Signs O’ The Times, number 1:

Secretary of Administration Jeb Spaulding says that if Vermont’s need for acute psychiatric care remains high, the Shumlin administration is committed to opening the Berlin State Hospital at its full 25-bed capacity in summer 2014.

“I would be surprised if it doesn’t open with 25 beds,” he said Friday.

His statement, as reported by VTDigger, came after the Department of Mental Health informed lawmakers that psychiatric patients continue to experience longer and longer wait times, languishing in emergency rooms, jails and prisons due to a shortage of psychiatric inpatient beds. You may recall that after Irene, the Shumlin Administration wanted to move to a community-based system with an absolute minimum number of hospital beds — no more than 16 in any one facility, and far fewer overall than the 54 at the old Vermont State Hospital. Indeed, earlier this summer, key lawmakers were still indicating a desire to stick to 16 beds at the Berlin facility.

I don’t know what kind of progress the Administration has made with establishing that community-based system — it may well have been slowed due to the constant revolving door at the top of DMH — but it sure hasn’t done a damn thing to reduce the need for inpatient care.

Of course, the Administration and Legislature haven’t, ahem, budgeted for a 25-bed BSH. But Spaulding says they can “tweak the budget.”

Funny how there’s always room for a “tweak” when it’s something the Administration wants or needs, but the wallet is empty when it’s somebody else’s idea.

Signs O’ The Times, number 2:

Governor [Shumlin] says he is going to ask the Legislature next year to look at Vermont’s involuntary medication law to make it easier for doctors to administer medication to a state hospital patient who is refusing treatment.

… In Vermont, a doctor must seek a judge’s approval before administering medication to a patient who is refusing treatment, a process that can take two months or more to complete.

Actually, the average time is almost three months — and it can take twice that long or more. During that process, a patient is basically warehoused in one of the state’s rare inpatient beds — greatly exacerbating the strain on the system. And on caregivers, who have to deal with unmedicated patients every day. It also generates huge costs for lengthy and treatment-free hospitalizations.

Shumlin framed this as a long-term issue that was also a problem at the old Vermont State Hospital. Indeed, the law  apparently played a part in VSH’s decertification by the feds. And it’s one of the reasons that the Brattleboro Retreat is in danger of losing federal certification. Which would be, among other things, a huge blow to Shumlin’s master plan for mental health care.

There’s sharp disagreement in the GMD community (and Vermont’s Dem/lib community) on the issue of involuntary medication for psychiatric patients. Both sides do agree on one thing: the current judiciary process takes too long. They disagree on the remedy, of course; and if Shumlin plans to pursue this in the 2014 session, he’s going to have a hard row to hoe.

The Governor described this as a matter of giving “acutely ill patients” better treatment. But really, it’s of a piece with Jeb Spaulding’s commitment to a 25-bed BSH: it’s another sign that the current system is overtaxed. And it’s a sign that, while the Governor may be trying to craft a better system with better treatment options, he clearly has an eye on the bottom line as well.

Streamlining the involuntary-medication process would move patients in and out of hospitalization much faster. That will reduce the strain on the inpatient system and cut costs. Would it improve the quality of care? That’s up for debate. But when the Governor suddenly unrolls a proposal to fix a longstanding problem, there’s got to be a more immediate reason. In this case, that reason is the inadequacy of the post-Irene mental health care system.

And Governor Shumlin is slowly, painfully, executing a complete reversal on the issue, gradually expanding the inpatient side of the system. (By the time he’s done, the system will have almost as many beds as the old one. They’ll be spread around the state, which will create new challenges in staffing and specialty care, but that’s one of the drawbacks to Shumlin’s Big Idea.)

He’s being dragged along by reality, and he’s probably hoping to do it slowly enough that he can claim he hasn’t changed one bit. But he has.

p.s. Congrats to the Mitchell Family Organ (North) a.k.a. the Times Argus, Print Edition, for putting its thumb on the journalistic scale with its headline, “Shumlin: Forced Medication OK.” Yeah, that’s kind of the most emotionally freighted wording you could have chosen. Images of Nurse Ratched and Evil Mad Scientists come to mind. The M.F.O. (N) online version opts for the more neutral “Vt. Governor Wants to Ease Involuntary Medication.”