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New 10-Year Mental Health Plan Could Mean Changes For The Retreat

A brick building.
Howard Weiss-Tisman
/
VPR
Linden Lodge, where the Brattleboro Retreat is adding 12 beds, is over 150 years old. The Retreat does not have the money to upgrade its campus to meet patient safety and regulatory standards, a recent report found.

The Department of Mental Health will soon release a 10-year plan for psychiatric care in Vermont. Mental Health Commissioner Sarah Squirrell said even before the Brattleboro Retreat’s financial crisis became public, lawmakers were looking for a new model for caring for people with mental health issues.

That model could mean the state will rely less on the Retreat, which is now over 150 years old.

“One of the grounding factors that really drove this report was the charge of the Legislature to evaluate, you know, comprehensively, our overall system of care,” Squirrell said. “And then create a vision for the integration of mental health care within the broader health care system.”

Squirrell said patients should be able to receive some levels of psychiatric care at regular hospitals, closer to their communities.

"This is really, I think, an opportunity to have a thoughtful discussion about the socially and fiscally optimal size of the Retreat, which may help establish a viable transition path toward sustainability." — Sarah Squirrell, Mental Health Commissioner

And at the same time, she added that services like group homes, where people can receive care and live independently, as well as outpatient care, allow people to live and receive treatment away from a centralized psychiatric hospital.

Having a stand-alone facility like the Retreat, Squirrell said, is not the best model for Vermont's future.

“This is really, I think, an opportunity to have a thoughtful discussion about the socially and fiscally optimal size of the Retreat, which may help establish a viable transition path toward sustainability,” she said.

Brattleboro CEO Louis Josephson said he needs cash – early estimates were as high as $2 million – to keep the doors open. He said the short range talks between the state and the Retreat continue.

Three people stand in neon yellow construction hats.
Credit Howard Weiss-Tisman / VPR
Mental Health Commissioner Sarah Squirrell, left, tours a new 12-bed expansion project at the Brattleboro Retreat, with Deputy Commissioner Mourning Fox, center, and Retreat CEO Louis Josephson. Squirrell said the Retreat's financial troubles should encourage talks about the "socially and fiscally optimal size" of the hospital.

But Josephson said the Retreat also wants to take part in the statewide long-range planning, even if it means reducing services at its facility.

“If we can do more in the community for people, for less money, and keep them in the community, we should absolutely do that,” Josephson said. “Even if it means we shrink or disappear. That’s the way to go, 100%.”

Josephson said if the new 10-year plan directs the state to increase community-based services like housing with social service assistance, it won’t be cheap, and it will take some time.

“There’ll always be some people who need hospital-level of care, at least briefly,” he said. “But I bet if we do it smartly, we could shrink the number of beds, but it won’t be between now and you know, June. You’ve got to really plan for it. And you’ve got to stand up those services thoughtfully and safely.”

"The model for care that's recognized and supported by Medicaid and Medicare is more community-based, so I think there are problems that we've managed to put off for a long time in Vermont that we're going to have to face. And maybe this is a crisis that could bring us closer to facing those things." — Ed Paquin, Disability Rights Vermont

Disability Rights Vermont is an advocacy group that’s worked for patients at the Retreat. Ed Paquin is executive director, and he said the financial crisis at the Retreat could be a catalyst for sending fewer patients to the Brattleboro hospital and supporting more services closer to where people live.

“The model for care that’s recognized and supported by Medicaid and Medicare is more community-based, so I think there are problems that we’ve managed to put off for a long time in Vermont that we’re going to have to face,” he said. “And maybe this is a crisis that could bring us closer to facing those things.”

The Department of Mental Health says the 10-year report will be released before the end of January.

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