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Mental Health Care in Virginia, Part 1: Beds

Mental health services in Virginia progressed leaps and bounds over the last 40 years. But many experts argue that more needs to be done.  May is Mental Health Awareness Month, so WMRA’s Jordy Yager caught up with some veterans of the system to get a sense for how we’re doing, in this first of a series of reports on the state of mental health care in Virginia.

For 37 years, John Beghtol worked at Western State Hospital, one of the largest mental healthcare facilities in the commonwealth.

JOHN BEGTHOL: At Western, when I arrived there, it didn’t matter if you didn’t have beds, you threw cots up. In January, 1991, we had 23 cots up in the admission ward, now that’s dangerous stuff. 23.

A former Air Force man, Begthol said it reminded him of his military barracks. But these are patients with serious mental health needs. And not just one or two. Western State’s capacity at that time was 750 patients. Cots meant that they were filled to the brim.

BEGTHOL: Today that can’t happen. Western over there cannot put up a cot in the admissions area. They’ll get into big trouble. That’s a big change. But it takes a crisis to trigger money.

Virginia has had its fair share of crises. In 2007, after a Virginia Tech student shot and killed 32 people, the state identified more than a dozen failings in its mental health system. The General Assembly passed some significant statutory changes and injected $42 million into the system.  But then the recession hit.

BEGTHOL: We eventually lost it all during the budget crisis.

Some of the same systemic issues arose again in 2013, when Sen. Creigh Deeds’ 24-year old son had a mental breakdown. After an attempt to get him inpatient treatment, he was told there were no available beds and was sent home. The next day, Deeds’s son brutally attacked him with a knife, slashing and stabbing his face and chest, before killing himself.

DUSTIN WRIGHT: As a clinician that’s been in community mental health for a while now, it’s just really frustrating when we try to get funds from different entities and it seems like there’s a pattern of these events that keep happening.  

Dustin Wright worked for seven years in emergency services at the Valley Community Services Board, where he’s now a community liaison.

WRIGHT: And sometimes it brings significant change, and then sometimes it doesn’t. And that’s really unfortunate, because as a clinician, in the back of my mind, you’re kind of waiting, what’s the next thing.  

Five months after Deeds was attacked, Gov. Terry McAuliffe signed new mental health legislation. One major shift was extending how long mental health staff has to find a bed for a person in crisis. They used to have four hours, with a possible two-hour extension if they could find a magistrate to sign off. But now staff gets a full eight hours, which increases their chances of finding a bed. The other major change was the creation of safety net beds.

WRIGHT: That wasn’t the case for adults back in the day. Now it is. Where you call every hospital in the state, and if you can’t find one, then you call Western.… And that’s a postitive.  However, the funds to support that legislative change, or that procedural change, didn’t follow. At least not as quickly as the rule change.

As a result, Wright says, Western State has an increasing number of mental health patients with co-occurring intellectual disabilities, or cognitive disabilities, such as dementia. It’s also common for mentally ill patients to self-medicate with illicit drugs and alcohol. Sometimes patients show up still drunk.

WRIGHT: And Western, as many great awesome services as they have, are not set up to work with someone with dementia, or work with someone living with intellectual disability or substance use…

KALA DOSS: Also autism as well. We’ve been seeing a lot of individuals currently who have a diagnosis of autism.

Kala Doss is an occupational therapist at Western State. She’s also a board member of the Staunton chapter of NAMI — the National Alliance on Mental Illness — where Wright is president. In their monthly meeting, they repeatedly stressed the importance of getting the right level of care to the right patients. When patients have illnesses or issues that could be better treated at different facilities, they take up beds at Western State that could be used for other people in crisis.

DOSS: I can let you know, just from last weekend we were full. It’s very scary when that happens, and it’s not because it’s scary because we don’t want to help people, but it takes one person to need a bed. Once one place in the system is clogged it trickles down.

There are emergency procedures in place if all of Western State’s beds get filled, ensuring that patients in need will always have a bed. But the Staunton chapter of NAMI argues that that sort of strain on the system could be avoided if money was better allocated.

Over the last four decades Virginia’s government has gradually shifted how it allocates mental health dollars. In the ‘70’s Western State had more than 1,200 beds. By the ‘90’s they were down to 750. And now they’re at 246. The focus has shifted to smaller, local, more in-touch Community Service Boards, or CSBs. In 1977, there were 13 CSBs. Now there are 39. Of course, many local service providers say not enough money is being focused on CSBs. But they agree, we’re better off now than where we were.

Jordy Yager was a freelance reporter for WMRA from 2015 - 2019.