RESEARCH WEEKLY: Virginia State Hospital System’s Challenges

By Shanti Silver

(January 17, 2023) In December 2023, the Virginia Joint Legislative Audit and Review Commission staff released a report on Virginia’s nine state hospitals, including recommendations for the Virgnia Department of Behavioral Health and Developmental Services. In this research weekly, we highlight several key findings from the report including staffing shortages, challenges to providing quality care, and increasing numbers of forensic patients in state hospitals.

Staffing Shortages

One finding from the report surrounds staffing shortages in Virginia. According to the report, one of the greatest challenges to providing effective care to patients in state hospitals is difficulty recruiting and retaining staff. Virginia state hospitals had a 30% turnover rate in the 2023 fiscal year, which is double that of all state government employees in Virginia. The report cites uncompetitive pay and unsafe working environments as two of the reasons for this high turnover and recommends increasing salaries for social workers, psychologists, housekeeping staff, and food services staff.

Inappropriate admissions impact on quality of care

State hospitals face unique challenges due to their inability to legally refuse to admit patients, leading to potential issues in safety quality of care. This report identifies that all state hospitals were operating above a recommended 85% occupancy rate because of the requirement to admit patients, posing risks to both patient and staff safety, while private psychiatric hospitals were being underutilized in the same timeframe. State hospital staff also reported concerns about patients being admitted to the hospital even when staff lack the expertise to treat them. These patients include those with neurodevelopmental disorders (e.g., autism), neurocognitive disorders (e.g., dementia), and those with acute medical needs.

Despite concerns from staff about the safety and wellbeing of these patients, the report identifies that Virginia’s Office of the State Inspector General, the office designated for investigating complaints about patient safety, “receives hundreds of complaints but independently investigates only a relatively small portion of them.” Accordingly, the authors of the report recommend that OSIG begins to submit annual reports on the number of complaints they receive and investigate to ensure they are fulfilling their duties to protect patients. Ensuring accountability for mistreatment of patients may be especially important in Virginia, as the state hospitals use coercive measures like seclusion and restraint more often than other states.

Increasing numbers of forensic patients

The report additionally indicates a growing number of forensic patients in state hospitals. Forensic patients are patients who have been required to receive treatment through the criminal system, such as those awaiting competency restoration. In Virginia, as in other states, private hospitals often do not accept forensic patients, leading to limited availability of state hospital beds for other patients. According to the report, “if state hospitals remain the only inpatient setting for treating forensic patients and no other action is taken to prioritize who is admitted for competency restoration, the capacity pressures they place on state hospitals are likely to worsen.”

Implications

Staffing shortages, increasing numbers of forensic patients, and lack of control over admissions can all contribute to safety issues for patients and staff. To address these challenges, the authors of the report recommend increasing salaries for staff, funding new positions, and providing funding to assist private hospitals with accepting some patients. It is also important to note that many states face the same challenges as Virginia when it comes to their state hospitals. For more information on state hospitals, keep an eye out for Treatment Advocacy Center’s upcoming beds report next Wednesday.

Reference:

Joint Legislative Audit and Review Commission. (December 2023). Report to the Governor and the General Assembly of Virginia: Virginia’s State Psychiatric Hospitals.