After Irene forces reckoning, mental health care rebuilt

WILSON RING

MONTPELIER, Vt. — For most Vermonters, Tropical Storm Irene was a disaster that tore roads, communities and lives apart. But for many of the state’s neediest mental health patients, it was a blessing in disguise.

The small state had struggled for years with its mental health system. The Vermont State Hospital in Waterbury lost its federal Medicaid funding after two patients committed suicide there in 2003. In 2010, the Justice Department and the state settled a lawsuit that claimed the hospital was deficient in care, treatment and programming. Some improvements were made, but a permanent, long-term solution remained elusive.

Then Hurricane Irene roared out of the Caribbean and up the East Coast of the United States in late August 2011. It killed dozens of people along its path but saved its biggest wallop for Vermont, where it hit Aug. 28 as a tropical storm, killing at least six people, its raging floodwaters cutting off communities, damaging and destroying more than 1,000 homes, and tearing up 500 miles of road and 200 bridges.

An alarm early the next day as the floodwaters moved downstream woke the 50 or so patients sleeping at the state hospital, Vermont’s only secure psychiatric facility, warning that the Winooski River was creeping their way. While buses and alternative housing around the state were hastily arranged, patients were fed McDonald’s for breakfast and pizza for lunch.

“Waiting for the bus to get out of there, it was like a miracle,” said Marla Simpson, now 43, who was being treated for bipolar disorder at the time at the hospital, a place she described as more of a prison with “evil energy.”

Vermont officials knew of many physical limitations of the building, originally constructed around the turn of the last century, including a lack of air conditioning, adequate treatment facilities, access to outdoor space for the patients and fire safety issues.

“The hurricane, as far as the hospital was concerned, was for me like an act of divine intervention,” said Simpson, of Randolph.

Most of the state office complex in Waterbury, of which the hospital was a part, had to be abandoned and temporary work spaces found for the employees. The $130 million repair to the complex was the largest state construction project in history.

Patients who had been at the state hospital were moved to temporary locations while state officials and the Legislature looked for permanent fixes to the state’s mental health system. The original state hospital was demolished.

“It was a good thing in the sense that it got us on our horse,” said Anne Donahue, a Republican state representative from Northfield who has had a long interest in mental health issues. “It forced our hand when we were really caught up in this maze of differing ideas of what to do and inadequate urgency.”

Most of the 54 beds available to the most severely mentally ill at the state hospital have been replaced by a new 25-bed Vermont Psychiatric Care Hospital in Berlin, 14 beds at the private Brattleboro Retreat and six at the Rutland Regional Medical Center.

But challenges remain. What was created in the place of centralized care at one facility was a regional system where the most seriously mentally ill would be hospitalized at the three locations. Patients who need the beds now sometimes wait for days in emergency departments before they can get treatment.

Emergency room delays did occur before Irene, but they were rare and “they were counted in hours not days,” Donahue said.

The reasons for the delays are a complicated combination of an increase in pressure on the system due to an aging population, increases in substance abuse and, most significantly, changes in the way patients move into and out of the new locations, she said.

Such delays would never be tolerated for patients suffering from physical conditions, said Dr. Robert Pierattini, the chief of psychiatry at the University of Vermont Medical Center in Burlington.

As of Thursday morning, 12 psychiatric patients were waiting at the UVM emergency department for beds, Pierattini said.

The new facility in Berlin “is just not big enough to care for the acute need,” he said.

Frank Reed, the state mental health commissioner, said he believes there are enough acute care beds in the system. What is lacking, he said, are beds for less-intensive fulltime, secure care that can take patients ready to leave top level care.

The department is trying to determine the cost of a 14to 16-bed secure residential treatment center for people who do not need hospital-level care and will report to the Legislature.

After the storm, Simpson was moved from Waterbury to the Brattleboro Retreat, where she continued her treatment for another month or so before she was released. Her condition has stabilized, she’s in a loving relationship, and she is working at a job she loves.

“I think Irene was the catalyst,” Simpson said. “I think without Irene, we would be kind of stuck in a holding pattern.”