health system in vermont after irene with commissioner patrick flood welcome to the commission of flood began his career in state government in one nine hundred eighty four as a state's long term care  hundred eighty eight became the first director of the office of public guardian he's done all sorts of jobs like being the director of the division of licensing and protection which certifies medicare and medicaid providers licenses nursing homes and boards and care homes and that the unit also houses the is the place where they investigate abuse and neglect of the elderly in department of aging disability and independent living excuse me disability aging and independent living and in two thousand and seven he became the deputy secretary for the agency of human services when irene hit the work of the state became very much focused on what to do with the with the care of the people at the waterbury state hospital and commissioner flood was one of those people who is sort of took the lead and is now moved into that for the past year has been the commissioner of the department of mental health so i want to just start by saying thank you for being here my pleasure and also perhaps just as a high level thing  if you could talk a little bit about what the department of mental health does in the state where the partner in the house responsible for all mental health services in the state is this primarily those funded by state government under the medicare medicaid program so it's a small department because most of the work of delivering mental health services actually done by community mental health agencies in this area you have the howard center for example they provide all the d employees don't do that so it's relatively small department but we're responsible for making sure that services for adults as well as for children are in place and that they're i quality so could you give us the quick overview of what happened within mental health system but specifically with the waterbury state hospital when irene hit well i can give you a quick overview of those actually pretty complicated ripple effect i mean the state hospital is only fifty four beds  but it how's the sickest people in the state and so when it had to be vacated when it had when it closed we suddenly had to make room for those fifty people and it really did have a ripple effect throughout the whole system because other hospitals like and the brattleboro retreat which weren't used to caring for this level of patient suddenly had to and they did and i give him a tremendous amount of credit for stepping up and doing that but they really in many ways they just weren't ready for that and there was they were they had to train their staff they had to hire more staff to make a bunch of changes but what that did then was the beds that they used with the sickest population were now in no longer available for people who otherwise would you know maybe not a sick but still people who needed care so throughout the system was there was this ripple effect of displacing people and not having and of sites in locations for people to get the care that the work about where did they move to the first thing i'd say what actually was that that night been pretty dreadful because the power went out the water was actually rising and the first floor of the state hospital they had to leave and go upstairs they  the first thing in the morning they were moved very rapidly to different settings some went to hospitals some went to other care settings they were not hospitals because they were ready to move but hadn't found a place yet and people were just scattered and their staff scattered with them it was an amazing thing amazing twenty four hours for them and some of them you know were fairly readily discharged back home or something but some of them have been at the hospital whe of what i really appreciate about the terrible tragedy of irene is the opportunity that it presented and i wonder if we could talk about that a little bit in terms of what kind of thinking went on  then for the next steps i know in appropriations committee you know coming in with different design plans and i really wanted to run the program so that people could hear and see that kind of very interesting dynamic process that took place in  about solutions and kind of redesigning and rethinking how are we providing services to people what's the best way to do that and what if you could just talk a little bit about that process absolutely first of all i should say that there's been a conversation going on  vermont for over a decade about closing the state hospital and what would we do if we could close a state hospital but that discussion was very difficult to bring to a conclusion because the money that would need to be needed to expand services in the hospital and not to bore your listeners with complicated stuff but it was all state money we were getting no federal money because of problems of state hospital had so that money was all tied up and it was impossible to move it without causing the hospitals what i mean actually did was create the opportunities that you mention with all the negative things that happened that was the one good thing created an opportunity the hospital is now gone there was no more debate about that it was gone so it opened the door tremendous opportunity to think about ok now what do we do and there wasn't a lot of new thinking that went on actually because those discussions and were going on for decades so there was the outlines of a plan already in place and there was discussion about tweaking this into eating that adding that we did add some things into the plan that hadn't been there before but that opportunity created a terrific chance to really redesign what you'd like to have an a in mental health system so where is the sort of current status of where we're at with every design of the system well i think everything is going pretty well for example just a week or so ago we got the permission from the state regulators to build a new hospital called the certificate of need that was approved and so the new hospital process is moving right along and we still think will be opening the new hospital a twenty five bed city in berlin in january twenty four team that's just one example but every we in the meantime we developed are developing a what we're calling a temporary eight bed hospital marcil inside of an old nursing home we expect and what we hope anyway that this thursday will get a license from the board of health it will be actually able to start moving people into that site like the week after all across the state the things that  the legislature approved are happening there are unfolding there's so much going on and i take the rest of the show to tell you it but everything is from new facilities that are being developed to new programs that didn't exist before and couldn't exist  and have the money we're doing much more work with police i was at a meeting a couple of weeks ago with over one hundred police officers and and crisis workers now working together in the field to try to make sure people in crisis get dealt with by mental health person not just leaving it to police officers so that i could go on and on the work is it's amazing and it is all happening so i just want to be sure to mention on the program because this is about mental health and that the linkage is to the resources the website for the department of mental health and the crisis number that crisis numbers you were saying earlier have to do with the region that you're right and so we're publishing here on the screen the number for our agency so i think every every phone book in vermont has the number for them and all of you know services matters is they'll have a number there for your mental sort but also what i invite people to call in if you have a question for the commissioner we'd love to take your call the number is four three four to five five zero we're doing this has a live call in it also streaming so we hope and invite your calls i wonder if you could talk now about the challenges that you see from sort of here forward like water the upcoming things for the next legislative session with regards to the mental health system you know let me talk about in more general terms for as you know we we move of implementation so there's a lot of implementation work to be done and as i said we have to continue to work on developing a new twenty five but hospital so those are the you know that that's going to be a large focus i don't think there's going to be too much focus in the legislature this year although one thing one piece of legislation we're looking at is updating the statutes that govern what we call involuntary treatment when somebody is having a crisis and they really need to be in a hospital perhaps they don't want to be in a spittal they don't think they have a problem there's a whole process for unvoluntarily committing people and they used to get committed to the state hospital well now they're getting committed to other hospitals and what we're finding is the whole statute that was written for the state hospital services isn't really relevant today so we're thinking about making some changes to that i don't see anywhere near as complicated as what we went through last year so we may see some modest legislative proposals like that and i think  the big issue is is maintaining our commitment to pay for the services i just heard the governor talking about the budget and level funded budgets and all that but when it comes to this mental health system i think we have to make sure that true to our commitment to fund this so some of the money last year that we appropriated didn't include for example all the money for the new hospital so we're going to have to this year your committee will be looking at that issue again and i think that the like because you think well people are breaking the law and the police but what was it that you're working well here here's a simple example and there are many examples but a person might have committed a minor crime in most of the people in the health issues who commit crimes and get picked up by the police they're nuisance crimes they're trespassing disorderly conduct their debt sort of thing but they're creating they're getting in trouble because their mental health needs are not being taken care of so years ago the mental health systems used to go out and respond to these but because of budget cuts they stopped doing that and it was left to police to intervene and then what happens is the police pick somebody who is acting strange they take  to a hospital for an exam person at that point the person probably is going to get admitted to the hospital maybe it was unnecessary but once they're in the hospital the rules take over so what we're trying to do is go back to what we used to work and do what we call mobile crisis get people out of the offices and into the field so if you had somebody in richmond who's having a problem it would be far better to have a mental health worker come out here and deal with the problem than to have the police  about the waterbury complex and the conversations with the state and seem is there any update that you can share with us about yes that i think being insular well first of all let me tell you that you have to do at least three shows they're not looking at necessarily just because we want to build a new hospital they're going to pay for it and so in our case because we're not just dealing with the emergency we are also thinking to planning for the future there's been a lot of negotiations with team about well maybe that part team should cover this part they shouldn't cover but the latest word i have is that it's looking better than say did a few months ago when we thought we might get nothing for the hospital or for even a temporary hospital morsel that should be covered by fema that's a response that's soli or she wants to and we think that that will be covered but some of the other things that we weren't sure were going to get covered we can now think we're going to get least partial cover partial payments so we're feeling more optimistic now but we'll see more cover if what do you were talking a lot in the legislature and now about measures results results based budgeting you know trying to get at this concept of how do we know what do we say to taxpayers about how responding there what are we getting for our taxpayer dollars and i wonder in your experience within the department or even if you wanted to speak broadly for the agency of human services what are the indicators of results or how do you approach that question well i think some for minute because of the flood and the whole new system was put in place actually gives us a good another great another great opportunity gives us is to actually define and measure the system differently than we were in the past so you know in the short term we're looking at things like how long do people or how long do people who get stuck in emergency rooms stay there how many of them are there and how long do they get stuck because that tells us what our capacity is but that's just sort of short term and i think what you really caring and they haven't always thought about how to how do i know when i'm being successful and i think that's a question we should always ask so for example in the field of mental health you know one thing you want to measure is do people you know get get better in the sense they recover from their s but so what to what purpose well so that they can do things like work you know and employment is a very good measure about how your your services are working if people are actually able to go out and get a job and keep  don't you're doing something right so we're looking at not just the measures the sort of the medical measures or the utilization of the system measures we're looking at real outcomes for people can they stay housed they not you know can we prevent homelessness do they have a job you know do they do they participate in other activities in the community like voting you know people are well enough and active enough that they want to vote that and so again if you would like to call in the number is four three four to five five zero for any question you might have commissioner patrick blood from the department of mental health what did truly heroic things in the past year the year plus since irene they first of all they did they left that morning sometimes with their belongings to go work at the probable retreat or go to work around to go to work in some of the with the pit where the patients were going and then some of them continued for almost over a year back in march or so we actually stopped sending people to the other hospitals but we still had staff going to the we had five patients with the springfield prison because it was only really secure place that we had that we could put some of these very challenging folks which is another whole story i'd love to talk about a minute but and  our staff were traveling to springfield and you know working four days a week twelve hour shifts driving back and forth some were stand down there is extremely disruptive i went down and visited with them a number of times it was extremely disruptive but the good news is that we closed down the springfield prison and move people into other settings and we're about to open the more schools hospitals i said a lot of people say employees are really looking forward to that because they get to go do you see the future now i guess one of the question i do want to ask you was about the idea yes i know that in the mapping out about no longer have whatever state hospital have these community locations and then there was this concept of something that was new to me about people's self directing their care or let me come let me come answer your question kind of a roundabout way to go back to sort of the beginning one of the one of the opportunities we had was that once the hospital was gone that state money that we were using could be matched with federal dollars this is something that every hospital does but we couldn't because of some problems we were having so by people who have mental themselves we call them and there's several programs now that are being developed or expanded because there were some peer programs before but they're being expanded now with some of this new money because we think that people who have had the experience of mental illness have an awful lot to give to other people going through that kind of crisis and out of that came the idea of the satiric house now it's not a pure driven service but what it is it's it's a type of facility where people can go and get the care that they need when they're in crisis but not necessarily take sectoral medications or psychiatric medications which a lot of people object to a lot of people feel that they have terrible side effects and they'd like to try to get better without medications so it's very cutting edge it's only been done a few times in this country and we're really looking forward to seeing what impact that has for certain people you know there's no doubt that there are there are people who simply can't manage in the community without medications but there are other people who who believe in there's some reason to believe that have a target date start sometime between the middle of next summer and the fall now is the target for opening we gave a grant to a group that is doing the planning and of developing in the research and i think they're doing their due diligence and doing a good job so you know next summer or next fall for an opening would still be pretty good  services up and running every day there's somebody waiting for a hospital bed and apartment doing everything we can to try to to make that happen so we're we spent a lot of time just like crisis management but i think you know there's there's an opportunity in this state now to really think about not just the buildings and the number of beds but how do we really want to provide care to people that are in psychiatric crisis you know what are the what are the  tools or what are the the care management proteas the philosophy that we want to use in this state there's a lot of debate about that we didn't spend a lot of time on it in the state house because everybody again was focused on how do we deal with the crisis but there is going to be an emerging debate and the search area is for example just one of those questions is do we can we get people well can we help people get well with medications that's just one question i think there's going to be more questions like that what are the benefits that we talked a little bit about work what are the benefits of work actually lowering the need for other services there's and there's evidence that people are working they actually feel better they do better they go into crisis less those kinds of things so i think there's an emerging debate about what mental health care should even in the state and i do think for months on the cutting edge you know on the one hand that's exciting and can be fun sometimes and it's nerve wracking to be out  so appreciate your taking the time to come and visit with us and i do hope that one of the messages that i think is important about mental health is mental health rather than mental illness you know i think that as a nurse and you have  background and are saying that lots of times you know we sort of focus on the illness part of mental health and the challenges that that presents but really the focus on mental health and even the physical building i'm excited about a new building in berlin just because of the physical space a lot of very space certainly was satisfactory but didn't feel healing it didn't feel like a place where you would go and you could feel better and on like a place where you were you know certainly fed and cared for but not a place where you would perhaps be healed or be in a place of healing yourself and so that's the new plant the physical place in berlin is near   but it is exactly as you described it's a place for healing it's designed to be that way we use the term recovery around mental illness is that you actually recover you go back to work  just the layout of this which creates more freedom more light for example there's an internal courtyard and it may not seem like a big deal but what it means is it so the building itself kind of surrounds this courtyard the building  secure but you can go in and out of the courtyard freely which is something you had no options like that for months and out of almost us because we have this green space in the in the middle of the hospital you see it from all the different  it's kind of exciting that as tragic as irene was this is like a wonderful outcome for him and improve mental health system and improve its state hospital for the  just people coming together and thinking differently about mental health the mental illness and how we work with police or treat each other so happy that that one kind of when you try to find the little kernels of good things out of irene i think this is a really good story and i really appreciate your leadership in it i know you've been to the appropriations committee many times looking like you've had a long day already and here you are with a whole new set of plans and numbers and budgets and i appreciate that that's a lot of work and effort on your part and i just want to say thank you i want to thank you for tuning into our program this evening  very happy to be i'm happy to be taking questions about this topic or any other topics if you want to give me a call or e mail i look forward to chatting with you again next month on meet the experts good night