Four psychiatric wards in Northern Virginia have closed recently or will be shut down soon, eliminating 100 beds and threatening to create a mental health care crisis, health officials say.
The closures at four suburban hospitals are the result of national trends in health care economics, but the fallout could mean longer waits in emergency rooms, more mentally ill patients in jails and fewer options for very troubled -- and occasionally dangerous -- people, mental health advocates say.
"You have to practically die before you're able to get any help," said Dotti McKee, whose schizophrenic son has been shuttled from hospitals to homeless shelters to jail cells in Fairfax.
The recent closure of the psychiatric units at Potomac Hospital in Woodbridge and Inova Alexandria Hospital and the planned closure of Dominion Hospital in Falls Church and Northern Virginia Community Hospital in Arlington will place more pressure on the sole state-run hospital in the area, which is already over capacity.
"A drastic situation is going to get a lot worse," said George Barker, associate director of the Health Systems Agency of Northern Virginia, a regional health planning agency. "It raises major concerns about how all these people will be accommodated."
The disappearance of psychiatric beds in Northern Virginia grows out of an ad hoc national mental health system in which resources and economic incentives do not match needs, advocates and planners say. There is desperate demand for short-term options for mentally ill people in their own communities -- acute-care hospital beds, halfway houses, outpatient support services and detoxification programs.
But public and private insurance reimbursement rates, which cover a fraction of the cost of care, make mental health a financial loser. Also, more than one-fourth of mentally ill patients have no insurance, health officials say, meaning hospitals often swallow the cost of care.
Potomac Hospital closed its 12-bed psychiatric unit three weeks ago after losing what it said was $4.7 million on mental health services since 1998.
"Basically, it was a cost issue,'' hospital spokesman Leigh Dunlap said.
A growing national nurse shortage means that even when there is an empty bed at a private or community hospital, a patient may be turned away because appropriate staff members are unavailable to provide care to a difficult or violent patient.
The overall result is that there are fewer options for some of the region's most vulnerable and sickest people.
While the bed situation in Northern Virginia is especially acute, shortages in mental health care are chronic across the region, given continuing budget problems in local and state governments. To save money this year, Maryland closed down a 200-bed mental hospital in Crownsville and transferred its patients to other hospitals, leading patient advocates to warn that shortages of available inpatient beds could be a problem down the road.
In Prince William, Rita Romano, a Community Services Board staff member, said she has to make dozens of calls to find a bed for a sick patient. Sometimes that bed is as far away as Hampton Roads. Other times, patients sit in hospital emergency rooms or handcuffed in police cruisers because there is nowhere else for them to go.
"We're kind of holding our breath here just to find out what is going to happen,'' Romano said, referring to the wave of expected closings.
There are even cases in which police have charged patients with minor offenses just to get them into an environment, such as jail, with some supervision, Romano and others said.
She said many patients come to her organization from law enforcement, and if a bed cannot be found, they can be released by a magistrate after four hours.
"Now you're really into scary territory. . . . We're not talking the severely depressed, we're talking imminent risks, a dangerous situation.''
A few weeks before Potomac Hospital closed its mental ward, Inova Alexandria shut down its 19-bed psychiatric unit, transferring seven beds to the company's Mount Vernon Hospital, according to an Inova spokeswoman.
The for-profit Healthcare Corp. of America is planning to close the 100-bed Dominion Psychiatric Hospital in Falls Church and the 20-bed psychiatric ward at Northern Virginia Community Hospital in Arlington. HCA, which says its beds are frequently empty, is planning a 40-bed youth mental health facility as part of a planned new hospital in Loudoun.
A dangerous situation is exactly what Dotti McKee's son, Mike, found himself in in September 2003. Mike, 35, who is diagnosed with paranoid schizophrenia, felt himself relapsing and made his way to the Woodburn Center for Community Mental Health in Annandale, which is run by Fairfax County.
"They told him there were no beds available,'' said McKee, who did not want her son's last name used. Mike, a college graduate, soon found himself in a homeless shelter, where he got into a fight with another resident. Then, his condition worsening, he attacked two teenagers on a bus.
"He thought they were talking about killing me,'' McKee said.
That incident landed him in Fairfax County Adult Detention Center, where he stayed in near isolation for 37 days, McKee said. McKee said she met with county authorities and begged them to send Mike to a mental hospital, but they said he was not in "imminent danger.''
Mike then stopped eating and lost 30 pounds in jail.
"He figured if he did something drastic he could get a bed,'' said McKee, who now serves on her local board of the National Association of the Mentally Ill.
He was soon sent to Western State Hospital and now is at the state-run Northern Virginia Mental Health Institute in Fairfax, where McKee said he is finally getting the help he needs.
"If they would have put him in a bed the first time, he would have balanced his meds and he would not have wound up in jail or in the hospital for so long,'' she said.
James Kelly, a psychologist and manager of emergency services at the outpatient Woodburn Center, said he could not comment on the specifics of Mike's case.
But, he said: "I can't think of a time when someone who was seriously needing hospitalization was turned away. It might take a while, but we would figure it out.''
One thing is clear: There are not enough beds at state-run hospitals for all of those in need in Northern Virginia.
Lynn DeLacy, director of the Northern Virginia Mental Health Institute, said her 127 beds are almost always full. The state has to "buy'' dozens of additional slots at private hospitals daily to take care of those most in need. Most of them are indigent or have been ordered detained by the courts.
On a recent tour of the hospital, which is discreetly behind Inova Fairfax Hospital, some patients were preparing for a plant sale. Others were reading newspapers, and still others were getting their daily exercise, walking an internal route around the sprawling, single-story hospital. But a few sat forlornly and alone, including one who had a jacket covering his head.
DeLacy said just counting beds is not the answer.
"The simple answer is more beds. But we need more community resources to get people out of the hospitals and back into the community,'' said DeLacy, who co-authored a study of the bed shortage last summer.
Her co-author, James A. Thur, executive director of the Fairfax-Falls Church Community Services Board, said the answer is more, broader services to meet the growing need. Their report recommends better reimbursement rates for inpatient hospitalization and additional funding for other, less intensive care.
"Across the commonwealth, residential care, day treatment, medications, all of these things are universally underfunded,'' Thur said. "And that increases the likelihood that someone will need inpatient care.''