Care when it’s needed
Legislature must act swiftly to address crisis in psychiatric hospitals
If the crisis in Virginia’s psychiatric hospitals wasn’t clear before — and it should have been — the suspension of new admissions at five of the commonwealth’s nine facilities in 2021 put it into focus. The hospitals lacked the staff to safely provide care even as a state law required them to admit a greater number of patients.
Those problems have persisted and demand the legislature’s attention in January. Lawmakers will come armed with a new report about the extent of the problem and recommendations to address it, leaving them no excuse for inaction next year.
Molding Virginia’s mental health system to adequately meet public demand for services has vexed the commonwealth for decades. It arguably stretches back to 1773, when Eastern State Hospital opened in Williamsburg making it the first facility in the fledgling nation dedicated to the care and treatment of mental illness.
Since then, Virginia has tried to adopt policies consistent with best practices while also accommodating the growing need for services expected from the commonwealth’s population. Some ideas have worked, while others, however well intentioned, exacerbated the problem. That’s where Virginia finds itself again. In 2013, the son of state Sen. Creigh Deeds was denied a psychiatric bed while experiencing a mental health crisis. A few hours later, he attacked his father at their home in Bath County before taking his own life.
The commonwealth has spent the subsequent decade working to reform the mental health system to meet its many needs — from a rural resident in a mental health crisis seeking care to a criminal suspect whose actions may be the result of mental illness.
A joint legislative subcommittee formed after that tragedy advanced a number of promising reforms. These included requirements that all community service boards, which provide mental health care on a local level, expand services regardless of location.
The 2014 legislature also passed a “bed of last resort” law, which requires psychiatric hospitals to admit patients if a bed can’t
be found at another facility after an eighthour period. It meant to ensure that those in crisis would receive treatment rather than be left to fend for themselves.
The practical effect, however, has been to send admissions at psychiatric hospitals soaring. At the time five of Virginia’s nine hospitals suspended new admissions in 2021, then-Department of Behavioral Health and Developmental Services Commissioner Alison Land said the number of patients under temporary detention orders had increased 400% from 2013.
In that same period, the number of staff at those hospitals dwindled. DBHDS reported at the time it had 1,547 staff vacancies out of 5,500 positions. Inadequate staffing put patients and employees at risk; Land reported there were an average of 4.5 serious injuries per day at the time.
In 2022, the General Assembly directed the Joint Legislative Audit and Review Committee to study Virginia’s mental health hospitals and recommend changes that could improve conditions. That report, released this week, is eye-opening and necessary reading for lawmakers and citizens alike before the start of the next session.
JLARC found that seven of the nine hospitals operate at around 95% of capacity and three were routinely at 100%, well above the industry standard of 85%. It points to the “bed of last resort” law as the driving factor, since hospitals are required to admit patients under that statute.
The agency also found that hospitals are further stretched by competency hearings and other obligations to the criminal justice system; that staffing is a challenge due to low pay and poor working conditions; that oversight isn’t suitably robust; and that capacity in private hospitals could alleviate the space crunch in public facilities.
Here, then, are the legislature’s marching orders. Virginia has a habit of studying problems as a way of avoiding action, but there is no time to waste. The alarm bells are ringing, the red lights are blinking, and the crisis at Virginia’s psychiatric hospitals must be addressed now.