Public Comments for 09/10/2021 Health, Welfare and Institutions - Subcommittee #3
Good Morning, Thanks for your support of behavioral health and your service on the behavioral health subcommittee. NAMI Virginia would like to express grave concerns over state behavioral health hospital bed closings due to a shortage in workforce: 1) All state hospital beds are desperately needed. Prior to COVID, Virginia’s number of behavioral hospital beds was lacking. Now with the closure of beds and the increase in behavioral health needs as created by COVID, all pre COVID beds are needed more than ever. Sadly, Virginia’s shortage of psychiatric beds is not new. The state has been hemorrhaging beds for decades, to the detriment of some of the most vulnerable Virginians, those with severe mental illness. Closing Virginia hospital beds must not be an option. 2) The entire continuum of care has been disrupted by state hospital bed closures. Maximum pressure has been placed on an already overwhelmed community system of care. While we recognize that Virginia’s hospitals are doing the best they can with worker shortages and full-capacity patient censuses, the pandemic’s worsening impact on mental health has made psychiatric hospital beds more necessary than ever. Losing these beds would be devastating to individuals in need, and could have tragic repercussions. 3) Private hospitals are not always an option as they can be selective in the patients they accept. These hospitals can exclude patients based on level of illness, insurance and means of payment, or state of crisis. In many cases, Virginia state hospitals have been the sole source available for numerous patients. If state hospital beds are not available, some patients will have no access to hospital care. State beds are a bed of last resort for many individuals needing hospitalized medical care. In addition, private hospitals are also facing workforce shortages. 4) In addition to adult hospital bed closures, Virginia has shut down 30 out of 48 beds for adolescents and children at the Commonwealth Center for Children & Adolescents, leaving only 18 state psychiatric hospital beds available for Virginia’s children at the adolescent facility in Staunton. The closure of these beds hinders access to acute care to Virginias children with serious emotional disorders which can lead to devastating consequences. 5) Virginia’s law enforcement community often has nowhere to take patients in crisis. One Sherriff said that one of his deputies sat with a suffering and hurting patient that was in crisis for 31 hours because he could not find a hospital bed. The closing of beds has put a tremendous strain on Virginia’s law enforcement and is forcing patients to suffer needlessly. NAMI Virginia asks that funds be allotted to increase the behavioral workforce and reopen all state hospital beds. We also ask that funds be provided to support community services that support recovery. Respectfully, Kathy Harkey, MAPP, BSP, BSMDS Executive Director
Virginia's capacity for psychiatric treatment beds is inadequate to meet its needs. The demand for beds will increase at all levels when 988 and Marcus Alert programs are implemented. The goal of decriminalization of response to psychiatric crisis is to shift the responsibility away from law enforcement, where it has unfairly and inappropriately rested for far too long, back to the medical and mental health treatment systems where it belongs. This will fail without adequate capacity to address acute crisis needs. Without the ability to fully stabilize individuals in crisis, attempts to decriminalize crisis response will fail. Virginia cannot afford to lose any beds - and should in fact be looking to expand its capacity to meet its demonstrated need for more beds of various types of critical need.
The following are indicators of the bad effects of insufficient bed capacity in Virginia: Bed numbers (Treatment Advocacy Center Going, Going, Gone, 2016): 1,526 state inpatient psychiatric beds in 2016, 18.2 beds per 100,000 adult population Amounts to only 36.4% of the 4,200 beds recommended from international experts on psychiatric bed availability for VA’s population 25% of those beds are for forensic patients, meaning an individual needs to be arrested before accessing a bed Average wait for competency restoration in VA is 73 days (J. Mitchell death example) 10,412 people with SMI incarcerated in Virginia Discharging quicker but sicker due to lack of beds (SAMHSA Uniform Reporting System data, 2019): Average length of stay in VA state hospitals for civil patients is 71 days, compared to the US average of 235 days. 30-day readmission rate for civil patients is 10%, higher than US average. 30-day readmission rate for forensic patients is 15%, compared to US average of 3% Yet VA report suggests the acuity of patients admitted to the state hospital is increasing: dls.virginia.gov/groups/mhs/tdo120418.pdf Psychiatric boarding and law enforcement transport: In 2021, media reports hospitals are so full that they are not accepting patients brought to hospital by law enforcement. Montgomery County Sheriff office reports that they have officers waiting more than 24 hours for an inpatient bed, the result is the officer is on guard waiting in an ED with an individual. https://roanoke.com/news/local/crime-and-courts/watch-now-montgomery-co-sheriff-others-blast-systemic-failure-in-state-mental-health-admissions/article_4327691a-9260-11eb-be5d-cb285c3daa03.html VA Sheriffs Association reported needed 26.3 FTE officers purely for psychiatric transport and ED waiting responsibilities. (TAC Road Runners, 2019) Patient dumping: Op-Ed written by Pete Earley published in the Washington Post highlighting patient dumping by VA private hospitals: https://www.washingtonpost.com/opinions/2021/07/22/virginias-mental-health-hospitals-are-burdened-by-patient-dumping/