A recent report by Virginia’s Office of Inspector General for Behavioral Health and Developmental Services has documented what families of people with serious mental illnesses in our state have known for decades. The report warns that hundreds of people who have been clinically and legally found to meet Virginia’s involuntary commitment criteria because they have a mental disorder and need to be immediately hospitalized to prevent harm to themselves or others are being turned away by state and private facilities. There is no room for them, so they are being “streeted,” the commonplace term for releasing a person from care because services are not available.
In one recent case, a Virginia court ordered a 66-year-old Virginia woman to receive mental health treatment. Emergency services workers contacted more than 15 private hospitals trying to find a bed. No luck. They all turned her away.
The woman was then driven by two staff members 100 miles to a crisis stabilization unit. She failed to make it through the unit’s medical clearance process due to lethargy — a medication side-effect — and was not admitted.
Forty-eight hours later, she was taken to another emergency room and was finally admitted to that hospital. This can be considered a success story. In other cases, people are arrested and end up in jail because jails are at least thought to be secure settings — even though treatment there may be minimal.
Northern Virginia is the fastest-growing region in the state yet has the lowest number of beds per capita — and, because of state budget cuts and downsizing, is losing beds each year. The Virginia state hospitals that exist to provide mental health care can refuse to admit the sickest people. Private hospitals can do the same, leaving no safety net.
In 2010, the number of beds at the Northern Virginia Mental Health Institute in Falls Church was reduced from 129 to 123; an additional 13 beds will be lost starting July 1. Eastern State Hospital in Williamsburg saw its beds cut from 250 to 150. Last year a specialized children’s unit in Marion in southwest Virginia was shuttered, and next month the Chesapeake Regional Medical Center will close a 24-bed mental health unit for older people.
Existing community mental health services cannot make up for these losses. Late last year, Gov. Robert F. McDonnell proposed more than $7 million in funding for urgently needed crisis-stabilization programs — an alternative to hospitalization that provides short-term treatment and other community services. The proposal would have lessened, but not completely alleviated, the problem of streeting. Unfortunately, the General Assembly approved only about half of it.
An estimated 308,000 Virginia adults have had a serious mental illness during the past year, and 102,000 children have had a serious emotional disorder.
There are several approaches to addressing the problem of streeting. First, Virginia must scrutinize public and private hospital policies, and the insurance payers that fund such care, to remove patients’ obstacles to reaching the safety net. Second, preventive services must be expanded and integrated into all communities in Virginia, for youth and adults.
Third, if downsizing must occur, it should be accompanied by responsible and extensive planning to develop robust mental-health services elsewhere in the community. If patients are ready to be moved out of hospitals and back home, there must be adequate services to support their transition. Fourth, Virginia must invest in proven and effective housing models that are known to keep people with even the most serious mental illnesses safe and healthy.
Unfortunately, the consequences of an underfunded, fragmented system are known all too well. Virginia is failing people who are most in need. Shortcomings lead to tragedies and every tragedy can compound others.
It is a tragedy if a woman with mental illness is put on the street and cannot get the care she needs. It is compounded if she is assaulted on the street and further worsened if she dies on the street. “Streeting” violates all standards of human decency — it’s time for Virginia to end it.
Mira Signer, Richmond
The writer is the executive director of the National Alliance on Mental Illness of Virginia.