- The Washington Times - Monday, April 2, 2012

RICHMOND — A 22-year-old Virginia man who had been living in a group home was brought to an emergency room on July 18. He had been biting staff, pouring antifreeze, motor oil and cleaning fluid on himself and running into traffic. Voices were telling him to harm himself.

Other private hospitals had declined to temporarily detain him, either because of his severe condition or bed capacity problems. It took more than nine hours before an attending physician finally demanded that he be placed in the facility’s psychiatric unit.

The same man was brought back to an emergency room on July 28 by police for similar behavior, and that time it wasn’t until he struck and injured a worker who had been attending to him that he was finally admitted to a psychiatric unit July 31.

Facilities declining to temporarily detain mentally ill people because of capacity or service issues — also known as “streeting” — is a growing problem in Virginia, as the state grapples with how to properly provide for individuals with severe mental illness.

The issue surfaced in a report from the office of the inspector general (OIG) for the Department of Behavioral Health and Developmental Services, which said 200 such people were turned down from April 1, 2010, through March 31, 2011.

A follow-up report found that from July 15 through Oct. 13, a total of 72 people were in need of a “temporary detention order” to allow for a comprehensive evaluation to determine the proper level of care, due to clinical risks. But the orders were not executed.

The search for treatment options for people having severe mental episodes is also causing patients to be held beyond a six-hour limit during which they can be legally detained under an emergency custody order.

The follow-up report said 273 people were, as in the example above, admitted after the legal time limit.

And while more than 4,100 patients were admitted properly over the time period listed in the follow-up report, Inspector General G. Douglas Bevelacqua said the state must aim higher, given the potential consequences.

“I really do think that public safety and mental health overlap in this issue, and we need to get it right every time,” he said.

Part of the problem is the lack of licensed psychiatric beds in the state. The Joint Legislative Audit and Review Commission, the General Assembly’s investigative arm, reported in 2007 that the state had an adequate number of beds: 1,794.

But by September 2011, that number had declined to 1,699.

Private hospitals, licensed to operate 1,540 psychiatric beds across the state, were only staffed to operate 1,305 beds, according to the Virginia Hospital and Healthcare Association.

The Northern Virginia region had the second-lowest number of cases reported, with five instances of streeting and 15 cases in which a patient was admitted after the six-hour limit. Southside Virginia had the fewest, with 16 total, and the Hampton Roads area had the most, with 99.

George Braunstein, executive director of the Fairfax-Falls Church Community Services Board, said a shortage of hospital beds is a chronic problem and that they’ve lost about $16 million out of a $150 million base budget over the past four years. But when necessary, they’ve come up with alternatives.

For example, they’ve increased the capacity of day-treatment programs to be partial hospital programs so available patients can receive treatment without overnight stays, freeing up space for people with more serious conditions.

“We’re trying to find community alternatives that are not hospitalizations,” he said. “We have realigned the resources we have to be more effective.”

A scathing U.S. Department of Justice report last year said that Virginia was needlessly institutionalizing people with intellectual and developmental disabilities in violation of a recent Supreme Court decision saying that individuals must be treated in the most-integrated settings possible.

The state and the federal government recently reached a $2.1 billion settlement that would close four of Virginia’s five “training centers” for people with intellectual and developmental disabilities over the next 10 years.

A public-comment period on the settlement ends Friday, after which U.S. District Judge John A. Gibney will set a date for a hearing on it.

• David Sherfinski can be reached at dsherfinski@washingtontimes.com.

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