Week 8 - Our Mental Health System Budget

In last week’s legislative update I provided the House healthcare committee’s recommendation to Appropriations on the Governor’s Healthcare FY2019 budget.  This week we came back to the discussion on the Governor’s FY2019 Department of Mental Health Budget. 

The department was advised to level fund their budget.  Specific to our jurisdiction are any recommendations specific to the mental health system - only two items were included this year.
 
One, the department recommended a general fund increase of $400,000 to place outreach workers as an extension of crisis services at designated agencies in the following communities: 4 towns in Chittenden County (including Essex), Rutland, Barre/Montpelier and Brattleboro.  These communities were targeted for these resources due to the high use of emergency departments for homelessness and general use assistance with mental health concerns.   According to testimony, the Chittenden County communities met together over the summer to create a strategic plan on how to best serve the needs of those in their communities.  They advocated with the Department of Mental Health for the addition of outreach workers.  The other communities were approached by the Department with the idea to hire additional outreach works; however, at this time the non-Chittenden County communities haven't created a plan for their use.

Two, the department recommended $1.5m for three months of operating costs for a yet to be built 12 bed forensics unit.  This unit would provide hospital level of care for those being referred for a competency and/or sanity evaluation that requires inpatient care; those who have been found incompetent to stand trial or not-guilty by reason of insanity; and inmates/detainees whose psychiatric needs reach inpatient level of care.  Providing these 12 beds for this cohort of people the Department of Mental Health, and other stake holders, believe the overall bed capacity for mental health patients will increase ensuring a higher level of care for all.  The capital budget for building this facility is under review by the House Institutions and Corrections committee.  At this time we do not believe the facility would be ready for use until 2020.

On the same day our committee is debating these two items, Governor Scott releases a letter to the legislative body outlining his list of recommendations for “maintaining the safest, healthiest and strongest communities and schools.”  This was in direct response to the horrific event in Florida and the arrest of the young man in Fairhaven, VT.    I applaud the Governor for releasing these recommendations and for his courage to change is stance on gun violence prevention.  However, I am also really discouraged by the wide chasm between his statement in his letter and the mental health system budget recommendations.  In this letter he advocates to “restore the foundation of the mental health system”.  Specifically he says “we do not currently have the capacity to meet the needs of those requiring inpatient mental health services.  To help meet this need, the Legislature should support our funding request for additional mental health outreach workers as well as funding for mental health treatment facilities”. 

I want to be clear – we have a mental health crisis separate and distinct from gun safety issues. 

Unfortunately, it is not just the capacity to meet the needs of those requiring inpatient mental health services that is causing a persistent crisis in our mental health system.  We need to attract qualified therapists, fill over 400 open positions within the designated agencies, pay employees of the designated agencies to reduce turnover, increase funding to complete the 24/7 peer support line, increase community  and school services, increase housing with supportive services and much more.  We need to ensure we are diverting a crisis going to an emergency department so the person in need is receiving the care they need, when they need it and in the best place to receive it.  At the same time we need a support system in place upon discharge from an inpatient stay.

Last year we passed Act 82 requiring the Secretary of Human Services to work in collaboration with the Commissioner of Mental Health, the Green Mountain Care Board, providers and persons affected by current services to produce an analysis and action plan for the General Assembly by December 15th, 2017.  Some of the areas of focus were to include:

• Specify steps to develop a common, long-term vision of how integrated, recovery and resiliency oriented services shall become part of a comprehensive and holistic health care system
• Identify causes underlying increased referrals and self-referrals for emergency services
• Identify gaps in services that affect the ability of individuals to access emergency psychiatric care
• Determine whether appropriate types of care are being made available as services in Vermont, including intensive and other outpatient services and services for transition age youths
• Identify the resources necessary to attract and retain qualified staff to meet identified outcomes required by designated and specialized service agencies

The agency and others worked diligently over the summer to analyze our system and provided reports on almost all the sections in the Act.  We need all parties to dig into these reports and suggest meaningful budget and legislative changes to our mental health system that will provide high quality care for all Vermonters, finally integrate mental and physical health and “restore the foundation of our mental health system”.  We need the administration and legislative body to step up to this challenge, now.