Report: Patients were shut out of Eastern State

Eastern State Hospital's downsizing last year locked out dozens of fragile behavioral health patients in need of care, according to a new report.

The James City County inpatient behavioral health facility declined to admit 85 patients because it was in the process of downsizing, according to the report by the Office of Inspector General for Behavioral Health and Development Services.

"The behavioral health system cannot credibly claim to be a person-centered system of care, driven by the principles of recovery, if we allow the most fragile of a vulnerable population to receive anything less than the best, most clinically appropriate, treatment available," the report said.

Last year was the final stage of a years-long process to reduce the number of beds at Eastern State in an effort to shift more patients to community-based treatment. The facility was pared to 300 beds, 85 fewer than were available the year before.

So last year, the hospital stopped admitting new patients, including 30 patients who met stringent admissions criteria and were in some cases delusional, aggressive and suicidal, according to the report. The hospital also shut out 55 forensic patients — inmates who pleaded not guilty for reason of insanity to criminal charges or who needed to be assessed to determine if they were competent to stand trial. Those inmates remained in jail until they could be transferred to Eastern State.

The blame for this rests on the confluence of factors: the downsizing, inadequate facility leadership (there's a new director at the helm now) and the elimination of $2.6 million in requested funding in 2009 to expand community capacity, the report said. Without community capacity, there's nowhere for Eastern State patients to go after discharge.

The faster a person experiencing a behavioral health crisis is treated, the more effective the treatment is, said Chuck Hall, the Hampton-Newport News Community Services Board executive director.

The patients shut out of Eastern State weren't a danger to society, Hall said. But in many cases, their conditions worsened as they cycled in and out of short-term stays at private behavioral health centers in Hampton and Chesapeake.

"Like a revolving door, they would come out and they would go back in. That was a tremendous waste of public resources," Hall said.

"When a person has such psychiatric distress over and over again, it damages them. Physically and mentally, they deteriorate. We try to keep people from that psychiatric distress."

One patient was recommended for Eastern State three times. The patient dropped off the radar until he was found hiding in a shed.

"This individual almost died from renal failure due to an inability to care for self," the report said. "As a result of mental illness and associated paranoid ideation, the person was refusing to eat or drink. The person had to be tazered by law enforcement to be taken into custody. …(T)he individual's repeated return to the community from acute care hospitalizations without a period of psychiatric stability has resulted in deterioration in the person's level of functioning and quality of life."

Meanwhile, there weren't places to put Eastern State patients once they were ready for discharge. Lack of adequate housing with appropriate levels of supervision was the primary barrier to discharge, the report said.

Community services boards repeatedly tried to sound the alarm that the downsizing was inadequately planned, but effort continued, the report said.

Gov. Bob McDonnell proposed $2.4 million for the region's community services boards in the 2011 budget. That will help fund transitional housing for patients who need around-the-clock support and care plans for individuals needing special supports in the community, such as psychiatric care, housing and medications.

"To help ensure appropriate community services are in place to support and maintain Eastern State Hospital downsizing, the governor proposed a budget amendment of $2.4 million that would go towards targeted services in the region," department spokeswoman Meghan McGuire said. "In the meantime, we continue to work with partners in the community, including the community services boards, to make sure only the most appropriate individuals are admitted to Eastern State Hospital and to make sure those ready for discharge have the support in the community they need."

"The department clearly recognizes the gravity of the problem" of denying admission to Eastern State, Inspector General Doug Bevelacqua said. "They did not attempt to defend what happened last year, and they are doing all they can to correct the situation. The problem is they need money. They're not policy makers or appropriators. They need the funds to send to the CSBs. Until there's money for additional supervised housing, the number of beds at Eastern State will remain inadequate to serve Hampton Roads."

The problems that remain are the backlog of mental health patients in jails awaiting transfer to Eastern State and housing, Hall said.

"There is almost no supervised housing for people with mental illness," he said. "We have gotten so many patients out of Eastern over the years; now those that remain are more challenging. Unfortunately, the $2.4 million that the governor's recommending won't solve all those problems, but it will help."

From the report

What happened in some of the 30 cases explored in the report involving people who were denied treatment at Eastern State:

"This individual was hospitalized six times until incarcerated."

"Efforts have been made to secure a longer-term bed at ESH three times this past year. With each denial, the individual's level of functioning has deteriorated. Treatment staff are very concerned about his safety if the pattern continues."

"Increasing violent and unpredictable behavior and treatment non-compliance."

"Most recent suicide attempt resulted in being placed on a respirator for life support, needed a tracheotomy and had a long-term medical rehabilitation as a result."

"Person has had 30 hospitalizations in the last year, not counting ER contacts. Most recent placements have been at assisted living facilities with intensive CSB outpatient services. At last two assisted living facilities, the person has accessed medications and attempted suicide. She has been removed from assisted living facility settings because of lack of funding for 1:1 supervision, which is necessary for safety."

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