Cuts at state mental hospital put pressure on local Va. officials

The fiscally strapped state psychiatric hospital serving Northern Virginia is cutting beds for people in crisis, forcing local mental health officials to scramble to come up with alternatives.

Already, community services boards in the region are turning more frequently to hospitals as far away as Petersburg to find empty beds, and that is straining the resources of county law enforcement agencies, which are often responsible for transporting patients.

Like other state-run institutions, the Northern Virginia Mental Health Institute, a 123-bed facility on Gallows Road, often serves as a hospital of last resort for psychiatric patients whom private hospitals cannot or will not admit. That’s particularly true of those who have been temporarily detained as dangerous.

Last year, 19 of the institute’s 38 acute-admission beds were slated to be eliminated because of systemwide budget cuts. But local officials were able to pool enough money to keep 13 of the 19 beds open through the end of this fiscal year.

Now the extra funding is running out, and with no plans for another infusion of local dollars, the beds that were saved last year will be gone when the new fiscal year begins July 1, officials said.

It is without question the most pressing issue facing local mental health officials and goes to the heart of the mission of community services boards, said George Braunstein, executive director of the board that serves Fairfax County, Fairfax City and Falls Church. “We have people who need an intensive, acute level of service, and sometimes we don’t have the resources to get them what they need,” he said.

On Friday, Braunstein and his counterparts from Alexandria and Arlington, Loudoun and Prince William counties will be meeting in Chantilly to consider the possibility of creating a regional emergency psychiatric center, which would handle some of the patients who might otherwise go to a state hospital.

But funding such an emergency facility would fall largely to local governments, and they are hardly flush with extra money. “I don’t see quite how we can pull it together without some help,” said Tom Maynard, Loudoun’s mental health director. “Nothing is free.”

State officials are sympathetic but have little to offer. “We would like to help,” said John Pezzoli, assistant commissioner of Behavioral Health and Developmental Services, “but the problem is money, and the solution is money.”

A bit of assistance might be in the offing. Gov. Robert F. McDonnell (R) sought $4 million for the sort of emergency programs under consideration by officials in Northern Virginia, and the General Assembly approved $2 million.

But even if Northern Virginia received a sizable share of that money, a big chunk of local dollars would be needed to set up some sort of emergency psychiatric care center.

One option might be a partnership with staff from Inova Fairfax, which is one of the region’s biggest hospitals and which already handles some patients screened by the community services boards. But it’s unclear how much of an expanded role Inova would want to play, where such a center would be housed and what the cost would be.

In trying to preserve roles for both private hospitals and state institutions, local governments are facing one of the great challenges in public mental health, officials say.

Over the past several decades, deinstitutionalization reduced the role of large state hospitals in caring for people with mental illness and increased the role of private hospitals and other community providers.

But the interests and obligations of private providers don’t always coincide with those of the government, leaving the government to fill the need that no one else can or will.

Inova Loudoun in Leesburg, for example, has been a vital resource in Maynard’s county, but its psychiatric practice focuses on geriatric patients. A very aggressive adult cannot be placed there, Maynard said.

“When we need a secure unit and more intense services, we tend to go to the institute,” he said. Increasingly, though, there is no room.

On occasion, Maynard’s staff has had to call as many as 30 hospitals to find a bed. “What we fear is that the situation is going to come up more often, that it’s going to be routine,” he said.

In Fairfax, the most populous jurisdiction in Northern Virginia, county police had to transport 10 patients to hospitals outside the region in January, compared with 11 in all of 2009 and 25 in all of 2010.

Maj. Mike A. Kline, who oversees the Mount Vernon, West Springfield and Franconia districts, said that the transports take a toll on police manpower and that the long-distance ones are especially challenging. “It takes two officers to do those transports, and they end up being out of service for an entire shift.”

And they are not good for the people being hospitalized, either, Kline said. Already in a troubled state, patients are forced to spend a couple of hours in the cramped back seat of a police cruiser. “It’s not the best way to treat people who have an illness,” said Cindy Kemp, executive director of Arlington’s community services board.

 
Read what others are saying