$25M Essex psychiatric facility aims to ease capacity crisis

Published: Dec. 8, 2022 at 6:19 PM EST
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ESSEX, Vt. (WCAX) - A surge of Vermonters in psychiatric crisis are waiting for help in emergency rooms. Mental health officials say a new Essex facility set to open in a few months will improve the backlog and relieve the strain on state resources. Reporter Christina Guessferd got an exclusive tour of the $25-million project and examines the unique role it will play in the state’s evolving mental health care continuum.

To some, a climb-resistant fence symbolizes psychiatric institutions of old, not facilities of the future. But the Department of Mental Health has demonstrated to the Legislature the dire need for a place to safely house and effectively treat a small cohort of Vermonters who can’t receive adequate mental health care anywhere else. So, by late spring officials plan to open this state-owned and operated, 16-bed recovery residence off Route 15 in Essex that all agree is a decade overdue.

The property where Vermont’s only juvenile detention facility once stood has a new purpose. Last fall, the state demolished the Woodside Youth Rehabilitation Center and began building the more than 17,000-square-foot River Valley Therapeutic Community Residence from the ground up.

Outside in the courtyard are a paved walking path, a gazebo, and raised garden beds. “We also have a greenhouse behind me where they can do potting and planting,” said project manager Tabrena Karish

Inside, they are exchanging the cold, concrete blocks with warm, wooden beams. The facility features two patient wings with eight spacious bedrooms on each side. “This is a typical bedroom. It’ll have a built-in desk, a full-size bed, built-in window seat with some wardrobe storage. Each bedroom also has its own bathroom,” Karish said.

The wings are separated by a core of communal spaces. “Behind me is a dining room. In front of me will be a skills kitchen for the residents to use,” Karish explained. Plus, a multi-purpose area, art studio, sensory room, and exercise gym.

While the state has raised a residence out of the rubble in seemingly record-time, River Valley has been in the works since 2005, six years before Tropical Storm Irene destroyed the Vermont State Hospital in Waterbury. In 2012, the Legislature passed Act 160 and Act 79 which codify the statutory basis of a secure residential recovery facility where the patients are supervised 24/7 and physically locked on the premises. That’s when the state created the 7-bed Middlesex Therapeutic Community Residence, a campus of FEMA trailers. Since it opened in 2013, what was intended as a temporary site has long outlived its lifespan and fallen into disrepair while consistently operating near or at capacity.

DMH in 2019 presented an Analysis of Need to lawmakers detailing why simply replacing the 7 beds at the Middlesex facility wasn’t sufficient. The state had to go bigger and better, and fast. “We needed to expand, to reach out to more people, to be able to support more people, but we wanted to make sure to not lose that homey feeling,” said Troy Parah, River Valley’s program director. The new therapeutic community residence is considered as transitional. Residents will stay for between six to 18 months and develop life skills like shopping for groceries, cleaning the home, and practicing social engagement that will be integral to their independence. They will also participate in group and individual therapy and learn coping mechanisms. “Maybe there’s still challenges there, and we can hopefully help them prepare for those,” Parah said.

The 2019 Analysis of Need for residential mental health beds shows almost all referrals to the current facility in Middlesex are from intensive inpatient hospital settings, Vermont’s highest level of mental health care. At any given time, the report says seven to 10 Vermonters requiring treatment could step down from a hospital to a physically secure recovery residence like the new facility in Essex. This is a population of people whose psychiatric symptoms have stabilized enough to leave the hospital but still pose a risk to themselves or others. A patient is only admitted to River Valley on an involuntary court order under the custody of the mental health commissioner. Some may meet these criteria if they’ve been accused of a crime -- even murder -- and a judge rules they’re incompetent to stand trial. Many struggle with behavioral dysregulation and experience sporadic violent episodes. While they’re no longer in active crisis, they aren’t ready to rejoin the community, and other recovery programs that aren’t equipped to keep them safe turn them away.

Some mental health advocates are concerned River Valley is too big. They also worry how the state will staff these additional nine beds if existing facilities are struggling to recruit and retain employees, forcing many to close the beds the state already has. That’s why some opponents argue the state could have made wiser investments with the $25 million.

“You could get a lot bigger bang for your buck to invest in those things that prevent a need for a higher level of care, prevent someone from getting into crisis or enable them to move out of a hospital instead of a hospital bed,” said Rep. Anne Donahue, R-Northfield, vice chair of the House Committee on Health Care. She has been involved in the policy discussions since they began in 2005.

“There was no question we needed to replace the secure facility in Middlesex and there was, I think, near-unanimous support for that. But to more than double it in size -- we didn’t feel the justification had been demonstrated.”

Donahue says rather than dumping $25 million into one building that serves a narrow subset of patients, the state should have dispersed the money between lower-level, preventative programs benefitting potentially hundreds of Vermonters, as opposed to just 16. Session after session, Donahue says the state has failed to prioritize the right resources. “It’s always ‘next year.’ That never happens. So, in theory, will this be the year where we see significant investment in community-based care? I’m not hearing signs of that yet,” she said.

Though they acknowledge other programs are starved for support, state officials remain confident the Essex facility must come first and will ease pressure on Vermont’s acute bed availability. That’s because without an appropriate place to go, patients eligible for discharge to a secure residence -- however small a number -- are left in limbo, occupying the limited intensive in-patient hospital beds for months at a time.

In its pitch for a 16-bed secure residence, DMH officials say vacating those spots and filling them with acute cases presenting in emergency rooms will free up resources at the first line of defense, expediting the flow of patients through the entire mental health care system.

River Valley won’t initially open at full capacity. The state is hiring 63 full-time positions and there are only 32 full-time employees at Middlesex. Project leaders say they hope most will stay on board but that still leaves at least 31 vacancies. Once construction is finished, the seven residents living in Middlesex will transfer to Essex. The facility plans to bring the additional nine beds online gradually as staff becomes available.

The Department of Mental Health Thursday launched a new plan to recruit physicians to staff the Essex facility and the Vermont Psychiatric Care Hospital in Berlin, which has also been plagued by staffing shortages since its opening in 2014. They want qualified individuals and companies who can provide psychiatry-related services to submit bids. The RFP includes positions for physicians, primary care providers, and medical directors.

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