BRATTLEBORO — It's safe to say Louis Josephson has his hands full.
As the Brattleboro Retreat's new president and chief executive officer, Josephson is in charge of more than 800 employees and an array of programs including 122 inpatient beds for children and adults; multiple outpatient offerings; a school; and a busy “hub” for treatment of opiate addiction.
Josephson has taken the reins of a community institution with 182 years of history, along with a more-recent history of difficulties with federal and state regulators.
But he said he believes the Retreat can maintain - and possibly grow - its mental health and substance abuse offerings while remaining an economic anchor in Windham County.
“We've got our hands in a lot of different things, but our mission is to try to meet the needs of the community,” Josephson said.
“Quality is the No. 1 thing that I care about here - making sure every service we provide is as high quality as it can possibly be,” he added. “Making sure we have that firm foundation, and the reputation flows from that.”
The 11th top administrator in Retreat history, Rob Simpson, stepped down at the end of 2015 after nine years in Brattleboro. Simpson's tenure was marked by accolades and by rapid growth at the Retreat, but there also were multiple run-ins with the federal Centers for Medicare & Medicaid Services (CMS) and an ongoing state investigation into allegations of financial malfeasance.
Josephson has inherited some of those challenges. He declined to comment on the state's investigation, aside from pledging the Retreat's cooperation. But he believes the CMS issues are over, given the federal decision in December to release the Retreat from a systems-improvement agreement.
In doing so, a regional CMS administrator cited the “impressive progress and strides the hospital has made over the past year.”
The Retreat also recovered its “deemed status,” meaning it is no longer under direct CMS scrutiny for quality and performance issues.
Josephson credited the Retreat's staff, as well as CMS and state regulators, for getting the facility back on track.
“I'm committed to never ever being in that situation again, and I don't see why we should be,” he added.
That's indicative of Josephson's optimism about the Retreat's future. He has worked in mental and behavioral health in his native New York City and in Concord, N.H., but he traveled cross-country from his most-recent post in Los Angeles - where he served as president and CEO of Vista Del Mar Child and Family Services - to take the Retreat job.
“What brought me here was the position,” Josephson said. “There's no question, if you're in the mental health and substance abuse field and a position like this comes up at a place like the Retreat, you definitely pay attention.”
Josephson is used to working in much more urbanized areas: From Los Angeles County, with a population of more than 10 million, he has relocated to a county with fewer than 45,000 residents. But he sees potential benefits in that change.
“You can get a lot more done and be a lot more effective in a small state like New Hampshire or Vermont,” he said. “So that was very attractive to me, too - to be a presence and to be a leader in the state in terms of helping a state do its best for mental health and substance abuse.”
The Retreat draws patients from across the nation, though most come from New England. Josephson sees some room for growth, though he doesn't expect to purposefully expand the Retreat's reach.
“I would doubt that's going to be a big strategic thrust for us,” Josephson said. “If we continue to enjoy the reputation we have, continue to improve our services and the types of services we offer, that will get (notice) certainly in our field and beyond, so you would see an uptick (in patients) from out of region.”
Still, he believes that “our core mission is to be a Vermont hospital serving citizens here. We're happy to serve others as we can.”
The focus on Vermont includes a continued connection to state government. When Tropical Storm Irene's severe flooding crippled the Vermont State Hospital in Waterbury in 2011, the Retreat accepted those patients and has continued to provide such care via a contractual relationship with the state.
“We stretched ourselves to admit what we call in our field the involuntary patients - patients who are so impaired by their illness that they're not able to be released safely, and they don't have the judgment to know that they need treatment,” Josephson said. “That's a very different population from what the Retreat had traditionally served.”
The change led to creation of a new, 14-bed adult-intensive unit that was dedicated at the Retreat in 2013. State officials including Gov. Peter Shumlin attended that event, and Retreat officials now are looking to Vermont leaders to again partner in a Retreat improvement project. Josephson is hoping a public-private partnership eventually can spur a rehabilitation of the adolescent unit.
“We are still the de facto child and adolescent state hospital,” Josephson said. “There are no other child and adolescent beds in Vermont for kids needing psychiatric inpatient care.”
In an interview about five weeks after he started work at the Retreat, Josephson touched on a variety of other topics in discussing the Retreat's future:
• Josephson wants to see more “downstream care” in Vermont. By that, he means step-down services for those who are ready to leave the Retreat's inpatient units but still need significant structure.
As an example, he cites a need for a “secure residential” facility for adolescents departing inpatient treatment.
“If we developed more of these downstream resources, it would certainly lower costs because people wouldn't need to stay here as long,” Josephson said. “Some of our stays are just backed up because there's no place to go.”
• Inpatient care is still a big part of the Retreat's mission. But administrators are drawing attention to other services including partial hospitalization/intensive outpatient programs; a uniformed service program for emergency and military personnel; and an alternative school that Josephson said has “grown tremendously.”
There's also been growth in the state's “hub and spoke” opiate-addiction program at the Retreat, where addicts can receive outpatient Suboxone treatment. “It's an (opiate) epidemic out there, and we're trying to support the community with that,” Josephson said.
• Josephson is advocating for a more “whole person” approach to health care - one that takes into account medical issues as well as mental health and substance abuse problems that often are co-existing.
For example, he said there is a known connection between major cardiac problems and post-treatment depression.
“If you want (patients) to make progress on their cardiac rehab, you'd better be asking them about and attending to issues of depression,” Josephson said, adding that such an approach can improve treatment and save money.
• Finances are on Josephson's mind as he takes over the Retreat. He characterized the Retreat's economic situation as stable but also sees room for improvement, both in terms of cash on hand and reserves.
“We need to do more in the fund-raising area to build up our reserves and to have money for capital projects - things we want to improve,” he said.