Virginia has temporarily stopped admissions to two state mental hospitals, as a series of COVID-19 outbreaks has intensified pressure on overcrowded behavioral health institutions.
Piedmont Geriatric Hospital stopped admissions more than two weeks ago after a COVID-19 outbreak that has killed five patients, infected 24 others and sickened nine employees at the state hospital in Burkeville, 55 miles southwest of Richmond in Nottoway County. Six of the infected patients are receiving medical care in private hospitals.
State behavioral health Commissioner Alison Land halted admissions at Southern Virginia Mental Health Institute in Danville on Wednesday, days after alerting Virginia legislators of an escalating crisis in state mental institutions that reached their full capacity at the end of last week and are scrambling to find private institutions and community programs to accept patients.
“With the increase in state hospital census, it is very difficult to maintain bed availability while addressing the infection control, staffing concerns, and isolation protocols to prevent an outbreak within our congregate settings,” Land and Secretary of Health and Human Resources Dan Carey said in a letter to General Assembly members on July 23.
The state hospital in Danville has confirmed COVID-19 cases among four staff members and seven patients, including one recovering in a private hospital. However, the interconnected, communal layout of the hospital’s three units has forced the state to quarantine the entire facility until the Virginia Department of Health tests all staff and patients.
“It makes it very difficult, without doing some facility-wide testing, to determine who may be exposed and who may be asymptomatic,” said Angela Harvell, deputy commissioner for facility services at the Department of Behavioral Health and Developmental Services.
Statewide, 92 patients and employees at Virginia’s behavioral health institutions have tested positive for COVID-19, with almost 300 test results still pending. The only deaths have occurred at Piedmont, but the state is coping with outbreaks at Eastern State Hospital near Williamsburg, where 16 employees and six patients have tested positive, and Southeastern Virginia Training Center in Chesapeake, where three employees and five patients also have tested positive for the disease.
Western State Hospital in Staunton has one patient and two employees who tested positive for COVID-19. Five other state institutions have confirmed COVID-19 infections among staff, but not patients — Central State Hospital near Petersburg, four; Catawba Hospital near Salem, four; Northern Virginia Mental Health Institute in Falls Church, four; Central Virginia Training Center in Lynchburg, one; and the Virginia Center for Behavioral Rehabilitation, next to Piedmont in Burkeville, with three.
The only state institutions with no confirmed cases of COVID-19 are Hiram Davis Medical Center next to Central State in Dinwiddie County; Southwest Virginia Mental Health Institute in Marion; and the Commonwealth Center for Children and Adolescents in Staunton, the state’s only psychiatric hospital for children.
Lull, then overload
The crisis began in Virginia’s behavioral health institutions after a lull in admissions turned into an overload beginning in mid-June.
Land and Carey said the patient census at the state’s seven mental hospitals for adults had been stable or declining early in the coronavirus public health emergency that began in early March, but the situation worsened rapidly as Virginia began to loosen restrictions the state had imposed on business and public life to control the spread of COVID-19.
“As communities began to reopen, state hospitals experienced rapidly increasing census levels and are currently at critical levels with utilization at or above maximum capacity statewide,” they said in the letter.
The crisis is worst in geriatric hospitals for elderly patients with psychiatric issues, who are hard to place in private psychiatric facilities or nursing homes that have been at the epicenter of the COVID-19 pandemic in Virginia. Piedmont had been operating above its capacity before the outbreak began, but now has 92% of its beds occupied.
“That is where the real problem is,” said Sen. Frank Ruff, R-Mecklenburg, whose district includes Piedmont, as well as two nursing homes in Mecklenburg County that have had 176 COVID-19 cases and 27 deaths between them.
“It’s regrettable, but I don’t know there is any real solution,” Ruff said Wednesday.
Geriatric units were operating Wednesday at 115% of capacity at Eastern State; 110% at Southwest Virginia Mental Health Institute; and 105% at Catawba. Systemwide, Virginia’s mental hospitals were operating at 98% of their capacity on Wednesday, with both Central State and Western State at or slightly above 100%.
State legislators have been trying to reduce reliance on state institutions for emergency psychiatric care, but the system already was overloaded before the coronavirus crisis.
The assembly included money in the two-year state budget to help relieve the pressure on state institutions, but those investments were suspended in April because of concerns about a shortfall in predicted tax revenues to pay for increased spending.
‘Put the fire out’
“The house is on fire,” said Sen. Creigh Deeds, D-Bath, the leader of a bipartisan legislative commission to make long-term changes in Virginia’s behavioral health system. “We’ve got to figure out how to put the fire out and move forward.”
Deeds said he remains focused on spending less money on institutions and more on community-based programs to keep people out of institutional care, but the assembly will face difficult choices when it convenes next month to revise the budget to match spending with potentially $2 billion less in revenues that had been forecast for this year and next year.
Suspended budget initiatives include almost $50 million to expand mental health services in communities, more than $25 million to pay for supportive housing for people with behavioral health problems, $20 million to discharge patients from institutions when they no longer clinically need to be there, and $15 million to reduce the daily census at state institutions.
“That’s something I think should be a priority,” said Sen. Emmett Hanger, R-Augusta, who chairs the Senate Finance health and human resources subcommittee.
State officials previously have blamed the problem partly on an increasing reluctance of private psychiatric facilities to accept more patients under temporary detention orders.
Private psychiatric hospitals also are scrambling to contain the spread of COVID-19 in their facilities, forcing them to operate with fewer beds and leaving Virginia with fewer options as it responds to coronavirus outbreaks at state institutions.
“We’re the only room at the inn,” said Land, a former private hospital official whom Gov. Ralph Northam appointed commissioner last year after Commissioner Hughes Melton died from injuries in a traffic accident.
As a result of the state diverting admissions from stricken hospitals, 17 people in psychiatric crisis are waiting — primarily in private hospital emergency rooms — for placement in beds for treatment after being found a threat to themselves or others, or unable to care for themselves.
“They have to go somewhere,” Land said.