It was not complete deliverance. Weighing just 20 pounds when she adopted him, his head the size of a 9-month-old’s, he would always be small. He was finally walking by age 3, a good athlete by elementary school. But there were learning disabilities. And by 10 or 11, signs of depression, then bipolar disorder. In young adulthood, the diagnosis was schizophrenia.
He twice landed in state psychiatric hospitals, where he received excellent care but also languished much longer than necessary, Alonge said. Both times, doctors deemed him ready to leave after several months of treatment. And both times, despite Alonge’s dogged efforts, he could not leave until months later.
The state of Virginia simply had no place else to put him.
“It was easier getting him out of Romania,” said Alonge, a 56-year-old lawyer whose son is 23. “It really was.”
The problem is a common and highly expensive one for the commonwealth. A shortage of group homes and other community-based housing for the mentally ill keeps many patients hospitalized far longer than needed — at significant state expense and possibly in violation of the Americans with Disabilities Act, according to a report that will be presented to legislators Thursday.
It costs $214,000 a year, on average, to keep a patient in a state psychiatric hospital, compared with $44,000 a year for community-based housing, according to the report, prepared by the inspector general’s office for the Department of Behavioral Health and Developmental Services.
With at least 70 “discharge-ready” patients stuck in state hospitals, the report says, Virginia is spending about $12 million a year on unnecessary psychiatric hospitalizations.
“[S]cores of individuals remained in the Commonwealth’s behavioral health facilities for an average of almost eight months after they had been determined by clinicians to be discharge-ready,” the report says.
The cost is not merely financial. Many patients deteriorate mentally during the long, frustrating waits to be discharged, experts said.
“They’re told, ‘You’re ready to go. You have done well . . . but there is no place for you to go,’ ” Alonge said. “So you can kind of give up hope. . . . My son said to me, ‘Don’t let me die in here.’ ”
Prospect of real savings
Inspector General G. Douglas Bevelacqua spent six months reviewing the state’s eight psychiatric hospitals that serve adults. During that time, an average of 13 percent of patients were clinically ready to be discharged but unable to leave.
The state puts those patients on what it calls an “extraordinary barriers list,” meaning it is very difficult to place them outside the hospital. Bevelacqua said that about half the time, “extraordinary” is a misnomer.
Over the study period, from July through December, an average of 165 people were on the list. Nearly half were difficult to place because of their age or status in the criminal justice system. Some were elderly and had related medical needs, but nursing homes did not feel equipped to handle their psychiatric issues. Others had been institutionalized by the criminal justice system — judged not guilty of crimes by reason of insanity, in some cases — and could not be released without a court order.