Ken Libertoff: The $18 Million Question About Mental Health

This commentary by Ken Libertoff, Ph.D. who was director of the Vermont Association for Mental Health in Montpelier for 30 years. He retired in 2010 but continues to work as a consultant on health care issues.

Why was $18 million not used and even ignored while Vermont’s mental health system was in crisis?

For the past decade, empty rhetoric, endless handwriting, countless studies, special hearings, and inept leadership have proven to be a case study of many failed responses to a mental health system that is overwhelmed and overworked.

One of the major problems has been the shortage of inpatient psychiatric beds. For a decade, Vermonters young and old in need of care have been sitting in hospital emergency rooms across the state for days, weeks, and even longer because they could not access proper care. It is not only a tragedy for the patients and their families, but it also afflicts the caregivers who do not have any alternatives or timely clinical solutions.

The fact that these conditions still exist today is nothing short of an insult.

An intriguing development emerged in 2018, when the Green Mountain Care Board drew up a plan to allow the University of Vermont Medical Center to use $21 million in its excess revenue account to build new inpatient hospital beds and support it.

During 2015, 2016 and 2017, UVM Medical Center was a moneymaker with net patient revenue exceeding the state-approved budget for several consecutive years. For example, in 2016, UVM Health Network had an additional $29 million in revenue and an even larger balance than the previous year.

Threatening to impose more stringent regulations on the hospital or reduce its future budget, the parties – the Green Mountain Care Board, representing the state, and the UVM Medical Center – devised an unusual plan, which was voted the most creative or innovative plan. Might be considered risky. Instead of taking punitive action or more stringent regulatory measures, the Green Mountain Care Board urged UVM Medical Center to commit to investing this money in expanded access to care.

Conceptually, the proposal to include the state’s premier hospital was a major step in the right direction. For decades, Vermont hospitals have been reluctant to work with the state in collaborative ways, especially when dealing with patients with severe mental illness. It could be argued that the engagement of one or more of our non-profit hospitals may prove more administratively and clinically effective than facilities operated by the state of Vermont, such as the old one in Waterbury, built in the 1960s. Now-defunct State Hospitalth century, or even the relatively new 25-bed Vermont Psychiatric Care Hospital in Berlin, which has faced complex staffing problems since it opened in 2014.

Central Vermont Medical Center in Berlin, under the direction of UVM Medical Center, implemented an extensive planning process in 2018 that resulted in calls for a new 25-bed facility on the Berlin Hospital’s main campus. However, in early 2020, the process suffered a major setback when UVM Medical Center estimated that the 25-bed unit would cost $150 million.

This resulted in an angry outcry from several parties. Even John Brumstedt, then-CEO of UVM Health Network, admitted that the proposal was too expensive. It can be said that despite spending hundreds of millions of dollars on planning, the project lost its momentum.

The pandemic further delayed the process, and efforts stalled with only feeble attempts to resurrect it. The UVM Medical Center’s commitment to the project lost “air” like a deflated balloon.

The writing was on the wall, but it took until early 2022 for UVM Medical Center to officially announce that it plans to build this new inpatient psychiatric unit at Central Vermont Medical Center, which will address a major budget shortfall. has been cited and it has been formally announced that this cannot happen anymore. Carry out this much needed project. UVM Medical Center claimed a total of $3 million was spent on the planning process, leaving $18 million for badly needed services.

The project, now referred to here as the proverbial white elephant, will be nearly a year from now. With limited oversight or press attention, it is possible that this failure will undermine Vermont’s already fractured system of mental health care for years.

This means that the Green Mountain Care Board, the governor, or state agency leaders, or the Legislature must account for the remaining $18 million that is in limbo. These funds were dedicated to increasing access to mental health care. And there’s no excuse for delay.

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