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Commonwealth's Counties

Workgroup Issues Recommendations on State Hospital Overcrowding

The workgroup established in 2019 Appropriations Act language to examine the causes of high usage of the state hospitals for individuals for mental illness and make recommendations for relieving these pressures issued its report on November 22. The workgroup met throughout the spring and summer to discuss the issues surrounding the census pressures on the state hospitals, which at times are operating at or above 100 percent of operating capacity, stressing the hospitals’ ability to care for patients and often requiring individuals who are subject to a Temporary Detention Order (TDO) to be transported long distances to an available bed. (VACo reported on the group’s discussions in May and July articles in County Connections.)

Legislation enacted in 2014 provides that the state hospitals serve as the “bed of last resort” for individuals subject to a TDO if no alternative placement is available before the expiration of an Emergency Custody Order (ECO). Since passage of the “last resort” legislation, state hospitals have experienced a 333 percent increase in TDO admissions. While the majority of TDO admissions are received by private hospitals, the share of TDOs admitted by private hospitals has decreased since the “last resort” legislation (as noted in the report, private hospitals point out that they are accepting larger numbers of voluntary admissions, which limits their ability to accept involuntary admissions). In an effort to relieve pressure on the state hospitals, the Department of Behavioral Health and Developmental Services (DBHDS) took steps over the summer to add 28 beds at Catawba Hospital, with plans to add 28 more beds pending approval of funding by the General Assembly.

The workgroup’s report proposes a set of consensus recommendations, as well as several proposals on which the group disagreed. Among the consensus recommendations are the following:

  • Support the continued implementation of STEP-VA, which requires a standard array of services to be offered at each Community Services Board and seeks to provide a comprehensive system of community-based care.
  • Support the behavioral health redesign efforts underway at DBHDS and the Department of Medical Assistance Services, which would add several services that focus on prevention and early intervention for mental health crises to the package of services covered by the state’s Medicaid program.
  • Increase the use of Crisis Stabilization Units and mobile crisis services, and assess the Crisis Intervention Assessment Center model to determine how it might be used to provide relief for law enforcement.
  • Support efforts to expand the behavioral health workforce.
  • Establish a workgroup to examine the civil commitment process.
  • Provide additional funding for private hospital beds for medically complex patients who need psychiatric consultation, and provide a specialized inpatient rate for hospitals serving individuals with intellectual or developmental disabilities.

Proposals included in the report that were the subjects of significant disagreement include extending the ECO period for individuals who require additional observation or treatment (for example, for individuals with an acute medical condition or individuals who are intoxicated) and expanding the ability to conduct TDO evaluations beyond Community Services Board employees or their designees to include hospital staff. Representatives from law enforcement, Community Services Boards, and private hospitals expressed concerns during the workgroup discussions that extending the ECO period would result in individuals experiencing mental health crises spending more time in law enforcement custody or in hospital emergency departments.

VACo Contact: Katie Boyle

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