Ken Libertoff: The $18 Million Question for Mental Health

This commentary is by Ken Libertoff, Ph.D., who served as director of the Vermont Mental Health Association in Montpelier for 30 years. He retired in 2010 but continues to work as a healthcare consultant.

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

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

One of several major problems is the lack of inpatient psychiatric beds. For a decade, young and old Vermonters in need of care sat in hospital emergency rooms across the state for days, weeks and even longer because they couldn’t access proper care. Not only is this a tragedy for patients and their families, but it victimizes caregivers who lack options or timely clinical solutions.

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

An intriguing development unfolded in 2018 when the Green Mountain Care Board crafted and approved a plan that would allow the University of Vermont Medical Center to use $21 million in its surplus revenue account to create new hospital beds.

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

Threatening to impose tighter regulations on the hospital or cut its future budgets, the parties — the Green Mountain Care Board, which represents the state, and UVM Medical Center — have come up with an unusual plan that could be considered the most creative, or perhaps the most risky. Instead of taking punitive action or stricter regulatory measures, the Green Mountain Care Board urged UVM Medical Center to commit to investing that money in expanded access to care.

Conceptually, the proposal to engage the flagship public hospital is a big step in the right direction. For decades, Vermont hospitals have been reluctant to work with the state in cooperative ways, especially when dealing with patients with severe mental illness. It could be argued that the involvement of one or more of our not-for-profit hospitals may prove to be more efficient administratively and clinically than public facilities in Vermont such as the old, now defunct Waterbury State Hospital, built in 19th century, or even the relatively new 25-bed Vermont Psychiatric Care Hospital in Berlin, which has faced complex staffing issues since it opened in 2014.

Central Vermont Medical Center in Berlin, led by UVM Medical Center, undertook a comprehensive planning process in 2018 that resulted in a plan calling for a new 25-bed facility to be located on the hospital’s main campus in Berlin. In early 2020, however, the process hit a major roadblock when UVM Medical Center estimated the 25-bed unit would cost $150 million.

This led to angry protests in the opposition from many parties. Even John Brumstead, then CEO of the UVM Health Network, acknowledged that this proposal was too expensive. Arguably, despite spending several million dollars on planning, the project lost the momentum it had.

The pandemic further slowed the process and efforts stalled with only feeble attempts to resurrect him. UVM Medical Center’s commitment to the project deflated like a burst balloon.

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

It will soon be almost a year since the project, referred to here as the proverbial white elephant, suffered its death. With limited oversight or press attention, this failure is likely to weaken Vermont’s already fragmented mental health system for years.

That means the Green Mountain Care Board, the governor or state agency heads, or the Legislature must account for the remaining $18 million that remains unaccounted for. These funds were intended to expand access to mental health care. There is no excuse for further delay.

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