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Shortage of Beds And Psychiatrists Plagues Much of Va.
Reimbursement Cited as Problem, Too

By Chris L. Jenkins
Washington Post Staff Writer
Thursday, October 11, 2007

Virginia lacks experienced psychiatrists to evaluate the mentally ill, there aren't enough beds for those seeking emergency treatment in many areas and hospitals are losing money on mentally ill patients, according to a state government report.

Several findings in the 230-page report released this week by the General Assembly's auditing agency echo earlier examinations of the state's mental health system, which has come under scrutiny since the Virginia Tech shootings, in which a student killed 32 students and faculty and himself 16 months after being admitted to a mental health clinic for a night.

The report, prepared by the Joint Legislative Audit Review Commission, states that 47 of Virginia's 135 localities do not have public psychiatrists and that 87 do not have public child psychiatrists. In addition, half of the state's psychiatrists are in seven Virginia localities, according to the report, and one in five are in Fairfax County, Fairfax City and Falls Church.

The report suggests that the shortage floods emergency rooms with mentally ill people in crisis and prevents the system from adding beds or discharging people on time.

"Additional psychiatric beds cannot be opened unless there are psychiatrists available and willing to staff them," the report says. It adds: "On the outpatient side . . . a lack of psychiatrists affects licensed hospitals because individuals in need of psychiatric service cannot find them in the community and . . . turn to emergency departments."

A higher percentage of people live an hour's drive from a psychiatric hospital in rural areas than in such areas as Northern Virginia and Tidewater, the report finds. It also says that in Northern Virginia, more psychiatric beds are needed for children and adolescents.

Some of the report's other key points, including its call for more emergency crisis beds and services, have been raised by several state commissions. Since the massacre at Virginia Tech, each branch of government has studied the system, and Gov. Timothy M. Kaine (D) and General Assembly lawmakers have pledged to address the issues raised during next year's legislative session.

Some findings will not be easy to address. The study, which began months before the shootings, also found that on a single day in 2005, 60 percent of the 6,350 mentally ill people in state hospitals or jails were in jails. Previous state reports have found that approximately 16 percent of the people in Virginia jails are mentally ill.

"This was one of the most shocking things to me," said Sen. Charles J. Colgan (D-Prince William), who sits on the Joint Audit and Review Committee. "The jails aren't equipped to handle these kinds of numbers. . . . This is a bad situation."

The study found that private hospitals licensed to take care of the mentally ill are losing money because they are not being reimbursed for the care they provide. It found that 24 of the state's 26 hospitals licensed to admit mentally ill patients reported unreimbursed fees of $61 million in 2005; 14 emergency departments reported $45 million in unreimbursed costs.

To address these shortfalls, the report suggests that the state "examine its potential role in . . . assuring an adequate supply of beds . . . [by] increasing financial support for uninsured psychiatric patients."

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