MONTPELIER — House budget writers say the state should stop paying for sheriff’s deputies to guard mental health patients in hospitals next fiscal year.
The House Appropriations Committee deleted funding for the program in the fiscal year 2020 budget. The committee’s action is in alignment with a request from Gov. Phil Scott’s administration, but it runs contrary to the recommendation of the House Health Care Committee.
State officials have said cutting the program would save only $268,490 from the general fund budget. But there are bigger concerns, including the fact that several Vermont hospitals have gotten into regulatory trouble for inappropriately calling on law enforcement to help handle psychiatric patients.
“We want to make sure that people in emergency rooms are receiving appropriate care by trained professionals,” said Rep. Mary Hooper, D-Montpelier, House Appropriations’ vice chairwoman. “And we certainly don’t want to jeopardize hospitals’ standing with the licensing agencies.”
The growing number of psychiatric patients becoming stuck in hospital emergency rooms has come to symbolize Vermont’s overburdened mental health system.
Hospitals have hired specialized staff and renovated emergency departments in an effort to accommodate the influx, and the state is pushing for construction of more psychiatric inpatient beds in Brattleboro and in central Vermont.
But the pressures have persisted, and hospitals have sought law enforcement help to handle potentially volatile situations. State payments for such services began after Tropical Storm Irene shuttered the Vermont State Hospital in 2011, and have continued since.
In presenting the Department of Mental Health’s fiscal year 2020 budget proposal earlier this year, Mental Health Commissioner Sarah Squirrell argued that it’s time for those payments to stop. The state is not obligated to fund a law enforcement presence in hospitals, she said, and that presence in some cases has drawn concern from the Centers for Medicare and Medicaid Services.
A debate about the need for the state funding has ensued. The Vermont Association of Hospitals and Health Systems opposed the funding cut, arguing that the state should somehow support psychiatric patients that are under the involuntary care of the commissioner of mental health.
“That means that the emergency department cannot allow that person to leave,” said Devon Green, the association’s vice president of government relations. “Our emergency departments, especially those in hospitals without an inpatient psychiatric care unit, need help to do this safely and in the most therapeutic way possible for the patients who are in the care and custody of the commissioner.”
The House Health Care Committee, in making its fiscal year 2020 budget recommendations, also did not agree with the administration’s plan to cut the funding. Instead, the committee deferred to a group that has been meeting to discuss the issue.
Rep. Bill Lippert, D-Hinesburg, chairman of House Health Care, recommended that the Appropriations Committee “reserve what is currently being spent for sheriff supervision and that it be redirected to fund the support of individuals in the emergency department who are within the commissioner of mental health’s custody per the recommendation of the stakeholder group.”
Though House Appropriations didn’t follow that recommendation, the group that Lippert referred to may come up with a way to resolve the funding dispute — and, potentially, a way to improve mental health treatment in medical hospitals.
In an interview on Monday, Squirrell said state officials have been meeting with interested parties including patient advocates and the hospital association to discuss the emergency room issue. The group plans to soon issue findings “related to opportunities for security and therapeutic supports in emergency departments,” she said.
“We all want the experience of those who are accessing services in an emergency room to meet their needs as therapeutically as possible and also ensure the safety of patients and staff,” Squirrell said.
Green added that hospitals are “looking to the Department of Mental Health to partner with us on the effort.”
“This may mean something different than sheriffs, such as mental health technicians or other training or resources,” Green said. “Our hospitals believe strongly that with wait times on the rise, this is the wrong time to take away resources from our emergency departments for individuals in mental health crisis, especially from rural hospitals that do not have inpatient psychiatric units.”