Medication Nation

http://beyond-vsh.blogspot.com/2007/11/new-report-on-vt-state-hospital.html

Ethan Allen Institute
4836 Kirby Mountain Road
Concord VT 05824

News Conference: Monday, November 26, 2007 10:00am State House Cedar Creek Room
(Full report on the Web Saturday at www.ethanallen.org/publications/specialreports/VSH.pdf)

New Report Urges Mental Patient Recovery in Community, not in Large, Costly New Facilities

“Building an enormously expensive new replacement facility for VSH, at the urging of a state bureaucracy and its employee union allies, over the objections of the Public Oversight Commission and most advocates for the mentally ill, will create a large and unnecessary burden for a generation of Vermont taxpayers, while offering inadequate recovery services for Vermonters with mental illness. It is not sound public policy.”

That’s the conclusion of a new report on the future of the Vermont State Hospital and treatment of severe mental illness in Vermont, issued by the Ethan Allen Institute Monday.

The Institute released the report, entitled “Don’t Send Me to Waterbury!", in anticipation of a major debate on the future of the new-decertified Hospital in the 2008 legislative session. Both administration and legislative study commissions have proposed retaining the 110-year old hospital, or creating a new state-run institution system at a cost of as much as $100 million.

“A major policy question,” says report author Bethany Knight,” is whether the inmates of the 110-year old Hospital will move to community settings, or to one or more costly new state institutions. That question must be informed by a modern awareness of the nature of mental illness, and the efficacy, expense, and humanity of various alternative methods and settings for treatment and recovery.”

“Perhaps most importantly, public policy and practices must be shaped in close partnership with the dedicated community of Vermonters who have lived experience with mental health crises, rather than shaped by the preferences of bureaucrats, clinicians, and the employee labor union.”

“Vermont now has the opportunity to fully develop mental health care system where three fourths of the present Hospital’s population can find support and healing in small, safe, secure and far more cost-effective community settings.”

The report recommends that

• The operative policy for Vermont’s seriously mentally ill population ought not be removal from society, but recovery in community. Vermont’s mental health system should be centered on community-based services, not built around a centralized psychiatric facility.
• The Department of Mental Health should abandon its relentless quest for the construction of new high-cost state-owned mini-VSH facilities, whether in Waterbury, the FAHC Burlington campus, or elsewhere.
• The DMH and designated agencies should welcome new private providers of services, such as residential recovery housing, and faith-based and peer-run drop-in centers. Every temptation to secure a monopoly, so damaging to the interests of consumers, must be stoutly resisted.
• Community hospitals must evolve to holistically address the physical and mental health of the people in their communities, and address the issue of forced medication as a serious question of medical ethics.
• Designated mental health agencies should employ peers and give them authority to serve creatively, not simply direct new workers to provide old models of care. Providers should seek new compassionate staff members who like people and are not looking for opportunities or evidence to punish clients.

The report contains numerous examples of community-based recovery programs, including three in Vermont (Safe Haven in Randolph, Home Intervention in Montpelier, and Second Spring in Williamstown). Of special interest is the highly successful Fairweather Lodges, founded in 1968 in Minnesota.

The report is sharply critical of the present state hospital’s penchant for forcible medication of patients. It also opposes the use of physical restraints on patients, a practice which has brought sharp criticism of the Waterbury hospital by the U.S. Department of Justice.

The report also says that “notwithstanding the reemployment language pushed into Act 147 of 2006 by the Vermont State Employees Union, providers should avoid automatically hiring former VSH staff members for patient care positions. Anyone who has been a part of the dehumanizing seclusion, restraint and forced drugging investigated by the U.S. Department of Justice and others ought to seek other types of employment.”

Of the union’s efforts to preserve at any cost the 200 union jobs at the present Hospital, the report notes that “legislators will need to keep in mind the interests of mental patients and of their taxpayer constituents when the VSEA presses for its special interest in preserving state employee jobs.”

The report’s principal author, Bethany Knight of Glover, was formerly executive director of the state nursing home association. She has served on the Vermont Human Services Board and the Public Oversight Commission, and as a volunteer in free peoples’ clinics in India.

The Ethan Allen Institute is Vermont’s independent free-market public policy organization. It earlier released comprehensive reports, also authored by Ms. Knight, on the Vermont developmental disability program and the home health care monopoly.