Congratulations! You’re Well, But Can’t Be Discharged!

How would you feel if you checked into a hospital for emergency surgery and after the operation was successfully completed, you were told that you couldn’t go home?

“But how long do I have to stay in the hospital?”  you might ask.

“Maybe weeks, maybe months, or even longer.”

For patients with severe mental illnesses in Virginia’s state mental hospitals this is not a theoretical  question. It’s what is happening every day across the state.  It also appears to be happening in other states, as well.

A new investigative report by Douglas Bevelacqua,  the Inspector General for the Virginia Department of Behavioral Health and Development Services, found that 70 patients in state mental hospitals were ready to be discharged.  But they couldn’t be released because there was no where safe for them to go!

The primary problem was a lack of affordable supportive housing. The next roadblock was a lack of community based treatment services, especially for elderly patients, those with co-occurring disorders, or those with such severe mental disorders that they require specialized care.

This bottleneck wastes tax dollars.  The average cost of keeping a patient in a state mental hospital is about $590 per day or $215,000 per year, according to the Virginia IG. The average cost of supporting that same patient in a community setting is about $120 per day or about $44,000 per year.  It doesn’t take a math wizard to see the savings. Taxpayers are shelling out $15 million for services that could be obtained for $3.3 million. That’s a staggering savings of nearly $12 million!

Bevelacqua also notes that keeping patients, who are ready to be discharged, in state hospitals takes up beds that are desperately needed by sick patients waiting to get help.

“It doesn’t make any difference which door is closed,” Bevelacqua said. “…If the hospital’s full, people can’t get in the front door. And if the community’s full, you can’t get out the back door.”

In two previous reports, the IG revealed that Virginia’s mental health facilities and emergency rooms have been “streeting”  patients. “Streeting” is slang for discharging patients, who are sick, back onto the streets because of a lack of treatment beds or staff to help them.  In a one-year period, Bevelacqua found that 200 patients had been “streeted” in Virginia.

“Streeting” people is  dangerous — not only for the person who is severely ill — but also for the community where that person is released.

In his report, Bevelacqua warned that the Department of Justice recently charged the state of New Hampshire with violating the Americans with Disabilities Act, which requires people with mental illnesses to be placed in the “most-integrated setting appropriate to their needs.”  New Hampshire was sued because it was warehousing people in state hospitals who could have been discharged.  Since that’s what Virginia is doing, Bevelacqua warned state officials that Virginia could be the DOJ’s next target.

The last thing Virginia needs is to be sued again by DOJ. The state was recently forced to sign a $2 billion, ten-year settlement because DOJ claimed state officials have been dragging their feet in closing state facilities.

Advocates are watching the New Hampshire lawsuit to see if the federal government can use the Americans with Disability Act to force state legislators to provide meaningful mental health care in a community setting.

But using the law to prompt states into action can sometimes backfire.

In my book, I describe how Dr. Morton Birnbaum argued that if a person was forced into a state mental hospital, then the state was required to treat that person, otherwise it was violating his civil rights.  Birnbaum hoped his legal argument would force state legislatures to begin pumping millions into state hospitals to make them decent places. Instead, his legal premise helped lead to the wholesale closing of state facilities.

I have three thoughts about the Virginia IG’s newest report.

1. It is outrageous and wrong that people who are ready to be discharged are not being released. But the horrific flip side is that it is better for some of these patients to be stuck in state hospitals than to be discharged without any hope of getting the quality of care that they need in a community. Since the 1960s, the federal government has been hell bent on closing state mental hospitals because it wants persons with mental disorders to be treated in community settings.  But sending people who are ill-equipped back into a community where no care is available is cruel. It is one reason why our jails and prisons have become our new asylums. We must begin providing community services if we want to open the bottleneck.

2. Bevelacqua’s newest report reveals how the mental health system can’t be divorced from housing. If our nation wants to reform its fractured mental health system, it must think of mental health services as encompassing more than simply sticking a pill into someone’s mouth. A community has to provide “wrap around” services, such as housing,  jobs, transportation, veterans aid, drug and alcohol rehabilitation and case management services too.

3. Thank goodness for IG Bevelacqua! Since he was appointed, he has been a tireless advocate for people with mental disorders. One reason why is because his mother was diagnosed with schizophrenia when he was young.  In the biography on the IG’s website, Bevelacqua recalls how he felt a flood of emotions when he saw the movie, The Soloist, based on my friend, Steve Lopez’s powerful book.   

“I was resolved by the end of this movie to refocus my professional life to help people living with mental disabilities,” he said.

Bevelacqua is putting his words into action.

Is anyone listening?

About the author:

Pete Earley is the bestselling author of such books as The Hot House and Crazy. When he is not spending time with his family, he tours the globe advocating for mental health reform.

Learn more about Pete.


  1. Mirasigner says

    Great blog post Pete! Keep up the good advocacy and awareness raising.