All in the Name Brattleboro Retreat Provides a Safe and Healing Environment

There are times in life when adults and children who suffer from clinical depression, post-traumatic stress disorder, bipolar disease, or other mental illnesses need intense treatment. But many never seek professional help because they don’t want to stay in a hospital psychiatric unit or encounter people who know them professionally.

Brattleboro Retreat in Brattleboro, Vt. offers a different option. “The word ‘retreat’ is a double entendre that means to go away or get away to a safe place. And we certainly provide that,” said Rob Simpson, president and CEO of the 150-licensed-bed regional psychiatric and addiction facility which served people from 20 states across the nation last year.

Unlike most hospitals, the retreat offers a relaxing atmosphere. Statuesque trees spread their leafy branches between buildings, and rooms have views of the West River, which runs along the campus perimeter. “We look like a New England college with lovely, golden brick buildings; it’s a Currier and Ives setting, and most rooms are private and have water views so patients experience a sense of calm,” Simpson said.

“We are a nonprofit, and the community at large embraces us, so there is also no sense of stigma here,” he continued, explaining that many of the retreat’s 550 employees live in Brattleboro or the surrounding Vermont towns.

The retreat serves children, adolescents, and adults via hospital settings, day programs and outpatient care. It also has an assessment center where people can receive medical and psychiatric evaluations on a walk-in basis 24 hours a day.

Many patients aren’t ready to return to their stressful lives when they leave the hospital, so the retreat includes a program that some patients use as a way to transition back to their lives. Patients can stay in the Ripley Building for $20 a day, attend programs that include counseling during the day, and eat in the retreat’s cafeteria or walk downtown to enjoy a variety of restaurants. “The building is set up like a hotel with a concierge service,” Simpson said.

Several new programs have been created over the past few years. One is an inpatient, seven- to 10-day program for lesbian, gay, bisexual, and transgender adults seeking help with depression and/or alcohol and drug abuse.

“It’s for people with mental health and gender-identity issues,” said Simpson. “They often find that traditional units don’t understand the stigma they face or the problems they have with daily living.”

Another success is the program for ‘uniform service’ workers, including veterans, police officers, and firefighters. “These are people with high-stress jobs, and many suffer from post-traumatic stress disorder, depression, alcoholism, substance abuse, and family discord as a result of seeing and dealing with trauma every day,” Simpson explained. “They are tough, and usually don’t ask for help. But in this program, they can be with others who have similar roles in society.”

Participants stay in two renovated homes on the campus where they receive psychiatric support, take part in group sessions, receive counseling and medication if needed, and take classes in yoga and mindfulness.

Simpson said caregivers at the retreat looked at best practices for this population when they created the program. Many are suffering as a result of a traumatic incident they were involved with and need to understand it in a new way.

“For some, it may be one horrific event, such as the death of a child, while others have become numb and fearful of going out on yet another call,” Simpson told HCN, noting that veterans face their own challenges when they have been traumatized and return to civilian life. For example, when a car backfires or they hear a loud noise, they sometimes experience flashbacks and react as if they are still in Iraq or Afghanistan.

The program has served people from large cities such as Boston and New York, as well as small towns as far away as Nebraska, who appreciate the anonymity of getting help on a campus where they don’t know anyone.

For this issue and its focus on behavioral health, HCN goes behind the scenes at Brattleboro Retreat to look at the many ways it lives up to its name.

Through the Ages

The 117 year-old institution, whose roots go back to 1834, was founded by a woman named Anna Hunt Marsh, who felt that the mentally ill were unfairly stigmatized.

“She donated $10,000, which is about the equivalent of $2 million today, to open up the retreat as a hospital. It was originally called Vermont Asylum for the Insane,” Simpson said.

It was one of the first 10 private psychiatric hospitals in the U.S., and its philosophy was based on what was called ‘moral treatment,’ which meant treating patients with dignity and respect in a caring, family-like environment that included meaningful work, cultural pursuits, wholesome nutrition, and daily exercise. “We had a farm here years ago because people used to spend most of their lives with us,” Simpson said.

Unfortunately, prejudice against the mentally ill still exists. “There is a lot of stigma in this country toward people whose brains are not working correctly,” Simpson explained. “And mental illness is a brain disease which needs to be treated just like cardiac disease or cancer. Yet we stigmatize people with it and say ‘something is the matter with them,’ which people never say when someone is diagnosed with cancer or another medical condition.”

Simpson has facilitated many changes at the retreat since he took the helm in 2007. They include new programs, rebranding the facility’s image, a complete renovation of its psychiatric unit, and streamlining the admissions process. “When people call here, it is a quick process to get to ‘yes,’” Simpson said, adding that admissions have risen by 54{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} since 2007 and were up by 23{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} last year.

The admission process is simple: physicians can call and get a quick answer or individuals can fill out a form on the Internet or talk to someone at the retreat and get a response within hours. After asking key questions, the coordinator determines what program will best suit their needs and they are often admitted within 24 hours.

The Brattleboro Retreat’s Department of Outreach and Education took home six awards at the 2011 Spring Symposia of the New England Society for Healthcare Communications. And last month, Simpson received the Grassroots Champion Award from the American Hospital Assoc. in honor of his attention to patient care and advocacy for people across the state with mental illness.

Those awards and others over the years have come in recognition of a wide array of programs covering all age groups and a number of behavioral health issues. And this portfolio continues to grow.

Starting Young

Indeed, a new program for young adults ages 18 to 28 will begin in the fall, and Simpson said it was created in response to their special needs. Symptoms of mental illness that have been latent, but are biologically or genetically based, typically emerge during this age period.

In addition, this demographic group is dealing with stress caused by the high unemployment rate and the fact that many are forced to continue living with their parents as a result. “It’s a time of vulnerability, and is also the time when major mental illnesses usually occur,” Simpson said.

Younger children who need help with mental illness also find it at Brattleboro Retreat. In August of 2008, the retreat consolidated several programs and created a new one called BRIDGES. The acronym stands for Brattleboro Retreat’s Individually Developed Guided Educational Services, whose goal is to provide local students with a quality education while they receive psychiatric care.

Simpson said Brattleboro Retreat is the designated children’s hospital in Vermont for children who require inpatient care for mental illness. However, the program also serves youngsters from other states. “We have a Medicaid contract with Massachusetts, and we see children from Springfield, Longmeadow, Greenfield, and many other cities and towns,” he said.

Some children are hospitalized there after suffering abuse and/or neglect. “They are depressed or have post-traumatic stress disorder that is a reaction to trauma they have experienced. We also see kids with autism-spectrum disorder, which is very difficult to treat. Children who have it often are depressed, have learning disabilities, and lack self-worth,” Simpson said. “Some have been bullied and engaged in self-harming behaviors which they learn at school or on the Internet.”

Other young people have early-childhood schizophrenia, bipolar disease, or any number of psychiatric conditions. “Although there is some controversy over diagnosis, our approach is to deal with the behaviors they exhibit within the context of their families. Our real thrust is to get them back on course,” Simpson said.

When it comes to the younger population, the retreat has a wide range of programs in place to provide assistance. It even has a fully accredited school for children in kindergarten through grade 12. Some are sent there by their school districts, while others are in programs at the facility. “On any given day, we have 75 to 100 kids in our Meadows School,” Simpson said.

One valuable component of their program is therapeutic recreation. The retreat offers a ropes course, a gym, game rooms, tennis courts, and more. “Play is important in children’s lives. It’s their work. But children with mental illness have forgotten how to play or have body anxiety. Our staff is trained to evaluate them and get them on course so they play better,” Simpson said. “It’s one of the benefits we offer that a community hospital does not have. We really try to create special services for people who need them.”

Another area of treatment is a dual-diagnosis program for people who suffer from mental illness and addiction. Many have used alcohol or drugs in an attempt to make themselves feel better, because they have never been correctly diagnosed or treated. “It’s an inpatient psychiatric and addiction program with 21 beds,” Simpson said.

Addiction is also addressed via an outpatient program called Starting Now. It’s based on the 12-step approach of Alcoholics Anonymous, combined with group and cognitive behavioral therapy and special activities.

In addition to hospital and day programs, Brattleboro Retreat conducts about 15,000 sessions of outpatient counseling each year through its Anna March Behavioral Health Clinic.

Life-altering Experiences

Most all of the programs at Brattleboro have been enjoying steady growth in recent years due not only to the quality of those initiatives and solid track records for success, but also what amounts to successful marketing, or branding, efforts that have made the facility more visible.

“We have always been here, but we have been generating a greater awareness of what we offer,” Simpson said. “We provide people with a choice. They can stay locally or come to us.”

And when they do, they can rest assured that they will be treated with compassion and caring in a pastoral setting that truly constitutes a retreat from life.