Need for youth psych beds prompts unusual budget request for Southwestern Vermont Medical Center

By Kristen Fountain

VtDigger

Published: 01-17-2023 4:32 PM

The midyear administrative budget adjustment that absorbs the first weeks of every Vermont legislative session usually involves requests to transfer money between already existing programs. And normally a hospital will take several years to launch a new service.

This year those norms have been turned upside down. In the budget adjustment package released late last week, Gov. Phil Scott’s administration requested approval to reallocate $9.25 million from this year’s budget to support the rapid development of an inpatient youth psychiatric unit at Southwestern Vermont Medical Center, which recently announced affiliation plans with Darmouth Health.

However, the Bennington hospital has not yet committed to the project. Administrators with the Vermont Department of Mental Health now say they would like to see the legislative language broadened to allow the funds to go elsewhere if SVMC leadership decides not to move forward.

“We know there is a need and we don’t have the capability right now,” Adam Greshin, commissioner of the Vermont Department of Finance and Management, told the House Committee on Appropriations on Friday.

The project involves renovating an existing hospital wing at Southwestern Vermont Medical Center, so it could likely open faster than a project involving a new building, said Greshin, adding that the goal is to have beds available by Jan. 1, 2024. “This is in the budget adjustment to try to keep the momentum going,” he said.

Should lawmakers approve the request for funds as part of the budget adjustment, the money would be available to the hospital during the current fiscal year, before next year’s budget kicks in on July 1.

Legislators and even the hospital’s leaders are skeptical about the possibility of such a rapid roll-out. But no one is questioning the need.

On an average day, a half-dozen children and their caregivers are in their second day of waiting in emergency departments around the state for access to inpatient mental health care. That number, from a weekly survey by the Vermont Association of Hospitals and Health Systems, has been consistent over the past two years.

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A broader study tracking the number of patients — adults and youths — in hospital emergency departments seeking mental health care is due to the Legislature next week. Last year’s version, looking at hospital discharges for the year prior to Sept. 30, 2021, found there were 1,438 youth cases during that period, with an average stay of two days.

A big gap in the system right now specifically is the lack of inpatient beds for youth within a medical setting, Emily Hawes, commissioner of the Vermont Department of Mental Health, told the House Appropriations Committee on Tuesday.

Currently, the Brattleboro Retreat is the only facility designated to provide emergency psychiatric care for youth, but it is not equipped to serve patients who “also have complex medical needs,” Hawes said.

Complex medical needs might mean conditions such as pregnancy, type 1 diabetes, epilepsy or developmental disabilities, or acute problems such as wounds from self-harm or the severe dehydration that can accompany an eating disorder. Youth in a psychiatric crisis with additional medical needs like these currently stay inpatient at hospitals, often in emergency departments, a setting which makes it difficult to provide the needed mental health care.

The department has been actively seeking a partner in opening a facility since last February. The UVM Health Network initially showed interest in adding the service at its pediatric hospital in Burlington, but stepped back after it paused all new construction because of significant annual budget deficits.

Southwestern Vermont Medical Center signaled its interest after the department issued a second request for proposals in June for up to 12 youth psychiatric beds, agreeing to study the feasibility of the new service, said Jim Trimarchi, director of planning for the Bennington hospital.

“We’re excited about it, and we’re pleased that Gov. Scott recognized the challenge and that he is taking budgetary steps forward,” Trimarchi said. However, in terms of the project, “it’s actually pretty early days.”

United Counseling Service of Bennington County, the designated social and mental health service agency for the region, has discussed the project with leadership at the hospital, said Executive Director Lorna Mattern by email. The agency already works with hospital staff daily to meet the psychiatric needs of patients there and has agreed to collaborate on staffing an inpatient facility, she wrote.

Trimarchi said the feasibility study should be completed in late March. The next steps would be approval of the project by the hospital’s board of directors as well as the Green Mountain Care Board, the state regulatory body for hospitals, through the issuing of a “certificate of need.”

A January 2024 opening might be achievable from a purely construction standpoint if there were no significant supply chain issues, he said, but “I don’t want to get ahead of our board and other regulators.”

Regulatory issues were also on the mind of lawmakers. No application for a certificate of need is on file for the project, according to the care board website.

Clearing that hurdle in itself could push the project into the next budget cycle, Rep. Robin Scheu, D-Middlebury, told the committee during Greshin’s testimony. “We appreciate your expediency with it, but we’ll have to find out what is possible or if there is anything in the way,” she said.

Administrators plan to work with legislators to make the language for the appropriation less specific to the Southwestern Vermont Medical Center, said Nicole DiStasio, director of policy for the Vermont Department of Mental Health, in an email. If the hospital decides against the project, the department would likely reissue the RFP for a third time, she said.

But the department would still like to see funds from this year’s budget adjustment set aside for that purpose, DiStasio said. Federal American Rescue Plan Act funding has offset the need for a significant amount of state spending in this fiscal year and the previous one, offering an opportunity to invest in helping to bring a hospital-based youth inpatient psychiatric unit into service.

“There is an ongoing need to be able to serve this population of youth in-state, especially those with co-occurring medical needs that would require a connection with a hospital setting,” DiStasio said.

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