Cost Effective Solutions Can Replace Abusive and Exhorbitant Psychiatric “Care”

Replacing the Vermont State Hospital with Humane Community-based Recovery—and Saving Millions of Dollars for Vermont Taxpayers

A report from Vermont’s Ethan Allen Institute (EAI) shows that there are low-cost, humane alternatives to sending emotionally or mentally troubled individuals to Vermont State Hospital (VSH), the state’s public psychiatric facility.

VSH has been decertified by the federal government for poor care three times since 1986. Decertification means that Medicaid no longer participates in treatment coverage, leaving the entire burden on Vermont’s taxpayers. The most recent decertification occurred in 2005, following a condemnatory report by the U.S. Department of Justice (DOJ) that called VSH “dehumanizing” and “prison-like.”

The results of the DOJ’s report have created on one side, a call for a new facility to be built (strongly supported by the state employee’s labor union) and on the other side, support for the abandonment of the state facility in favor of far less expensive, humane and community-based services (strongly supported by civil rights groups, psychiatric patients and legislators responding to taxpayers.)

However, the issue for closure of the 110-year-old VSH goes back to at least 1987 (following the hospital’s first decertification), when researchers led by a former Vermont commissioner of mental health concluded that it was both feasible and desirable to have “community support and rehabilitation services to replace the state hospital.”

Based on two subsequent decertifications, it is still both feasible and desirable.

VSH costs vs. benefits

According to the EAI’s report, the cost to treat a patient at VSH is $1,050 per day, or $383,250 per year. Among specific violations noted by the DOJ in their most recent investigation of VSH:

• Over-reliance on drugging of patients on PRN (pro re nata, “as needed”) basis with no physician monitoring.¹
• Consistent use of seclusion and restraint as an intervention of first resort, when the patient is neither an immediate danger to himself nor others. More than 90% of such incidents involved strapping patients to a bed in five-point restraints in a seclusion room—the most restrictive and dangerous form of intervention. The percentage of restrained VSH patients substantially exceeds the national average.
• Insufficient risk management system and unsafe conditions in the building’s physical structure that could facilitate suicide or self-injury. The DOJ’s report notes “the history of suicides at VSH.”
• There is nothing in the DOJ’s report (or publicly available elsewhere) that speaks of the benefits of treatment at VSH or of the institution’s statistic for patient rehabilitation. Their report does however state that due to its inadequate review process, “patients are likely being unnecessarily institutionalized and potentially deprived of a reasonable opportunity to live successfully in the most integrated, appropriate setting.”

The solution is peer support programs

The solution presented by EAI is that of the “peer support” model of treatment. Such programs are operated in communities, in residential housing—no locked wards, no forced drugging, restraint or seclusion and, in many cases, no mental health professionals—and provide a safe, non-coercive environment where a patient can rest, eat right and in some cases work.

The EAI report makes a distinction between forensic (criminal or potentially violent patients) and non-forensic populations—acknowledging that the peer support system is for non-forensic populations and that forensic patients belong in a more secure setting, for the safety of the public.

Examples of Vermont peer support programs:

Safe Haven houses six patients and is funded partially by a U.S. Housing and Urban Development (HUD) program for the homeless and routinely accepts patients discharged from VSH that have no home to return to. An analysis of patients housed at Safe Haven in 2006-07 showed that each of them successfully transitioned to the community, to either senior housing or a private apartment. Former patients often return to college, get degrees in the field and come back to work in recovery programs. Cost: $32 per day or $11,680 per year. This is a 3181% savings over VSH.

Second Spring serves up to 11 discharged VSH patients, and is staffed by peers and non-peers. Former patients come on a voluntary basis to learn how to live again in the community, something impossible to learn in a hospital setting. Cost: Approximately $750 a day—still less than VSH’s $1,050 daily rate—and a 40% savings.

The EAI’s report gives numerous examples of such programs in other states, such as Minnesota, Alaska and New York.

In addition to the savings, these programs provide recovery—something the state hospital model does not often approach. A 2003 report by the King County (Washington) Department of Community and Human Services showed that of 9,302 people who received publicly funded mental health services over a one-year period, less than 1 percent recovered.² Mental health watchdog Citizens Commission on Human Rights could find no reports from any county or state agency from any time period that painted a different picture.

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Compared to the state hospital’s failings and high cost, the benefits and low cost of the peer support model bring one to the inescapable conclusion that such a change in the treatment of the emotionally/mentally disturbed would result in a level of patient recovery that rarely, if ever, is attained in the state hospital model—not to mention significant savings to the state and thus, relief for taxpayers.

State legislators and others with budgetary or state hospital concerns owe it to themselves and their constituents to read it and examine the alternatives, which can be utilized or established anywhere.

To read the EAI report, “Don’t Send Me to Waterbury,” go to www.ethanallen.org/home.html and then select “Publications” from the list on the left side.