$18 Million from Hospital To Be Shifted
MONTPELIER – An $18 million fund left over after construction of new inpatient psychiatric beds by the University of Vermont Health Network was determined to be too costly will now be spent on a broader range of services.
UVMHN submitted a proposal for nine projects at the end of May to the Green Mountain Care Board, which will have the final say on that reuse of the reserved money. The two largest projects proposed were funds for the urgent care clinic being planned in Burlington (see article, page 6) and renovations to the Central Vermont Medical Center inpatient psychiatric unit.
The GMCB had required that a proposal for new uses of the money be developed in consultation with the Department of Mental Health and with contributions from community stakeholders. Members of the UVM Medical Center inpatient psychiatric advisory group and the Department of Mental Health State Program Standing Committee were asked to provide comments, according to DMH. The largest single proposed investment would be $4.5 million to renovate the Central Vermont Medical Center inpatient unit to accommodate more patients and “improve the environment of care.” The major change would be conversion of three double bedrooms to six single ones, which would allow more flexibility in using all of them, the proposal said.
Additional smaller projects would include new psychiatric capacity in the UVMMC primary care integration project, establishing esketamine and Transcranial Magnetic Stimulation (TMS) treatment capacity, adding providers to its eating disorders and transgender care clinics for youth, creating a pilot program for ambulance transport to the Brattleboro Retreat between 5 and 11 p.m., and conducting a bed need and feasibility study of future expansion of UVMMC inpatient psychiatric capacity for adults and children.
The Board’s order said that the proposal must show “how the use of funds will reduce the frequency and length of stay for adults, adolescents, and children experiencing a mental health episode who are boarded in EDs,” and “how the use of funds will increase capacity for mental health services.”
In 2017, UVMHN raised more money than it was permitted under the budget approved by the Board for that year. The Board ordered that $21 million in surplus funds be held for addressing the reported shortage of psychiatric hospital beds. Extensive planning was done on the creation of a new wing at Central Vermont Medical Center in Berlin, including a new emergency department.
The project cost estimate was much higher than expected, and UVMHC announced last year that the project had to be shelved. It then asked the Board to provide more leeway on how the remaining money could be spent.
DMH Head Ruled in Contempt of Court
BURLINGTON – A Superior Court found the Commissioner of the Department of Mental Health, Emily Hawes, in contempt of court in May for what it described as “knowingly and willingly disobeying the Court’s order” for an updated psychological evaluation of a defendant’s competency to stand trial.
Judge Alison Sheppard Arms of the Chittenden Criminal Division will fine Hawes, in her role as commissioner, $3,000 if DMH does not act to comply with the order.
DMH’s communications director, Alexandra Frantz, said that DMH had not initially received a “clear directive to complete the evaluation” last November, and once it understood the order, it placed the individual on the current waitlist.
According to the court decision, DMH had asserted that it was only under a statutory obligation to perform one evaluation per defendant. Arms said DMH used “nonsensical assertions and nonexistent legal grounds” to defend against its “continued obstruction of the criminal justice process.”
Frantz noted that DMH has had a significant backlog of evaluation cases, made worse by the COVID pandemic, that has caused waits of up to a year.
She said DMH hopes that some of the issues raised by the case will be addressed through S. 91, passed by the legislature this year and awaiting signature by the governor.
That bill requires a showing of changed circumstances before a new evaluation can be ordered once there has been an initial finding of competency, and allows, for a one-year trial period, forensic psychologists as well as psychiatrists to conduct evaluations.
Eating Disorders Study: State Lacks Services
WATERBURY – The state lacks any moderate- to high-level treatment settings for individuals with eating disorders, according to a special review on services available for eating disorders in Vermont that was directed by the legislature in 2021.
“The stark reality that none of these programs exist in Vermont at this time, for any age group,” the report by the Department of Mental health said.
“Vermont has a small pool of exceptional multidisciplinary outpatient providers specializing in eating disorder treatment,” the report said, but “available resources do not come close to meeting the need for individuals in Vermont.”
The report made eight recommendations: establish partial hospital and intensive outpatient programs; create opportunities for more training for all health care professionals: encourage routine screening in primary care settings; establish a continuing medical education requirement; provide annual free training to health professionals, social workers, and schools to increase awareness; provide education to school staff about prevention and identification of eating disorders; and create public health messaging on eating disorders on how to prevent them, identify them, and seek help early.
“Implementation of the recommendations must be well resourced in order to secure sustainability,” the work group said.
Court-Ordered Drug Numbers Decline
WATERBURY – The annual consultant report on court-order psychiatric drugs shows that the number of petitions being filed by hospitals and granted by judges has been on the decline over the past several years. The number of petitions granted was the lowest since 2013.
The report, which covered July, 2021 through June, 2022, did not include a comparison to the number of hospitalized patients, which decreased overall during the COVID-19 pandemic.
There were 52 petitions filed for involuntary medication under Act 114 during that one-year period. Of those, 36 were granted, 10 were dismissed, three were denied, and two resulted in an order of hospitalization.
The external review, conducted by Flint Springs Associates, includes comments from patients who were subjected to drug orders, hospital staff, and Vermont Legal Aid.
There were five patients who replied to the request for input on their experiences.
The majority of them said they were not asked whether they wanted a support person present while receiving the drug; they had little or no control over what drug was ordered, how much was ordered or how it was given; and that they did not feel supported or respected by hospital staff during the process, the report said.
Among the complaints shared were of “losing all control over my own body,” as well as loss of personal freedoms: “Having my clothes taken …” and, “Being stuck in a facility where you are required to share the bathroom with 8 to 13 other people, staff didn’t clean bathroom between our shower or bath times.”
Comments about staff among the patients who responded included, “They were usually not very caring and they didn’t respect my perspective.” One said that, “The experience of receiving medication was ‘physical torture.’”
The consulting firm said it recommended “that staff at hospitals administering Act 114 medication continue efforts to help patients understand the reasoning behind the decision to seek an order for involuntary medication and to invest time in talking with patients about the process and available options.”
Staff at one hospital, in response to a question about alternatives available to patients, said staffing shortages were a significant problem.
“On our unit it states all the things we have but not every patient can utilize the spaces. We cannot take patients to the atrium or to the gym without adequate staff.
“Then what ends up happening is the patient is unable to utilize the options and alternatives because there is not enough staff… it is utterly frustrating to tell a patient that is struggling that could use the gym to help dispense their energy in a more productive manner than what often occurs.
“There seems to be nothing to help patients that are experiencing crisis even though there are signs stating we have a gym (that no one can use because there is never staff unless it’s first shift).”
Another staff member raised a concern about the patient environment on the small, intensive unit where that employee works.
“Patients are often extremely upset due to the behaviors of other patients and cannot escape the over stimulus that is happening. The space is small and confined.
“Patients have limited access to outside, especially when there is not enough staff to provide trips to our atrium where the patients can get fresh air. The patients are bored, there are zero activities… or not enough staff to provide activities if we could.”
The report also asked for staff perception of the court process, and some said it helped with fairness while others complained about involving judges in the decision-making.
“Judges that are not with these patients, do not see what we see, do not see the way the patient struggles or how it saves patients, should not have any say on these medications.
“I have seen patients turned down [for a drug order] from a judge who has no experience in psychiatry or with the patient… and that patient loses their life because they can’t get the help they need and are sent from hospital to hospital or leave to a motel to just struggle.”
Patients under court-order drugs included 15 from the Brattleboro Retreat, nine from Rutland Regional Medical Center, two from the University of Vermont Medical Center, and 13 from Vermont Psychiatric Care Hospital.
New Data Show Use of Restraint Is Rare For Voluntary Patients, Except at Retreat
Emergency restraints and seclusion are rarely, if ever, used on voluntary patients on psychiatric units in hospitals, with the exception of the Brattleboro Retreat, according to new data being gathered by the Department of Mental Health.
The data is not completely clear because only the Retreat information is broken out between patients who are voluntary or involuntary.
However, in nine months of data reviewed by Counterpoint, there were no uses of restraint or seclusion at all reported at Central Vermont Medical Center in Berlin or on the general unit at Rutland Regional Medical Center, which both serve voluntary patients together with those under involuntary custody of the Commissioner of Mental Health.
There were also no uses of restraint or seclusion on the Shepardson 3 Unit at the University of Vermont Medical Center, which primarily serves voluntary patients.
The three quarters that were reviewed included January-March, April-June, and October-December of 2022, because the July-September quarter was not available from DMH.
The Retreat’s rates for the use of restraint and seclusion among all patients, and particularly among highest-risk patients, also exceeded all other hospitals among similar patient profiles, a trend that has continued over a number of years. The Retreat is Vermont’s largest psychiatric hospital, with eight units.
During those periods, the DMH report specific to voluntary patients at the Retreat showed use of restraint or seclusion 334 times with youth and 220 times with adult patients.
The most frequently used type of restraint with those patients was hands-on, which accounted for 334 uses. There were 197 uses of mechanical restraints, a term used for physical restraint tied to a bed or chair. A seclusion room was used 148 times during those nine months, and forced drugs were used 58 times.
The DMH data does not provide the rate of use of restraint and seclusion per patient hour for voluntary patients. A new law passed in 2021 required restraint and seclusion data to be reported by DMH for all patients, regardless of whether they are in the involuntary custody of the Commissioner, but the current data is aggregated for voluntary and involuntary patients except at the Retreat.
Patients in remaining units at other hospitals are all involuntarily held, including on Shepardson 6 at UVMMC, the south wing at Rutland Regional Medical Center, with highest-risk (“Level 1”) patients, and the four units at the Vermont Psychiatric Care Hospital in Berlin, with all Level 1 involuntary patients.
For each of those units, in January-March of 2022, the overall rate per patient hour at the Retreat’s Tyler 4, Level 1 unit was 2.29 and at Linden Lodge, also Level 1, the rate was .53. At VPCH the rate was .68, the RRMC south unit rate was .91 and Shepardson 6 was .21. The Retreat’s other five units had no use of restraint or seclusion, and one at .04.
In April to June, the overall rate per patient hour at the Retreat’s Tyler 4 was 3.11 and at Linden Lodge the rate was 1.03. At VPCH the rate was .26, the RRMC south unit rate was .38 and Shepardson 6 was .19. The Retreat had two of its other units with no restraint or seclusion, with others at rates of .23, .06, .08 and .01.
In October to December, the overall rate per patient hour at the Retreat’s Tyler 4 was 3.97 and at Linden Lodge the rate was 2.92. At VPCH the rate was .64, the RRMC south unit rate was .72 and Shepardson 6 was .60. The Retreat had four other units with no restraint or seclusion, with others at rates of .19 and .10.
Health Equity Office Gains Momentum
MONTPELIER – The Health Equity Advisory Commission made 37 recommendations and requested a base budget of $1.57 million from the legislature in its annual report in February, but its report was not reviewed until April and no action was taken on the requests for this year.
The report said that health equity “must be pursued with an understanding of the persistent nature of the disparate outcomes across all social determinants of health – housing, education, employment, economic development, criminal justice, etc.,” and that those disparities “compound adverse outcomes, including poor health, to a life altering, life threatening degree.”
It stated that as a result, “advancing equity is the responsibility of the whole of our government” and that “all agencies and departments within state government must address inequities in their existing and new policies and programs.”
The legislature responded to the request for funds to establish and staff an Office of Health Equity and to create a community grant program for equity projects w i t h a total of $750,000, but with the condition of receipt of a specific recommendation from the Council by January on where the new office would be situated within the state government structure. The funds, which would be released after the report is received, includes $250,000 for executive director and assistant positions, and $500,000 of the $750,000 it requested for the funding of grants.
Commission member Sarah Launderville, executive director of the Vermont Center for Independent Living, said that she was “very excited about the ‘whole government’ approach and how that can really begin to change how we engage on health equity overall.”
The Commission was created in 2021 to address health disparities from systemic discrimination against people with disabilities, the LGBTQ+ community, people of color and indigenous peoples. Launderville said she thought the community-based and neighborhood-based grant component “is very important as we look at how health equity is already happening.
“It’s in the communities, it’s led by people with lived experience and in order for that to thrive, having grant funding to shore up that community programming is important.”
Obituary: Rene Rose
ST. JOHNSBURY – Rene Rose, a leader in the psychiatric survivor movement and peer advocacy in the Northeast Kingdom for nearly three decades, died Dec. 12, 2022, in a car accident in Walden. She was 76.
Rose had been a past board member at Vermont Psychiatric Survivors. She worked in peer support at Northeast Kingdom Human Services and studied and practiced Non-Violent Communication.
Rose was known as an extraordinarily patient listener who encouraged peers to take the lead in improving their own wellness. She employed mindfulness-based cognitive therapy strategies to assist people in recovering from serious illnesses.
In collaboration with Gladys Mooney, she headed up several Vermont Psychiatric Survivor Peer Operated Projects grants.
In private practice, she co-facilitated Chronic Pain, Depression Relapse, and WRAP (Wellness Recovery Action Plan) support groups. Her gift was in seeing people as human beings – not as broken; not as less-than; just as people – struggling at times, like her, and looking for a way forward.
She is survived by her daughter Cathy and grandson Tristan.
Rene was born in Brooklyn, New York on Aug. 8, 1946 and studied at Brooklyn College and Syracuse University for her doctorate in women’s studies and taught undergraduate and graduate classes in Counseling, Encountering Illness, and Death and Dying at the St. Johnsbury branch of Springfield College of Human Services.
She lived and worked at a Gurdjieffian community in Walden on the community’s farm for 23 years. She sustained a number of debilitating injuries during this time, including broken ankles, knee replacements, and permanent injury to her back. She lived with chronic pain and used crutches after a fall 20 years ago.
Support Line Celebrates 10 Years
WINOOSKI – Pathways Vermont is celebrating the tenth anniversary of the Pathways Vermont Support Line. The Support Line was developed to provide confidential, non-judgmental support and connection for all Vermonters over the age of 18 by phone or text.
Since the inception of VSL, more than 87,200 calls have been completed, and 2,268 calls have been diverted from emergency services, the organization reported.
Different from a crisis hotline or emergency line, the support line is a “warm line,” a resource that can help prevent a situation from escalating to an emergency, Maria Moore, a spokesperson for the agency said, filling a previously unmet need in the system of care through immediate access to support.
The creation of a statewide warm line was mandated in Act 79, the legislature’s plan to redevelop the system of care following the closure of the Vermont State Hospital. It was intended as an alternative resource for individuals who regularly contact crisis and other emergency-level services in search of support. A year later, the Pathways Vermont service began taking its first calls. In response to increased need during the pandemic, the Support Line expanded to becoming a 24/7 line, as originally envisioned in Act 79.
Pathways Vermont has a relationship-first practice, Moore said. This means the organization values lived experience, recognizes each person as their own expert, and fosters connection through empathy and authenticity, she explained.
A relationship-first practice places principles of humanity, collaboration, curiosity, and hope at the forefront of every connection, Moore said. Support Line staff utilize lived experience to provide peer counseling on a wide range of issues including loneliness, substance use, medical concerns, relationship challenges, or thoughts of suicide.
“Our support line is unique in that all relationships and connections are rooted in autonomy, mutuality, and trust. Someone can call the line when they are having a bad day and just need someone to talk to,” Moore added.
“Pathways Vermont champions the peer support model and the success of connections without agendas or a helper/helpee relationship.”
Moore shared a comment from one caller, who said,“The support line is one place where I don’t feel alone in the world. It’s so good to be able to pick up the phone and hear an empathetic voice on the other end. I call each day because I find this line very effective.”
The Support Line can be accessed via call or text at (833) VT-TALKS / (833) 888-2557.
VPS Names New Patient Representatives
RUTLAND – Vermont Psychiatric Survivors has announced two new patient representative staff members.
Introductions on the VPS web site give these brief self-descriptions:
Kat Parker worked in the medical field for 12 years, working mostly in cardiology and neurology, prior to coming to VPS. She always made sure to take extra time for her patients to make sure that they felt comfortable and cared for.
She takes a Carrie Fisher approach to her mental health. She is not afraid to be transparent about her own mental health and neurodivergence. She is active in researching new ways to help people with different ways of neurodivergent thinking.
Kat lives at home with her husband and cat. She enjoys kayaking, being outdoors, and gaming. She has hobbies in arts, crafts and embroidery.
She also enjoys reading and writing. She has a poem published about mental illness. She is a nerd and can have conversations about many nerdy things like gaming, movies, Broadway and books.
Zachary Stroup, a psychiatric survivor, comes to VPS as a former EMT. His experience as a frontline worker in the community led him to seek options that would allow him to assist in the community’s mental health as well.
When he isn’t engaging with the community, Zach’s other passion is the stewardship of animals. If not taking care of the family menagerie of cats, dogs, chickens and fish, he can occasionally be found assisting rescue organizations or trying to commune with a random critter.