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Mental‑health system pressures: transports, more competency evaluations and travel‑nurse costs raised at appropriations hearing
Summary
Department of Mental Health Commissioner Emily Hawkes told the Senate Appropriations Committee that rising transports, broadened competency evaluations and heavy reliance on travel nurses are increasing costs at state psychiatric facilities and in community crisis response.
At the Jan. 8 Senate Appropriations hearing, Emily Hawkes, commissioner of the Vermont Department of Mental Health (DMH), outlined system pressures that are driving costs across crisis response and inpatient care.
Hawkes described the “foundation of our community mental health system” as community supports — micro residential programs, youth group homes, adult group residential homes and family‑based outpatient services — and said crisis response and inpatient resources sit higher in that service pyramid. "Without those community mental health supports, the rest of the pyramid doesn't exist," Hawkes said.
She told senators DMH has seen increased transportation use for inpatient admissions and out‑of‑state placements, attributing it to more people presenting for care and reduced family capacity to provide transportation. Hawkes also described a notable rise in court‑ordered competency and forensic evaluations; the population receiving such orders has broadened beyond people with serious mental illness to include those with traumatic brain injury, dementia and substance‑use disorders, increasing both volume and cost.
On inpatient staffing, Hawkes said Vermont Psychiatric Care Hospital and other facilities have relied heavily on travel nurses since the COVID era. "We've gone from the initial spike that happened during COVID to coming down every year since then," she said, while adding the hospital still employed about 47 travelers compared with roughly 14–15 pre‑COVID. Hawkes said the agency is pursuing recruitment and retention strategies — 12‑hour shifts, shift differentials and talent‑acquisition efforts — and negotiating lower contractor hourly rates to reduce travel‑nurse costs.
Hawkes also noted specific facility items: River Valley Therapeutic Residence has 16 beds for adults (not limited to those with criminal justice involvement) and the Vermont Psychiatric Care Hospital saw reduced Medicaid billings this year, which affected revenue for the hospital's special funds. DMH separates vacancy savings from travel‑nurse expenditures to show both the progress in hiring and the remaining contract cost burden.
Committee members asked follow‑up questions about whether increases in forensic evaluations reflected multiple evaluations for single individuals or more individuals being evaluated; Hawkes said primarily more individuals are being ordered for evaluations. No action was taken; DMH and AHS will return with departmental line‑item detail as requested.
Next steps: DMH will provide more detailed breakout of transports, forensic evaluation counts and travel‑nurse contracting costs to the committee.
