The Department of Mental Health is warning about a shortage of voluntary psychiatric beds for children after the news that two hospitals near Vermont's borders in neighboring states are either closing or scaling back their units.
Champlain Valley Physicians Hospital in Plattsburgh, New York, stopped accepting new patients under age 12 to its psychiatric unit May 6, a spokesperson said. The hospital's psychiatric unit has 12 beds for children and adolescents.
Meanwhile, Cheshire Medical Center in Keene, N.H., said it would stop accepting patients soon and close its psychiatric unit completely June 30. The unit has 18 beds — 12 for adults and six for children and adolescents.
The hospitals are affiliated through umbrella organizations with the University of Vermont Medical Center and Dartmouth-Hitchcock Medical Center, respectively. Both said they were forced to discontinue services because they couldn't find child psychiatrists, and both called staffing a national problem.
Frank Reed, the commissioner of the Vermont Department of Mental Health, raised concerns about the mental health system in a monthly newsletter, saying the closure will affect up to 30 beds, including 18 for minors. Vermont has just 33 beds for children and adolescents, all at the Brattleboro Retreat.
"In the years following the closure of the Vermont State Hospital, these two border hospitals have represented a relief valve for voluntary psychiatric inpatient beds impacted by the demands for higher acuity patient care in Vermont's inpatient psychiatric units," Reed wrote.
He said the loss of capacity would increase patient demand for voluntary inpatient beds in the region and, when there are not enough beds for patients who want medical treatment, could later lead to more involuntary hospitalizations, which he said should be a last resort.
"These two recent health care facility decisions signal a disappointing commentary on how timely access to acute inpatient psychiatric services ranks with other acute health care conditions and facility inpatient priorities," Reed said.
Chris Blake, the spokesperson for Champlain Valley Physicians Hospital, said the hospital's child and adolescent psychiatric unit stopped accepting patients younger than 18 on May 6 because the child psychiatrist was leaving. The hospital then lined up a traveling doctor to fill in, but the person canceled his contract.
The hospital was able to use its existing psychiatrist for adults to reopen the psychiatric unit to minors age 12 or older, Blake said, and had five patients as of Monday. The younger kids typically took up about one-fifth of the unit, according to Blake, and the hospital is now using a subsection of its emergency room to coordinate outpatient services for kids who arrive.
"We're exploring lots of different options to secure a child psychiatrist," Blake said. She said the hospital might work with the UVM Medical Center's Department of Psychiatry, but she added that even if a child psychiatrist agreed today to take a new job, the person couldn't start immediately.
Cheshire Medical Center said in a news release that it "worked vigorously with national search firms, Dartmouth-Hitchcock recruiters, and local agencies and organizations to recruit psychiatry staff since 2013." By 2014, according to the hospital, it was filling only nine of its 18 beds and serving as few as three patients in 2016.
Starting July 1, the hospital said, it will allow patients to consult a psychiatric nurse practitioner and other on-call psychiatric providers. The hospital said it would also use other doctors and nurses to "provide care coordination to assist with transitions back to the community" or to another mental health facility.
Reed said in an interview that the Brattleboro Retreat, which has 33 beds for adolescents and children, is consistently at 90 to 95 percent occupancy and "sometimes it's hit 100 percent." He said the state doesn't have the power to force hospitals, which are private nonprofit organizations, to add voluntary psychiatric beds.
"I think it's important for hospitals to not just focus on physical health but also look at where mental health is a part of physical health care," Reed said. "If you don't have access when people are gravely ill with a mental illness, then (the) likelihood of a faster return to the community is (lower)."
Rep. Anne Donahue, R-Northfield, a mental health advocate, said the loss of psychiatric beds near Burlington is a big problem for families in Chittenden County. If young children are able to get an inpatient bed, she said, their families will now have to travel to the Brattleboro Retreat in southern Vermont.
"If you are in Chittenden County or in any of northern Vermont, that's an incredible burden on children, their access to their parents, their ability to have family counseling, their ability for their parents to visit," Donahue said.
She also pointed to what she calls a bad system of how insurance companies pay doctors. The state of Vermont continues to seek a waiver through the federal government to set up a system that would make insurance companies pay doctors for the healing value of care, rather than its profitability.
"Any hospital will tell you they have their money-makers and their money-losers," Donahue said. "Psychiatry is one of those areas that does not pay for what it costs to run, in contrast to, say, surgery that brings in revenue."
The Department of Mental Health says psychiatry is a rare field to go into, which is why it has had problems recruiting psychiatric nurses for the adult hospital in Berlin. The department said child psychiatry is an even less common field for doctors to enter.
Al Jazeera America reported in 2015 that the entire country is facing a child psychiatry shortage. The Huffington Post said that as few as 4 percent of medical students choose to become psychiatrists.