Five of Virginia’s eight state-owned adult mental health hospitals will be closed to new admissions temporarily, due to staff shortages. On Friday, Department of Behavioral Health and Developmental Services Commissioner Allison Land sent a letter announcing the shortages, citing 1,547 direct patient support staff vacancies out of about 5,500 state staff, with 108 resignations occurring in the past two weeks. Contract staff are also leaving, due to “unrelenting stress, required overtime,” and a “dangerous environment.”
“As more state and contract staff are leaving, those left behind must carry on all aspects of patient care without adequate reinforcement,” Land wrote. “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.”
“There have been 63 serious injuries of staff and patients since July 1st and we are currently experiencing 4.5 incidents/injuries per day across the state facilities,” she wrote.
Land said the admissions closures were temporary until staff-to-patient ratios improve. Land has repeatedly warned legislators about low staffing levels at the state’s hospitals. The problem predates COVID-19, but the pandemic made the problem worse.
“We’ve been working on this issue for years and years before I came, and the picture just keeps looking bleaker, and not better, I have to say,” Land told legislators in April. At that time, Land said there were 1,000 state staff vacancies.
“We’re not only challenged in our facilities by the difficult job descriptions, the high-risk job descriptions, but also that direct-care compensation falls well below market value and so it’s just not competitive. So we’re looking at options including raising salaries to the market rate and other ways to attract and retain employees,” she told the legislators.
In her letter Friday, Land explained that the bed of last resort law is contributing to the higher amount of patients in state facilities. The law requires state mental health hospitals to accept emergency patients if no space is available for them in private facilities within eight hours. In 2018 The Daily Progress reported that the law, adopted in 2014, was contributing to pressure on the state facilities. In 2020, even as hospitals saw fewer patients for many kinds of treatment, there was an increase in patients seeking treatment for substance abuse and mental disorders.
In the April meeting, Land said admissions delays force law enforcement to stay with some patients for hours or longer. After Land announced the admissions closures Friday, the Virginia Association of Chiefs of Police warned that the closures could force officers to release patients who need emergency commitment.
“Law enforcement’s role is to transport people who are subject to emergency commitment orders (ECO) to hospital emergency rooms for medical clearance while the search begins for a psychiatric bed. If a bed is located in a private hospital first, or in a state institution as a ‘bed of last resort,’ then a temporary detention order (TDO) is issued,” a VACP statement said.
“The law enforcement officer then continues the transport to the mental health facility for detention and treatment. That’s if the system is working. With the lack of bed capacity and medical and mental health workers, there is simply no room at the inn,” the statement said.
The statement continued, “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. The mental health system says it lacks capacity to meet the needs of the mentally ill. 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.”
Mental Health of America of Virginia Executive Director Bruce Cruser told The Virginia Star, “The problem has been building for a long time, and the roots are in the state’s failure to sufficiently fund a community system of care that would prevent many people from having to go to the hospital.”
Cruser said, “The mission of state hospitals should be providing long term care, with short term crisis care handled by community hospitals and other community programs and facilities. Private hospitals do take most of the mandatory treatment patients, but since the ‘bed of last resort’ legislation over the last several years private hospitals have taken a smaller percentage of these patients, resulting in the state hospitals having to take more and more.”
Cruser said the state should work to add and retain staff. He also called for expanding eligibility for local facilities like crisis receiving centers.
In her letter, Land called for private facilities to help meet the need. In a Saturday letter to Land and other officials, Virginia Hospital and Healthcare Association (VHHA) President Sean Connaughton said that one private health system could open 58 beds as a short-term solution if the state allocates $8.5 million of American Recovery Plan Act (ARPA) funds to staff the beds. He also mentioned other systems might be able to open beds if funding is provided.
“While increasing Virginia’s permanent behavioral health workforce is a long-term goal, to address the immediate and significant needs, we propose utilizing ARPA funds to assist private behavioral health facilities in paying for behavioral health workers to staff beds that are licensed, but not currently staffed,” Connaughton wrote.
“This funding proposal will provide immediate interim relief and reduce pressure at the state facilities. The ARPA funds combined with the budget surplus far exceeds this modest funding request and is well within the criteria for funding,” Connaughton wrote.
VHHA Vice President of Communications Julian Walker told The Star, “Several things are happening. There’s an overall trend for increase in demand for the behavioral health care services.”
“[One,] private hospitals are already handling a significant volume of psychiatric patients in Virginia, both due to the overall trends of private hospitals accommodating more, by far, than state hospitals every year, and two, there’s also a big increase in demand for these specific services, behavioral health services. So you have that trend, and then you also have the companion challenge of staffing that’s been magnified during the COVID-19 pandemic,” Walker said.
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