COVID and Labor Shortages Are Aggravating Virginia’s Mental Health Crisis

Despite rising incidence of mental illness and substance abuse, admissions to hospitals in Virginia has trended lower in recent years. Something is broken. Source: Virginia Hospital and Healthcare Association

by James A. Bacon

The story made big headlines earlier this month when the Northam administration announced that five of the Commonwealth’s eight mental health institutions have stopped taking new patients. Two things are happening to make a chronically bad situation worse. First, the number of patients referred to state hospitals through Temporary Detention Orders (TDOs) has soared — from 3.7 patients per day in FY 2013 to 18 per day currently, or a 392% increase. Second, the hospitals are suffering staff shortages, in part due to the COVID-19 epidemic but also because “the level of dangerousness is unprecedented,” according to a letter from the Virginia Department of Behaviorial Health and Development Services to partners and providers.

“There have been 63 serious injuries of staff and patients since July 1 and we are currently experiencing 4.5 incidents/injuries per day across the state facilities,” the letter stated. Employees are quitting. One facility, the Commonwealth Center for Children & Adolescents, can safely operate only 18 of its 48 beds.

Similar supply-and-demand issues are spilling into the private hospital sector. Private psychiatric hospitals, which provide acute short-term care, are experiencing a similar imbalance between demand for psychiatric facilities and a labor shortage.

The social isolation caused by the COVID-19 lockdowns spurred a surge in mental illness and substance abuse, as illustrated by the 41% increase in drug overdose deaths in Virginia last year. Counterintuitively, admissions to private facilities have decreased over the past five years. Why? Because patients on longer are staying longer. The average length of stay now exceeds seven days, an 8% increase over two years ago, according to a letter from Virginia Hospital and Health Care Association President Sean Connaughton to legislators.

Cases are becoming more complex, VHHA spokesman Julian Walker explained to Bacon’s Rebellion. Mental health issues are more likely to be compounded by substance abuse issues, which may in turn be compounded by cognitive challenges or health issues. Increased complexity requires treatment by multidisciplinary teams and takes longer to resolve.

So, what happens when patients requiring longer-term treatment are blocked from entering the state facilities? They create back-ups in the hospital emergency rooms through which many of them cycle. The problem has become so severe that patients in some hospitals are being held in emergency room beds as long as 12 to 18 hours, Walker said. In other words, the crisis in state facilities has a cascading effect.

The process for determining who gets assigned where is mediated by a complex of state laws and regulations. Hospitals can’t assign patients willy nilly wherever they want. Cases must be reviewed and approvals must be gained. One avenue for committing patients is the emergency custody order or ECO, which involuntarily commits individuals who are incapable of making informed decisions. The issuance of ECOs has been increasing, says Walker. Another is the Temporary Detention Order , which requires individuals to receive hospitalization for further evaluation. Those, he adds, trended flat for private hospitals even as they have increased for state hospitals.

There is a lot of finger-pointing going on as state hospitals, private hospitals, jails and prisons, and community health programs try to dish off patients — and the attendant financial costs for those without insurance — to one another. The system in Virginia is under tremendous stress from the increase in both mental illness, substance abuse, suicides and drug overdoses aggravated by the social isolated associated with COVID-19. There are likely longer-term forces at work, too, as rapid technological, economic and cultural change causes increasing disruption to families and communities.

If there were easy answers, someone would have figured them out. The problem doesn’t lend itself to bumper-sticker solutions. But I would say this: If you want to see what the mental health/substance abuse crisis could look like, cast your eye upon the tent cities of California filled with tens of thousands of homeless people, many of them mentally ill or addicts of some kind. Surely, Virginians can agree on one thing: We don’t want that here.

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8 responses to “COVID and Labor Shortages Are Aggravating Virginia’s Mental Health Crisis”

  1. LarrytheG Avatar

    So, at the end of the day – is this a responsibility of government and taxpayers? Is there a Conservative view and a differing progressive view?

  2. Dick Hall-Sizemore Avatar
    Dick Hall-Sizemore

    This is a good summary of the problem, Jim. As I indicated in my series of posts earlier this year on jail and the mentally ill, the mental health system in Virginia is a mess. There is so much blame to cast all around, it is hard to know where to start. Although it was common knowledge that there were many problems lurking and about ready to explode, governors have neglected the system over the years and now Northam finds himself with a crisis that his successor will inherit. The General Assembly has dithered. It is torn between those members who want to expand the hospitals and those who feel it is best to treat most of the mentally ill in the community, never mind that many of the community mental health agencies are dysfunctional

    The GA was finally moved to action by the tragedy of Sen. Creigh Deeds’ son. The Deeds Commission has been meeting over several years and succeeded in making some improvements. Ironically, its major recommendation that was adopted, making the state hospitals the “bed of last resort”, contributed to the present crisis.

    The GA did take a major step forward this past session by creating the Behavorial Health Commission in the legislative branch. This will be on-going agency, with professional staff, dedicated to finding ways to improve the mental health system.

    Then there is DBHDS. I am not that familiar with the agency, so I can’t say much. I will point out that the 2018 GA appropriated $3 million in NGF to plan for a replacement for Central State Hospital in Petersburg, which would have more beds. Three years later, the agency has spent less that $1 million of this appropriation. It spent only $200 through all of last fiscal year. I don’t know whose fault it is that this project is going so slow. The GA has a tight rein on it and wants to make sure the department “right sizes” the facility.

    1. LarrytheG Avatar

      Is there a JLARC report?

      Mental Health is the proverbial black sheep/step child in the State budget as well as (apparently) the Agencies. It’s not the only one, the Opioid problem also seems to suffer from a lack of commitment.

      My question below was not flip. I wonder if some legislators don’t think this is the responsibility of government, at least not much more than in a minimal way.

      1. Dick Hall-Sizemore Avatar
        Dick Hall-Sizemore

        Here is the latest JLARC report:

    2. WayneS Avatar

      “… governors have neglected the system over the years and now Northam finds himself with a crisis that his successor will inherit…”

      “…but which he did nothing to ameliorate…”

      1. LarrytheG Avatar

        well, not exactly:

        ” Northam targets overcrowding of mental health hospitals in new budget”

        The JLARC report sounds like there are administrative issues perhaps not unlike what has been seen with VDH and VEC.

        The fact that the Gov puts money in the budget, and the GA approves but the problems continue – how does that get fixed? Is it a Dem or GOP failing?

        1. WayneS Avatar

          The governor runs the executive branch of the state government. It is his responsibility to make sure his agenda is being pursued.

          1. LarrytheG Avatar

            Correct. So he did advocate in the budget , but he’s dealing with Virginia’s version of the “deep state” where embedded state agencies may not be ready to change and most Gov GOP/Dem are not prone to tearing out root and branch to get change.

            Perhaps this is an opportunity for Youngkin to win over those on the fence ?

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