Lise Ewald took up rug hooking recently, after taking a class at the senior center in Montpelier. She’s been making a set of angels out of strips of blue wool.
“When sort of everything happened, I just turned to this,” she said. “It’s like zen. You’re focusing on that.”
Everything that happened started in November, when the University of Vermont Health Network announced it planned to close the inpatient psychiatry unit at Central Vermont Medical Center. A few weeks later, they had a date: Jan. 31.
The move came after state regulators told the Berlin hospital they had to cap the money they get from seeing patients by $16 million less than the hospital requested in their annual budget. (Regulators approved a revenue increase of 6% from last year, but not the 11.9% increase the hospital asked for.)
The unit cares for hundreds of patients each year, and lost $2.8 million providing that care last year, according to Central Vermont Medical Center.
Hospital leaders said they didn’t consider making any other cuts to patient services.
“Not currently, no,” said Anna Noonan, the president of Central Vermont Medical Center.
“Smaller services with higher loss was part of the criteria,” she said.
The unit is the only place in central Vermont where anyone in a mental health crisis can get hospital care. The Vermont Psychiatric Care Hospital is also in Berlin, but only takes patients with the highest needs.
The terribly irresponsible part of this is they shut it before they created an alternative.Lise Ewald, Montpelier
Ewald, who’s 64, has been a patient at Central Vermont Medical Center several times, including when she worked as a librarian in Northfield and, more recently, after moving to Montpelier. She’s been involved in mental health care advocacy for decades, including as a member of the psychiatric inpatient advisory committee at the hospital.
For her, learning this service was going away was overwhelming.
"I turned inside,” she said. “And I started to destabilize.”
She’s doing better now. But she says an important piece of mental health care is having support from friends and family and community resources — all easier to access when hospital care is close by.
Starting next month, if someone is in a mental health crisis, they can still go to the emergency department at Central Vermont Medical Center, but if they need to be admitted, they’ll be transferred.
From central Vermont, the next closest hospital open to anyone in a mental health crisis is 40 miles away, at the University of Vermont Medical Center in Burlington. That’s if a bed is available — they’re often not.
A lot of these decisions had to be made, unfortunately, relatively quickly.Anna Noonan, president of Central Vermont Medical Center
In Vermont, close to half of mental health patients are stuck in emergency departments for more than a day, waiting for a bed. That's according to data reported to the Vermont Association of Hospitals and Health Systems twice a week from every emergency department in the state.
“The terribly irresponsible part of this is they shut it before they created an alternative,” Ewald said. “I have that crushed feeling and, at times, just despair. And also, I'm really more angry than I've ever been in my life.”
Noonan, Central Vermont Medical Center's president, said the hospital received the budget order from state regulators in October, and had to resubmit a budget that included cuts to patient services soon after.
"A lot of these decisions had to be made, unfortunately, relatively quickly," she said.
The decision to close the unit has left other former patients, like Arianna Anaya, also at a loss.
“It freaks me the hell out. I have no idea where I would go,” she said. “I've always kind of thought of it as, worst-case scenario, I go there. Now, it's gone.”
Anaya is 40 and lives in Montpelier. A year and a half ago, at a really stressful time in her life, she started having delusions. It was the first time she realized she had a mental health condition. And it got bad. Eventually she was escorted to the hospital by the police. She stayed for 11 days.
“I do think the ward saved my life,” she said. “I didn't love it. I wasn't thrilled. The experience was, in certain respects, very, very frightening. But it was absolutely necessary.”
It freaks me the hell out. I have no idea where I would go.Arianna Anaya, Montpelier
She doesn’t think she’ll need hospital-level care again. But if she does — “It kind of makes me nervous to think about," she said.
"Am I driving myself? What if my partner is at a conference or something?" she said. "That would not work.”
Maddie MacDonald has worked at the hospital as a mental health tech for three and a half years. Over that time, several psychiatrists left, and the hospital couldn’t replace them. They hired temporary doctors to keep the unit open. Then, about a year ago, they reduced the capacity in the psych unit from about 15 patients down to eight. Last year, they cared for about 350 patients.
“It really changed the dynamic of patient treatment, not having as many providers,” MacDonald said.
Still, she didn’t expect the hospital to shut down the unit completely.
“It's just — it's very insulting to the community that we serve, to have us go from limiting the number of patients that we can have to now not having any at the end of the month,” she said.
“I know that all of us are going to miss our patients," she added. "We have a lot of people who are regulars. We have a lot of people that we feel like we service well. And I think it’s going to be a really hard transition.”
Like for Lise Ewald, the hospital has always been her last resort. She wants to think she won’t need hospital care again, but getting sick is not something she can control.
If she does need hospital care during a mental health crisis, she says she won’t go to Central Vermont Medical Center, if she can help it. She wants to avoid having to go to the emergency department, just to have to wait and go through the process again, somewhere else.
For now, she's focusing on other things — reading, rug hooking, her rambunctious 8-month-old kitten.
“There's going to be parts of my life that are going to be OK,” she said. "I’m going to be OK.”
Have questions, comments, or tips? Send us a message.
_
