Hospital Gives Up on Plan To Segregate Psychiatric Care

After two years of what has been described as contentious and often rancorous negotiations, Vermont’s largest hospital has agreed to a set of recommendations from a task force that will keep inpatient psychiatry integrated within the rest of the hospital’s medical and surgical services. The task force included mental health advocates.

Last month’s decision by Fletcher Allen Health Care in Burlington was a victory for the Vermont Psychiatric Association (VPA), which had fought hard against the hospital’s original plan to move psychiatry off campus to an isolated facility that VPA members likened to an asylum (Psychiatric News, June 7).

The VPA received strong support from APA, including funding through its Commission on Public Policy, Litigation, and Advocacy (now the Committee on Advocacy and Litigation Funding). The VPA was represented on the hospital’s mental health task force by Susan Deppe, M.D., and David Fassler, M.D., VPA’s legislative and public affairs representative and an APA trustee at large. The hospital convened the task force after it was stunned by a state regulatory panel’s decision to recommend that the proposed remote unit not be approved.

“The Vermont Psychiatric Association,” Fassler said in a prepared statement, “is very happy to support this plan. It was truly an impressive effort that produced this creative solution to a complex problem. We are happy that our patients will continue to receive the care they need in space designed for psychiatry on the main campus of the hospital, with appropriate access to the emergency room and with the full range of necessary medical backup and consultation services.”

As part of a $225 million renovation and expansion plan, the hospital had proposed in March 2000 that the psychiatric inpatient service be moved to a new, $10.7 million facility at a remote location—a former hospital owned and operated by a Catholic religious order of nuns—four miles from the main campus. The building that houses the psychiatry service is scheduled to be torn down in early 2004 as part of the larger project.

Early on, members of the faculty of the University of Vermont College of Medicine’s department of psychiatry voiced strong opposition to the hospital’s plan. They said that it would not only be dangerous to isolate psychiatric patients from full access to the rest of the hospital’s surgical and medical services—including emergency services—but also strongly stigmatize the patients, setting them aside in a “quiet, serene, and institution-like setting, out in the country.”

Faculty members were allegedly told by hospital administrators that the location of the replacement psychiatric unit was “not negotiable—it never was, and it never will be.” Several faculty reported to Psychiatric News that they were told by hospital officials that if they didn’t support the plan, they could look for employment elsewhere. The faculty then turned to VPA for help in fighting the plan.

What followed was a remarkable effort by VPA to assemble a broad-based coalition of mental health advocates, including members of the faculty, other VPA members, and representatives from the Vermont chapters of the American Psychological Association, National Association for the Mentally Ill, National Mental Health Association, and even the American Civil Liberties Union.

The coalition of mental health advocates was successful in convincing an advisory panel to state regulators to deny approval for the relocation of the psychiatric unit, ultimately forcing the hospital to work with them—forming the mental health task force—to find an acceptable solution to the space problems on the medical center campus (see box on page 10).

The new unit, a combination of renovated and new space costing Fletcher Allen more than $5 million more than the remote site would have, will open in time for patients to move from the existing space prior to its demolition. The new unit will maintain 28 inpatient beds, with 12 on an open unit and 16 on a secure unit. Only six beds will be in three semiprivate rooms, with 22 of the beds being in private rooms—effectively increasing the average number of patients the unit can hold over the existing unit, which is primarily semiprivate rooms that often must have only one patient assigned to them due to gender or safety issues.

“We never could have achieved this positive outcome without the joint effort of patients, advocates, and professionals,” Fassler commented to Psychiatric News. “That’s the real story here. And this coalition is already moving on to talk about quality issues with respect to the clinical program itself. That’s one of the major accomplishments: we now have patients, family members, physicians, and administrators all talking to each other, proactively, about clinical issues. Hopefully, this will be the lasting legacy of this initiative.”

In addition, the VPA, Fassler said, is working with a local attorney to complete an analysis of the issues related to the Americans With Disabilities Act raised by the hospital’s initial proposal and hopes to prepare a legal brief that would be available to other district branches and academic departments through APA. ▪