Ken Libertoff: The $18 million question about mental health

This commentary is by Ken Libertoff, Ph.D., who was director of the Vermont Association for Mental Health in Montpelier for 30 years. He retired in 2010 but continues to serve as an adviser on health care issues.

Why are 18 million dollars sitting unused and even ignored while Vermont’s mental health system remains in crisis?

For the past decade, empty rhetoric, endless handwringing, countless studies, special hearings, and inept leadership have proven to be a case study in one of many failed responses to a mental health system that is overwhelmed and overworked.

One of several major problems has been the lack of inpatient psychiatric beds. For a decade, young and old Vermonters in need of care have sat in hospital emergency rooms throughout the state for days, weeks, and even longer because they can’t access appropriate care. Not only is this a tragedy for patients and their families, but it victimizes caregivers who are without options or timely clinical solutions. 

The fact that these circumstances persist to this very day is nothing short of a disgrace.

One intriguing development unfolded in 2018, when the Green Mountain Care Board crafted and endorsed a plan to allow the University of Vermont Medical Center to use $21 million in its excess revenue account to create new in-patient hospital beds. 

During 2015, 2016 and 2017, UVM Medical Center was a money-making juggernaut with several consecutive years of net patient revenues exceeding its state-approved budget. In 2016, UVM Health Network, for example, had $29 million of excess revenue and an even larger balance the previous year.

Threatening to impose more stringent regulations over the hospital or reduce its future budgets, the parties — the Green Mountain Care Board, representing the state, and UVM Medical Center — crafted an unusual plan, one that might be considered most creative or perhaps risky. Rather than taking punitive action or more stern regulatory measures, the Green Mountain Care Board urged the UVM Medical Center to commit to investing this money in expanded access to care.

Conceptually, the proposal to engage the state’s flagship hospital represented a major step in the right direction. For decades, Vermont hospitals have been reluctant to work with the state in collaborative ways, especially when dealing with patients with severe mental illness. It could be argued that the engagement of one or several of our nonprofit hospitals might prove more administratively and clinically effective than Vermont state-run facilities like the old, now-defunct State Hospital in Waterbury built in the 19th century, or even the relatively new 25-bed Vermont Psychiatric Care Hospital in Berlin, which has faced complex staffing problems since it opened in 2014.

Central Vermont Medical Center in Berlin under the direction of UVM Medical Center, implemented a comprehensive planning process in 2018, resulting in a plan calling for a new 25-bed facility to be located on the main campus of the Berlin hospital. However, in early 2020, the process encountered a major setback when UVM Medical Center estimated that the 25-bed unit would cost $150 million. 

This resulted in an angry outcry in opposition from many parties. Even John Brumsted, then CEO of the UVM Health Network, recognized that this proposal was too expensive. It could be said that ,despite spending several million dollars on planning, the project lost whatever momentum it had. 

The pandemic further delayed the process, and the effort ground to a halt with only feeble attempts to resurrect it. UVM Medical Center’s commitment to the project lost “air” like a punctured balloon.

The handwriting was on the wall, but it took until early in 2022 for UVM Medical Center to officially announce it was shelving plans to build this new inpatient psychiatric unit at Central Vermont Medical Center, citing major budget shortfalls and formally announcing that it could no longer afford this desperately needed project. UVM Medical Center did claim a total of $3 million spent on the planning process, leaving $18 million for badly needed services. 

It will soon be nearly a year since the project, now referred to here as a proverbial white elephant, met its demise. With limited oversight or press attention, it is probable that this failure will weaken Vermont’s already fragmented system of mental health care for years.

This means that the Green Mountain Care Board, the governor, or state agency leaders, or the Legislature must account for the remaining $18 million that remains in limbo. These funds were dedicated to expanding access to mental health care. There is no excuse for further delay. 

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