Perhaps you’ve been reading a lot lately about the dismal state of mental health in our country, and especially our region. We’ve certainly been writing a lot about it.
Between the pressure being put on mental health providers by the opioid epidemic, the rising suicide rate and the root causes behind the growing “deaths of despair” phenomenon, and the refusal of those in power to treat mental ailments as seriously as physical ones, the overall mental health of our society is in crisis.
As we noted this past weekend, commercial insurance typically reimburses non-mental health providers at well over the estimated provider cost — effectively subsidizing providers for Medicaid reimbursement shortfalls — but doesn’t for mental health services providers.
So paying for mental health treatment is made harder by the framework upon which the nation’s health care system is built. But that’s just part of the issue. The other problem — exacerbated by the payment hurdle — is accessibility to care. The number of beds at mental health treatment facilities is woefully lacking in this region.
And it could get much worse soon. The Brattleboro Retreat, one of the largest providers of an array of mental health services in New England, is in financial trouble. Following a meeting with the Vermont Department of Health and Human Services over a request for added funding, Vermont Human Services Secretary Mike Smith made the spat between the two sides public last weekend. He charged the Retreat’s leadership with, essentially, mismanagement. For his part, the Retreat’s CEO notified the state the facility could be sold or shut down if help isn’t provided.
It’s uncertain how much of each public statement is posturing. One would think the state would be willing to bend extensively to keep open a facility that employs more than 800 people and serves about 5,400 people annually. The Retreat has, according to its website, the nation’s only LGBTQ-specific inpatient psychiatric program. It provides Suboxone treatment through the state’s hub and spoke system. And CEO/President Louis Josephson pegged the cost to the state of having to deal with the loss of those services at tens of millions of dollars.
At the same time, Josephson and the Retreat would gain little by an abrupt closure, or even shutting down a quarter of the facility’s 119 beds, as has also been floated. Such extreme measures carry a whiff of ultimatum, but as many a community has seen, when threatened with the loss of a major business over similar threats, there are times when there’s more truth than posturing involved. And that, the region cannot afford.
Said Vermont Gov. Phil Scott Thursday in his 2020 State of the State address: “This health care provider is simply too critical for us to let fail, especially without an alternative. This would have a devastating impact on our mental health system and the region’s economy.”
True enough, and on both sides of the Connecticut River.
Phil Wyzik, executive director of Keene-based Monadnock Family Services, said of the agency’s 443 admissions for inpatient services in fiscal year 2019, 161 of them were at the Retreat.
“The closure of the Brattleboro Retreat would mean our ability to provide timely and effective mental health care would be dramatically impaired,” noted Gary Barnes, executive director of Maps Counseling Services in Keene.
It would be grand had Scott gone on to announce actual measures to resolve the problem, but alas, that didn’t happen. State of the State speeches are, after all, about hope and inspiration, not reality and hard choices.
At some point soon, however, those choices must be made. And one of them will be for state governments — Vermont and, especially, New Hampshire included — to start contributing more to make Medicaid reimbursement rates workable for mental health providers.