UVM Health Network proposes $18 million program to address mental health crisis in Vermont

The University of Vermont Health Network wants to build a mental health urgent care clinic to take some of the heat off of its emergency departments, which often act as de facto shelters for patients suffering mental health crises.

The $2.85 million clinic is just one part of an $18 million proposal the Health Network made, in conjunction with the Vermont Department of Mental Health, to the Green Mountain Care Board last week to address the state's mental health care crisis.

The largest single expenditure in the proposal is $4.5 million to reconfigure the psychiatric unit at Central Vermont Medical Center in Berlin to "increase bed use and improve patient experience." The reconfiguration involves converting six beds from shared rooms to private rooms to give psychiatric patients more privacy, calm and quiet.

"This will help reduce the number of patients waiting in the Emergency Department and provide a better environment for healing," a news release stated.

Also in the proposal:

• Expand resources for eating disorder and transgender care clinics for youth. Hire additional staff, including a physician, dieticians, social workers, psychologists and support staff for youth with eating disorders or transgender care needs.
• Expand hours for ambulance transport to Brattleboro Retreat. This will be a pilot program offering ambulance transportation to the Retreat from 5 p.m. to 11 p.m. to determine the benefits for patients.

• Continue integrating primary care and mental health care. The Network has made "significant investments" in expanding access to mental health services into its primary care sites, according to a news release. Based on early success, the plan calls for adding these services into even more clinics.
• Develop and implement protocols for preventing suicides, focusing specifically on service members, veterans and their families.
• Expand access to innovative treatments for patients with severe depression. This involves establishing esketamine and transcranial magnetic stimulation programs at the University of Vermont Medical Center. Dr. Robert Althoff, chair of psychiatry for the UVM Health Network, explained in an email that esketamine is a nasal spray that can be used with an antidepressant in "treatment-resistant depression and depression with suicidality." Transcranial magnetic stimulation is a noninvasive treatment that uses magnetic fields generated on the scalp to improve symptoms in treatment-resistant depression and obsessive-compulsive disorder, according to Althoff.

The good old days of budget surpluses are gone

The $18 million to pay for the mental health care programs has been held by the UVM Health Network since 2018, when it was directed by the Green Mountain Care Board to use the budget surplus the Network generated in 2017 to help remedy Vermont's mental health care crisis.

Before the COVID-19 pandemic struck in 2020, the Network routinely brought in millions of dollars more than its regulated revenue targets, and the Board would stipulate what should be done with those surpluses. As the Network notes in a press release, the Board "closely regulates" Vermont's hospital budgets.

The pandemic, together with inflation, ended the days of budget surpluses for the UVM Health Network, and ushered in an era of financial difficulties. Last July, the Network asked the Green Mountain Care Board to approve an additional $142.3 million in payments from BlueCross BlueShield of Vermont and other commercial insurers to help bail it out of an unprecedented financial crisis.

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Chief Financial Officer Rick Vincent told the Board last year the total size of the hole in the Network's budget for the following year was $164.6 million. Vincent said the Network was facing the most challenged financial position he had seen in his 20 years in health care.

The Green Mountain Care Board denied the request for additional insurance payments, which would have required double-digit commercial rate increases, of nearly 20% for UVM Medical Center alone. The Network also includes Central Vermont Medical Center in Berlin and Porter Medical Center in Middlebury, in addition to three hospitals in upstate New York.

"Along with hospitals nationwide, the UVM Health Network has faced well-documented financial challenges, but has remained committed to using (the $18 million surplus) to improve access to mental health care," a news release stated.

Contact Dan D’Ambrosio at 660-1841 or ddambrosi@gannett.com. Follow him on Twitter @DanDambrosioVT. This coverage is only possible with support from our readers.