On Friday, the Brattleboro Retreat announced it will lay off 85 employees in the next two months, and cut four programs: its addiction treatment hub, its addiction management program, the Mulberry Bush Independent School early learning center, and its K-12 school, called Meadows Education Center.
The retreat currently employs 550 people, plus an additional 75 contract workers, according to its spokesperson.
The mental health facility has long struggled financially, relying on state subsidies to keep its programs afloat. And its census – the number of patients staying at the facility – has been far below normal levels, ever since the COVID-19 pandemic hit.
Now, the Retreat says it must cut $8 million dollars from its annual budget.
VPR’s Henry Epp spoke with Brattleboro Retreat CEO Louis Josephson about the cutbacks. Their conversation is below and has been edited and condensed for clarity.
Henry Epp: Louis, tell me first more about these significant cuts. Why are they necessary right now?
Louis Josephson: Well, they're necessary [because], as you mentioned in your lead-in, we've had our financial challenges in the last couple of years and we've been working really tightly with the Agency of Human Services on a sustainability plan that's been very public in the Legislature and here with our staff, that focuses on the Retreat as the real kind of inpatient hub that we are for the state of Vermont.
"Everything is on the table. We have not had pay cuts of any sort for staff at any level here at the Retreat... If salary reductions make sense and can make a difference, they will be done." - Louis Josephson, CEO, Brattleboro Retreat
We're one of the largest providers of inpatient psychiatric care. We're the only provider of inpatient psychiatric care for children, adolescents. We are focusing on that as our core mission, which it's been, really, since our inception 186 years ago. And we have to, because of financial reasons, not because of the value of other programs, but strictly because of financial pressures, reduce or eliminate programs where we just can't subsidize them anymore in our current structure.
I want to talk about a few of the programs that are being cut. First: your addiction treatment hub. This is being cut at a time when overdoses and overdose deaths are up significantly this year. Why cut this program right now?
For us, it's really about scale. So when I started at the retreat about five years ago, we had about 160 patients in our hub. Today, we have about 70. And there's multiple reasons for that. Some patients have gone to other providers, some are served in the spoke program, which is terrific. That's sort of the supported program in primary care practices that the retreat does and will continue to do into the future.
But the hub itself has shrunk. And for us at that level, [that] number of patients, we cannot make it succeed financially. So we've worked, again, really closely with Human Services, ADAP - the Substance Abuse Department of Human Services - and the Department of Mental Health, to have a plan to transition patients either to the spoke or to another provider in the Brattleboro area.
More from VPR: ‘We’re Stretched’: Mental Health Providers On The Pandemic’s Toll
You're also cutting some education programs: a child care center, as I mentioned, and a K-12 program, which serves both students who are at the Retreat and elsewhere in the community. What will those students do for school once these programs close?
For kids who are here, being served by Retreat programs either in residential care or in inpatient, we have teachers who provide that academic teaching and instruction that they need. Over many years, we had developed a school portion of the Retreat that would serve kids in the surrounding communities. In a small rural school district, if you have one or two kids with severe behavioral issues in the classroom, it's very hard for them to meet those needs. So we started taking those kids from outside the Retreat.
Right now, we have 17 children who are from outside the Retreat in about seven different school districts, including Claremont, N.H. So my hope is that no single school district will have a large number of students who are impacted. They'll probably have one, two, three students at most.
I want to talk more about the layoffs that are that are part of these cuts. 85 positions: that's a significant number. Given that, are you and other leaders also taking pay cuts along with this?
We haven't so far. Everything is on the table. We have not had pay cuts of any sort for staff at any level here at the Retreat. We are doing really a re-organization and a restructuring, which we think is the best way forward to right our financial ship.
If salary reductions make sense and can make a difference, they will be done. I can tell you that I did not take a salary increase for four years when I started here. If salary reductions make sense as part of the solution here, everything is on the table.
As I mentioned before, the Brattleboro Retreat has been in a precarious financial situation for years. What is at the root of the situation, which has led to having to cut up to $8 million from your budget today? Is mismanagement an issue here?
I don't think so at all. I think the issue is being mission driven. This is Vermont, right? And we care. We've been here 186 years. And for us, every single day, it's all about our patients and serving them well. And if anything, I would say management and board, you know, predating me and in my tenure as well, we put that first.
We have dug into our pocket and our reserves and our resources to keep things going for many, many years. And as we said very publicly at the beginning of 2020, we've whittled those resources down at this point. So it's been a long time coming; many, many years. I don't think it's mismanagement whatsoever. It's being mission driven.
Will these cuts result in local hospitals or emergency rooms, having to pick up more of the slack because these services will no longer be available at the Retreat, particularly the addiction treatment services? Is this just going to put more burden on other health care facilities around the region?
Well, it's a great question, and that's something we worked really hard to prevent. We do still have what's called an 'IOP,' an intensive outpatient and a partial hospital program. Those are still in place. So I don't anticipate a huge difference in the hospital room situation based on this.
"We have dug into our pocket and our reserves and our resources to keep things going for many, many years." - Louis Josephson, CEO, Brattleboro Retreat
We are still very rapidly taking patients from around the state to the Retreat. A lot of things are happening during the pandemic. I think the hospitals have adjusted. We've adjusted, but I really would be surprised if there is a dramatic increase of anyone waiting in an emergency room.
You mentioned the pandemic. How much of a factor is that in precipitating these cuts and the financial shortfall that you're experiencing right now?
It's huge. You know, I would say our volumes, in general, are off by about a third. And that's the biggest source of our revenue, is that service.
More from VPR: New 10-Year Mental Health Plan Could Mean Changes For The Retreat
I want to just circle back to sort of the root of the financial issues here. I mean, an $8 million need to cut doesn't come out of nowhere. What is at the root of this? What went wrong, essentially, that the Retreat's in the position that it needs to cut so many programs?
Well, I think what went wrong is what I alluded to earlier, that we ran out of cushion ourselves to kind of make up deficits that would happen because rates weren't where they could be for us to be financially successful. That's a big challenge. And then we were maintaining programs like the school, which are, you know, of great value to the community, but do not even break even. And so, we just do not have the capacity to essentially subsidize those programs at the rates we're paid.
We've carried these programs because they've been of such value to the community. We're so mission driven and we see the needs of these kids and their families. But at this point, our board has been really clear with me as CEO that we just cannot continue to cross-subsidize when we don't have the funds to do it.
Disclosure: The Brattleboro Retreat is a VPR underwriter.
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