Eastern State Woes Take Toll on Patients, Local Police

By Desiree Parker Tuesday, June 07, 2011

Eastern State Hospital is full to capacity. Combined with an insufficient community safety net, this means individuals who need behavioral health care aren’t getting it, according to a recent report from the Office of the Inspector General.

In the Historic Triangle, the overtaxed and underfunded system means local police officers are often spending hours a day transporting citizens who need mental health care all over the state to get them to an available facility. Colonial Behavioral Health, the community services board that functions as the local primary community-based safety net, has been struggling to do its job due to funding cuts and reduced numbers of beds in state facilities.

The biannual report, released last week, says recently downsized Eastern State Hospital (ESH) is over capacity and patients can’t be discharged because community-based programs aren’t sufficient. That means new individuals who need to be admitted are denied service. Locally, Colonial Behavioral Health needs to scramble to find facilities to take Triangle residents, which leaves local police to transport patients to facilities far away, according to a James City County police spokesman Steve Rubino and Williamsburg police spokesman Greg Riley.

Eastern State “has been unable to discharge patients into community-based programs because the needed community capacity has not been created,” according to the report. “CSB [Community Services Board] staff report that, in order to have someone admitted to ESH, the hospital must first discharge a current CSB client… the bottom line is that, as of March 31, 2011, ESH remains largely unavailable as a safety net for Hampton Roads residents requiring a secure state behavioral health facility.”

Colonial Behavioral Health Executive Director David Coe says that while ESH’s new director is doing a good job discharging more patients, there is still a waiting list of forensic patients from jails and from Central State in Petersburg who need the open beds. “Eastern State will have to work its way through the list first,” says Coe.

Also, since 2003 ESH has not been accepting short-term, acute admissions, according to Coe. At the time, the state charged the CSB to purchase beds in private facilities to treat these individuals. “The private hospitals are also full now,” he says.

In 2009, the region was set to receive $2.6 million in state funding to help pay for building community program capacity, but the funding was delayed, according to Coe. Finally, this year the state agreed to give $1.9 million of that funding to Colonial Behavioral Health, but most of it will go to pay for “keeping afloat” private hospital bed purchases. “That’s just filling gaps, though,” says Coe. “It won’t move us forward.”

Due to the capacity crunch at Eastern State and private facilities, people who would otherwise be getting behavioral health services are being released with no treatment.

“Streeting” is the term used to describe what happens when individuals in custody who meet the criteria for a Temporary Detention Order (for an individual who is likely to cause serious harm to himself or others and needs hospitalization or treatment) are instead released due to a lack of beds at ESH or insufficient community-based programs. This is of particular concern to the OIG. “Streeting represents a failure of the Commonwealth’s public sector safety net system to serve Virginia’s most vulnerable citizens and places these individuals, their families, and the public at-risk,” the report states.

About 200 people across the state over the past year who met the TDO criteria were released, according to the report.

The result of streeting is that “emergency services personnel are often left with trying to patch together other creative treatment options in an effort to assure safety of the person and others.”

CSB personnel often have to call 15 or more private providers to secure a bed for individuals, based on anecdotal evidence the OIG gathered from around the state. Coe says the Colonial Behavioral Health workers sometimes need to call more than 20 providers before finding one that has an available bed. If the local CSB finds a bed it is often far from the organization’s service area, and law enforcement personnel have to drive the patient to the location, according to the report.

That’s an issue that greatly affects the James City County police, according to Rubino. When an officer picks up an individual suspected of having a mental disorder, the officer takes the person for prescreening with a mental health professional through  Colonial Behavioral Health. If a Temporary Detention Order is filed, Colonial calls around the state trying to find an available treatment facility.

“Then [police officers] have to transport them somewhere – sometimes it’s Virginia Beach or Western State [Hospital] in Staunton,” Rubino says. “Depending on the situation, we may need to commit two officers. This is a real drain on resources, to have two officers tied up, sometimes for the better part of a shift, when they could be working here [in the community].”

This happens “on a regular basis,” he says, and the need for officers to perform this function has remained constant for several years. Years ago, the police would take an individual under a TDO to Eastern State, but the hospital doesn’t take these patients anymore.

The same is true in Williamsburg. Riley says his officers sometimes have to take people as far as Petersburg for treatment. Also, he says prescreening takes a lot of an officer’s time. “Any time we take someone to a prescreening, it can take up to six hours. The officer has to stay with the person.” This can consume most of a shift, he said.

Williamsburg police also no longer take people who need care to Eastern State. “When I first started, we used to take people to Eastern State all the time. Now, I can’t remember the last time I took someone there,” Riley said.

Eastern State now only accepts patients who need intermediate care (care for more than a few days) on top of the forensic population, according to Coe, if there is a bed available.

Those patients who aren’t placed in a facility somewhere else in the state are released, which can cause a dangerous situation. “To deny individuals an opportunity to receive the services, at the level of care deemed clinically and legally necessary, places each person at risk not only at the time of the immediate crisis but may create avoidable risk for the person and the community later,” the report warns.

The problems at Eastern State stem from a number of issues, according to the report. “The current crisis was triggered by the confluence of historically inadequate facility leadership, the loss of operating beds at ESH resulting from the downsizing initiative, $2.6 million in community funding that was not appropriated in 2009, the absence of a meaningful response by DBHDS (Department of Behavioral Health and Developmental Services)to the repeated petitions from local governments and CSBs during 2008 and 2009, and the inability to create essential community capacity before obsolete ESH buildings were removed from service and patients transferred into the new downsized facility.”

Eastern State has a new director, Jack Wood, who has been working to address the problems, according to the report. The OIG recommends that the Department of Behavioral Health and Developmental Services come up with a plan to fix the admission and discharge problems and create a list of community services that are needed, among other suggestions included in the report.

According to Coe, Colonial Behavioral Health is working on putting together more programs to shore up local community-based programs, but doing so “will take time and resources.”
As for the instances of streeting, the OIG “will monitor this issue going forward and make recommendations to end this questionable and dangerous practice, and hope that one day the term streeting will pass from the lexicon of Virginia’s behavioral health system.”