Virginia is expecting a nearly $2 billion state budget surplus. It’s sitting on $4.3 billion in federal pandemic aid. Shouldn’t some of that money be spent on the worsening mental health crisis? You bet it should.
State mental hospitals are suffering under a double burden: Admissions are up, but staffing is down.
More patients would indicate the need for more space and more staff. Instead, hospitals are operating with fewer staff — and one of the reasons is that overburdened and burned-out employees are simply quitting, unable to take the strain any longer.
Inadequate staffing compounds mental health problems. Patients are unlikely to obtain the full level of care that they need, which can cause their illnesses to worsen — in some cases, even deteriorating into incidents of aggression or violence.
Virginia’s public psychiatric hospitals are operating at an average 98% capacity, a state behavioral health commissioner recently said. At least one hospital is over capacity, the Washington Post also reported.
Meanwhile, hospitals are operating with around 20% fewer staff members than they need. In at least one case, staffing vacancies approached 50%.
One of the reasons for overcrowding over the past several years is a relatively new law requiring state hospitals to accept emergency mental health patients if no placement can be found for them in other institutions, including private facilities.
The law is intended to get crisis patients into care as rapidly as possible, before their conditions can worsen and before they can put themselves or others in danger.
It was passed because of the experience of state Sen. Creigh Deeds, who had sought emergency care for his son. Gus Deeds was sent back home after a regional mental health employee said he could not find a bed for him; hours later, the young man attacked his father and killed himself.
Mandating placement for patients in this kind of extremis is well-intentioned. What wasn’t anticipated was just how many patients would need such interventions, or how seriously these placements would overwhelm hospitals and staff.
A legislative group known as the Deeds Commission is working hard to find solutions, and find them quickly.
Speed is necessary because the General Assembly will meet in early August to determine what to do with the $4-plus billion that Virginia received from the American Rescue Plan.
There’s also a surprisingly robust surplus of nearly $2 billion expected from the final tally of the 2020-21 fiscal year, which ends June 30. Some of that money must be sent to the state’s rainy day fund and to a water-quality fund. The rest will be spread among programs and services in the budget that Gov. Ralph Northam will present to the 2022 General Assembly.
Some of his proposals will depend on how the legislature allocates the $4.3 billion currently at its disposal.
This federal aid must be used for purposes related to the pandemic. But although overcrowding and understaffing at state mental hospitals predate the pandemic, the stresses of COVID-19 undeniably worsened the problem.
Even within the mental health community, there is a lack of consensus on where the money should go. Adding beds to state hospitals would seem to be an immediate and critical need. But some advocates say the money should go to community-based mental health care to help prevent people from needing hospitalization in the first place.
Steps also must be taken to raise staffing levels at hospitals, which may require improving pay. This money may need to come from state, rather than federal, funding.
In any case, we’ve known for years that more money was needed for mental health care, both at in-patient hospitals and out-patient community settings.
The General Assembly must address this need.
Now would be a good time.
—The Daily Progress