Should the Vermont legislature vote to build a new state mental hospital in Waterbury or Burlington to replace the now-decertified Vermont State Hospital in Waterbury? That question will be at the top of the 2008 legislative agenda. Here's one view: "Building an enormously expensive new replacement facility for the Vermont State Hospital, at the urging of a state bureaucracy and its state employee union allies, over the objections of the Public Oversight Commission and most advocates for the mentally ill, will create a large and unnecessary burden for a generation of Vermont taxpayers, while offering inadequate recovery services for Vermonters with mental illness. It is not sound public policy." That's the conclusion of a new report on the future of the Vermont State Hospital and the treatment of severe mental illness in Vermont, issued by the Ethan Allen Institute on Nov. 26. The report, entitled Don't Send Me to Waterbury!, is a cloudburst of cold water on the ambitious plans of the Department of Mental Health and a special study group commissioned by the Democratic leadership of the legislature. Both have proposed either renovating the 110-year old hospital, or creating a new state-run institution in Waterbury. The department hasn't settled on a final proposal yet, but cost estimates for variants of this option run up to $100 million. That would represent a very large increase in the state's bonded debt and annual debt service, at the expense of competing state and local projects. Based on a middle range of assumptions from a report commissioned by the department, Vermont taxpayers could end up paying $276,000 per patient per year as the state share of an overall cost of $535,000 per patient per year. This assumes the capital cost is amortized over fifty years, and the 53 beds of a new facility are occupied every day of every year. Mental health advocates, many of who have had traumatizing experiences at the thrice-decertified state Hospital, hailed the report, especially its sharp criticism of forced drugging and use of physical restraints as dehumanizing and unacceptable behavior, a practice which has brought sharp criticism of the Waterbury hospital by the U.S. Department of Justice. They also agreed that "public policy and practices must be shaped in close partnership with the dedicated community of Vermonters who have lived experience with mental health crises, rather than shaped by the preferences of bureaucrats, clinicians, and the employee labor union." Around a dozen present inmates with a history of criminal acts need to be kept under lock and key at Corrections facilities, either in Vermont or elsewhere. But for the three fourths of the present inmate population, the emphasis ought to be on assisted recovery in small, safe, secure and far more cost-effective community settings. The report urges the Department and the designated mental health agencies to welcome new private providers of services, such as residential recovery housing and faith-based and peer-run drop-in centers. Among such programs already in operation are Safe Haven in Randolph, Second Spring in Williamstown, Home Intervention in Montpelier, and the very successful Fairweather Lodges in Minnesota. The report calls upon Vermont's community hospitals "to evolve to holistically address the physical and mental health of the people in their communities, and address the issue of forced medication as a serious question of medical ethics." It pointedly asks the Department of Mental Health to abandon its "relentless quest for the construction of new high-cost state-owned mini-VSH facilities," whether in Waterbury, the Fletcher Allen Health Care Burlington campus, or elsewhere. So, after decades of moving toward treating mental illness in community settings, who still wants to build new state mental institutions, that are likely to continue the awful track record of the Hospital in Waterbury? The answer is, simply, the state's mental health bureaucracy and especially the Vermont State Employee's Association. That union has worked aggressively with Democratic politicians like Senate President Peter Shumlin to mandate a new or completely renovated facility in Waterbury, and to slip through legislation favoring continued employment for the 200 VSEA employees now working at the old Hospital. That's not a great idea, the report says. "Anyone [employed by the Hospital] who has been a part of the dehumanizing seclusion, restraint and forced drugging.ought to seek other types of employment." And there is a pointed message to legislators: "legislators will need to keep in mind the interests of mental patients and of their taxpayer constituents when the VSEA presses for its special interest in preserving state employee jobs." That's good advice, from the standpoint of patients and taxpayers alike.