The day after the state’s top health official clashed, again, with legislators over plans to add beds at a western Virginia state mental hospital to ease overcrowding, the head of Eastern State Hospital thought she’d caught a break.
A couple of patients had done well enough to be discharged, freeing up a couple of beds. But a couple more had slipped into a mental health crisis, with nowhere else to go, and the mental health safety net for Tidewater Virginia was once again full to capacity — 302 people for 302 beds.
Virginia’s nine public psychiatric hospitals — housing a larger number, proportionately, than almost any other state — have been operating at more than 90% of capacity for the past three years. They peaked above 100% this summer and again in September and have been above 95% pretty much every week since Feburary, state Department of Behavioral Health and Developmental Services data show.
Eastern State, just outside Williamsburg, has hit that 100% or higher level more than once this year.
“We are in a crisis,” Virginia Secretary of Health and Human Resources Daniel Carey told the General Assembly’s joint subcommittee on mental health services last week.
He’s seeking $19.6 million over the next two years, on top of $4.1 million this year, to add a total of 56 beds at Catawba State Hospital in Roanoke County, a facility designed for older patients with mental illnesses complicated by dementia or other cognitive disabilities, who can be particularly hard to find places for in the state’s community services.
But that’s going in exactly the wrong direction, state Sen. Creigh Deeds, D-Warm Springs, chairman of the mental health subcommittee, told Carey last week. Deeds has been pushing hard for six years now to boost the state’s efforts to help people struggling with mental illness before things get so bad that they need a hospital — or, as was the case with his son Gus, before the lack of a hospital bed means they harm themselves. Gus Deeds killed himself in 2013, as his dad desperately pressed the local mental health agency to find a bed for him, without success.
Appalled by their much-loved colleague’s tragedy, the General Assembly enacted laws requiring state hospitals to take patients in a crisis. In addition to this “bed of last resort” law for people under a Temporary Detention Order, or TDO, the legislature also promised to boost funding for community mental health services.
That’s a promise that’s been made before. The idea is that better access to community services can keep people from falling into the kind of crisis that requires hospital treatment, and makes it easier for people to leave the hospital because they can get services they need to deal with their mental illnesses.
But the increases the General Assembly approved still left per-capita spending on community mental health services well below the national average — at $54.62, compared to the national average the year before Gus Deeds’s suicide of $93.50. That year, Virginia’s number was $42.46, or less than half the national average.
That gap was pretty much the pattern through the 1990s and into fiscal year 2014.
The result: Virginians get much less community care than do most Americans. The utilization rate here is 14.25 people per 100,000, or barely 60% the national average of 22.99, according to data collected by the federal Substance Abuse and Mental Health Services Administration.
Virginia’s utilization rate is down from where it was before the legislature’s previous promise to boost the system, after the 2007 Virginia Tech mass shooting.
State hospital utilization, at 0.87 people per 100,000, is more than twice the national rate, the SAMHSA data show.
But the results aren’t as good. Readmission rates — that is, returns to the hospital because the care received didn’t have an effect before 30 days — exceeded the national average, and are up from 2013.
While access to community care continues to lag the nation, the bed of last resort law has meant the number of people sent to state hospitals under a TDO ballooned, from 2,192 in fiscal year 2015 to 5,877 last year, state data show. Private hospitals, which account for the bulk of TDO admissions, saw a matching decline.
The change is even starker in this part of the state. Eastern State took in 39 patients under a TDO the year of Gus Deeds’ suicide. Last year, the total hit 541. It is still climbing, said Daniel Herr, assistant commissioner of the behavioral health department.
“Look, if you have someone in your E.R. acting up and you know there is someone else who has to take them, what do you think will happen?” he said.
Even as more people are coming into state hospitals, the number of people stuck there because they can’t get services in the community has been rising. At Eastern State, that number has climbed from an average of about 31 in 2013 to about 45 now. Statewide, it grew from 125 people to 218, Department of Behavioral Health data show.
Overcrowding means putting patients in housing units where they may not fit well with other residents, or where there may not be enough staff, said Eastern State’s interim director, Donna Moore.
At Eastern State this month, it’s meant one 18-year-old in crisis could only go to a unit of the hospital designed for geriatric patients, where he was able to smash a water fountain — not “hardened” as are the ones in other parts of the hospital — flooding the housing unit with four inches of water.
“We were here till 8 p.m. mopping that up,” Moore said.
A pregnant 18-year-old created a different challenge on a former geriatric unit a few days later when she discharged a fire extinguisher.
A blistering accreditation review by the Joint Commission on Health Care this summer noted that in just the months of May and June, 26 Eastern State staff were injured by patients. In one case, a patient under restraint was attacked by another patient when, the commission reported, the hospital did not provide physical security from other patients or have a staff member monitoring the situation. The commission found lack of enough staff was a common problem.
Carey, the health secretary, told the mental health subcommittee that when nearly 100% of state hospitals’ authorized beds are full, the issue is not just the number of beds. Looking at what experts advise on best practices for a psychiatric hospital, Virginia’s state system is actually operating at about 127% of capacity, he said.
Dave Ress, 757-247-4535, dress@dailypress.com