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Opinion/Editorial: Mental health deaths require study

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We’ve been dealing periodically in this space with Virginia’s ongoing problems with mental health hospitalizations.

A state watchdog group currently is focusing on an increase in deaths at state mental hospitals.

What’s more, most of the increase, although noted for the year 2020, does not appear to be directly related to COVID-19. Instead, it appears to be attributable to inappropriate hospitalizations.

But the watchdog organization has little definitive detail as of yet, partly due to the complexity of the issue but also to a lack of consistent and standardized data.

The Virginia Mercury reports that critical-incident statistics reviewed by the Disability Law Center of Virginia show an overall uptick in deaths at state mental hospitals since 2014.

That’s when legislation went into effect requiring state hospitals to accept patients in need of crisis mental health care if beds for them cannot be found at other facilities.

This makes state hospitals the last-resort solution for emergency patients who cannot be accommodated in private facilities or hospital psychiatric wings due to those institutions’ own capacity limits.

For the fiscal year ending in June 2019, The Mercury reports, deaths at state-run hospitals saw a surprising decline — the first in five years, going from a high of 76 the year before to just 56 in 2019. But in fiscal year 2020, the decline was reversed; deaths rose from 56 to 62.

At least seven of those deaths apparently were COVID-related.

Twenty-five deaths — 40% of the entire state’s total — traced to just one facility, Piedmont Geriatric Hospital. Certainly, retirement homes and geriatric facilities across the country saw a noticeable increase in deaths during the pandemic.

But Piedmont reported that only seven of its 25 death were “due to or concurrent with” COVID.

Still, if COVID was the proven or suspected cause of seven deaths, and those seven are removed from the total of 62, the state’s numbers begin to look less alarming. The total would drop to 55, more in line with 2019’s decline.

But while 2020’s results may look better under this scenario, the DLCV sees a longer-term trend.

“[W]e think … inappropriate medical admissions have been going on for years,” executive director Colleen Miller told The Mercury.

“Inappropriate” in this case doesn’t mean that the patients should not have been admitted. It means they should have been admitted to a facility better equipped to care for them.

These are patients who have serious medical conditions as well as mental health problems. State hospitals are not set up to provide complex medical care. When such care is needed, they work with outside providers — a system that was interrupted by COVID, as many practitioners restricted their practices.

A subgroup of patients often needing rigorous medical care are those with dementia. However, although we all generally understand what that term means, it isn’t formally recognized by the Diagnostic and Statistical Manual of Mental Disorders.

That’s just one aspect of the difficulty in simply collecting data to answer the questions surrounding state mental health hospital deaths.

More broadly, The Mercury reports, Virginia’s Department of Behavioral Health and Developmental Services says it doesn’t have a standard definition of, or category for, patients needing serious medical attention.

That makes the DLCV’s goal of tracking the problem all the more difficult.

To prove that there actually is a problem, researchers must quantify it. That requires a common language and a consistent collection of statistics beyond the raw totals now primarily available.

The DLCV has a reasonable hypothesis for the rising number of deaths, but it needs more data — and, moreover, data that are aimed at this particular issue.

The law center is asking good questions, however, and that’s an important beginning.

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