When the state denied a $2 million emergency bailout request by the Brattleboro Retreat this month, the public back-and-forth that followed shined a light on the psychiatric care facility's fragile financial situation.
While Brattleboro Retreat officials are no longer talking about immediate closure,health administrators across the state say they're watching the situation closely because they say any cuts in psychiatric services at the Retreat will have serious and potentially dangerous ripple effects in hospitals across Vermont.
"I think alarms went off, particularly for folks in our emergency department who are seeing these people come in with no place to go," said Wendy Franklin, a spokesperson for North Country Hospital, in Newport.
According to Franklin, in the last 10 months 127 patients came to their emergency department seeking mental health care. Of those people, Franklin said, 40 ended up being admitted for inpatient care.
"UVM is our closest other psychiatric facility, and they are chronically full," Franklin explained, so most of the 40 people who needed inpatient care were sent to the Brattleboro Retreat.
More from Vermont Edition — The Brattleboro Retreat's Financial Woes: What It Means For Vermont's Mental Health System [Jan. 14]
At Gifford Medical Center, in Randolph, CEO Dan Bennett said they too rely heavily on the Brattleboro Retreat.
Last week, when news was breaking about the financial problems at the pyschiatric care facility, Bennett said he and his staff immediately began trying to troubleshoot how their emergency department might operate without it.
"We don't possess the resources to adequately provide psychiatric services that would be needed over the long term," said Bennett. "So we would have to take our existing resources and reallocate people to caring for these patients, and what could happen is that that could put us in a situation where we're no longer able to care for other patients in our emergency department who come to us with medical issues."
Bennett added: "It would be a very bad situation for people who are dealing with a psychiatric situation, but it would also be very bad in general for all medical care that's provided."
Rutland Regional Medical Center has more options for treating mental heath issues. It operates a 17-bed inpatient psychiatric ward that treats about 750 patients a year.
Yet while demand for those services has been growing, CEO Claudio Fort said the department loses money annually; the hospital has been able to offset those losses with revenue from other more profitable departments.
But even that's getting more difficult, according to Fort, because he said profit margins are shrinking in every department.
"The challenge with psychiatric care: it is very staff intensive," Fort said. "A lot of it is one-to-one or two-to-one staffing."
Because demand has risen for mental health services, Fort said they’ve had to hire more staff at the same time Vermont is dealing with a statewide nursing shortage.
"And so especially when we have to use outside contract labor or temporary nursing staffing, that is a lot more expensive," Fort said. "And that's some of the challenges we're all dealing with."
When Tropical Storm Irene forced the closure of the state hospital in Waterbury, the Brattleboro Retreat took on more patients. Rutland Regional also stepped up and contracted with the state to open a separate Level I psych unit. Fort said it serves 35 to 40 high needs patients a year — all adults.
"These are folks who are under the care and custody of the Department of Mental Health," Fort said, "and who are involuntarily committed because they're at risk for their own safety or the safety of others."
But Fort and others say that while access to psychiatric care statewide has been improving in recent years, there's still not enough — especially for kids.
The Brattleboro Retreat is the only inpatient psychiatric and Level I facility in Vermont that treats children and adolescents, so there’s considerable worry about how kids may be impacted by budget problems there.
According to a new report, the number of kids accessing mental health services in Vermont has doubled over the past two decades. Dr. Robert Pierattini, chief of psychiatry at UVM Medical Center, has seen this firsthand.
"We are seeing many more children and families in crisis," Pierattini said. "We're seeing many more children in the emergency department. We've added child psychiatrists and related providers in our child psychiatry division here."
Pierattini said Vermont kids who need inpatient psychiatric care have alarmingly few options; Rutland Mental Health Services CEO Dick Courcelle agrees.
"It is cause of great concern in this state that we do not have a viable children's alternative," Courcelle said. "And when all your eggs are in one basket ... what will happen with that basket if it gets dropped?"
Back at Rutland Regional Medical Center, Fort said the state is under incredible pressure to control health care costs at the same time providers are frustrated trying to meet rising demand for services.
"At any given time, there's dozens of people out there in the throws of a psychiatric crisis waiting for placement in hospital emergency rooms. So losing even a portion of those Brattleboro Retreat beds without some alternative for inpatient hospitalization or some more robust community treatment will be felt in every single hospital in the state," Fort said, adding that "it will exacerbate some of the economic challenges that especially smaller hospitals are feeling already."
Disclosure: Brattleboro Retreat, Rutland Regional Medical Center and Gifford Hospital are VPR underwriters.
