There aren’t nearly enough inpatient beds in Vermont for children in mental health crisis. Instead, kids who are a danger to themselves and others wait idly — for days — in emergency rooms.
Last year at UVM Medical Center in Burlington, 73 children spent an average three and a half days waiting for placement somewhere else. Many spent much longer. Parents, doctors, even hospital officials agree this is an urgent problem.
There is a child psychiatric facility with twelve beds — six newly reopened — just across Lake Champlain. The UVM Medical Center helps run the facility. The only problem: Vermont kids aren’t getting to use it.
Over the last few years, a special deal between UVM Medical Center and its affiliate hospital in Plattsburgh — Champlain Valley Physicians Hospital — has allowed the chair of psychiatry in Burlington to take over the Plattsburgh psychiatry department.
Like other UVM hospital affiliations, it's intended to improve care and reduce costs.
And for almost everyone involved, the Plattsburgh arrangement has been a success. The Plattsburgh hospital and its patients now have twice as many usable beds, and five times as many child psychiatrists. In return, the University of Vermont Medical School can now offer its students clinical training in inpatient child psychiatry in Plattsburgh.
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Just one group has not benefited from the arrangement: Vermont kids. Of the 151 children treated in the Plattsburgh unit last year, only seven were from Vermont. Even fewer were from Chittenden County. That’s even though Plattsburgh is a third the distance from Burlington as the Brattleboro Retreat — the only acute inpatient facility that accepts children in Vermont.
There are a handful of reasons Vermonters haven’t been able to use the Plattsburgh beds. But none of them fully explains the paltry numbers.
Most kids who are a threat to themselves or others receive psychiatric treatment willingly. But between 10 and 20 percent of children are deemed “involuntary” and placed in the custody of the state. It turns out these kids can’t be taken to the Plattsburgh unit, because their involuntary status does not extend across state lines.
A Chittenden County 13-year-old named Emily was one of these kids. Urgently needing inpatient treatment, Emily visited the ER at UVM six times over the last year and a half. There, she waited for as many as four days at a time before the Brattleboro Retreat could find a bed for her. Once settled in Brattleboro, her mom Jennifer commuted the 150 miles south to support her.
Jennifer tried to get Emily admitted to the Plattsburgh hospital, instead. “The couple of times we pushed,” she said, “we definitely got the door shut.”
UVM Medical Center’s chief psychiatrist, Bob Pierattini, said the hospitals knew this would be a problem when they set out expanding the child psychiatry unit. Still, he said, “when you look at this, when you say there is an inpatient unit 45 minutes away that serves kids, and there’s nothing else close to Burlington — surely there's a way to work this out.”
But, Pierattini said, legal teams on both sides of the border looked for solutions without success. “In the end,” he said, “we don't see a path forward to being able to use those beds for involuntary care.”
Still, involuntary hospitalizations make up just a fraction of children in Vermont needing care. Last year, many dozens of kids in Chittenden County voluntarily sought treatment in Brattleboro instead of Plattsburgh.
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Brandi Littlefield, the Assistant Director of First Call, Chittenden County’s designated crisis intervention, assessment and referral service, explained to VPR what she thinks is the biggest barrier:
The Plattsburgh hospital, she said, “will only accept voluntary patients that don’t have aggressive behaviors.” Littlefield said aggressive behaviors are very common in kids who need acute care.
But Robert Althoff, who is the director of psychiatry at the Plattsburgh hospital, said Littlefield was mistaken. “We have capacity to take care of kids… with a range of psychiatric problems,” he said, “and aggression would certainly be one of them.”
Althoff’s supervisor back in Burlington, Pierattini also cast about an for explanation. “First of all, memories are very long,” he said.
Pierattini wondered if Vermont’s referral teams didn’t know the Plattsburgh unit had changed under UVM’s guidance. Or, he said, perhaps a clinician had seen a patient or two get rejected, and then come to inaccurate conclusions.
"The couple of times we pushed, we definitely got the door shut."
In other words, Pierattini seemed to think it was possible neither hospital was communicating with Chittenden County’s designated referral service.
Before Pierattini hired Althoff to run things, the Plattsburgh hospital’s psychiatry department struggled to recruit and retain doctors. In 2017, the department was down to one child and one adult psychiatrist. Even though children across the region desperately needed access to acute inpatient psychiatric beds, the hospital had to stop using six beds for children due to staffing.
The affiliation with UVM Medical Center allowed the department to attract Althoff and four other child psychiatrists, all five of whom received assistant professorships at the Larner School of Medicine, as all UVM Medical Center doctors do. These doctors now provide clinical training to medical school students and care for children in all twelve beds in the Plattsburgh unit. However, the hospital says it is still struggling to recruit enough nursing and technical staff to prevent occasional bed closures.
According to Althoff, the Plattsburgh facility is designed to serve families on both sides of the lake. “I would like to have kids be treated as close to home as they can,” he said, “and have family be close and involved in their care.”
In the meantime, the University of Vermont Health Network is investing in inpatient psychiatric beds inside state lines. The UVM Health Network is one year into a four year plan to build a new inpatient psychiatric facility on the Central Vermont Medical Center campus in Berlin. Current facility plans would add 25 new inpatient psychiatric beds for Vermont patients.
But like the inpatient beds at the University of Vermont Medical Center; the Vermont Psychiatric Care Hospital; Rutland Regional Medical Center; and Springfield Hospital’s Windham Center — the new Vermont facility will not serve children.
