Almost four decades after Virginia began emptying the teeming mental wards of its state hospitals, jails across Virginia now house more people with mental illness than state and private hospitals combined.
Of the 6,350 mentally ill people in hospitals or jails on a single day two years ago, 60 percent were in jails. And 43 percent of jails responding to a state commission’s query said regional mental-health agencies do not provide mental-health services.
In 1936, only one person with mental illness was in jail for every six in state hospitals. In 2005, that ratio had gone to five people in jail for every two in a hospital.
Those are among the statistics compiled in a 200-page report released yesterday by the General Assembly’s Joint Legislative Audit and Review Commission.
The study found that the number of available psychiatric beds in Virginia is generally adequate.
But the report said clear data on services, needs and disabilities are lacking, hospitals are losing millions of dollars in caring for the mentally ill and in vast areas of Virginia nearby hospital beds for the mentally ill don’t exist.
Virginia has 40 cities and 95 counties. Seven of the state’s localities have more than half the roughly 1,500 psychiatrists in the state. Forty-seven localities have none; 87 localities don’t have a child psychiatrist.
The sobering analysis yesterday left legislators with few questions and state mental-health officials with few answers as evidence continues to mount about the state’s system of mental-health care.
Most of the issues have been festering for years and have been brought to the forefront by the mass killings at Virginia Tech in April by mentally ill student Seung-Hui Cho.
A half-dozen studies and legislative committees have been meeting, from a commission set up by the chief justice of the Virginia Supreme Court to legislative committees in the state Senate and the House of Delegates.
After yesterday’s JLARC meeting, speakers lined up at a House committee meeting telling stories of a broken system of care, unfunded needs and imbalances in resources across the state.
The JLARC report offered an examination of a small element of mental-health care in a document that was part textbook, part call for action.
It quoted with telling relevance the comments in 1841 of then-Virginia Gov. Thomas W. Gilmer, who called it regrettable that so many of the state’s “unfortunate class” were not in institutions but are “confined in jails.” That was almost a century after the founding of Eastern State Hospital, the first in the country built for the mentally ill.
Hospital care accounts for only a fraction of the needs of the state’s estimated 400,000 seriously mentally ill adults and children.
Since 1962, the average daily number of mentally ill adults in state hospitals has dropped 87 percent, from 11,532 to 1,452.
But JLARC found that the number of licensed psychiatric hospital beds at nonprofit and for-profit hospitals has fallen since 1991 by almost 800 beds, a 31 percent decrease.
As patients streamed over the decades from state institutions to receive community-based care, local governments and hospitals were expected to take up the slack.
But the report found vast disparities in the quality of care from one jurisdiction to another and a failure by state agencies and local mental-health agencies to follow state laws mandating how patients are to be assessed and singled out for care.
JLARC found that a decade-old state law requiring public hearings and regulations to set payment rates for temporary detentions has never been implemented. The rates are set unilaterally by the state Department of Medical Assistance Services.
Nor have state laws enacted 25 years ago been followed that require regulations for pre-screening procedures for patients entering state hospitals.
As a result, some state hospitals have simply declined to admit some groups of patients who once received care. Those people include patients with dementia, substance-abuse problems and traumatic brain-injuries, according to JLARC.
The report also raises questions about agreements among partnerships of regional mental-health agencies that show differences in care and in the use of state money; nor are the partnerships and their duties spelled out in state law.
Bill McKelway is a staff writer at the Richmond Times-Dispatch.