Evelyn Hockstein For The Washington Post
The Virginia commissioner in charge of behavioral health on Friday closed five of the state’s eight adult mental health hospitals to new admissions, a step she said is necessary to protect workers amid unprecedented staffing shortages.
The pandemic exacerbated overcrowding and inadequate staffing at the state’s psychiatric hospitals, which are required to admit some of the most challenging and often violent patients under involuntary detention orders.
Calling the situation an “immediate crisis,” Alison Land, the commissioner of Behavioral Health and Developmental Services, said about 30 percent of positions that directly support patients are vacant, with 108 people having resigned over the past two weeks, citing long hours and lack of safety.
Workers who left during coronavirus outbreaks early in the pandemic were able to get better-paying, less-stressful jobs elsewhere and have not returned, she has said.
“The result is a dangerous environment where staff and patients are at increasing risk for physical harm and where effective treatment to help patients recover is much harder to deliver,” Land wrote.
There are on average 4 1/2 incidents or injuries to staff or patients every day across state psychiatric facilities, with 63 serious injuries since July 1, she said.
New admissions are closed at Catawba Hospital, Central State Hospital, Eastern State Hospital, Piedmont Geriatric Hospital, and Western State Hospital, Land wrote in her letter, while Northern Virginia Mental Health Institute, Southern Virginia Mental Health Institute, and Southwestern Virginia Mental Health Institute can continue to accept patients.
The letter comes as state lawmakers prepare to convene for a special session in August to decide how to spend the first tranche of more than $4 billion — Virginia’s share of American Rescue Plan Act money — to help the economy recover and make investments for the future.
Gov. Ralph Northam (D), a pediatric neurologist, will propose devoting a “significant amount” of ARPA funding to increasing staff salaries, hiring workers and taking other actions to ensure the well-being of patients and staff at the mental health hospitals, spokeswoman Alena Yarmosky said.
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Lawmakers have been meeting for weeks to come up with proposals for how to use the money for mental health, and have discussed staff bonuses, expanding loan forgiveness programs in exchange for working in an underserved area and funding crisis centers as alternatives to emergency rooms and jails for people in crisis.
State Sen. Creigh Deeds (D-Bath), chairman of the Joint Subcommittee to Study Mental Health Services in the Twenty-First Century, supported the ideas, but noted that the pandemic money is one-time funding. He hoped lawmakers would come up with a long-term strategy to boost salaries in the special session.
“We are in a desperate situation,” he said. “I get why admissions had to be closed. I’m frustrated and saddened by it, but we’ll do what it takes to fix the issue.”
Anna Mendez, board president of the nonprofit advocacy group Mental Health of Virginia and executive director of the Charlottesville affiliate, Partner for Mental Health, attributed the bed shortage, in part, to years of inadequate funding of community based mental health services leading to an overreliance on inpatient treatment.
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Virginia should “double its mental health care spending, bringing it into to the top ten in the nation, so that our Commonwealth can better support its residents with mental illness and crises like these can be prevented in the future,” she said.
The Commonwealth Center for Children and Adolescents, which treats minors in Staunton, has a 57 percent job vacancy in direct patient care positions, which has caused the 48-bed facility to go down to just 18 beds, Jaime Bamford, the medical director at CCCA, said.
The center has seen increased aggression, suicidal thoughts and attempts, and psychosis as well as substance abuse and other behaviors among its patients, exacerbated by the isolation and stress of the pandemic, she said.
“It’s a really critical time for CCCA in providing safe supervision for the children in our care,” Bamford said in an interview Friday.
A report by the Centers for Disease Control and Prevention released last month found across the United States, adolescent girls’ visits to the emergency department for suicide attempts increased by about 50 percent from the early months of 2019 to the same period this year.
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A spokeswoman for Land did not respond to a request for comment on whether Land’s letter exempts the state psychiatric hospitals from a rule that says the facilities must provide the “bed of last resort” for involuntary detention if a bed cannot be found elsewhere.
Land has said the rule allowed private hospitals to decline the most challenging cases because the public hospitals had no choice but to admit them. Since the rule went into place in 2014, she said, daily admissions at public hospitals increased from about 4 to more than 18.
Northam last summer signed an executive order pausing the rule, due to the pandemic, but the order expired on June 30 after the coronavirus state of emergency lifted.
In her letter, Land called on private hospitals to admit more challenging cases given the dire staffing shortages at the public facilities.
In response to the letter, Julian Walker, a spokesman for the Virginia Hospital and Healthcare Association, said bed shortages mean people with acute psychiatric needs wait in emergency departments for hours or days, delaying care to other people.
“The challenges of this has ripple effect that can be felt across the continuum of care throughout the public health and private health system,” he said.
Private hospitals are also facing similar challenges as public ones, such as staffing shortages — meaning it wouldn’t be safe for them to take in certain patients, either, Walker said.
“We continue to see an increase in demand for these services … and this situation unfortunately may get worse before it gets better,” he said.
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