Virginia is halting admissions at five mental hospitals because they don’t have enough staff to safely care for patients.
Alison Land, commissioner of behavioral health and developmental services, said Friday that she is closing admissions immediately at Central State Hospital near Petersburg, Eastern State Hospital near Williamsburg, Piedmont Geriatric Hospital in the Nottoway County town of Burkeville, Western State Hospital in Staunton and Catawba Hospital near Roanoke.
The temporary halt in admissions will allow the five hospitals to reduce the number of patients they are treating by attrition, rather than discharging them, until they have enough employees to care for them safely.
“Despite our aggressive recruiting and retention strategies, state hospitals continue to lose staff while admissions continue to rise,” Land said in a message on Friday. “It is no longer feasible to operate all state beds in a safe and therapeutic environment.”
The order represents a breaking point for Virginia’s behavioral health institutions, which have struggled to keep up with a surge in admissions of people in psychiatric crisis since the enactment of the so-called “bed of last resort” law in 2014 to prevent the release of people from emergency custody if they pose a threat to themselves or others.
Admissions of people under temporary detention orders have increased by almost 400% at state mental hospitals since 2013, the year that the 24-year-old son of state Sen. Creigh Deeds, D-Bath, attacked his father and then killed himself less than 13 hours after being released from emergency custody because no bed was found for him at a private or public psychiatric facility.
The COVID-19 pandemic also has thrown the hospitals into a staffing crisis with 1,547 direct-care jobs vacant in a workforce of 5,500 — a job vacancy rate of 28%.
“It’s very frustrating,” Deeds said Friday. “It’s very disappointing, but we did see it coming.”
The halt of admissions at more than half of the state mental hospitals for adults alarms law enforcement officials who say they have been forced to keep mentally ill people in prolonged custody because they have nowhere to take them for treatment.
Dana Schrad, executive director of the Virginia Association for Chiefs of Police, warned Friday that if no psychiatric bed is available for people under emergency custody and temporary detention orders, “the only options are a jail bed or street release.”
“Neither is a viable or responsible option for the treatment and care of an individual in mental health crisis,” she said.
Outbreaks of the coronavirus disease have killed 25 patients and two employees at overcrowded state facilities. The outbreaks forced the state to temporarily halt admissions at several hospitals during the past year and prompted Gov. Ralph Northam to issue an executive order last August to allow state hospitals that are already full to decline to admit people who haven’t been found a danger to themselves or others by a court magistrate under emergency custody orders.
This time, however, admissions were halted because of insufficient staff to care for the patients at five hospitals that were operating at or near capacity on Friday. Central State, in Dinwiddie County, had 167 patients in a facility with 166 beds.
The hospitals are among eight state facilities for adults, but Virginia’s only psychiatric facility for youth, the Commonwealth Center for Children and Adolescents, is operating only 18 of its 48 beds — or less than 38% — because it doesn’t have enough employees to care for more.
“It’s our own fault because the pay was never adequate,” Deeds said, “but the pandemic has exacerbated every problem we have.”
As a result of the staffing crisis, Land said that 63 patients and employees have been injured at the state’s mental hospitals since July 1.
“The challenges faced by the state hospitals are now an immediate crisis for two reasons,” the commissioner said. “First, the level of dangerousness is unprecedented and second, recent admissions are occurring in an environment that is no longer adequately staffed.”
Land said the state also is accelerating its efforts to discharge patients who are therapeutically ready to leave the hospitals but have been thwarted by the lack of adequate community programs and services to accept them.
“As a result, my sincere hope is this admissions closure will not last a day longer than it needs to,” she said.
The staffing crisis in state mental hospitals already is a high priority for the General Assembly, which will convene in special session on Aug. 2 to determine how to spend $4.3 billion in federal aid to Virginia under the American Rescue Plan Act.
“The action taken today brings it even closer in focus,” said Del. Mark Sickles, D-Fairfax, vice chairman of the House Appropriations Committee and chairman of the House Committee on Health, Welfare and Institutions. “It makes it even more imperative that the state address the problem on a long-term basis.”
Alena Yarmosky, senior communications adviser for Northam, said that “despite significant investments from the state, Virginia’s mental health hospitals have operated at extremely high census levels for several years — and the COVID-19 pandemic has made this situation even more challenging.”
She added: “That’s why Governor Northam will propose a significant amount of federal American Rescue Plan funding go towards boosting staff salaries, hiring critical workers, and ensuring the well-being of patients and staff.”
Deeds said the assembly can help during the session with one-time bonuses and other short-term measures, but also must address the staffing and workplace safety challenges when it meets in January to adopt a new two-year budget.
“We’ve got our work cut out for us,” he said.
The temporary closures will put immediate pressure on private psychiatric facilities, which accept most of the patients held under temporary detention orders, but a smaller proportion of them since enactment of the “last resort” law required state hospitals to accept them.
“The commonwealth needs all available private beds for temporary detention treatment open to accept patients, even those patients that might be challenging, or might need behavior management,” Land said. “In addition, the commonwealth needs every possible step-down and long-term care facility to be ready to accept patients who are ready for discharge from state facilities.”
Julian Walker, spokesman for the Virginia Hospital & Healthcare Association, said Friday, “If the state says it doesn’t have the capacity, our members are going to accommodate as many patients as they can.”
However, Walker said private hospitals also are coping with staffing shortages for psychiatric patients, who are sometimes too difficult to handle in a general hospital setting.
“The reality is these challenges are going to become more difficult before they get better,” he said.
Staff writer Mark Bowes contributed to this report.