Staffing shortages are overwhelming Virginia’s psychiatric hospitals

Staffing shortages are overwhelming Virginia’s psychiatric hospitals
Eastern State Hospital in James City County (Source: Virginia Department of Behavioral Health and Developmental Services)

Staffing shortages have left Virginia’s mental hospitals overwhelmed as the facilities continue to struggle with a surging patient population. It’s a problem that’s only grown worse since the start of the COVID-19 pandemic.

Alison Land, the Commissioner of the Department of Behavioral Health and Developmental Services, told state lawmakers Tuesday that low pay, burnout and growing workloads are pushing employees out of the field. In many cases, the shortages leave available staff scrambling to respond to a high-need patient population. Assaults and injuries within facilities are common, Land said — a difficult cycle that leads to more turnover.

“This is a very complex, acute, somewhat assaultive and aggressive patient mix that’s coming in,” Land told the agency’s board in a similar presentation last week. “And it’s low pay that we’re able to offer them. So you see how a serious situation begins to emerge.”

Even before the pandemic, DBHDS had more than a thousand vacancies at state-run mental hospitals — roughly one-fifth of the roughly 5,500 staff the facilities normally require. In fiscal 2020, some facilities saw more than 30 percent of their direct care positions remain unfilled. At Eastern State in James City County, for example — the first hospital in the country built specifically for patients with mental illness — there was a 37 percent vacancy rate among the nursing staff and a 52 percent vacancy rate among physicians, including psychiatrists and internal medicine specialists.

Those empty positions have only grown, and Land said facilities across the state are operating at roughly 65 to 70 percent of staffing. At the same time, most have either met or exceeded their available bed space.

Even in ideal circumstances, DBHDS hospitals are staffed — and budgeted — with the assumption that roughly 90 percent of their beds will be full at any one time, said Angela Harvell, the agency’s deputy assistant commissioner for facility services. But at its highest point in fiscal 2021, the statewide census was at 112 percent of its total capacity.

“So, we obviously have morale issues with the current workforce,” she said. “They work a significant amount of overtime. And we’ve had to tap into other positions at the facility — administrative staff, professional clinical staff — just to maintain our hospital coverage.”

Staffing and census problems at state-run facilities are nothing new. Sen. George Barker, D-Fairfax, said many of the challenges date back to 2014 when Virginia passed legislation that’s now more commonly known as its “bed of last resort” law.

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