New numbers highlight Covid-19’s impact on inpatient mental health care and emergency departments


Chart courtesy of VTDigger

New numbers reported this week suggest that inpatient psychiatric care capacity in Vermont slowly started to rebound last year, but still remains significantly below pre-pandemic levels. 

Meanwhile, the total number of days that patients seeking mental health care spent in emergency departments statewide reached new heights. That number, over 10,500 days, now appears to be more than triple what a similar analysis found as a baseline in 2015.

That result is not surprising to Ben Smith, medical director of the emergency department at Central Vermont Medical Center in Berlin. His department’s internal numbers show at least a doubling of inpatient days waiting for crisis mental health care over the last five years. The impacts on patients of all kinds seeking care and on his staff are profound, he said.

The increase has reduced his department’s capacity to respond to emergencies of all kinds because both beds and staff are occupied, Smith said. Also, “it’s terrible for these patients,” he said. “You couldn’t tailor-make an environment that is less therapeutic for someone in a mental health crisis.”

“It’s not because our staff isn’t there doing heroic work to try to keep these folks stabilized and comfortable,” he added. 

The stress of the situation, and the frustration, is causing people to leave to work elsewhere and leading to greater difficulty recruiting new staff to the emergency department, which is required to provide treatment to all comers. “We are the only place that can’t say no, and so our staff have to do this even though they know they are not able to deliver the right amount of care,” Smith said.

Representatives of both the state hospital association, which produced the new statewide data, and the Vermont Department of Mental Health, which made it public in an annual report to the Legislature, cautioned that while psychiatric care capacity and emergency department stays are related to each other, they interact in complex ways. 

“Inpatient bed capacity is, I would say, a major driver of why people are boarding in emergency departments,” said Emma Harrigan, director of policy analysis with the Vermont Association of Hospitals and Health Systems, which represents the state’s 14 hospitals, plus the Brattleboro Retreat and the Veterans Administration Hospital in White River Junction. “But we also recognize that there are other challenges that could be contributing to that.”

According to the new report, the number of people discharged by inpatient psychiatric facilities in the state increased over the previous year by about 10%. But a VTDigger review of the same reporting back to 2019 shows that the number of discharges remains more than one-third lower than prior to the Covid-19 pandemic. 

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