A New Standard of Care for Mental Health Treatment in Vermont

Residents of the new River Valley Therapeutic Community Residence in Essex, Vermont wake up in private rooms, take meals in a bright dining area with forest views, and can choose to garden or create art in common areas during the day.

It may sound like a resort, but the River Valley Residence is a 16-bed secure mental health facility for adults in need of a high level of psychiatric treatment. Jointly designed by Freeman French Freeman and Lavallee Brensinger Architects, the 17,000 square foot building seeks to bring a new standard of care to Vermonters facing severe mental health challenges.

The new facility is a far cry from the days when most of Vermont’s psychiatric patients were crowded into the Vermont State Hospital in Waterbury, built in the late 1800s. At its peak in the 1930s the Waterbury campus housed over 1,700 patients with conditions ranging from alcoholism to severe mental illness. Those numbers declined in subsequent decades, but the facility still housed dozens of patients when it was destroyed by Tropical Storm Irene in 2011.

While catastrophic, the destruction of the State Hospital allowed the State of Vermont to completely re-imagine  how it cares for people with mental illness. The new River Valley Residence reflects the latest thinking in mental health architecture, where the building’s design has a major impact on patients’ care and recovery.

A primary objective in designing the new facility was to create a home-like environment for residents.  On the outside, this goal is reflected in the structure’s gabled roofs, clapboard siding, quaint front porch, and landscaped courtyard. On the inside, residents enjoy private bedrooms with built-in wood furniture, full-size beds, a comfortable window seat, and a separate bathroom with shower.

The two residential wings meet at a central core of communal spaces. A teaching kitchen for residents’ use faces the dining room and gives the space a home-like feel. A large multi-purpose room with an LED fireplace has ample space for group therapy sessions, staff meetings, and social events. An adjacent “living room” has a more intimate, home-like feel for playing games or watching television. A separate art room, exercise room, and greenhouse provide additional options for resident activities and therapy.

Nature plays a big role in the new facility as well. Located in the Woodside Natural Area, the aptly named River Valley Residence is surrounded by nature on all sides. A secure courtyard with walking path, gazebo, raised garden beds, and lush green lawns provides plenty of opportunities for fresh air and sunshine. Nature scenes by Vermont artists adorn interior walls.

Studies have shown that amenities like these have real benefits. When patients are less stressed, they make faster and more lasting progress. This may help shorten stays, which can vary from six  months to two years for most people. Employees fare better, too, which can reduce staff burnout and improve employee retention in a profession where qualified workers are in extremely short supply.

The serenity and beauty of the place can make you forget this is a secure facility, just one step down from a Level 1 Psychiatric Hospital Unit. This means residents are no longer in acute crisis, but still must be carefully monitored 24/7.

Balancing safety and autonomy is reflected in every aspect of the design. Window glass is replaced with polycarbonate glazing, for example, which is scratch- and shatter-proof. Plumbing fixtures and door hardware have been specially designed to prevent patients from harming themselves or others.

Governor Phil Scott and community leaders officially opened the new River Valley Therapeutic Community Residence on May 5, 2023. The opening is timely, given the sharp rise in mental illness in recent years. National polls show Americans’ assessments of their own mental health is the lowest it’s been in 20 years, and Vermont has a higher prevalence of mental health and substance use disorders than all but six other states, according to Mental Health America.

The new facility will reduce pressure on hospital psychiatric units and emergency rooms, which often serve as overflow beds when psych wards are full. It also allows the state to close a temporary 7-bed facility in Middlesex, which has long outlived its lifespan since it opened in 2013.

“River Valley represents a huge step forward for mental health care in Vermont,” says Shawn Brennan, Project Manager and Vice President at Freeman French Freeman. “We are immensely proud to play a role, however small, in improving lives for people with severe mental health challenges and their families.”