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Amid a crisis at state mental hospitals, calls for private providers to step up

Eastern State Hospital in James City County
Eastern State Hospital in James City County(Virginia Department of Behavioral Health and Developmental Services)
Published: Jul. 20, 2021 at 12:09 PM EDT
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As Virginia’s state-run mental hospitals struggle to navigate a long-brewing crisis in staffing and admissions, lawmakers and advocates are asking private hospitals to relieve more of the burden.

For years, officials have warned that Virginia’s beleaguered psychiatric facilities were on the verge of collapse. But the system reached a tipping point earlier this month when Alison Land, commissioner of the Virginia Department of Behavioral Health and Developmental Services, halted admissions at five of the state’s nine hospitals, citing severe understaffing and high census levels that created “unprecedented” levels of danger.

State legislators have been debating ways to relieve the system ahead of a special General Assembly session in August when they’ll allocate roughly $4.2 billion in federal aid. But amid the push for reforms, there’s been growing attention on the role private hospitals have played in the crisis. Over the last six years, those facilities have admitted a decreasing share of psychiatric patients who enter the system through emergency custody orders and temporary detention orders, legal mechanisms that mandate mental health evaluations and hospitalization in cases when patients could pose a danger to themselves or others.

“When you hear that private hospitals have contributed to what’s happening, that’s generally the reason — that they haven’t taken as many TDOs and ECOs as they used to,” said Del. Mark Sickles, D-Fairfax, the chair of the House Health, Welfare and Institutions Committee. And as involuntary admissions have declined at private facilities, state hospitals say they’ve struggled to keep up not just with a growing number of patients, but a higher proportion of patients with more severe symptoms or complex medical needs.

Julian Walker, vice president of communications for the Virginia Hospital and Healthcare Association, said its members still accept the majority of involuntary admissions across the state regardless of changes in proportion.

“Even with the share declining, we are still taking thousands and thousands more TDOs than the state hospitals,” he said, citing internal data from the hospital association. At the same time, the association says private facilities are accepting a steady increase, involuntary psychiatric patients, even while facing the same workforce challenges as the public sector.

But with the pause in admissions now stretching into its second week, advocates and law enforcement officials say vulnerable patients are at increased risk of being released from custody before they can receive mental health treatment. And the crisis, many says, can be traced back to Virginia’s overreliance on state-run facilities to treat involuntary admissions.

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.(Virginia Mercury)

The Virginia Mercury is a new, nonpartisan, nonprofit news organization covering Virginia government and policy.

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