The Joint Legislative Audit and Review Commission (JLARC) study concluded that Virginia is demanding too much from its public facilities, while the state’s private hospitals are operating below capacity and could wipe out burdens that create conditions dangerous in sister institutions by accepting more patients.
“The situation reflects an urgent need for immediate action to improve patient safety, the safety of their staff and the overall quality of operations in public hospitals,” said Tracey Smith, associate director of JLARC.
The report revealed the following:
- The state’s nine psychiatric hospitals operated at 95 to 100 percent capacity last fiscal year, above the 85 percent industry standard considered safe for patients and workers.
- Capacity issues have forced more than 8,500 people considered a threat to themselves or others to be placed on a waiting list for a bed in a state psychiatric hospital. At least 235 of those patients were never admitted, a violation of a state law, known as the “bed of last resort” law, which requires public hospitals to accept patients who it is not possible to find space elsewhere.
- Nearly a quarter of jobs in the public hospital system are vacant – a rate that has more than doubled over the past decade. Large numbers of workers are leaving the system due to inadequate wages and unsafe working conditions, harming the quality of care.
- The Commonwealth Center for Children and Adolescents (CCCA), Virginia’s only public hospital for children in crisis, uses restraints 20 times the national average, has disturbing levels of patient violence and self-harm, and lacks means of restraint. other measures. The report recommends closing the establishment.
- Law enforcement officers dropped off more than 1,400 people at a state hospital before staff members admitted them to the facility. Some had urgent medical needs that hospitals were not equipped to treat, and at least one nearly died.
- Patients who do not receive mental health care, such as those with dementia and autism, are admitted to public psychiatric hospitals, putting their safety at risk and taking up limited bed space.
- The Virginia Office of Inspector General, which is charged with investigating complaints at the state’s psychiatric hospitals, has only reviewed about 115 of the more than 600 complaints it received in during the last financial year.
The report is the latest wake-up call for Virginia’s mental health system, which Gov. Glenn Youngkin (R) called in crisis late last year before unveiling $230 million to add teams crisis mobiles, funding reception centers and making other changes to improve care.
The pandemic has created a surge in need for mental health resources in Virginia and exacerbated existing staffing and overcrowding issues at public hospitals, forcing officials in 2021 to stop new admissions in five of the establishments for a handful of months. The system is still recovering.
Lauren Cunningham, spokesperson for The Virginia Department of Behavioral Health and Developmental Services, which operates the hospitals, said it has worked to address issues identified in the report, including reducing vacancies in direct patient care, housekeeping, food services and security.
“We are incredibly proud of our staff who are dedicated to this challenging and rewarding profession and helping people stabilize and recover from serious mental illness,” she said. said in a statement.
Cunningham said the administration has no plans to close the CCCA, which it This involves hiring and using constraints less often than in previous years.
“Our focus right now is to ensure patients and staff are safe and receive better services,” Cunningham said.
She highlighted the need for stronger community health services to avoid the need for inpatient psychiatric care in public hospitals.
Lisa Dailey, executive director of the Treatment Advocacy Center, said closing CCCA was not a good solution, despite its problems.
“This is the kind of thinking that has led to the elimination of hospital beds for psychiatric care for decades, but ultimately it is not a solution that can succeed,” Dailey wrote in a E-mail. “What happens to those who need this level of care? There is no adequate response to the closure of facilities.
Nelson Smith, commissioner of the Department of Behavioral Health and Developmental Services, acknowledged that public hospitals “have been struggling for years” with capacity and staffing issues created by covid-19.
The state Office of Inspector General did not respond to requests for comment on 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 a previous one examining how the state administers mental health services in local communities.
“The state relies too much on our public hospitals and they are really feeling the strain,” said Drew Dickinson, JLARC chief legislative analyst and project leader.
The report identifies the Last Resort Beds Act, passed in 2014, as one of the drivers of the increased demand for public 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 committed suicide. 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 that scenario from happening again.
The study also found an increase in the number of patients entering public hospitals due to the criminal justice system, many of whom need to be reinstated in order to stand trial. Dickinson said it was likely the result of greater awareness of the role mental health issues play in crime.
The report reveals that these capacity constraints sometimes meant patients could not be moved to another room if they posed a danger to themselves or others, because there were no extra beds and members staff could not intervene quickly in confrontations because they were busy elsewhere.
Deeds, who also chairs the Commission on Behavioral Health, said Republicans and Democrats are both responsible for the problems at state psychiatric hospitals identified in the report. The Behavioral Health Commission will hear a presentation on the report Wednesday, and Deeds said it will review its findings in more detail.
“I take this report very seriously and I’m trying to think as much as I can about possible solutions,” Deeds said. “Whatever the problems are, they have been there for a long time. We need to look at that, and that might mean we have to re-examine some of the things we’ve done.
