A Walk-In Center for People Facing Mental Health Crises Is Proposed for the NEK 

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• Don Whipple
• Betty and Chris Barrett holding a photo of their son, Michael, who killed himself in 2004

Urgent care for the mind — that's the idea behind a new proposal to improve mental health care in the Northeast Kingdom.

A nonprofit mental health agency in the region wants to launch a treatment center for people suffering from panic attacks, suicidal thoughts and other psychiatric crises. They would be able to walk in off the street without an appointment, see a trained clinician and even stay a few days for observation, if necessary.

As Vermont grapples with a mental health crisis that has strained local resources, the proposal is envisioned as a way to serve people before they land in a hospital emergency room to languish for days, or even weeks, awaiting treatment — tying up precious beds in the process.

The problem is especially pronounced in rural areas, where hospitals typically have small emergency rooms and no psychiatrists on staff. At North Country Hospital in Newport, mental health "boarders" — those who are awaiting treatment — sometimes fill nearly half of the 11-bed emergency room. "The only thing we're really doing is keeping them safe," said Megan Sargent, the hospital's vice president of patient care services.

Sargent said the logjam forces people with medical emergencies to wait longer for care. Some end up leaving without being seen.

The proposed center, which would be named the Front Porch, is based on a model from the National Alliance on Mental Illness that's proven successful elsewhere.

Walk-ins would be assessed by mental health professionals, who could determine how to stabilize them. That might mean talking to a therapist and returning for follow-up sessions. Those feeling suicidal who do not want to be alone could also choose to stay overnight. The center would eventually have up to six beds that it could use to observe people for as many as 10 days.

The administration of Gov. Phil Scott supports the idea and has proposed spending $1.6 million in Medicaid dollars to cover costs, a request that lawmakers would need to approve.

"If this goes well, we'd like to spread it elsewhere," said Alison Krompf, deputy commissioner of the Vermont Department of Mental Health.

That might include Chittenden County, where the Howard Center and the University of Vermont Medical Center say they are collaborating on a program. "We anticipate support from the state and look forward to bringing a program on-line in the near term," said Bob Bick, the Howard Center's CEO, in a statement.

The concept for the NEK proposal came from Chris and Betty Barrett, a Newport Center couple who have spent years calling for better mental health services in their rural slice of Vermont. Theirs is an advocacy born of grief: In 2004, the couple's son, Michael, killed himself while living out of state. That led Betty to join a local suicide prevention group.

Years later, a brief stint at North Country Hospital inspired Betty to adjust her efforts. She was moved out of a room in the ER to an overflow space because staff members needed the bed for an incoming mental health patient — their fourth that day. She later learned that people were routinely housed in the ER because there were no dedicated psychiatric beds available anywhere in the state.

Betty, who had long struggled with depression and spent time in psychiatric units during her forties, was incensed: Chaotic emergency rooms were the last place psychiatric patients should be. She arranged a meeting with the hospital's CEO and later testified before the legislature to call for a new mental health facility in the NEK. But nothing came of it.

Frustrated by the state's inaction, the Barretts eventually went straight to the top. Betty wrote to Scott last year asking that his administration fund a new mental health treatment center in their region. To her surprise, Scott responded, writing that he would put the Department of Mental Health on the case.

Not long afterward, Krompf, the department's deputy commissioner, began to look into whether the Northeast Kingdom needed more mental health services — and if so, whether the state could afford them.

Krompf knew that some of the state's highest rates of suicide were in two NEK counties: Orleans and Caledonia. And recent data showed that roughly a third of people seeking emergency psychiatric care in the region went to hospitals instead of the local mental health agency, suggesting that people didn't know where else to turn.

In talking to the Barretts, Krompf sensed that they had been dismissed over the years because officials thought the couple was asking for a new inpatient facility, which could cost tens of millions of dollars. But she quickly realized that they simply sought a place outside of the hospital for treating urgent mental health needs — and that seemed doable.

"They've been talking about this for a long time, but they just didn't have the technical language to explain it," Krompf said in an interview.

Still, a big hurdle remained. The most logical choice for an organization to run the center was the nonprofit Northeast Kingdom Human Services, which contracts with the state to provide mental health services in the area, but the Barretts were leery. Long waiting lists and gaps in service had plagued the agency, and state officials had placed it on a probationary license.

But at Krompf's urging, the Barretts agreed to meet with the agency's newly hired executive director, Kelsey Stavseth. They came away impressed. Less than a year later, they learned that Scott had included the project in his proposed budget.

"It's amazing how much has happened so quickly," Betty said.

A similar center for children opened in Bennington a few years ago and has proven successful. School staff members now routinely call Psychiatric Urgent Care for Kids, or PUCK, when a child is in crisis. More often than not, those children are stabilized at the urgent care center, allowing them to stay out of the ER. The year after the program launched, Southwestern Vermont Health Care reported 40 percent fewer pediatric mental health emergency cases.

A federal grant will help Northeast Kingdom Human Services construct a new building for the center once state funding is approved. The House Committee on Health Care has endorsed the idea, strengthening the likelihood that it would be included in the final budget that lawmakers will vote on later this spring.

Stavseth said he would then look for a place where Northeast Kingdom Human Services could launch a temporary version of the urgent care program this summer while he figures out where to locate the new one. That process could prove a heavy lift, he said, because the stigma surrounding mental illness often makes residents wary of such programs in their neighborhoods. But he's optimistic that he'll succeed.

Said Chris Barrett: "We plan to be at the ribbon cutting."

If you or someone you know is thinking about suicide, dial 988 for the Suicide and Crisis Lifeline or text VT to 741741 for the Crisis Text Line.