Retreat staffing shortage traps patients at the ER

Children and adolescents wait for days, or even weeks, for inpatient beds at the psychiatric hospital

BRATTLEBORO — A deepening staffing crisis at Vermont's largest psychiatric hospital is forcing children and adolescents in distress to wait for days, or even weeks, for inpatient mental health beds.

The Brattleboro Retreat is the only psychiatric facility in Vermont that works with children and adolescents. Staffing there has been tight for years, but a recent Covid-19 outbreak sidelined 30 staff members at one time, causing a backlog in child and adolescent admissions.

Since December, children and adolescents have spent more and more time in emergency rooms - sometimes up to 40 days - before a psychiatric bed becomes available.

As of Tuesday, 12 children and adolescents awaited a mental health bed at emergency departments across the state. The Retreat had two open beds for that age group as of Feb. 1.

State health officials have helped the Retreat hire temporary staff to reopen some beds, but increasingly they are looking for long-term solutions outside the psychiatric hospital in Brattleboro. Late last week, the state began seeking proposals to open up to 10 psychiatric beds for children and adolescents somewhere else.

“We want to diversify,” said Alison Krompf, deputy commissioner at the Department of Mental Health. “We have a sole reliance on the Brattleboro Retreat for inpatient psychiatric care for children and adolescents, and that sole reliance isn't working.”

The state asked for proposals by the end of February, but it's not clear when or who would take on this project. On Monday, executives at the University of Vermont Medical Center, which operates the only children's hospital in the state, said they do not intend to apply.

Louis Josephson, president and chief executive officer at the Retreat, acknowledged the challenge his organization faces.

“We are working very hard every day to boost hiring and are using a lot of travel labor to keep beds open,” he said.

The Retreat, meanwhile, has been in the red since at least 2018, according to recent filings to the Green Mountain Care Board. Krompf said the state's stabilization plan for the Retreat includes an increase in Medicaid payment rates as well as assistance with paying for temporary staff.

The mental health bottleneck at emergency rooms has been an issue for months, but the recent Covid-19 outbreak forced the Retreat to close roughly 20 beds at once, Krompf said. At the same time, the pandemic, with its widespread disruption of school, community and home life, took a serious mental health toll on children and adolescents. Instances of depression, anxiety and suicidal thoughts in this age group are on the rise.

Without the Retreat, however, there are few options for caring for young mental health patients, said Stephen Leffler, president and chief operating officer at the UVM Medical Center, the largest hospital in the state.

“It's really difficult for our patients, both psychiatric and otherwise,” Leffler said. “And it's very hard on staff who are not trained to take care of psychiatric patients for 40 days at a time.”

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