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Vermont Psychiatric Care Hospital: A Dramatically Different Approach

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by Nat Frothingham

Photo by Michael Jermyn
Photo by Michael Jermyn

Afew days ago I took a tour of the new Vermont Psychiatric Care Hospital (VPCH), talked to its CEO, Jeff Rothenberg, and tried to understand what the Berlin hospital is, what it does, what it costs and what’s being attempted with the population that it serves.

Viewed from the road, VPCH has the spread-out look and feel of a series of connected buildings with courtyards and wings. It occupies a campus on high ground with good light and spacious views. It stands across from the Vermont National Guard Armory on Fisher Road, not far from the Central Vermont Medical Center.

We have a history, across the country, of so-called mental hospitals and asylums that were often pretty depressing-looking places. What’s remarkable about VPCH is the attention, care and cost that have gone into not just constructing a building to house people who are contending with mental health issues, but to create an overall environment whose positive attributes can contribute to the healing process—a place of “safety and recovery,” to quote Rothenberg.

After my tour of VPCH, Rothenberg followed up by sending me a research paper by three Scandinavian scholars about some of the design measures that can create a positive climate for patients in psychiatric hospitals.

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What if such hospitals had views of nature, plenty of natural light, very little noise, staff stations close to activity areas, moveable seating in spacious dayrooms and lounges?  Wouldn’t such design features lessen stress and encourage positive outcomes?

VPCH has incorporated all of these features—as well as good food, prepared under the knowing eye of a former New England Culinary Institute instructor. The new hospital is a radical departure from Waterbury’s 54-bed Vermont State Hospital, which lost its Medicaid-Medicare certification in February, 2005, and had to be shut down.

In putting together a new statewide configuration of hospitals, beds and treatment options to deal with the people across Vermont with the most severe mental health problems, the state of Vermont assigned 25 beds to the VPCH, 14 to the Brattleboro Retreat, and six to the Rutland Regional Medical Center—a total of 45 beds.

Building that system across the state has cost $40 million—hardly an insignificant sum.  Nor is the $20 million annual price tag for running VPCH insignificant. But, as Rothenberg explained, “Acute care is really, really expensive.” To be specific, acute care at the new hospital is costing about $2,200 a day or a staggering $700,000 a year if a patient spends 365 days at VPCH.

None of the patients at the new psychiatric hospital entered it voluntarily. All are above the age of 18. Some have committed a crime, major or minor; in such cases a judge can order someone hospitalized to assess his or her competency to stand trial. Others may have been admitted because they were judged by medical professionals to be dangerous to themselves or others.

In determining who is admitted to VPCH, there’s a critical distinction between thinking and doing.  If you were to tell your therapist that you’re thinking of committing suicide, and then worked out a way around suicide with your therapist, that’s one thing, Rothenberg said.  But, he continued, “If you went to see your doctor and you were planning to kill yourself tomorrow because of some trauma in the past, he would call the crisis team to have you assessed and you could end up in an involuntary situation.”

According to Rothenberg, not everyone who is admitted to the VPCH is released to the community.  Some who are restored to competency go back to court and may be sent to prison or see the charges dropped, allowing them to go free.  Some might be reassigned to a different level of care, which is almost always in the community.

I asked Rothenberg how long a typical patient might stay at VPCH. Since the hospital only opened this past July, he could not produce solid data on that question, but he did say that recently, when he was running an interim eight-bed acute mental health care hospital in Morrisville, the average stay there lasted seven weeks. “Our goal is to reduce that,” he said.

Asked about the prevalence of mental illness across the United States, he said that about 13.4 percent of adults nationwide received treatment for a mental health problem in 2008.

Then, in a more casual, philosophic, reassuring vein, he said, “We all get a little blue at times.” 

Indeed, we all feel anxiety, and some people experience depression from time to time.  But overall, only a very small percentage of Vermonters will ever need the help that’s available at the Vermont Psychiatric Care Hospital.

Snapshot:

Vermont Psychiatric Care Hospital

This snapshot of the Vermont Psychiatric Care Hospital was developed with the generous help of hospital CEO Jeff Rothenberg.

Mission Statement: “To provide excellent treatment in a recovery-oriented, safe, respectful environment that promotes empowerment, hope and quality of life for the individuals it serves”

Construction: Begun January 3, 2013; completed June 27, 2014

Construction cost:   $23,037,263

Hospital campus: 7.36 acres

Size of hospital building: 53,300 gross square feet

Footprint of building: 46,564 gross square feet

Annual budget: $19,345,788

Annual payroll:  $14,645,158

Hospital staff:  182 staff members from the Department of Mental Health (therapists, administrators, support staff); six Buildings and Grounds employees

Patient cost per day: $2,120

Beds: 25

Vermont adults hospitalized voluntarily or involuntarily for mental illness, 2011: About 1,900