Eastern State Hospital in James City County is one of Virginia’s eight publicly run mental hospitals, which have struggled with understaffing and an influx of psychiatric admissions. Expanded mental health services under Medicaid were intended to reduce admissions at state-run facilities. (Virginia Department of Behavioral Health and Developmental Services)
More than half of Virginia’s state-run mental hospitals are immediately closing to new admissions, the Department of Behavioral Health and Developmental Services announced Friday.
The abrupt order from DBHDS Commissioner Alison Land comes amid a workforce crisis that’s resulted in a “dangerous environment where staff and patients are at increasing risk for physical harm,” she wrote in a letter to providers across the state.
Five facilities — Catawba Hospital, Central State Hospital, Eastern State Hospital, Piedmont Geriatric Hospital and Western State Hospital — were ordered to reduce their bed capacity and consolidate staff. As a result, those hospitals will “temporarily” close to new admissions, Land wrote, though she gave no indication as to how long the order would last.
The dramatic reduction in beds is a new low point for the state’s beleaguered mental hospitals, which have been struggling for years with an unsustainable spike in patient admissions. In 2014, Virginia passed legislation that’s now commonly known as its “bed of last resort” law. The bill was sponsored by Sen. Creigh Deeds, D-Bath, after his own son killed himself and seriously injured Deeds during a mental health crisis.
Under state code, Virginia’s psychiatric hospitals are required to admit patients after an eight-hour period if a bed can’t be found at another facility, including private hospitals with behavioral health units. As a result, those private hospitals have become more and more reluctant to admit psychiatric patients, especially if they’re experiencing complex or aggressive symptoms.
The burden has fallen on state hospitals to accept those patients, resulting in a surge of new admissions over the last several years. Increasingly, the state is handling what are often referred to as “inappropriate admissions” — patients with complex medical needs that can’t be treated in the public psychiatric facilities.
Since the law went into effect, the number of patients admitted through temporary detention orders — which mandate mental health evaluations and treatment — has risen from 3.7 a day to 18 or more a day, a 392 percent increase, Land said.
“Keep in mind that all operational activity to support and treat this huge increase in patients also increased proportionally,” she wrote. But over the same time period, staffing levels have plummeted across the facilities. Nearly 30 percent of all positions are unfilled, with vacancy rates closer to 40 percent in some hospitals. The Commonwealth Center for Children and Adolescents — the only state hospital that can accept minors — is only operating 18 of its 48 beds due to low staffing levels.
“We have experienced 108 new resignations over the past two weeks,” Land wrote. “For years, DBHDS has attempted to cushion its staffing levels with international nurses, locum tenens [temporary staffers] and other staffing contracts. Not only are these staffing contracts incredibly expensive — sometimes three times our regular staff salaries — but now the contract staff are increasingly not renewing or leaving before their contract is over.”
Those shortfalls have made it impossible to safely treat patients, according to DBHDS. Land said there have been 63 serious injuries among staff and patients since July 1, with an average of 4.5 serious incidents across the hospital system every day.
The conditions give Lane “the responsibility (and the authority)” to halt new admissions “to protect the safety of her staff, patients, and facilities,” Alena Yarmosky, a spokeswoman for Gov. Ralph Northam, wrote in an email on Friday.
“Despite significant investments from the state, Virginia’s mental health hospitals have operated at extremely high census levels for several years—and the COVID-19 pandemic has made this situation even more challenging,” she added. “That’s why Governor Northam will propose a significant amount of federal American Rescue Plan funding go towards boosting staff salaries, hiring critical workers, and ensuring the well-being of patients and staff.”
As beds are consolidated, DBHDS will work with each of the five facilities on a plan for merging staff and discharging patients, according to spokeswoman Lauren Cunningham. Lane said that the agency will continue to follow the necessary safety procedures and that the reduction in bed space will come “through attrition.”
What’s not immediately clear, though, is how Virginia’s mental health infrastructure will be affected by the sudden loss in beds.
For months, law enforcement officials have sounded alarms over long wait times in local emergency rooms, where officers and patients often spend days waiting for a psychiatric bed to open at a state or private facility. DBHDS is urging hospitals across the state to accept new patients, “even those patients that might be challenging, or might need behavior management.”
“My sincere hope is this admissions closure will not last a day longer than it needs to,” Land wrote. “We will keep working diligently to find solutions to improve staff to patient ratios and plan to reopen beds incrementally as staffing levels improve.”
Julian Walker, the vice president of communications for the Virginia Hospital and Healthcare Association, said that private hospitals regularly discuss capacity concerns with DBHDS and would accept new psychiatric patients “if there are opportunities and beds available.”
“If patients that can’t be accommodated in the state system can be accommodated in a private hospital, that will be evaluated by the clinicians and the caregivers,” he said. “But at the same time, speaking in generalities, if there are patients who have specific needs and challenges that are to a degree that would make them disruptive or have outbursts toward staff or other patients, that’s a factor in the evaluation as well.”
Walker said that private hospitals, which generally have more beds than state-run facilities, have also seen a dramatic increase in psychiatric needs throughout the pandemic. Systemically, staffing and capacity are a huge concern for Virginia’s overall mental health system.
Jennifer Faison, executive director of the Virginia Association of Community Service Boards, told the Mercury that workforce shortages are the “primary challenge” facing local agencies, which provide safety net services for patients with mental health disorders. Many private hospitals are also experiencing huge patient backlogs, including Children’s Hospital of The King’s Daughters in Norfolk, which currently has over 1,600 children on the waitlist for its mental health program.
“The unfortunate reality right now is that the strain the state system is experiencing is also being experienced by the private hospital community, in terms of staffing, in terms of capacity,” Walker said. “The reality is that the difficulties being experienced now may worsen before they get better.”
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