Larger hospital best serves mentally ill
I am writing to support your editorial of March 2, “Getting it right,” that “Federal rules involving Medicaid money should not be driving decisions about the treatment of mentally ill Vermonters.” In fact, the debate’s focus on the numbers of beds itself, while understandable, is very misplaced. The creation of a system of prevention and care for Vermonters with mental health problems, especially when there is widespread support for community-based care, should be based on where individuals live and work, receive services, and have or have access to peer and family support.
The crisis created by Irene is a wonderful chance for Vermont to rethink this system. While financing is always an important element, it should not be driving the system design. The distribution of beds as envisioned by the administration perforce finds individuals hospitalized far from their homes, follow-up care and support systems. Most Vermonters live in central and northwestern Vermont. It is essential that the in-patient portion of the overall system of prevention and care be robust enough to provide care close to home and family and community-based services. A 16-bed facility located to serve the bulk of Vermont’s population is very likely to be inadequate as well as inefficient.
While no one wants to return to large and undifferentiated in-patient facilities, discussion and debate in the Legislature has shown that there are efficiencies of size that also attract qualified personnel and, most importantly, permit patient-centered care.
I urge the legislative conference committee to report out a compromise that is more closely aligned with the opportunities associated with a larger facility, which may in fact have more than 25 beds. But most importantly, I urge the committee to see this decision as one that affects all parts of a complex but essential system of services for all Vermonters.
Rilla A. Murray
National Association of Social Workers
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