Virginia Hospitals Offer Plan to Enhance Behavioral Health Treatment Capacity to Accommodate Patient Needs
May 9, 2019
During National Mental Health Awareness Month, Private Virginia Hospitals Recommend Solutions to Help Address Growing Demand for Voluntary and Involuntary Inpatient Psychiatric Treatment, and Continue to Add New Behavioral Health Bed Capacity
RICHMOND, VA – At a time of growing demand for voluntary and involuntary behavioral health treatment services, Virginia’s hospital community is putting forth a series of recommendations to respond to current conditions and to help increase treatment capacity for patients throughout the Commonwealth. Those recommendations are in addition to private hospital investments in expanded treatment capacity – nearly 160 new psychiatric beds are coming online at hospitals across the state between now and 2022.
The behavioral health recommendations, in development for months, have been formulated by members of the Virginia Hospital & Healthcare Association’s Behavioral Health Committee, which is comprised of mental health leaders from hospitals and health systems throughout the Commonwealth who have hundreds of years of combined experience working in this field. They include a series of proposed strategies to help relieve capacity challenges at state hospitals. The recommendations arrive as both private and state hospitals are encountering a surge in demand for mental health treatment services, which has strained capacity in public and private hospitals.
- The increase in the number of people requiring temporary detention attributable to a psychiatric crisis has occurred at a time when private hospitals have experienced significant growth in the number of people seeking voluntary inpatient admission for psychiatric care.
- Community hospitals accommodated 29,278 voluntary admissions in fiscal year 2018, up from 25,526 such admissions in fiscal year 2015 (representing a 10.9 percent increase).
- The demand for voluntary admissions has led to a decrease in the number of involuntary admissions at private hospitals in recent years. However, private hospitals continue to accommodate the vast majority of patients admitted under temporary detention orders (TDO) in Virginia.
- To wit, community hospitals in Virginia accepted 20,220 TDO admissions in fiscal year 2018, nearly four times as many TDOs as state hospitals handled that year.
- And private hospitals are adding 159 new psychiatric beds in communities across the Commonwealth to respond to patient needs.
“Growing demand for behavioral health and substance abuse treatment services is not unique to Virginia. It is a trend that has been felt across the nation. Here in Virginia, the hospital community is working with state officials, stakeholders, advocates, and community partners to develop solutions that meet the needs of patients seeking mental health care in the Commonwealth,” said VHHA Board of Directors Chairman Dr. Michael P. McDermott, the President and CEO of Fredericksburg-based Mary Washington Healthcare. “A combination of factors has contributed to some of the capacity challenges experienced in Virginia including an increase in voluntary psychiatric admissions, a lack of sub-acute levels of care, and behavioral health workforce staffing shortages, among other things. Recognizing these conditions, the hospital community is offering a creative set of recommendations to address capacity concerns and adding bed space in our facilities, too. In offering these recommendations, as well as investing in new psychiatric beds, Virginia hospitals are demonstrating a commitment to work together with state partners to address behavioral health treatment needs.”
Hospitals have offered strategies aimed at working with behavioral health partners to address workforce adequacy, situationally leveraging telepsychiatry when appropriate to expand access to care, reducing inpatient admissions through the creation of a Medicaid benefit for mental health partial hospitalization and intensive outpatient treatment, and improving access to crisis services for patients with substance use disorder to help reduce unnecessary hospitalizations. Each of these strategies can help free up precious bed space so that more patients seeking inpatient treatment can receive care in their hour of need.
These recommendations are just the latest example of the collaborative approach taken by Virginia’s hospital community to find solutions to behavioral health conditions in the Commonwealth. Last fall, for example, the Virginia Department of Behavioral Health and Developmental Services (DBHDS), the Virginia College of Emergency Physicians, and VHHA unveiled and implemented statewide Medical Assessment and Screening Guidelines to enhance timely access to treatment for psychiatric patients. Two years in the making, the pact established baseline standards for use when evaluating patients who arrive at a hospital emergency department with psychiatric symptoms to determine the proper setting for their care.
“These recommendations represent a sincere and serious proposal to help better serve patients and relieve some of the capacity issues that have been experienced at public and private hospitals in Virginia,” said Southside Regional Medical Center (SRMC) Behavioral Health Services Director Lisa A. Castro, MSW, MBA, LCSW, who also serve as Vice Chair of the VHHA Behavioral Health Committee. “One of the ideas we’ve offered at Southside Regional is to dedicate five acute psychiatric beds to meet the specific needs of patients who are dually diagnosed as intellectually and developmentally disabled. The goal of this proposal is to divert those patients to SRMC to relieve nearby Central State Hospital. That’s just one example of the ideas we’ve put forward to be provide solutions to challenges the behavioral health system is experiencing.”
“Each hospital patient has different needs. This is true in an acute medical care setting, and it is certainly the case in the behavioral health environment,” added Bon Secours Virginia Health System Behavioral Health Service Line Administrative Director James R. Newton, the Chairman of the VHHA Behavioral Health Committee. “Community hospitals in Virginia are accommodating tens of thousands of voluntary and involuntary psychiatric admissions each year. As health care providers, we want to serve every person in need. Yet in each situation involving a potential psychiatric admission, hospital staff must evaluate multiple factors when determining whether a particular patient can be accommodated. Community hospitals are bound by federal mandates such as the Emergency Medical Treatment and Active Labor Act (EMTALA) which requires hospitals to treat patients who arrive at the emergency department regardless of circumstance. If a patient is admitted under the terms of EMTALA, a previously unoccupied bed that might have accommodated a behavioral health admission is no longer available. Hospitals serve patients in the order in which they present themselves for treatment. And in every situation, medical necessity is an overriding concern. The fact is that the rules of the system within which we operate can be complicating factors. Even so, we consistently strive to meet the needs of patients. And we are continuing to do so, as demonstrated by the development of these recommendations to tackle head on some of the challenge the treatment system faces.”
Added National Alliance of Mental Illness (NAMI) Virginia Executive Director Rhonda Thissen: “The behavioral health community is a diverse mixture of individuals and families, public and private partners, and stakeholders who share a common goal – enhancing access to high-quality treatment. From advocates, to state government, and private hospitals, we each have key roles to play in solving the challenges confronting the health care delivery system. Different partners bring unique perspectives and resources to the table. We need the active engagement of all stakeholders, including those participating in treatment, to ensure people receive the care they need. The recommendations being offered by Virginia’s hospitals demonstrate their focus on identifying behavioral health treatment capacity strategies. They are a welcome addition to the ongoing conversations and work occurring to improve access to care. NAMI Virginia stands ready to work in collaboration with our partners to address these challenging issues.”
About VHHA: The Virginia Hospital & Healthcare Association is an alliance of 110 hospitals and 27 health delivery systems that develops and advocates for sound health care policy in the Commonwealth. Its vision is to achieve excellence in both health care and health. Its vision is through the power of collaboration to be recognized as a driving force behind making Virginia the healthiest state in the nation. Connect with VHHA through Facebook, Twitter, YouTube, LinkedIn, Instagram, and ISupportVirginiaHospitals.com.
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