The former leader of Virginia’s behavioral health system slammed Gov. Ralph Northam’s administration this week for the unfolding crisis at the state’s mental hospitals.
Five are closed to new admissions and the only state behavioral health facility for children is using a fraction of its capacity because it does not have enough skilled staff to operate safely.
Dr. Jack Barber, a former interim commissioner of behavioral health, told the man who replaced him three years ago that the Northam administration had failed to heed years of warnings about overcrowding and understaffing. The current commissioner, Alison Land, immediately halted admission of civil patients — those not committed by the courts — to five state hospitals on July 9.
“For me, and no doubt others who dedicated the bulk of their careers to [the Department of Behavioral Health and Developmental Services], the neglect of the hospitals and its consequences are distressing and demoralizing,” Barber said in a lengthy email message on Thursday to Dr. Dan Carey, secretary of health and human resources under Northam.
“Honestly, I am amazed at the lack of accountability for you and the administration for the cascade of decisions and actions that led to this point,” wrote Barber, who has spent more than 30 years in Virginia’s public mental health system, including four as interim commissioner.
Carey said Friday that he welcomed the comments from Barber, “who has been a passionate advocate for Virginians in the mental health and behavioral health system for years. I’m grateful for his service and commitment.”
“While managing COVID-19, Commissioner Land and I have worked together on meaningful, enduring solutions to the census and staffing situation and will continue to do so until the state hospitals achieve the 85 percent capacity, the minimum in order to keep patients and staff safe,” he said.
“We are currently exploring additional legislative changes and developing multiple projects to reduce the census,” Carey said in an email. “The governor will propose significant new funding for Virginia’s hospitals when the General Assembly meets in two weeks.”
Barber shared his message to Carey with four state legislators — two Democrats and two Republicans who have been deeply involved with efforts to restructure Virginia’s mental health system to shift care from state institutions to community programs, as well as a reporter for the Richmond Times-Dispatch.
All four legislators have been strong supporters of the former interim commissioner, but they declined on Friday to address his criticisms or fault the administration.
“We just have to be forward-looking and keep our foot on the gas,” said Sen. Creigh Deeds, D-Bath, chairman of the newly named Behavioral Health Commission.
The other lawmakers who received the message from Barber are Sen. Emmett Hanger, R-Augusta, chairman of the Senate Finance subcommittee on health and human resources; Del. Mark Sickles, D-Fairfax, vice chairman of the House Appropriations Committee; and Del. Rob Bell, R-Albemarle, a longtime legislative advocate on behavioral health issues.
“I worked with Jack for many years and we’re going to review what he says carefully,” Bell said.
Carey, a Lynchburg cardiologist whom Northam appointed secretary in early 2018, replaced Barber more than three years ago with Dr. Hughes Melton, a doctor who specialized in opioid addiction.
Melton died on Aug. 2, 2019, at age 52 from injuries in a head-on car crash in Augusta County that killed an 18-year-old Staunton woman. Law enforcement attributed the crash, caused by Melton, to a medical condition that never has been publicly explained.
Carey hired Land as commissioner in late 2019, less than two months before the General Assembly convened to adopt a new budget and less than four months before the COVID-19 pandemic swept into Virginia.
Barber questioned the state’s response to the crisis that was already building in the mental health system because of passage of a law in 2014 that made state mental hospitals provide the “bed of last resort” to people in psychiatric emergencies and the subsequent decline in admissions of those people to private hospitals and psychiatric facilities.
The state enacted the law the year after Gus Deeds, the senator’s 24-year-old son, attacked his father with a knife and then killed himself, less than 13 hours after he was released from emergency custody because the regional mental health agency failed to find him a bed in a psychiatric facility.
“It has not been good enough and it is extremely disappointing and frustrating to read about, knowing the many individuals, patients and staff and stakeholders affected,” Barber wrote Carey.
Almost four years ago, just after Northam’s election, Barber warned legislators of the coming crisis and proposed a plan to restructure the way Virginia finances its public mental health system to shift funding from institutional care to community services.
“We’re already on fire — and the fire is going to get hotter,” he said then.
Barber’s proposal to restructure the system and its financing has gone nowhere since his replacement as commissioner, but Deeds said Friday, “It absolutely still needs to be done.”
The crisis came to a head last week when Land temporarily halted admissions at five facilities for adults: Central State Hospital near Petersburg, Eastern State Hospital near Williamsburg, Piedmont Geriatric Hospital in Nottoway County, Catawba Hospital near Roanoke, and Western State Hospital in Staunton, where Barber served as director for 16 years.
The Commonwealth Center for Children and Adolescents in Staunton, the state’s only mental hospital for minors, is facing such a severe shortage in direct-care staff that it is operating only 18 of its 48 licensed beds. Barber served as acting director of the center for one year after he was replaced as interim commissioner.
Land’s order sent “a shock wave” throughout the state system, Hanger said Friday, the day after the commissioner told him and other legislators that she made the decision without first seeking approval of the governor’s office.
Hanger said he would support the department’s request for more than $335 million in federal aid under the American Rescue Plan over the next four years, including $75 million this year, to raise pay to recruit and retain nurses and other direct-care staff at the hospitals.
“Right now, fortunately, we have some money to put where it’s needed,” he said, “and I think we should do that, without question.”
The General Assembly will decide in a special session next month how to use the $4.3 billion that Virginia has received under the emergency package, which President Joe Biden signed on March 11.
The federal aid is one-time funding that the state normally would not use for recurring expenses, such as salaries, but a $2.6 billion surplus in state revenue in the fiscal year that just ended will enable the governor and the assembly to revisit the need in the two-year budget that Northam will propose in December.
Barber told Carey he supports the department’s funding request and hopes that “further, effective actions related to [hospital] census and staffing will be forthcoming.”
He said Land “appears to have had no choice but to close off hospital admissions to five facilities last week, but this merely transfers risk to individuals in the community,” forcing mentally ill people to “languish” in private hospital emergency departments, be released without effective treatment or be subject to arrest.
“I think it has been extremely fortunate if there have been no untoward outcomes,” he said.
But Barber’s central message was that the Northam administration should have acted sooner to address the crisis in overcrowding and understaffing at the state facilities long before the COVID-19 pandemic, which has killed 25 patients and two employees at state behavioral health institutions.
He said the facilities have managed the pandemic well, but now face “overwhelming problems with census, staffing and safety” that the administration had failed to recognize and address before they became a crisis.
“In reality, it has left [the hospitals] feeling abandoned and only now does [the department] seem to realize the urgency of predictable problems,” Barber wrote. “It has placed patients, potential patients, staff, and communities at risk.”
In his email statement in response on Friday, Carey said, “I share with everyone the commitment that our efforts will be successful in ensuring much deserved relief to the hospitals’ invaluable direct care staff and reducing the overwhelming census in our state hospitals.”