All of Virginia’s mental hospitals have reopened gradually to admitting more patients in crisis, but staffing challenges remain in state institutions and local behavioral health programs, especially those serving children and teens.
All eight of the state’s mental hospitals for adults are accepting new patients as they discharge those who’ve been treated, including six institutions that had suddenly closed to admissions in early July because they lacked the staff to care for patients safely.
Two institutions soon will expand the number of beds they can fill — 14 at Catawba Hospital near Roanoke on Friday and seven at Central State Hospital near Petersburg next Wednesday — but the state is still operating 248 fewer beds than before the crisis began and the nearly 1,100 beds available are 98% full.
Virginia Behavioral Health Commissioner Alison Land told legislators on Wednesday that she was committed to increasing admissions as long as the institutions have enough staff to operate safely.
“Our staffing is not perfect,” Land said in a presentation to the Behavioral Health Commission. “We did not try to reach perfection. We just needed it safer so we were able to open.”
Two hospitals — Catawba Hospital and the Commonwealth Center for Children and Adolescents in Staunton — are operating with just 45% of their normal direct-care staffs of aides and nurses. Eastern State Hospital near Williamsburg is operating with 52% of its normal staff, while Piedmont Geriatric Hospital in Nottoway County and Western State Hospital in Staunton each has about 54% of its staff.
The staffing crisis is especially acute at the Commonwealth Center, the only state behavioral health hospital for children and adolescents. It continues to operate just 18 of its 48 licensed beds, even though pressure is building on both public and private facilities that serve children and teens as the school year nears the end of its third week.
The effects are taking a toll on private providers, who run residential treatment programs for children and adolescents, provide special education services, and help children in foster care settings.
“The kids are there, but the staff is not,” said Bill Elwood, executive director of the Virginia Coalition of Private Provider Associations, representing 20 individual organizations and two regional coalitions. “You’re asking them to take more and more difficult cases, and we just don’t have the staff to do it.”
Elwood said Virginia’s relatively low reimbursement rates, especially compared with neighboring states such as Maryland and North Carolina, make it harder to recruit and maintain staff. As a result, some facilities are operating fewer beds or filling them with children from other states at higher rates, which he said has the perverse effect of forcing Virginia to pay more to place its children at facilities elsewhere.
“The result is less placement options for Virginia children,” he told the commission.
Elwood’s members also report high numbers of children and adolescents sleeping in private hospital emergency departments, local social services offices and hotel rooms.
Commission members voiced similar concerns about staffing at local and regional community services boards, as well as pressure on local law enforcement officers, as adults and children in psychiatric crises have been unable to receive treatment in overcrowded state institutions that also are understaffed.
“I’m afraid that in many respects we just pushed the problem down when we closed the hospitals to law enforcement and the CSBs,” Sen. Creigh Deeds, D-Bath, the commission’s chairman, told Land.
Del. Terry Austin, R-Botetourt, echoed that concern. “Staffing in rural areas for CSBs is crucial,” he told Land.
Federal emergency aid under the American Rescue Plan Act has helped ease the problem for state hospitals. The Department of Behavioral Health and Developmental Services has used all of its financial reserves to pay bonuses to recruit and retain direct care aides and nurses, supplemented by $45 million in federal funds that Gov. Ralph Northam and the General Assembly approved to pay for bonuses in this fiscal year.
Northam also has promised to include an additional $76.9 million for hospital staff salaries in the two-year budget he will propose in December.
“Fortunately, the new funding is already demonstrating some relief to our staffing situation,” Land said.
She also told Deeds that funding proposals are being prepared to address the staffing crisis in all parts of the behavioral health system, not just state institutions.
“Workforce is one of our biggest issues,” Land said.
Deeds replied, “It’s a huge issue, and I’m just hoping that we can eventually get to the place where we have an approach that recognizes that we have a system, and that includes CSBs and the hospitals, and we’ve got to take care of our employees to make sure we have employees at every one of our facilities.”
Land responded, “I agree totally.”