Flagship Hospitals Continue to Have a Role to Play

(Editor’s Note: This article was published July 26, 2015. It’s part of the Uneven Efforts​ series.)

Most experts and advocates agree that the quality and availability of care depend, to a large degree, on a state’s ability to deliver services in a variety of community settings and facilities while reducing reliance on flagship, state-owned mental hospitals.

Yet those hospitals — which provide high-level, expensive, inpatient treatment for acute cases of serious mental illness — will continue to play an important role in mental health care. Today, the leading psychiatric hospitals in Vermont and New Hampshire bear little resemblance to the asylums of yesteryear.

The $31 million Vermont Psychiatric Care Hospital, which opened in Berlin on July 1, 2014, sits at the pinnacle of that state’s mental health care system.

The hospital was built after Tropical Storm Irene in August 2011 destroyed the century-old state hospital in Waterbury and created an urgent need for replacement services. That broke a long-standing legislative logjam that was blocking mental health care reform in the Statehouse in Montpelier.

The new, 25-bed facility, with an annual operating budget of $20 million (or $800,000 a bed) has a laboratory, a pharmacy, a medical supply room, treatment units, a recovery services area, a central kitchen, a greenhouse, doctors’ offices, a medication dispensary, an exercise room (with treadmills, Nordic tracks and rowing machines), an outdoor basketball court and walking track, a library and multiple comfort and sensory rooms. A round room for meetings and religious services converts into a courtroom during a judge’s weekly visit. The University of Vermont Medical Center provides a psychiatric staff that includes an around-the-clock presence.

All that in what Jeffrey Rothenberg, the hospital’s chief executive, describes as “the smallest state psychiatric facility in the country.”

Rep. Ann Pugh, the South Burlington Democrat who chairs the House Human Services Committee, said the new Berlin facility should not be viewed in the traditional way as “a state hospital. We have a distributed, level-one hospital system.” Level-one beds are used to treat “the most acutely distressed and involuntary individuals” with mental illness, according to a recent DMH report.

In addition to the new Berlin facility, Vermont has six level-one beds in the Rutland Regional Medical Center and 14 at the privately owned Brattleboro Retreat, for a total of 45 level-one beds.

New Hampshire Hospital is much larger, with 158 beds. That 173-year-old institution is in its third decade of operation in an airy, light-filled building that sits unobtrusively off Clinton Street, just down the hill from a cluster of brick buildings that house various state agencies. Those buildings were part of the state hospital when its population numbered in the thousands. New Hampshire Hospital has the police, trained staff and infrastructure “to handle the most chronic, severe mentally ill that pose a danger, because of their behavior, to others,” said Robert MacLeod, the hospital’s chief executive.

The New Hampshire Hospital’s total capacity is more than six times greater than, and its fiscal 2015 budget of $61.8 million was about triple that of, Vermont’s smaller flagship facility. New Hampshire Hospital’s current daily cost per case is about $1,200, or about $400,000 a year, according to a May budget presentation by the state Health and Human Services Department. The hospital has about 600 employees and its psychiatrists are affiliated with Dartmouth College’s Geisel School of Medicine.

Vermont Psychiatric Care Hospital has a staff of about 180 and its psychiatrists work under a contract with the University of Vermont Medical Center.