Department of Mental Health tells appropriations committee state has about 229 psychiatric beds; committee hears near $2 million pressure for youth residentials

The House Appropriations Committee on Jan. 16 heard Department of Mental Health leaders outline Vermont’s inpatient and community mental health system and reviewed Budget Adjustment Act (BAA) items that would shift and increase spending in the current year.

“ We have around 229 beds across the state of Vermont, for inpatient psychiatric care,” said Emily Haws, commissioner for the Department of Mental Health. She described that total as including youth and adult units at hospitals and a 25‑bed state facility in Berlin, the Vermont Psychiatric Care Hospital.

Why it matters: Committee members pressed officials about rising costs for youth residential placements, staffing and centralized IT charges because those items affect the current fiscal year budget and planning for FY26. Department staff said some increases reflect utilization and late‑reported rate‑setting changes rather than new policy changes.

Overview of capacity and crisis services

Haws and deputy officials described a “pyramid” of care: hospital‑level inpatient units (including adult and youth units at Brattleboro Retreat, UVM Medical Center, Rutland Regional Medical Center, Springfield/Wyndham Center and Central Vermont Medical Center while that unit remains open); a secure residential facility (River Valley Therapeutic Community Residence in Essex, 16 beds); and a range of lower levels of care including intensive recovery residences, peer‑run residences and community services provided by designated agencies.

Haws said the state has expanded crisis services since earlier years: 988 is answered by Northeast Kingdom Human Services and Northwestern Counseling Services in St. Albans; the state recently opened six mental health urgent care sites around Vermont (including services with Howard Center, Pathways, CSAC in Middlebury, Front Porch in the Northeast Kingdom, an Access Hub in Washington County and EPIC in Lamoille) to provide urgent care without an overnight hospital stay.

Budget Adjustment Act items discussed

Shannon Thompson, financial director for the Department of Mental Health, walked the committee through specific BAA “ups and downs.” She identified: a $62,202 increase tied to a service‑level agreement (SLA) with the Agency of Digital Services (ADS); a $29,772 increase related to the Department of Health; and several net‑neutral transfers that move previously held program funds back to the Department for Children and Families (DCF) — including DS waiver children’s funding and funds for Addison County Parent Child Centers.

Thompson said the department also requested increased federal spending authority to accommodate additional federal block grant funds rather than using excess receipts accounting.

Pressure in youth residential (PNMI) line

Committee members raised a projected increase to the private nonmedical institution (PNMI) line for children. Thompson and Samantha Sweet, identified in the hearing as a deputy commissioner, said the PNMI line is experiencing pressure driven by placement utilization and rate‑setting. Committee members noted the increase is “almost $2,000,000.” Thompson said the overall PNMI budget line is roughly $89 million.

Officials and committee members discussed why placements have increased: the departments cited higher adolescent acuity coming out of the pandemic, family instability, housing and poverty stressors, increased screening (leading to higher detection), and climate‑related displacement as factors that vary by case. Department staff said the goal is to place youth as close to their home communities as possible and to bring out‑of‑state placements back in‑state when feasible to support family reintegration and aftercare.

Staffing and other operational items

Haws told the committee the department’s hospitals have reduced reliance on traveler nurses as they have hired more permanent staff; she estimated roughly 35–40 mental health specialist vacancies statewide but noted recent increases in applicants and efforts to retain travelers as permanent hires. Committee members asked about the effect of centralized ADS charges and Microsoft licensing increases that can appear after a budget is finalized; department staff said they are reviewing those charges and will provide more detail.

No votes; requested follow‑up

The exchange was a briefing and question‑and‑answer session; the transcript records no formal committee votes on the BAA items during this session. Committee members asked departments to supply updated data and documentation (including recent wait‑time data and spreadsheets) and staff said they will provide that information. The committee chair indicated the panel would reconvene at 1 p.m. and staff would circulate memoranda and portfolio assignments to committee chairs and vice chairs.

End note

Department leaders recommended continued emphasis on community‑based care, early intervention and strengthening the crisis continuum to reduce reliance on hospital and out‑of‑state placements; committee members signaled interest in receiving more granular data on utilization, rate impacts and ADS charge drivers to evaluate current‑year budget pressures.