Mobile Crisis Services Delayed

Vermont’s statewide mobile crisis response program will not launch on Sept. 1 as planned, according to the Department of Mental Health. Deputy Commissioner Alison Krompf named Jan. 1 as a likelier start date.

DMH contracted Health Care & Rehabilitation Services of Southeastern Vermont to lead the project, which, with the involvement of the state’s nine other community mental health centers, will send mental health workers into homes and other community settings at callers’ request. Krompf attributed the delay to July’s floods.

“HCRS got hit with some of the most significant flooding, so there’s been a bit of a pause for some of this,” Krompf told Counterpoint on Aug. 15. “We were in the final stages of finalizing that contract when that happened. And they had to stop because they’re out there working with all sorts of people in the community.”

The mobile crisis service isn’t the only new program intended to reduce visits to Vermont’s emergency departments for psychiatric needs. Alongside four other community mental health centers, HCRS also received a grant earlier this year to establish a new mental health urgent care clinic.

But owing again to the flood, Krompf expected to see its opening date “pushed back a few weeks,” possibly. She anticipated that the new urgent care clinics at Lamoille County Mental Health Services, Washington County Mental Health Services, and Howard Center would launch in September.

The new program at Counseling Service of Addison County, called Interlude, has already begun operations at 99 Maple Street #16, in Middlebury. Using the so-called Living Room Model, it offers a “voluntary, homelike, and trauma-sensitive environment,” as the agency put it, for people experiencing mental health crisis.

Retreat Aims to Reopen Adolescent Residential Beds

The Brattleboro Retreat, Vermont’s largest psychiatric hospital, has convinced the Green Mountain Care Board that it shouldn’t have to navigate a lengthy regulatory process before reopening an adolescent residential treatment program that shut down during the pandemic.

According to a letter sent by the Retreat to state regulators in August, the program operated from the 1970s until 2021, when a worker shortage, among other factors, led to its closure. The Retreat also runs two inpatient units for adolescents.

In May, the Vermont Department for Children and Families issued a request for proposals in the hope of contracting a vendor to launch a psychiatric residential treatment facility for adolescents. By its own account, the Retreat responded.

A spokesperson from the Agency of Human Services told Counterpoint that they couldn’t provide information about other possible bidders or about the selection of a winning bid before the finalization of an agreement. The RFP anticipates a start date of Oct. 1 for the contract.

If the Retreat’s bid wins, it will be able to operations without first having to earn a Certificate of Need, as new healthcare projects in Vermont typically do. In its August letter, the Retreat argued that a reopened residential program “doesn’t constitute a ‘new health care project.’”

The restarted program wouldn’t occupy the same location on the Retreat’s campus as its previous iteration, but it wouldn’t require the construction of a new facility, either. The Retreat estimated startup costs at $98,999.

The GMCB ruled in the Retreat’s favor on Aug. 25.

SVMC to File for Regulatory Approval, Eventually

Southwestern Vermont Medical Center’s board of directors gave hospital administrators its approval in July to apply for a Certificate of Need from the Green Mountain Care Board for a new adolescent psychiatric inpatient unit.

In order to avoid the creation of duplicative facilities, Vermont requires healthcare providers to get permission from state regulators before undertaking any large projects. SVMC Director of Planning James Trimarchi told Counterpoint that he expects the filing to take place by the end of 2023.

“Filing for the Certificate of Need requires financial tables that project into the future the five-year impact of starting the mental health unit,” he said. “In today’s healthcare environment, it’s incredibly challenging to put forward a five-year projection of what the financials are going to look like.”

Trimarchi doesn’t anticipate that the GMCB will render a swift decision once it has the application in hand.

“It is likely that there’ll be some interested parties in both support and not-support of the project that could result in the CON process becoming protracted,” he predicted. “We’re a long, long ways from doing anything.”

In July, the New Hampshire-based multi-hospital system Dartmouth Health, which includes Dartmouth Hitchcock Medical Center in Lebanon, acquired SVMC. Trimarchi believes that, when it comes time to staff the new psych unit, the affiliation will offer a major advantage.

“The Dartmouth Department of Psychiatry has agreed to supply the providers for the mental health unit,” he said. “There’s no way that we could get the talent we need in order to run this unit without Dartmouth’s backing and support.”

DAIL Seeks Specialized Caregivers

According to the Vermont Department of Disabilities, Aging and Independent Living, roughly 110 Vermonters with “complex needs” can’t find placements in Medicaid-funded long-term care facilities. The state is searching for a vendor capable of accommodating this population.

Many of Vermont’s nursing homes, residential care homes, and assisted living residences don’t have sufficient expertise to care for people with particular behaviors resulting from brain injury, stroke, or dementia. Most of all, they struggle to take in residents with mental health diagnoses, who make up 63% of those who meet the state’s eligibility criteria for long-term care but, due to a shortage of specialized service providers, don’t yet receive it.

Some end up, in DAIL’s words, “‘stuck’ in an inappropriate setting (e.g., hospital).” Others look for out-of-state options.

DAIL issued a request for proposals on Aug. 9. Bidders will propose adding services to an existing licensed facility or establishing a new one. In either case, they will aim to offer, as the document puts it, “a reliable, high-quality option for specialized care that promotes dignity and quality of life in a safe, secure setting.”

Proposals will include a “use of restraints plan” and “use of anti-psychotic medication plan,” as well as information about how many residents the contractor can serve.

The RFP closes on Sept. 14. DAIL expects to select a winning bid on Sept. 30 and execute a contract around Dec. 1. It will offer a two-year agreement with a renewal option for two additional years.

The Vermont legislature allocated $9.225 million in public funds to pay for the adolescent inpatient unit’s construction in May.

Burlington Goes Mad Again

Psychiatric survivors celebrated Vermont Mad Pride 2023 on July 15. For the second year in a row, the event took place in Burlington, starting with a march between the Hood Plant and Battery Park – this time, without a police escort.

With a megaphone in hand, Life Intervention Team Executive Director Karim Chapman, formerly of Vermont Psychiatric Survivors, led attendees up Church Street. Signs and chants helped bring their message of civil rights for psychiatrically labeled people and neuroinclusivity to the public.

A 14-person planning committee had invited journalist Robert Whitaker and Massachusetts-based nonprofit director Sera Davidow to give keynote addresses following the march and a free outdoor lunch. They joined four other speakers (Hilary Melton, Calvin Moen, Chris Hansen, and Wilda White), two poets (Rajnii Eddins and Zenni Muhammad), and the band Flashback under Battery Park’s bandshell. Ericka Reil emceed.

Sponsors included Intentional Peer Support, Pathways Vermont, and Disability Rights Vermont, all of which set up tents and tables inside the park alongside other organizations and local artists.

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