RICHMOND, Va. (WRIC)–More than half of Virginia’s state-run mental health hospitals aren’t accepting any new patients and there is still no concrete timeline for when admissions will resume.
The Virginia Department of Behavioral Health and Developmental Services made the announcement on Friday. The change is impacting five of eight total facilities, including Catawba Hospital, Central State Hospital, Eastern State Hospital, Piedmont Geriatric Hospital and Western State Hospital.
“Without doubt, the pandemic drove many workers to positions that pose less risk to their personal health and well-being and shattered an already fragile staffing milieu,” DBHDS Commissioner Alison Land wrote in a letter to partners and providers. “Despite our aggressive recruiting and retention strategies, state hospitals continue to lose staff while admissions continue to rise. It is no longer feasible to operate all state beds in a safe and therapeutic environment.”
DBHDS declined an interview request on Monday.
Former employee says problems aren’t new
Katie Stuart, a former patient recovery specialist and forensic technician, said many of the problems driving staff shortages existed before COVID-19 came along. She said she left her job at Central State Hospital in Petersburg, Virginia in 2019 after three years of employment.
“Nothing has improved. Things have only gotten worse,” Stuart said.
“I’ve had punches thrown at me. I’ve had feces thrown at my face. I have been chased. I have been threatened to be raped, beaten and kidnapped,” Stuart continued. “It would take sometimes 10 to 15 minutes for a security person to get there and help the situation out.”
According to DBHDS, many staff members have cited long hours and lack of safety as their primary reason for leaving in exit interviews.
The letter said there have been 63 “serious injuries” among workers and patients just since July 1. The agency said they are seeing an average of more than 4 incidents per day across all state facilities.
In total, DBHDS reports having 1,547 unfilled direct patient support positions out of about 5,500 total employees, with 108 new resignations just over the past two weeks.
Stuart said low pay is also driving people out the door.
Even with a college degree in psychology, Stuart said she made less than $25,000 annually. While she enjoyed helping patients, especially after dealing with her own mental health struggles, she said she currently makes much more as a bartender in Richmond.
“You have to put your money where your mouth is. No one is going to put their lives and families at risk for pennies,” Stuart said.
Low morale meets rising admissions
With staff morale low, DBHDS said the number of temporary detention order admissions has risen by 392 percent since 2013. In other words, while state-run facilities used to admit less than 4 of these patients per day, that has now increased to at or above 18 patients per day, according to state data.
In her letter, Land cited the Commonwealth’s “Bed of Last Resort” law as a pivotal shift contributing to this trend.
The legislation, which took effect in 2014, required Virginia’s mental health hospitals to accept patients as a last resort if they couldn’t find a bed elsewhere.
Sen. Creigh Deeds (D-Bath) pushed for the law after his son died by suicide in a mental health crisis.
“Previously, people determined to be a danger to themselves or others were not given a bed. They were basically put on the street and that was an untenable situation,” Deeds said in an interview on Monday. “Since the legislation passed, the reality is a lot of the private hospitals have used that to change their business model to push the toughest cases to the state hospital system.”
While Deeds points to the pandemic–not the policy change–as the driving factor behind recent issues, he is open to hearing proposals on how to adjust state law to meet this new reality.
In the meantime, Land is calling on private partners to step up.
“The Commonwealth needs all available private beds for temporary detention treatment open to accept patients, even those patients that might be challenging, or might need behavior management. In addition, the Commonwealth needs every possible step down in long-term care facilities to be ready to accept patients who are ready for discharge from state facilities,” Land wrote.
Can federal COVID-19 relief funds help?
Deeds said the General Assembly needs to urgently increase funding for employee salaries and security at state-run hospitals, as well as preventative community support services.
“We’ve increased funding for mental health services by over $100 million just in the last few years. But that’s not enough,” Deeds said.
In a special session set for early August, Deeds said lawmakers should look at using federal coronavirus relief funding from the American Rescue Plan for one-time bonuses for state employees working in the mental health field.
Deeds said the General Assembly may also be able to use that money for facility improvements like new HVAC systems and roof repairs.
However, when it comes to long-term, recurring funding commitments like salary increases, Deeds said lawmakers will likely have to revisit that in the 2022 regular session.
“That’s not something we can deal with using one-time funding because it’s not coming back next year,” Deeds said.
Right now, Land said the state is trying to use emergency facility funds to procure additional contract staff. They are also planning to award recruitment and retention bonuses. Notably, she said those funds will only last through the first quarter of this year.
Police chiefs say the system is ‘broken’
Meanwhile, the Virginia Association of Chiefs of Police is raising the alarm about widening gaps in treatment.
Law enforcement groups were already frustrated by long wait times and strained resources in cases where officers are asked to carry out emergency commitment and temporary detention orders.
In a statement, the VACP called the current situation another symptom of a broken mental health system.
Law enforcement does not have a viable choice: if an ECO/TDO is ordered and there is no psychiatric bed, the only option is street release. This is not a viable or responsible option for the treatment and care of an individual in mental health crisis.
More than 25 years ago, Virginia made a verbal commitment to community-based mental health care to eliminate the use of state institutions. The verbal commitment has never been realized.
Law enforcement cannot answer this lack of capacity nor meet the expectations of the public when it comes to mental health care. Virginia is in a state of crisis, and no one is listening.Virginia Association of Chiefs of Police