ESSEX, Vermont (WCAX) – A wave of Vermonters in psychiatric crisis await help in emergency rooms. Mental health officials say a new facility in Essex due to open in a few months will reduce the backlog and relieve pressure on state resources. Journalist Christina Guessferd got an exclusive tour of the $25 million project and examines the unique role it will play in evolving the state’s mental health care continuum.
For some, a climb-resistant fence symbolizes the mental institutions of yesteryear, not the institutions of the future. But the Department of Mental Health has demonstrated to the Legislature the urgent need for a place to safely house and effectively treat a small cohort of Vermonters who cannot receive adequate mental health care anywhere else. So, by the end of spring, officials plan to open this state-owned and managed 16-bed recovery residence off Route 15 in Essex, which all agree will a decade behind.
The property where Vermont’s only juvenile detention center once stood has a new purpose. Last fall, the state demolished the Woodside Youth Rehabilitation Center and began building the more than 17,000 square foot River Valley Therapeutic Community Residence from scratch.
Outside in the yard you will find a paved pathway, gazebo and raised beds. “We also have a greenhouse behind me where they can do some repotting and planting,” project manager Tabrena Karish said.
Inside, they swap the cold concrete blocks for warm wooden beams. The facility has two patient wings with eight spacious rooms on each side. “This is a typical bedroom. It will have a built-in desk, a double bed, a built-in window seat with wardrobe storage space. Each bedroom also has its own bathroom,” Karish said.
The wings are separated by a core of common spaces. “Behind me is a dining room. In front of me, there will be a skills kitchen for residents to use,” Karish explained. In addition, a multipurpose area, an art studio, a sensory room and a gym.
While the state pulled a residence from the rubble in seemingly record time, River Valley has been under construction since 2005, six years before Tropical Storm Irene destroyed the Vermont State Hospital in Waterbury. In 2012, the Legislature passed Bill 160 and Bill 79 which codified the statutory basis for a secure residential recovery center where patients are monitored 24/7 and physically confined within the premises. It was then that the state established the 7-bed Middlesex Therapeutic Community Residence, a FEMA trailer campus. Since opening in 2013, what was meant to be a temporary site has long outlived its lifespan and fallen into disrepair while constantly operating at full capacity.
In 2019, DMH presented a needs analysis to lawmakers explaining why simply replacing 7 beds at the Middlesex facility was not enough. The state had to get bigger and better, and fast. “We needed to expand, to reach more people, to be able to support more people, but we wanted to make sure we didn’t lose that sense of home,” said Troy Parah, director of the River Valley program. The new therapeutic community residence is considered transitional. Residents will stay between six and 18 months and develop life skills such as grocery shopping, house cleaning and practicing social engagement that will be integral to their independence. They will also participate in group and individual therapy and learn coping mechanisms. “Maybe there are still challenges there, and we can hopefully help them prepare for that,” Parah said.
The 2019 analysis of residential mental health bed needs shows nearly all referrals to the current Middlesex facility are from intensive hospitalizations, the highest level of mental health care in Vermont. At any given time, the report says seven to 10 Vermonters in need of treatment could leave a hospital for a physically secure recovery residence like the new Essex facility. This is a population of people whose psychiatric symptoms have stabilized enough to leave hospital, but who still pose a risk to themselves or others. A patient is only admitted to River Valley by involuntary court order in the custody of the Mental Health Commissioner. Some may meet these criteria if they have been charged with a crime – even murder – and a judge decides they are incompetent to stand trial. Many struggle with behavioral dysregulation and experience sporadic violent episodes. Although they are no longer in active crisis, they are not ready to rejoin the community, and other recovery programs that are not equipped to ensure their safety are turning them away.
Some mental health advocates worry that River Valley is too big. They also worry about how the state will staff those nine extra beds if existing facilities struggle to recruit and retain employees, forcing many to close beds the state already owns. That’s why some opponents argue that the state could have made wiser investments with the $25 million.
“You could get a lot more bang for your buck by investing in those things that prevent the need for a higher level of care, prevent someone from going into crisis, or get them out of a hospital instead of a hospital bed,” said Rep. Anne Donahue, R-Northfield, deputy chair of the House Health Care Committee. She has been involved in the political discussions since they began in 2005.
“There was no doubt that we needed to replace the Middlesex secure facility and there was, I think, near unanimous support for that. But for more than doubling in size, we didn’t think the justification had been shown.
Donahue says that rather than pouring $25 million into a building that serves a narrow subset of patients, the state should have split the money among lower-level preventative programs potentially benefiting hundreds of Vermonters, compared to just 16. Session after session, Donahue says the state hasn’t prioritized the right resources. “It’s always ‘next year’. It never happens. So, in theory, will this be the year we see significant investments in community care? I don’t hear any signs of that yet,” she said.
While acknowledging that other programs lack support, state officials remain confident that the Essex facility must come first and will ease pressure on the availability of Vermont’s acute care beds. That’s because without a proper place to go, patients eligible to be discharged to a secure residence – even small numbers – are left in limbo, occupying the limited intensive hospital beds for months at a time.
In its case for a 16-bed secure residence, DMH officials say freeing up those spots and filling them with acute cases presenting to the ER will free up resources at the first line of defense, accelerating the flow of patients throughout the mental health care system. .
River Valley will not initially open at full capacity. The state hires 63 full-time positions and there are only 32 full-time employees in Middlesex. Project leaders say they hope most will stay on board, but that still leaves at least 31 vacancies. Once construction is complete, the seven residents living in Middlesex will move to Essex. The property plans to bring the nine additional beds online as staff becomes available.
The Ministry of Mental Health launched a new doctor recruitment plan on Thursday to staff the Essex facility and the Vermont Psychiatric Hospital in Berlin, which has also suffered from a staff shortage since its opening. in 2014. They want qualified individuals and companies who can provide psychiatry-related services to submit bids. The RFP includes positions for physicians, primary care providers and medical directors.
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