Proposed hospital is a false solution to a real problem

A new 16-bed therapeutic community residence would subject its inmates to psychiatric incarceration. We can give people the supports they need more quickly, more cheaply, and with greater efficacy.

DUMMERSTON — Vermont's mental health system is poised to move millions of dollars toward the wrong side of history by prioritizing control and psychiatric incarceration over community care and voluntary support. Community members and legislators can act now to prevent decades of harm and address our communities' real needs.

The governor's budget this year includes $11.6 million for a new 16-bed “secure residential” facility in Essex to replace the current seven-bed Middlesex Therapeutic Community Residence (TCR). The new facility would also be licensed as a TCR, the lowest level of license that Vermont residential programs can have.

“Therapeutic community residence” sounds nice but is, in this case, a radically inappropriate misnomer.

The floor plans include a “seclusion area” (a.k.a. solitary confinement) and a restraint chair. The facility will also subject its inmates to forced drugging, a violent practice that many survivors describe as torture.

No other adult mental health residential program in the state allows restraint, seclusion, or forced drugging. The locked facilities that do use these practices are licensed as hospitals and share enough features with prisons that they can both be considered forms of incarceration.

This proposed state-run facility can only be understood as a second state psychiatric hospital and carceral institution.

When the Department of Mental Health (DMH) was asked during a stakeholder meeting about how the new “residential” would be different from a hospital, the only response was, “It's different in the intention.”

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The problems with this carceral project abound and are almost too numerous to list.

The process has excluded, ignored, or tokenized advocates. DMH has co-opted language like “recovery-oriented,” “community based,” “step down,” and “trauma-informed” to talk about what is functionally a prison. Data to justify the expansion is absent or insufficient.

And, most importantly, this project is a false solution to a real problem.

People experiencing emotional crises have been getting stuck in Vermont emergency departments for days before being psychiatrically incarcerated. This is a true problem that causes real trauma, pain, and suffering - all frequently compounded by the trauma meted out by the prison-like psychiatric hospitals that folks eventually end up in, where seclusion, restraint, and forced drugging are always present as latent threats.

DMH says there need to be more step-downs from the hospital to reduce emergency department wait times, but the proposed “secure residential” is not a step down from inpatient like other residential programs are - it is the same level of care being marketed as a lower level of care.

The solution to the emergency department problem is not more incarceration.

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There are solutions, though, and they can be created more quickly, more cheaply, and with greater efficacy.

Fewer people would have to go to the emergency department in crisis in the first place if we invested in affordable housing, spaces that are open around the clock and are tolerant and friendly toward people who are experiencing extreme or altered states, education for the community in how to support people in distress, peer respites (which are more accessible to some people who will not voluntarily participate in clinical models), and more truly voluntary community supports.

Many people end up psychiatrically incarcerated because there are insufficient, unsafe, or nonexistent community resources, and they are restrained from leaving the hospital for the same reasons.

Four peer-run agencies (Alyssum, Another Way, Pathways Vermont, and Vermont Psychiatric Survivors) submitted a white paper in 2019 outlining a plan for creating a network of six peer respites and community centers around the state for a fraction of the cost that the new state hospital would incur. This would be a much wiser use of resources and better meet the needs of our community members experiencing distress.

The question of whether to build this facility is also a racial justice issue. Data from the existing state hospital (Vermont Psychiatric Care Hospital in Berlin) shows that 15 percent of the people incarcerated there are “non-white” (people of color), showing a clear bias against Vermonters of color in a state that is more than 94 percent white.

This data is consistent with research showing that people of color are over-represented in psychiatric incarceration while being underserved in the community.

The state-hospital-licensed-as-group-home is being considered even though there is already a new state-funded 12-bed unit opening at the Brattleboro Retreat this year, a development that occurred after the plan was made to add nine beds in the Middlesex replacement.

In a discussion about the proposed facility at a recent public meeting, DMH said that they intend to focus on community solutions to the emergency department problem after inpatient capacity has been expanded.

This is the wrong order of operations.

Community solutions will have no chance of reducing incarceration if construction of new inpatient beds comes first, because those beds will demand to be filled.

It is not too late for the state to avoid spending millions upon millions on something that is both unnecessary and harmful, to cut its losses, and abandon this project.

Ask your legislator to direct money away from expensive, ineffective, and trauma-producing incarceration facilities like the Middlesex replacement, and redirect that money instead toward housing and community supports.

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