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The costly holes in Virginia’s mental health safety net

Can you imagine being told that you are ready to be discharged from a hospital but you can’t leave?

“How long before I can go?” you might ask.

“A week, a month, maybe longer.”

For Virginians with severe mental illnesses, this is not a theoretical question. According to a recent report issued by a state inspector general, about 13 percent of patients — roughly 165 — currently housed in Virginia mental hospitals could live in community settings but can’t be discharged. The main reason is a lack of supportive housing in their communities.

G. Douglas Bevelacqua, the inspector general for the Virginia Department of Behavioral Health and Developmental Services, warned that this bottleneck is not only hurting patients but also squandering public funds.

Keeping a patient in a state mental hospital costs an average of $214,000 annually, Bevelacqua noted in his May 31 report. Treating that same patient in a community would cost roughly one-fifth as much, or $42,800 per year. Applied to 165 patients, that would be a whopping savings of $28 million a year.

Unfortunately, “ready to discharge” patients can’t be released because Virginia has failed to build an adequate community mental health infrastructure that includes supportive housing.

In a previous report, Bevelacqua noted that 200 Virginians in need of immediate psychiatric help were being turned away from emergency rooms and state hospitals each year because there were no hospital beds available or adequate staff to help them. This practice has become so commonplace that there’s now a slang term for it. “Streeting” means pushing mentally unstable persons back onto the streets without treating them.

“It doesn’t make any difference which door is closed,” Bevelacqua said. “If the hospital’s full, people can’t get in the front door. And if the community is full, you can’t get out the back door.”

The inspector general’s newest report shows the importance of cost-effective supportive housing. My adult son lived in a Fairfax County supportive housing apartment for several months until he became mentally stable enough to find a job and rent his own apartment. He’s an example of how people with mental disorders can recover if helped.

Unfortunately, getting Richmond legislators to spend money for services — especially supportive housing — that may take years to reap savings is tough, especially when the most in need have no wealthy PACs or lobbyists to plead their causes.

Bevelacqua noted that the Justice Department recently sued New Hampshire for not discharging patients from state facilities when they were ready. The feds accused New Hampshire of violating the Americans with Disabilities Act, which requires states to provide adequate services to disabled persons in the least restrictive setting. Virginia could be Justice’s next target, the inspector general warned.

Because of the painful memories of the Virginia Tech shootings that left 33 dead, Virginians should know better than most the dangers caused by hospital bottlenecks, “streeting” and ignoring people who are mentally unstable.

Bevelacqua, whose mother suffered from schizophrenia, has been relentless in exposing wasteful and dangerous gaps in the state’s troubled mental health system since his appointment two years ago.

Sadly, he’s been a voice crying in the wilderness.

The writer is a former board member of the Corporation for Supportive Housing, which helps communities finance housing for the homeless.

 
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