The following letter was sent today to the Green Mountain Care Board from five consumer/survivor members of the Advisory Committee to the Central Vermont Medical Center Psychiatric Services, in response to UVMMC’s announced the planned closure of the inpatient psychiatric center in Berlin due to budget constraints.
We are the consumer/survivor/peer members of an advisory committee at Central Vermont Medical Center focused on quality of psychiatric services in collaboration with staff and administration. Each of us has a history of past psychiatric hospitalization at CVMC, including experiences of the trauma of long emergency room waits while in the grips of severe crises, and the current anxiety and depression being triggered for some of us from seeing this very sudden closing of a critical safety net.
We urge the GMCB to take any actions available to immediately block the University of Vermont Health Network’s intended closure of the CVMC inpatient psychiatric unit.
Every other category among the announced service cuts from UVMHN are scheduled to take place in graduated fashion with replacement services in place. The inpatient psychiatric unit closure includes no viable alternative to access care and is scheduled for a date certain in a matter of weeks; it will rapidly be irreversible because of staff departures.
Critical factors include:
- UVMHN is under a current GMCB order and agreement to conduct renovations to expand capacity at the CVMC inpatient psych unit, itself a revision to a prior order to add significant new inpatient capacity. This planning work was already underway, using those restricted dollars; closing the unit disobeys the existing order.
- The current 14-16-bed unit (not 8 — that is an artificial current cap based on workforce shortages) does not serve patients eligible or appropriate for diversion, urgent care centers or other alternative settings. To be eligible for admission, patients have been screened and deemed to require this highest level of care: there are no unnecessary inpatient admissions that can be absorbed by other programs. This distinction was emphasized by UVMHN in presenting data in support of its (never completed) 25-bed expansion plan in 2019.
- Unlike cuts where services can be found elsewhere, no such services are available for inpatient psychiatry, which has a statewide – and even national – shortage of capacity. Regular data from the hospital association demonstrates the ongoing crisis with patients being “boarded” across the state. Close to 50% of patients still routinely wait more than 24 hours for a bed after being found in need of admission; some still wait for days. Those in crisis will not be able to rely on out-of-area services, and UVMHN is well aware of this, planning on adding staff to provide “care” in the ED to increased numbers of patients awaiting transfers while in a health crisis.
- Health equity was identified by the UVMHN as a key factor it considered in making decisions regarding cuts. The inpatient psychiatry cut is the only one, however, which directly singles out a known health disparity group – those with psychiatric disabilities – from access to necessary services.
- Financially, the lack of reimbursement parity for psychiatric care means it is revenue negative. Thus, existing insurance discrimination has become a justification used for further discrimination, reinforcing the disparate lack of access to essential health services. CVMC would become the only hospital of its size without an inpatient psychiatric unit, affecting not only central Vermont but the larger catchment area for this service.
- Vermont is in a known state of severe mental health crisis with a nationally high suicide rate, and any reduction in access to care, especially at the highest level, will exacerbate this crisis and lead directly to additional deaths.
Whatever the context and disputes leading to the opposing views between the Green Mountain Care Board and the University of Vermont Health Network regarding budget reductions and/or reductions in services, this specific decision stands apart from the others. It is discriminatory; it violates prior GMCB orders; it offers no alternatives and creates irreversible harm.
We ask that it be addressed as a critical emergency.
Thank you,
Nicole DiDomenico, Berlin
Anne Donahue, Northfield
Lise Ewald, Montpelier
Zachary Hughes, Montpelier
Dan Towle, Montpelier