Ever since that morning in November 2013 when news broke that state Sen. Creigh Deeds was fighting for his life in a Charlottesville hospital after being attacked by his mentally ill son Gus, who later killed himself, Virginians have known the state faces a dire mental health care crisis. Health care professionals had known for years prior to that tragedy, but there was little impetus to reform a rickety system.
In the wake of the Deeds family tragedy, the extent of the system’s failures shocked the public and forced political leaders in Richmond to finally tackle that difficult task.
An investigation revealed shortcomings at the level of local community service boards, which proved utterly incompetent and unable to find prompt psychiatric hospital care when Deeds brought his son to a medical facility near his home in Bath County the day before the attack. No available beds could be found, anywhere, in private or state facilities. And how was that determined? By a social worker calling a list of hospitals asking about bed availability — in the connected age of the internet, there was no complete, online list of open beds in the commonwealth. The younger Deeds’ assessment at intake was rudimentary, at best, because of short staffing. The cause of short staffing? Poor pay and the inability to attract and retain qualified mental health professionals at the local level, especially in rural areas.
In short, Virginia’s was a broken system.
In the years since, Deeds has chaired a statewide panel exploring ways to reform that system in the near term and to rebuild it from the ground up in the long term. But the hurdles, long known and in plain sight, have stubbornly remained in place: money and will power.
Just in the last several weeks, though, there have been developments that would indicate a modicum of success moving forward but that also underscore the extent of the challenge mental health care professionals in Virginia face.
On May 9, the Virginia Hospital and Healthcare Association (VHHA) announced that hospitals in the state would be adding 200 badly needed psychiatric beds to meet a growing need for inpatient care. Also, just last week, mental health professionals told legislators on the Joint Subcommittee to Study Mental Health Services that psychiatric care for children in the commonwealth is just as broken as the system for adults. But most distressing of all, over the past four years, admissions to hospitals for psychiatric care have jumped by 10 percent, putting a strain on a system hardly able to keep ahead.
When VHHA officials announced the creation of additional psychiatric beds, they stressed their move was just a drop in the bucket compared to the needs of the overall system. Hospitalization of patients for mental health care, they stressed, should be a last resort, that ideally a comprehensive statewide mental health care system would provide a variety of outpatient services at the local level to keep people out of hospitals. Virginia, unfortunately, just isn’t there.
According to Virginia Department of Health data as compiled by The Roanoke Times, voluntary and involuntary admissions for mental health care in 2015 totaled 50,145 with only 2,192 of those in state facilities. The numbers increased each succeeding year; in 2018, the total number of admissions was 54,854 with 5,356 of those at state psychiatric facilities. (Ironically, the data start with 2015 because that’s the year the state went live with an online, real-time bed registry, an early success of the Deeds commission.)
So that’s one rare bit of semi-good news on the care front. Now for the bad news.
Last week, the public learned of the depth of the problems plaguing the state’s care system for children. And the revelations are shocking.
According to Nina Marino, director of child and family services for the Department of Behavioral Health and Developmental Services, at least a tenth of Virginia children have experienced a major depressive episode. Of those, 63 percent — about 48,000 children — did not receive any treatment at all. Of those who did, only 20 percent received treatment on a consistent basis.
Part of the problem is that Virginia ranks 41st in the nation for the number of mental health providers for children and adults. Low pay, in both state and private jobs, simply is not conducive to attracting trained professionals or retaining those who do sign up but who leave for higher-paying jobs in other states. Another part of the problem is that the state only has one — one — facility specializing in mental health care for children and adolescents. That’s a 48-bed psychiatric hospital in Staunton where admissions have risen from 615 in 2088 to 1,053 in 2018. Also, in 2008, “only” 27 percent of children were readmitted to the system for additional care, but in 2018, fully 42 percent were.
Virginia, we must do better. We know, in broad terms, what needs to be done — increase the availability and quality of local, outpatient care while addressing the cost and availability of inpatient care — but we seem to lack the will to do what needs to be done. It shouldn’t take another high-profile tragedy like that that befell the Deeds family to move us forward.