Psychiatric hospital admissions in Virginia

Hospitals in Virginia are adding nearly 200 psychiatric beds to relieve some of the pressure of having more patients than rooms to treat them, but hospital leaders on Thursday said more must be done to keep people from needing inpatient care.

The Virginia Hospital and Healthcare Association held a news conference in Richmond to discuss ways its members are addressing the increased demand for psychiatric care and to offer proposals that include having more outpatient services — such as partial hospitalization and intensive outpatient treatment — fully covered by Medicaid.

State lawmakers who serve on a committee to reform mental health services have grappled with overcrowding in recent years at state psychiatric hospitals and have questioned whether the private sector is doing its share.

“The fact of the matter is both private hospitals and state hospitals are dealing with a surge in demand for inpatient psychiatric care,” said Dr. Michael McDermott, chairman of the state hospital association board and CEO of Mary Washington Healthcare. “To help put that in perspective, consider this: Last year, community hospitals in Virginia accommodated 29,278 voluntary admissions. That’s up from 25,526 admissions in 2015. That growth represents a 10.9% increase.”

Voluntary admissions involve people who agree to be admitted to the hospital. Involuntary admissions, those that arise when a temporary detention order is obtained to treat a person thought to be a danger to themself or others, are also increasing. Private hospitals accepted 20,220 TDO patients last year, and another 5,356 were admitted to state hospitals. In 2015, private hospitals treated 22,697 TDO patients, and the state hospitals, 2,192.

The year 2015 is the first full year following the implementation of a statewide bed registry that was created in the wake of a family tragedy involving state Sen. Creigh Deeds, whose son attacked him and then killed himself hours after a community service board worker failed to find a psychiatric bed for him.

The law requires state hospitals to serve as the bed of last resort, which has added pressure, but the increase in overall admissions is more complex. Some of it may be due to a better understanding that mental illness is a brain disorder and not a moral failing, said Carilion Clinic psychiatric chair Dr. Bob Trestman.

“The reduction in stigma is having a wonderful effect in allowing people to seek care,” he said. “We are being more open about the realities of life and the stressors we are all experiencing. It indeed is making it easier for people to seek care.”

During the last nine months, Carilion spent $2 million renovating three floors in its rehab building in Roanoke that houses a 16-bed unit for children and adolescents and two adult units, for a combined 35 beds.

To undertake the project, Carilion had to empty one of the floors, temporarily cutting in half the number of adults it could treat. Then the project went floor-by-floor, moving patients to make the rooms safer and cleaner, update systems, deaden noise and create an environment that encourages nurses to interact more with patients.

The project did not add additional capacity. Carilion is asking the state for permission to add 15 psychiatric beds. If approved, the unit could open as soon as August, Trestman said.

LewisGale also expects in August to open a new facility it is building at its Pulaski hospital. The new 16-bed adult behavioral health unit will include addiction services and will enable LewisGale to offer comprehensive behavioral health services in Pulaski for the first time. It is also expected to bring 25 new jobs.

“There is a demonstrated and growing need for additional mental health services in our community, and throughout Southwest Virginia. This new facility will enable patients to receive treatment close to home and near the support of family and friends,” Sean Pressman, CEO of LewisGale Hospital Pulaski, said.

Statewide, five other hospitals expect to add 159 beds in the next year or two with most of them designated to treat children and adolescents.

Trestman said there is such a crucial need for these types of beds that Carilion kept its children’s unit open during the renovations.

He said Carilion also is developing more programs to keep people from needing to be admitted.

“Since I’ve been here the last two years, we’ve worked to upgrade clinical services. We were able to dedicate more clinical time to the emergency room for both children and adolescents,” he said. “Kids who otherwise might have needed to be admitted we were able to treat, coordinate care and discharge safely from the emergency room.”

A bridge clinic was set up so kids and their families can be seen quickly after discharge. A similar program is helping to treat more adults in the community.

But getting timely care outside of the emergency department is still problematic.

“Right now our average wait time is just under three weeks, and it is extremely difficult for us to shrink it,” Trestman said. Psychiatrists are working with primary care doctors to try and treat patients in the physicians’ offices.

“Several of us are running telehealth clinics, so my Monday afternoon clinic is in support of primary care physicians and seeing patients in their office by telepsychiatry,” he said.

Trestman said that Carilion has hired five more psychiatrists for inpatient, clinic and telehealth, and four psychiatric nurse practitioners for Roanoke and the New River Valley, all of whom will begin in the coming months.

Building more psychiatric services is difficult, he said. “For a host of reasons, there is a national shortage of psychiatrists that is expected to only get worse over the next decade, so we are struggling with others around the nation to recruit people we need.”

James Newton, chairman of the hospital association’s behavioral health committee and director of behavioral health for Bon Secours Virginia Health System, said during the news conference that workforce shortages are a pressing concern and a topic of daily discussion.

He said the association is also working with the state Department of Behavioral Health and Developmental Services and Virginia’s Medicaid program to find ways to increase the options for people to be treated in the community.

The hospitals are looking for Medicaid to begin to pay for additional services that would keep people from becoming inpatients.

The state’s Medicaid program has been used similarly to increase the number of providers and types of services for treating people with addictions.

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