The Washington PostDemocracy Dies in Darkness

Opinion Virginia’s mental health hospitals must be restored

Western State Hospital in Staunton, Va., was ordered to cease admissions. (Evelyn Hockstein for The Washington Post)

Marian Huber is the legal guardian for a family member who has received services from the Department of Behavioral Health and Developmental Services for most of her 61 years.

The sudden suspension of admissions to five of the eight Virginia Department of Behavioral Health and Developmental Services’ psychiatric hospitals on July 9 has been labeled a crisis driven by uncontrollable factors. Most of the factors driving the system to this state were known years before the coronavirus struck.

Department of Behavioral Health and Developmental Services Commissioner Alison Land did not issue a clear warning that a hard shutdown of psychiatric hospital admissions was coming before releasing her letter. Her plea to hospital partners on July 9 to step up and admit more patients is not likely to help many of the people stranded without care. Why was there no collaboration on rescue plans ahead of time?

Virginia Gov. Ralph Northam’s endorsement of her decision shows a lack of concern for the seriously ill individuals who without any immediate help, may harm or kill themselves, family members or police officers. Land and Northam (D) would likely feel angry and betrayed if a member of their family was turned away from an emergency department with a heart attack or trauma from an accident and there was nowhere else to go.

Legislators, city officials, police chiefs, hospital system administrators and every person affected by this sudden loss of critical mental health hospital services should let Northam know that services need to be restored now.

If the commonwealth can deliver emergency services for natural disasters, it can create surge facilities for people who need immediate psychiatric treatment. To address Virginia’s mental health crisis, emergency facilities could be established on the campus of existing DBHDS facilities or other hospitals with psychiatric beds, with patients transferred into them as capacity allows. Because patients in emergency rooms do not have a therapeutic environment, or even much treatment, surge psychiatric hospitals that start treatment right away might help some patients stabilize without a long hospital stay.

Hospital administrators are supposed to have plans in place to deal with events that could overwhelm their operations. The governor and DBHDS did not have a plan.

Filling empty positions and increasing salaries will also not make the system work better without the strategic and transformative changes that have been promised for years. But if government-run psychiatric systems inherently lack the flexibility and vision to transform themselves, allowing things to continue in this direction may drive the system to collapse.

DBHDS understands that its hospital patient census keeps increasing because not enough people can be discharged to offset incoming patients. Up to 200 people now in psychiatric hospitals operated by Virginia don’t need hospital care; they need places to live with adequate supports to keep them from returning to the hospital.

To help speed the discharge of patients ready for release from Virginia’s psychiatric hospitals but without a suitable home or services, the commonwealth could issue a request for proposals for multiple assisted-living facilities with integrated medical and mental health services. Residents’ care might cost $4,000 to $8,000 a month or more, but that is less than the cost of a long-term psychiatric hospital stay. A comprehensive residential-care option would also reduce frequent trips to emergency departments for medical and psychiatric care. Those ER costs are already being borne by the public through taxes or higher insurance premiums.

Admissions to psychiatric hospitals could also be slowed and reduced if Virginia had more mobile crisis teams supported by rapid follow-up community services. The best mobile teams can stabilize up to 70 percent of the people they assist, thus keeping them out of hospitals, according to the Substance Abuse and Mental Health Services Administration. If more investment in crisis intervention simply fills the hospitals faster, then Virginia’s model needs to be reexamined and modified. Crisis intervention mobile teams should also help reduce conflicts with police that result in arrests. Fairfax County and other areas already have operating mobile programs. Other DBHDS Community Services Boards localities may have to wait until July 2026 for mobile crisis teams operated under the DBHDS.

The Minneapolis City Council recently approved $6 million to start a mobile service for mental health emergencies. The concept was advanced after George Floyd’s murder, and it took only a year to award a contract to a nonprofit called Canopy. Many of the mobile mental health services operating now are modeled on the Cahoots operation out of Eugene, Ore., which started more than 30 years ago.

Another approach to help people in mental health crises get faster and more appropriate treatment — and avoid hospitalization — has been developed by Vituity. One of their solutions is EmPATH, a crisis stabilization unit created by Scott Zeller. It evaluates patients with compassion and provides treatment that allows most patients to be discharged to a lower level of care within 24 hours. This helps preserve ER capacity for trauma cases while reducing the need for inpatient admissions and ER boarding of patients. Treatment models like this should be examined and tested.

Other organizations and companies have innovative programs that could improve delivery of emergency mental health services. Maybe it’s time for a pilot program to outsource some of the work that DBHDS is struggling to do well.

Without a course correction, better leadership and accountability, Virginia’s mental health care will continue getting worse and more expensive.