In a strange way, the disaster presented an opportunity that many state officials and mental health advocates had been seeking in vain for years. The state hospital had so many problems that the federal government decertified it in 2003; state leaders had been vowing to close it ever since, but were stalled by indecision about what to build in its place. “All of us thought that it was so shabby and so old and so difficult to make safe that it was time to replace it,” said Dr. Robert Pierattini, chief of psychiatry at Fletcher Allen Health Care in Burlington, the state’s teaching hospital. “But I don’t see any evidence that we can get by without a state hospital.”

While other states have shuttered psychiatric hospitals and sharply reduced the number of beds in an effort over the decades to place mentally ill patients in less restrictive environments, virtually all have kept at least one open, according to the National Association of State Mental Health Program Directors Research Institute. And none have had such an abrupt closure as Vermont’s hospital, which has forced the state to create alternatives at breakneck speed instead of the years it usually takes. The short-term result is patients requiring intensive psychiatric care scattered at facilities not equipped to handle the newcomers.

Fletcher Allen and the Rutland Regional Medical Center agreed to temporarily take some patients who would otherwise go to Vermont State Hospital, but they question how long they can continue, citing a rise in staff injuries and a chaotic environment on their psychiatric units. “It comes with an unacceptable level of risk,” Dr. Pierattini said. “We will make do for now, but what is our plan for creating a new system of intensive mental health care?”

Thomas W. Huebner, president and chief executive of Rutland Regional, said his hospital has needed to use emergency medication or restraints on agitated patients seven times more often in the 10 weeks since the floods than they normally do in a whole year. One challenge, he said, is that Vermont’s legal standard for allowing involuntary medication is among the strictest in the nation. And while every patient who refused treatment used to go to the state hospital, some are now at Rutland Regional and Fletcher Allen, where providers are not used to handling them.

“Much of the stress is just constantly monitoring the level of chaos versus calm and gauging what people can tolerate,” Dr. Pierattini said.