A coalition of mental health advocates, patients, and clinicians are celebrating state regulators’ final approval of plans mandating an integrated, state-of-the-art, inpatient psychiatric unit at Fletcher Allen Health Care in Burlington, Vt.

Nearly two years ago, mental health advocates in Vermont had no idea what they were getting themselves into. As psychiatrists, psychologists, counselors, advocates, and patients, the unlikely coalition of concerned citizens simply knew they could not sit silently on the sidelines as the state’s largest medical center—literally as well as figuratively—marginalized patients with mental illness (Psychiatric News, May 18, 2001; November 16, 2001; June 7, 2002; June 21, 2002; September 20, 2002). The hospital was planning to relocate its inpatient mental health unit to a setting several miles removed from the hospital’s main campus, caring for psychiatric inpatients in what amounted to a "separate but equal" facility.

Adopting the slogan "Nothing About Us, Without Us," the coalition members proved that, working together, they could take on one of New England’s leading health care providers and force it to do what they believed was right for psychiatric inpatient care.

The group, led by members of the Vermont Psychiatric Association (VPA), set out, along with others, to convince hospital administrators, the community, and state regulators that the proposal for a separate mental health inpatient unit was not appropriate or acceptable.

The coalition’s impact became significantly greater than ever imagined in a collaboration that would wield considerable influence and power. Along the way the coalition exposed wrongdoings that led to the resignations of hospital administrators, a gutting of the facility’s board of trustees, state and federal criminal investigations that involved charges of lying under oath to state regulators, falsified documentation, and fraudulently obtained state-backed financing for the hospital’s massive renovation and expansion, known as the Renaissance Project.

By the end of the fight, the hospital made limited admissions of wrongdoing and paid a fine of $1 million to the state and federal governments.

Moreover, a particularly strong patient advocate and leader in the mental health coalition became known as a local hero, winning election to the state legislature. And four prominent psychiatrists on staff at Fletcher Allen and members of the faculty of the University of Vermont School of Medicine were recognized with APA’s Profile of Courage Award for their efforts to safeguard their patients’ care (Psychiatric News, December 6, 2002). The four provided crucial testimony to state regulators amid threats of being fired for speaking out against the hospital’s plan.

In an 89-page decision, regulators gave the hospital the final go ahead to build the hospital’s massive, $365-million project.

More than 15 of those pages concern mental health services at the hospital. State regulators ordered the hospital to begin immediately an analysis of conditions in the current psychiatric inpatient unit and to collaborate with members of the mental health coalition to identify and undertake immediate improvements. The state also ordered the hospital to consult regularly with the coalition to finalize plans for a new, $17 million inpatient unit that will be housed on two floors of completely renovated space in an existing building on the hospital’s campus (see diagram). The hospital was ordered to submit final plans for improving the old unit and final designs for the new unit, including clear indication of "the recommendations as to the plan of each member of the Mental Health Task Force." The plans must address patient safety, improved access to outdoor space, and privacy.

The approval is clearly a sweet victory for the coalition’s varied members.

"It is a profoundly exciting experience to see the enormous power of a community that stretches from the consumer to the advocate to the practitioner," Ken Libertoff, director of the Vermont Association for Mental Health, told reporters.

David Fassler, M.D., APA trustee-at-large and state legislative affairs representative for the VPA, noted that "the process wouldn’t have worked so well without a team of dedicated consumers, advocates, and providers who were determined to hold folks accountable and to do whatever was necessary to ensure ongoing access to appropriate care for people with psychiatric illnesses." ▪