On the streets

About 200 mentally ill Virginians who posed a threat to themselves or others were turned away from psychiatric facilities over the past year, according to a state report issued Tuesday.

The report by the state Office of Inspector General for Behavioral Health and Developmental Services says the practice, known as "streeting," appears to be most prevalent in Hampton Roads but occurs statewide.

"Streeting represents a failure of the Commonwealth's public sector safety net system to serve Virginia's most vulnerable citizens and places these individuals, their families and the public at risk," Inspector General G. Douglas Bevalacqua wrote in the report, issued Tuesday. "To deny individuals an opportunity to receive the services, at the level of care deemed clinically and legally necessary, places each person at risk not only at the time of the immediate crisis but may create avoidable risk for the person and the community later."

According to the report, between April 2010 and March 2011 eight of nine Community Service Boards in Hampton Roads acknowledged that individuals who met criteria for a temporary detention order were released from custody because no psychiatric facility was willing to admit them.

"We will monitor this issue going forward and make recommendations to end this questionable and dangerous practice, and hope that one day the term streeting will pass from the lexicon of Virginia's behavioral health system," the inspector general wrote.

Chuck Hall, executive director of the Hampton-Newport News Community Services Board, told the Daily Press that CSBs usually follow up with patients who are turned away, and the vast majority of those who need treatment get it.

"One day we may in Hampton Roads have a terrible situation where someone dies or injures or kills someone else, but so far we've been able to manage with our limited capacity successfully," Hall said.

The report highlights yet another problem of Virginia's mental health system. In February, the Department of Justice sent Gov. Bob McDonnell a letter stating that the state failed to care for patients' civil rights and threatening to sue unless changes were made. Federal and state officials are projected to settle in June. ('Mental mess,' 5/18)

The report also highlighted "unsustainable" costs at the Virginia Center for Behavioral Rehabilitation, a program in 2004 created for treatment of sexual predators. The annual budget for the facility, which houses only 260 individuals, is $24 million. The yearly cost per resident, not including facility costs, is $91,000 per person per year, and past inspections have documented concerns such as "limited treatment opportunities provided the residents; inadequate treatment planning; failed programming initiatives; and inadequate staffing to assure safety and effective programming."

The report remarked that a shakeup in staff has created more "promising" conditions at the facility, but said the program costs would continue to increase to over $62 million per year, plus additional tens of millions to construct new facilities. Legislators have considered privatizing the costly program, and June 2 was the deadline for companies to submit proposals for running it. ('Privatizing program,' 5/26)

The inspector general also expressed concern about the Virginia attorney general's interpretation of a federal regulation dealing with the use of restraint to medicate over a patient's objection. The attorney general says a patient can be restrained only to ensure the immediate physical safety of the patient or others. That interpretation in some cases "will allow a person's psychosis to deepen," the report says.

The inspector general has petitioned the federal Centers for Medicare and Medicaid Services to review the issue and determine whether restraint can be used to administer medication to a patient unable to make informed decisions even if physical safety is not endangered.

The Associated Press contributed to this report.

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