The Brattleboro Retreat

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Annually, the Brattleboro Retreat serves about 5,400 people across all its programs, including 2,500 in its 119-bed inpatient unit, according to President and CEO Louis Josephson.

BRATTLEBORO — After the Brattleboro Retreat’s chief executive confirmed the not-for-profit organization could close due to financial pressures, local mental health providers are warning of the strain this would cause in the region.

“The closure of the Brattleboro Retreat would mean our ability to provide timely and effective mental health care would be dramatically impaired,” said Gary Barnes, executive director of Maps Counseling Services in Keene.

Annually, the Retreat serves about 5,400 people across all its programs, including 2,500 in its 119-bed inpatient unit, according to President and CEO Louis Josephson.

This accounts for more than 50 percent of all of Vermont’s inpatient psychiatric treatment beds, all of Vermont’s child and adolescent treatment beds and 150 Suboxone treatment slots, a statement the Windham County, Vt., delegation issued Sunday says.

The Retreat also offers the nation’s only LGBTQ-specific inpatient psychiatric program, according to its website.

“In consultation with the Board of Trustees, we are exploring every avenue to change the Retreat’s unsustainable business model and reimbursement but no matter what the outcome, the Retreat, if it exists at all will be a very different organization in the future,” Josephson said in a letter to Vermont Gov. Phil Scott and Human Services Secretary Mike Smith about the board’s decision.

That came on the heels of a Dec. 30 meeting with Smith and Retreat representatives, according to Josephson, during which, he said, the organization sought state help with its financial situation.

In an interview with The Sentinel Sunday, Josephson blamed these fiscal challenges partly on many years without a Medicaid rate increase.

Smith said in a statement Sunday that he denied the Retreat’s request for an additional $2 million, but Josephson refutes that a specific dollar figure was discussed at that meeting.

Smith said he denied the money in part due to a lack of significant management or operational changes made by the psychiatric and substance-use treatment center.

And he noted the additional funding would have been on top of a recent financial package — valued at $16 million — that includes the construction and ongoing operating costs of 12 new beds.

“I want to be clear: just asking taxpayers to put up more money, in order to avoid necessary change, is not an option I can support, or an option I believe the Governor or Legislature would want me to bring forward,” Smith said in his statement.

‘A new burden’

If the Retreat shutters, or even reduces services, it would exacerbate an already dire need for mental health services in both Vermont and New Hampshire.

The next closest inpatient psychiatric unit to Keene is at The Windham Center in Bellows Falls, followed by Concord’s New Hampshire Hospital.

Keene’s Cheshire Medical Center, an affiliate of Dartmouth-Hitchcock Health, closed its inpatient adolescent and mental health unit in 2016 when officials said the hospital couldn’t recruit enough psychiatrists to staff it.

Expressing hope the Retreat will overcome its financial problems, Cheshire Medical Center said in a statement Monday that the Brattleboro organization “is a tremendous asset in our area providing a range of services for the adult and pediatric population” and its “closure would be difficult for us all.”

“That said, we reach out to the entire MA, VT, and NH region when searching to place a patient in care outside of our facility,” the statement says.

Other options for inpatient psychiatric care include Dartmouth-Hitchcock Medical Center’s main campus in Lebanon and Vermont Psychiatric Hospital in Berlin.

Even if a patient has transportation to any of these facilities, though, it doesn’t mean there is a bed available for them.

As of Monday afternoon, 26 adults and three children in New Hampshire were waiting for involuntary admission to an inpatient psychiatric bed, according to data provided by the New Hampshire chapter of the National Alliance on Mental Illness.

Barnes, at Maps Counseling Services — which also has a location in Peterborough — said losing the Retreat’s beds would just worsen the region’s lack of providers and services.

“They may spend more time in the emergency rooms waiting for more beds to open, and the rate of discharge could then be greater ... leaving [them] without the services we’d like them to have,” he said.

Barnes said inpatient treatment is recommended when a person’s mental illness makes them unable to care for themselves or when they are at risk of harming themselves or others.

He noted it’s typically the last resort for treatment options, so if inpatient beds aren’t available, there’s really no alternative care.

“... usually when we are thinking of inpatient care, it’s because we aren’t thinking of another option for that person,” he explained.

Phil Wyzik, executive director of Monadnock Family Services, said of the agency’s 443 admissions for inpatient services in fiscal year 2019, 161 of them were at the Retreat.

“When people need that level of care, we look high and low for an open bed, so they might need to go to Vermont or Portsmouth or Massachusetts,” he said. “To try and find 161 other admission places, it’s going to add a new burden to an already strained situation.”

The Retreat’s neighbor, Brattleboro Memorial Hospital, sees about four mental health patients in its emergency department each day, according to President and CEO Steve Gordon. Of those who need inpatient treatment, almost all are referred to the Retreat, he noted.

The Retreat also provides Suboxone treatment through the state’s hub and spoke system. Suboxone is one of three medications approved by the U.S. Food and Drug Administration to treat substance-use disorders.

Gordon, who described the hospital’s relationship with the Retreat as “significant,” said losing that program would be a “very difficult challenge for the community.”

One new development locally is Phoenix House New England’s plans to open an office in Brattleboro soon that will offer outpatient mental health services and medication-assisted treatment, including Suboxone, for those with substance-use disorders.

Peter Mumma, president and CEO of Phoenix House New England — a network of nonprofit substance-abuse treatment agencies with locations in New Hampshire and Vermont — said the new office will open in “a few weeks” at 300 Maple St.

But though he said this location would be happy to assist anyone in need of services if the Retreat closes, the disappearance of any substance-use disorder treatment provider in the region “would be challenging.”

If the Retreat does shutter, Barnes said it will be just another example of mental health care not being taken seriously.

“The fact that psychiatric services so often are closing or in jeopardy reflects a lack of awareness of the severity of mental health problems in our communities,” he said, “and of the impact that they have on our families, our schools, our businesses and our future.”

Olivia Belanger can be reached at 352-1234, extension 1439, or obelanger@keenesentinel.com. Follow her on Twitter @OBelangerKS.