Virginia state hospitals resume limited TDO admissions, amid VHHA response

Two Virginia state hospitals will resume civil Temporary Detention Orders (TDO) on a limited admissions basis starting Thursday, Department of Behavioral Health and Developmental Services (DBHDS) commissioner Alison Land announced this week. 

Piedmont Geriatric Hospital in Burkeville and Western State Hospital in Staunton will join Catawba Hospital — which reopened July 29. However, all three hospitals are operating on a “one discharge to one admission” basis. The reopenings come weeks after Land announced on July 9 that five of eight state hospitals would temporarily halt TDO admissions due to staffing capacity and safety issues. 

 

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According to Virginia’s Legislative Information System, TDO into psychiatric facilities occur when a person with a mental illness is at risk of seriously harming themselves or others. DBHDS data from fiscal year 2020 shows 11,856 people were admitted to state and private hospitals for TDO that year.

State behavioral health facilities are in the midst of a workforce crisis, with some hospitals experiencing over 20 percent staff vacancies — and as high as 54 percent in some areas, according to DBHDS spokesperson Lauren Cunningham. To fill these shortages, state hospitals must rely on contract staff and international nursing programs, a costly alternative, said Cunningham via email. She continued:

“This pressure, combined with the high census, means the safety of staff and patients is a significant and serious concern.”

The ongoing staffing challenges at state facilities raises broader concerns about the impact on patient care, said Julian Walker, vice president of communications of the Virginia Hospital and Healthcare Association (VHHA). 

On July 21, VHHA president Sean T. Connaughton sent a letter to members of the Senate and House finance and appropriations committees, in response to public criticism of private hospitals’ TDO admissions rate.

DBHDS data shows that since 2018, TDO admissions into private hospitals have decreased. TDO admissions in state hospitals, in comparison, remained more constant. 

 

Image: DBHDS; VHHA Inpatient Database

 

Walker noted that along with TDO, private hospitals also handle voluntary behavioral health and substance abuse admissions, while state hospitals do not. He said:

“When you look at all of those numbers, Virginia hospitals, our members, continue to handle the vast majority [of] behavioral health admissions in Virginia across all categories, including those individuals who are involuntarily committed, those individuals who voluntarily seek out care, [and] those individuals who are seeking substance abuse treatment.”

The letter also outlines concerns over the quality of care patients would receive if transferred to private acute care centers: 

“While acute care hospitals can temporarily support most – though not all – patients in crisis, they are not designed or intended to provide long-term care for patients with specialized needs. This includes “boarding” of behavioral health care patients in emergency departments, as many of our hospitals are currently experiencing due to the challenges facing the state’s psychiatric hospitals.”

Walker said that based on conversations with VHHA members, there has been a disconnect in communicating such nuances to DBHDS: 

“On the staffing component, if you’ve got a disruptive patient, you might need to have what’s known as a one-to-one ratio with a psychiatric technician to staff that particular patient, or [a protection officer] to respond to patients who are experiencing psychiatric crisis. That requires some staffing adjustments, potentially moving staff around, reallocating staff, to accommodate a patient with specific challenges. What’s been relayed to us is that in the past when these conversations occurred, DBHDS wasn’t as receptive to them.”

During the special legislative session, Sen. Jen Kiggans (R-Virginia Beach) proposed an amendment from VHHA that would provide $33 million to private hospitals to expand care for people in mental health crises, thus alleviating some of the pressure for state hospitals, the Richmond Times-Dispatch reports. However, that amendment was one of many rejected by partisan and cameral divisions during the session.  

Approximately $45 million in federal funds from the newly-approved special session budget, along with Gov. Ralph Northam’s pay raises for state employees, will attempt to address the state facility workforce shortages. However, despite some state hospitals resuming admissions, Land says the situation is still unstable.

“It is incredibly important to note that while this news is encouraging, this crisis continues to be fluid and intense across the Commonwealth. We are carefully monitoring the status of the other two state hospitals that remain closed to civil TDO admissions and the three state hospitals that remained open, as well as Catawba. The state hospitals that remained open shouldered the burden of diversions from their sister hospitals and remain at 100 percent capacity with staffing concerns of their own.”

Editors Note: This story has been updated to include the correct total number of TDO admissions into state and private hospitals, and to note voluntary behavioral health and substance abuse admissions in the cases private hospitals handle.