Virginia mental hospitals are struggling with “dangerously high” numbers of patients, prompting them to delay admissions and straining the ability of law enforcement officers to maintain custody of people in psychiatric crisis who are waiting for treatment.
Behavioral Health Commissioner Alison Land told legislators on Tuesday that the state’s eight public mental hospitals for adults are operating at 96% of their capacity. Crowding is worst at Central State Hospital, outside of Petersburg, which is 99% full, while Eastern State Hospital near Williamsburg and Western State Hospital in Staunton are operating at 98% of their capacity.
“The picture is bleaker, not better,” Land told the Joint Subcommittee to Study Mental Health Services in the Commonwealth in the 21st Century.
Longstanding pressures on state mental hospitals have intensified because of the COVID-19 pandemic, which has killed 27 patients and employees and forced the state to temporarily restrict admissions to six of its eight hospitals for adults in the past year.
The pandemic also has triggered an exodus of employees — direct care workers and medical providers — from the state hospitals, which Land said are “overwhelmed” and operating at 60% to 75% of full staffing. Commonwealth Center for Children and Adolescents in Staunton has enough staff to treat 32 patients in the 48-bed facility, which is expected to face a surge in demand when in-school instruction fully returns in September.
“It’s a steep uphill climb, and we’re not making the progress we need to make,” the commissioner said of state efforts to fill more than 1,000 staff vacancies at the institutions dating to March 2020.
The Department of Behavioral Health and Developmental Services also is working on ways to divert elderly patients with dementia away from state institutions that have been hit hard by COVID-19 outbreaks.
Piedmont Geriatric Hospital accounted for 15 deaths from COVID-19 — more than half of all deaths from the virus at state mental hospitals and other behavioral health facilities. Piedmont, located 50 miles from Richmond in Nottoway County, at one point last year operated at 112% of its capacity. It’s operating now at 85%, but only because of a health department requirement that it quarantine admissions for at least 14 days as part of its recovery from a shutdown in admissions.
Gov. Ralph Northam issued an executive order in August to allow the institutions to not accept anyone who wasn’t committed under an emergency custody order because of a threat to harm themselves or others, despite being the “bed of last resort” under state law.
However, the state also is struggling to find beds for patients under emergency custody orders, issued by a magistrate and executed by law enforcement agencies.
Virginia sheriffs, especially those serving rural counties, warn their deputies are stretched thin because of responding to psychiatric emergencies that require them to hold people in psychiatric crises and transport them for treatment.
“I’ve had deputy sheriffs tied up for days at a time,” said John Jones, executive director of the Virginia Sheriffs’ Association, in an interview on Tuesday. “We’re at a crisis point.”
Jones and two sheriffs told legislators that their departments have been tied up with people in emergency custody as many as six days.
“We really need to get some help with this desperately,” said Gloucester Sheriff Darrell Warren, president of the sheriffs’ association board of directors.
Land acknowledged that delays in admissions “are requiring law enforcement to stay with some patients for several hours or days before a bed becomes available.”
She emphasized that the state is not denying access to treatment but “working to create a safe and appropriate bed space.”
However, Land said in her presentation, “Patients may not be receiving treatment during these delays.”
Del. Margaret Ransone, R-Westmoreland, said the problem is severe for law enforcement and patients in her six-county district, extending from Caroline County through the Northern Neck.
“It’s not just about law enforcement,” Ransone said. “It’s the patient sitting in the emergency room and having a mental health crisis. We’re not meeting their needs.”
Last month, the state completed the 17-month rollout of a new system of alternative transportation of psychiatric patients to relieve the stress on deputies and other law officers. The system also began transporting children and adolescents in March to address concerns about the trauma of putting them in law enforcement custody.
The behavioral health department estimates the alternative transportation system has saved law enforcement more than 5,000 hours spent on transporting patients for an average trip of 190 miles.
However, Land acknowledges that the contract does not require the transport company to stay with the patients in hospital emergency departments until an appropriate psychiatric bed is found.
“They can’t sit with the patient,” she said.
Sen. Creigh Deeds, D-Bath, chairman of the joint subcommittee, unsuccessfully sought money in the state budget this year to expand the contract to include custody before transport and reimburse sheriffs for overtime pay because of the duty.
The crisis will be a priority for Deeds’ subcommittee, which will become a full-time legislative commission this summer to tackle problems in Virginia’s behavioral health system that have defied solution.
“If we have to take further action, we will,” he said.