Hospitalization and Crisis

Hospitals - Voluntary Hospitalization - Commitment - Crisis Intervention - Emergency Evaluation - Suicide

Private insurance may cover a short hospitalization. Check carefully to see how much of the cost is covered; most policies have very limited coverage for mental health or psychiatric problems. Check with your insurance company about continuing a child's coverage after the age when coverage generally stops (usually 19, if they are not attending college); it may be possible to continue coverage past that age on a parent's policy.

If the patient is seriously disturbed, violent, or suicidal, but refusing to go to a hospital, the family may have to consider how to accomplish involuntary hospitalization. This may mean use of the Vermont State Hospital (VSH) in Waterbury. VSH, the Fletcher Allen Health Center in Burlington, and Central Vermont Hospital in Berlin are currently the hospitals available for involuntary admission in Vermont. The Brattleboro Retreat is a 'designated' psychiatric hospital by the State Department of Mental Health, but is rarely used by the State for involuntary hospitalization.

Medicaid may cover hospitalization expenses if there is no private insurance coverage. Personnel from the Community Mental Health Center and/or the Department of Social Welfare may be able to assist you with an application for Medicaid.

Some Community Mental Health Centers have an alternative arrangement for individuals in crisis, such as 'crisis beds' at a group home or other facility which are used to provide care in the acute episode while avoiding hospitalization.

Helpful Hint: Voluntary patients in psychiatric crisis may be referred by their doctors to:

• Fletcher Allen Healthcare (hospital) in Burlington
• Central Vermont Medical Center in Berlin
• Southwestern Vermont Medical Center in Bennington
• Rutland Community Hospital
• The Brattleboro Retreat
• Windham Psychiatric Care Center in Bellows Falls
• Dartmouth Hitchcock Medical Center, Lebanon, NH
• Chesire Medical Center, Keene, NH
• Franklin Medical Center, Greenfield, MA

Helpful Hint: The patient must give consent before a staff person can release certain information; ask to have them sign an authorization for release of information. If the patient does not want certain information released, the form can specify which information can be released.

As soon as possible, family members should make an appointment with the treatment team to discuss the following:

• What is the diagnosis?
• What is the treatment plan?
• What are the specific symptoms about which they are most concerned? What do they indicate? How are these symptoms being monitored?
• What medications is the patient getting? Is the response what was hoped for? What are the possible side effects?
• Has the doctor or nurse discussed with the patient the diagnosis, medications, and treatment plan?
• How often will you be able to meet to discuss progress?
• What is the aftercare plan when the patient is released from the hospital?

• Assistance in securing appropriate housing, such as group homes, supervised apartments, independent living and community care homes.
• Assistance in applying for appropriate public benefits, such as general assistance, medical assistance, and Social Security income.
• Assistance in the orderly transfer to community-based mental health services, such as timely psychiatric medication reviews, supportive counseling, and a case management system of coordinated care and treatment which provides a network of services through an identified program and staff at the Community Mental Health Center.

Serious mental illness is usually a long-term condition; families should plan ahead even if they are fortunate enough to have to deal with only one or two episodes. Families who have lived with mental illness for a long time often describe how carried away they were at the time of the first episode and how they sometimes imprudently committed themselves to expensive treatments in expectation of a cure that was never to be realized.

Remember, the most expensive care is not necessarily the best! Money will not buy back the health of our loved ones. Private care is not necessarily better than public. What most patients need is continued medication management, a safe place to live, an opportunity to develop or relearn social skills, and someone who cares about them. The best place to look for comprehensive services over a long period of time is through the local Community Mental Health Centers. If such services do not seem to be available to your friend or family member, contact NAMI-Vermont – and we will be able to help you.

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