Even though it only housed 51 patients, Vermont has been having difficulty replaced the state hospital which housed its most seriously mentally  ill patients.  Patients – medical, psychiatric, assisted living – all have more particularized needs: ramps for gurneys, power for medical equipment, adequate power and water – a complete list would be long. When we assess risk and plan, perhaps we need to start  planning with the most difficult and the most vulnerable populations. Abby Goodnough, reporting in The New York Times, gives a clear picture of the difficulty of rapidly replacing specialized facilities. From Storm Has Vermont Scrambling to Find Beds for Mentally Ill

Among the casualties of the flooding that ravaged Vermont during Tropical Storm Irene was a faded brick hospital that housed the state’s most seriously ill psychiatric patients.

Eight feet of water from the Winooski River inundated the century-old building on Aug. 28, forcing the 51 residents, most of whom had been sent there involuntarily, to the upper floors. The next day, they were evacuated by bus to temporary placements around the state.

 

Two months later, the Vermont State Hospital remains closed — for good, Gov. Peter Shumlin says — and the state is grappling with how to care for acutely mentally ill residents.

 

“We really have kind of an unprecedented situation on our hands,” said Jill Olson, a vice president of the Vermont Association of Hospitals and Health Systems, an advocacy group, “where the highest level of care for a mental health situation in Vermont just washed away.”

 

In a strange way, the disaster presented an opportunity that many state officials and mental health advocates had been seeking in vain for years. The state hospital had so many problems that the federal government decertified it in 2003; state leaders had been vowing to close it ever since, but were stalled by indecision about what to build in its place. “All of us thought that it was so shabby and so old and so difficult to make safe that it was time to replace it,” said Dr. Robert Pierattini, chief of psychiatry at Fletcher Allen Health Care in Burlington, the state’s teaching hospital. “But I don’t see any evidence that we can get by without a state hospital.”