Randolph For evidence of the failings and limitations of the network of public and private providers that deliver mental health care in Vermont, look at the headlines.

In recent months, there were stories of the suicide of Vermont Law School professor Cheryl Hanna a few days after she was forced to wait in a emergency room until a psychiatric bed became available in the states largest hospital; of a patient kept in restraints for 12 hours at a Bellows Falls mental health facility and coerced into taking medication; of a pair of suicide attempts by teenagers receiving psychiatric care at the Brattleboro Retreat.

For a view of what the state is doing to prevent future tragedies, as well as to improve care and replace a problem-plagued, 54-bed psychiatric hospital in Waterbury that was destroyed by Tropical Storm Irene, look to Act 79.

That law, passed in 2012, put forward a master plan for a comprehensive, humane and efficient mental health care system that encouraged even some skeptics. Theres a lot good to be said about Vermonts system, said Ed Paquin, executive director of Disability Rights Vermont, a nonprofit that represents and advocates for Vermonters with disabilities. Were pretty supportive of the direction that Act 79 puts the state in.

But implementing that plan has proved challenging. Said Julie Tessler, executive director of the Vermont Council of Developmental and Mental Health Services, an organization of 16 social service agencies: Act 79 expressed a wonderful vision and we are still working on it.

That work is done every day and night by caregivers around the state, often in the psychiatric wards of hospitals and less visibly in local clinics and other community programs.

People dont understand what we do, said Linda Chambers, executive director of the Clara Martin Center, which provides services in Orange and parts of Windsor counties. Were doing the heavy lifting with the hardest clients, she added. Otherwise, they go to higher levels of care.

Clara Martin is one of 10 nonprofit organizations tapped by the Mental Health Department to deliver front-line care for mental illness in their communities. Like their counterparts in many states, Vermont advocates and caregivers would like to see the role of large state hospitals minimized and caregiving decentralized and integrated in communities. But as in other states, the shift in caregiving responsibilities to local clinics and programs has rarely been accompanied by a similar shift in resources.

Constrained for revenue, community mental health providers have been hard-pressed to offer competitive salaries. That has made staff recruitment and retention difficult. The resulting vacancies in caregiving positions can translate into extended waits for therapy and other programs. And that can delay the start of treatment for new patients and leave stranded in high-level care facilities patients who have recovered enough to return to treatment closer to home that is less expensive.

The repercussions dont stop there. When scarce high-level care beds are occupied by less severely ill patients, they arent available for those whose needs are desperate. And when care is unavailable from mental health specialists, patients turn instead to hospital emergency rooms and primary care doctors.

Original post:

Challenges Abound for Vermonts Mental Health Care System