(3-31-17) My good friend and long time mental health advocate, Betsy Greer, is outraged that an Arlington, Virginia hospital is reportedly turning away 57% of individuals who need psychiatric services but wants Arlington county officials to offer it land to expand so it can build 100 profit-generating surgical beds without improving psychiatric patients’ needs. While this story focuses on a wealthy Washington D.C. suburb, it is not unique as more and more hospitals strive to grow fat while bypassing mental health. Betsy tells me that on Monday, April 3, advocates will be pleading their case at a 7:30 p.m. meeting at the Health Systems Agency of Northern Virginia, 3040 Williams Drive, Room 200, Fairfax, Va.
ARLINGTON VIRGINIA ADVOCATES FIGHT FOR LOCAL HOSPITAL MENTAL HEALTH SERVICE
By Betsy Greer
A newly created group is asking Arlington county officials to make the sale or swap of 5.5 acres of prime Arlington county property to the Virginia Hospital Center (VHC) conditional on that hospital improving its emergency room and psychiatric ward services for individuals with mental illnesses.
“Too many Arlington residents have been turned away from VHC due to a shortage of beds or because they don’t treat minors,” said Naomi Verdugo, one of the organizers of the Arlington Mental Health Alliance. “This requires them to travel all over the state for psychiatric hospitalization, far from their families who should be part of their treatment. Arlington residents deserve better from their community hospital.”
For the advocates, it is a fight between them and Goliath, an independent, not-for-profit hospital operated like a well-heeled corporation, which in 2014 had more than $600 million invested in securities, excess revenue of more than $60 million over expenses. It is coming at the time VHC is requesting state approval for licensure for 100 new medical and surgical beds, but NONE for patients with mental illness.
VHC’s own 2014 Community Health Needs Assessment, gained from a survey of community stakeholders, listed mental health conditions and depression as the two most important health concerns, ahead of adult obesity, diabetes and substance and alcohol use! 
‘There are a number of reasons why it is important for the Virginia Hospital Center to respond positively to the requests made by us and the Arlington Community Services Board (CSB), which provides mental health services in our county,” said Anne M. Hermann, chair of the Arlington CSB. “This is a community hospital and the beds they have are not nearly enough to cover the need. This shortage is demonstrated by the frequency with which Arlingtonians experiencing a mental health emergency are turned away from VHC and sent elsewhere in the Commonwealth, sometimes quite some distance.”
A primary CSB request is that VHC commit to a minimum of 15 additional single-occupancy adult psychiatric rooms and commit to opening additional psychiatric beds to meet demand when a compelling need is demonstrated. VHC uses only 35 of its currently 40 licensed behavioral health beds, 17 for substance abuse treatment. The remaining 18 beds reserved for those needing stabilization for a mental illness crisis are in double rooms which restricts use unless a new patient is of the same sex and deemed stable enough to share a space. (Ironically, VHC markets itself as the only area hospital offering private rooms.)
Judy Deane, a CSB member and another long-time Arlington advocate, echoes Hermann’s point. “Every year, [VHC} turns away several hundred people who are suffering a psychiatric emergency and tells them to go elsewhere because of the severe shortage of psychiatric beds.
“Since VHC is acquiring County land that used to be used for mental health treatment, it seems only right that, as part of the deal, VHC add enough psychiatric beds to serve the community’s needs, “ she said.
Outdated mental health units!
The CSB wants VHC to update its psychiatric treatment unit for those with mental illness, currently placed in one of its original buildings that offers minimal natural light. Describing this request as an “urgent issue” that should occur in any VHC renovation plans, the CSB says that the psychiatric unit should be configured “in line with best practices with regard to design, natural light and staffing to create” a more therapeutic and pleasant environment for recovery.
A third request is for VHC to staff its Emergency Department with a full-time mental health clinician and designate a separate suite of rooms attached to the Emergency Room, to allow patients who manifest primarily psychiatric symptoms to be assessed, treated and provided respite separate from other Emergency room patients — and, where possible, diverted from psychiatric hospitalization.
Lastly, the CSB asks, and the Alliance strongly urges the VHC to establish an inpatient psychiatric unit to treat children and adolescents with serious mental illness.
These requests are grounded in the heart-wrenching stories of patients and their families. At a November forum, the CSB heard the experiences of Arlington families who used or attempted to use VHC facilities. Their testimonies movingly speak directly to the CSB and Alliance positions. The CSB and the Alliance know there are many more such stories in the community.
The human cost: putting patient into a taxi and sending her home debilitated
One Arlington mother spoke of the experience of her adult daughter, taken to VHC because of suicidal threats and the consumption of an unknown combination of prescription medications.
“VHC did not have adequate bed space and released her via taxi in a debilitated state,” not even checking to see if anyone was home, she said. “VHC has inadequate facilities for both emergency and non-emergency psychiatric services. Arlington County should leverage their position to provide better facilities (e.g., a separate psych ER, greater capacity and flexibility for minor and adult psych patients, a psych unit with natural light, space for county social services personnel to facilitate follow-up care) for some of the most vulnerable citizens.“
Comments highlighted long Emergency Department waits for loved ones suffering a mental illness crisis and being sent to other hospitals – as far away as Petersburg, VA – because VHC did not have an open psychiatric bed. For another Arlington family, this meant a two-hour drive from their home. “Consequently we were not able to visit our son much.” To the Alliance, it is clear the devastating effect that this had on the family who, when the son in crisis needed his family most, could not be with him enough. Psychiatric beds in Northern Virginia would help.
The insufficient number of psychiatric beds at VHC is a major driver for the CSB, which under state law has the responsibility of handling temporary detention orders (TDOs), those orders when an individual, needing care, will not voluntarily accept hospitalization and seeks a commitment hearing. The CSB has eight hours to find a psychiatric bed, using a state psychiatric hospital as a last resort. This was one statutory change that followed the case of the son of State Sen. Creigh Deeds, who was released because no hospital bed could be found for him. He attacked his father before committing suicide.
Hospital turned away 57% of individuals needing mental health care
The CSB has the data showing that in the first half of the current 2017 fiscal year, of 229 CSB cases, the hospital turned away 57 percent – or 130 individuals. That required placing 72 at other private hospitals with the added expense of police transportation to these out-of-county facilities (which in fiscal year 2016 came to more than $50,000 of County dollars). Fifty-eight ended up at the Northern Virginia Mental Health Institute in Fairfax as the hospital of last resort.
In its explanation of the issue, the CSB concludes the lack of [VHC] hospital capacity has a significant, negative impact on people with mental illness and their families.
Another family’s story concerned its 21-year-old son who has had seven TDOs. “More often than not, my son was released to come home after four or five hours and told there were no beds available. The beds that were found for him were sometimes as far away as Poplar Springs Hospital in Petersburg, VA. That was too far for us to visit and too far for us to make it to his [commitment] hearing.”
The testimonies also highlighted the experiences of Arlington families in the need of psychiatric beds at a medical facility for children and adolescents with mental illness. Children and adolescents frequently have other medical conditions in addition to mental illness and with such co-morbid diagnoses, a psychiatric-only facility like Dominion Hospital in Falls Church won’t work.
One mother related that she was able to walk from her home to VHC to give birth to her child, but when another child at eight years old needed psychiatric care he ended up at Johns Hopkins Hospital in Baltimore, a daily four-hour round-trip drive for her to be with him. One evening in bad weather, it took the father four hazardous hours to drive from Baltimore to Arlington to visit their very ill, lonely and frightened little boy.
Another family said their son had been hospitalized three different times to stabilize and treat him for psychotic behaviors, and not once was this at VHC. “The telling part of this story is we live three blocks from the hospital.” This family said it strongly believed Arlington County must make increased psychiatric capacity at VHC a part of the sale or swap of land to the hospital.
Hospital pays no federal, state or corporate income taxes
The Alliance notes that as a not-for-profit hospital, VHC pays no federal, state or corporate income tax – nor does it pay Arlington County property tax. As a not-for-profit hospital, VHC is required to provide community benefits, such as uncompensated care (not the same as bad debt), serving Medicaid patients and services in specialties that make little or no money for the hospital – such as psychiatric care. For all of the above not-for-profit benefits, VHC states it gives back “$30.7 million in community benefits.”
Arlington has to consider whether this is an equal benefit exchange with the community.
The Alliance is following the VHC process closely. It argues that as a condition of any land transaction, VHC needs to add psychiatric beds and enhance its psychiatric services. Before it completes its land sale or swap, VHC wants to obtain a state-mandated Certificate of Public Need for the additional 100 licensed beds — again, none of which are for psychiatric patients – which the hospital wants.
Alliance members plan to testify to all these points at an April 3 hearing before the Health Systems Agency of Northern Virginia and to continue to engage their County Board members. The Alliance knows there are others in Arlington – and the region – who have similar VHC mental health experiences, and invites others to join its effort.
Naomi Verdugo is the contact at verdugo.naomi@gmail.com.
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