Overcrowding at Virginia’s public psychiatric hospitals is creating unsafe conditions for patients and workers, prompting a staff exodus and causing delays in care for those in crisis, according to a comprehensive study of the system.
The 159-page report by a body that oversees state agencies for the General Assembly found breakdowns in many facets of the nine-hospital system and recommended closing a troubled facility for children despite a decade of changes aimed at bolstering how the state cares for some of its most vulnerable residents.
The Joint Legislative Audit and Review Commission (JLARC) study concluded that Virginia is asking too much of its public facilities, while private hospitals in the state operate below capacity and could erase the burdens that are creating dangerous conditions at sister institutions by taking more patients.
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“The situation reflects an urgent need for immediate steps to be taken in order to improve the safety of patients, the safety of their staff and the overall quality of operations at the state hospitals,” said Tracey Smith, JLARC’s associate director.
The report found the following:
- All nine of the state’s psychiatric hospitals operated at 95 to 100 percent capacity during the last fiscal year, above the 85 percent industry standard considered safe for patients and workers.
- The capacity issues forced more than 8,500 people deemed a threat to themselves or others to be put onto a waiting list for a bed at a state mental hospital. At least 235 of those patients were never admitted, a violation of a state statute, known as the “bed of last resort” law, that requires public hospitals to accept patients if space can’t be found elsewhere.
- Nearly a quarter of jobs in the state hospital system are vacant — a rate that has more than doubled over the last decade. Workers are leaving the system in large numbers because of inadequate pay and unsafe working conditions, hurting quality of care.
- The Commonwealth Center for Children and Adolescents (CCCA), the only public hospital in Virginia for children in crisis, uses restraints at 20 times the national average, has troubling levels of patient-on-patient violence and self-harm, and is deficient on other metrics. The report recommends shuttering the facility.
- Law enforcement dropped off more than 1,400 people at a state hospital before staff members had admitted them to the facility. Some had urgent medical needs that the hospitals were not equipped to treat, and at least one nearly died as a result.
- Patients who do not benefit from mental health treatment, such as those with dementia and autism, are being admitted to state mental hospitals, jeopardizing their safety and taking up limited bed space.
- Virginia’s Office of the State Inspector General, which is tasked with investigating complaints at state mental hospitals, only examined about 115 of the more than 600 complaints it received during the last fiscal year.
The report is the latest red flag for Virginia’s mental health system, which Gov. Glenn Youngkin (R) called in crisis late last year before unveiling $230 million to add mobile crisis teams, fund intake centers and make other changes to improve care.
The pandemic created a surge in need for mental health resources in Virginia and exacerbated existing staffing and overcrowding issues at state hospitals, forcing officials in 2021 to stop new admissions at five of the facilities for a handful of months. The system is still recovering.
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Lauren Cunningham, spokeswoman for the Virginia Department of Behavioral Health and Developmental Services, which runs the hospitals, said it has worked to fix problems identified in the report, including reducing vacancies in direct patient care, housekeeping, food services and security.
“We are incredibly proud of our staff who dedicate themselves to this challenging and rewarding profession and help people stabilize and recover from serious mental illness,” she said in a statement.
Cunningham said the administration is not considering closing CCCA, which she said is hiring and using restraints less often than in previous years.
“Our focus right now is on making sure patients and staff alike are safe and receiving better services,” Cunningham said.
She emphasized the need for more robust community health services to prevent the need for inpatient psychiatric care at state hospitals.
Lisa Dailey, executive director of the Treatment Advocacy Center, said closing the CCCA was not a good solution, despite its problems.
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“This is the kind of thinking that has led to elimination of hospital beds for psychiatric care for decades, but ultimately it is not a solution that can succeed,” Dailey wrote in an email. “What happens to those who require that level of care? There is no adequate answer in closure of facilities.”
Nelson Smith, commissioner of the Department of Behavioral Health and Developmental Services, acknowledged that the state hospitals “have been struggling for years” with capacity issues and staffing problems created by covid-19.
The Office of the State Inspector General did not respond to requests for comment about the JLARC report.
The authors of the JLARC report spent a year analyzing data, visiting facilities and conducting about 100 interviews to produce the study, which grew out of an earlier one examining how the state is administering mental health services in local communities.
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“The state is very much relying too heavily on our state hospitals, and they are really feeling the pressure,” said Drew Dickinson, chief legislative analyst for JLARC and the project lead.
The report identified the bed of last resort law, which was passed in 2014, as one of the drivers of the surge in demand for state hospital beds. The law was a response to the 2013 attack on state Sen. R. Creigh Deeds (D-Charlottesville) by his mentally ill son, who later took his own life. A Virginia mental health worker failed to find a treatment bed for Austin “Gus” Deeds the day before, and the law was intended to prevent the scenario from happening again.
The study found that there has also been a rise in patients entering state hospitals from the criminal justice system, many of whom need to be restored to competency to face trial. Dickinson said it was probably the result of more awareness about the role mental health issues play in offending.
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The report found that these strains on capacity sometimes meant that patients couldn’t be moved to a different room if they presented a danger to themselves or others because there were no extra beds and that staff members couldn’t quickly intervene in confrontations because they were busy elsewhere.
Deeds, who also chairs the Behavioral Health Commission, said both Republicans and Democrats are to blame for the problems at the state psychiatric hospitals identified in the report. The Behavioral Health Commission will hear a presentation on the report Wednesday, and Deeds said he will examine its findings in more detail.
“I’m taking this report very seriously and trying to think as much as I can about what some possible solutions could be,” Deeds said. “Whatever problems there are have existed for a long time. We have to examine that, and that might mean we have to reexamine some of the things we have done.”
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