcontract Vermont’s nine other community mental health centers, creating a unified system for the entire state.

Deputy Commissioner Allison Krompf told legislators that “the go-live date is set for Sept. 1,” but HCRS leadership was not clear whether that would be possible. Contract negotiations between DMH and HCRS have not yet concluded.

Last year, the legislature mandated that the mobile crisis response program incorporate peer support workers.

“Having people with lived experience being able to be deployed is a really important theme as we roll this out,” Chief Operating Officer Anne Bilodeau said.

According to DMH, each two-person mobile response team will have at least one clinician. A peer can fill the other role but, by HCRS’s account, may not always do so.

“It will be flexible,” Karabakakis said. “In many cases, the response will be based on what the family or what the individual needs. Oftentimes they might be working with a case manager who really knows the individual, who really knows the family, and they might be that second person.”

In testimony before the House Committee on Health Care, RMHS Director of Emergency Services Loree Zeif wondered where the needed employees would come from.

“While I support this two-person initiative,” she said, “I cannot imagine how we will staff it.”

Zeif suggested that it would “cost many more times what the state has anticipated to provide the level of service we’re looking at.”

In May, the legislature allocated $422,812 to fund four new positions within DMH to oversee the program, which is intended to reduce strain on emergency departments by sending mental health workers into homes and communities at callers’ request.

“We’re hopeful” about the timeline, HCRS Executive Director George Karabakakis told Counterpoint. “If we really want to operationalize this and make this happen in a successful way, we need to have that date reflect the reality of what’s on the ground, so we’re in the process of discussing that.”

“I would just say that there is a lot of complexity to creating a statewide initiative that involves saving lives in crisis situations,” Bilodeau added. “And we want to be particularly thoughtful and caring to make sure that everyone has the staffing that they need and those staff are trained and that we have the right protocols in place.”

HCRS submitted the only response to a request for proposals last year that offered a maximum of five DMH contracts to serve 10 catchment areas throughout Vermont. Its executives characterized the proposal as a statewide collaboration.

“There were other options, like maybe taking regional approaches, but I think in the end we all agreed that, if we worked together, HCRS would be the lead,” Karabakakis said. “I met with all the executive directors for many hours to really sort of flesh this out.”

Each of Vermont’s community mental health centers already offers emergency services, for which DMH data indicates rising demand. But capacity varies, and in DMH’s telling, none can currently provide mobile outreach at all times.

The new program will standardize practices in accordance with requirements set by the Centers for Medicare & Medicaid Services, which include an obligation for 24/7/365 readiness. Special CMS funding will help bolster the program for a three-year start-up period.

“You shouldn’t have to worry about which [community mental health center] it’s attached to. It’s just mobile crisis response,” Krompf said. “And at some point, it may be able to be dispatched through 988, which would even provide a centralized number.”

Per a DMH report, the youth-oriented pilot by Rutland Mental Health Services “experienced significant workforce challenges,” reducing operations to 40 hours a week.

“It’s clear to us that there’s a vacancy issue in existing programming,” Krompf told Counterpoint. “It’s clear to us that any expansion will also have to manage the fact that there’s a staffing crisis. So the hopeful news is that not all of this has to be brand new. There’s ways to take existing resources and leverage them.”

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