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'Streeting'

June 7, 2011 12:15 am

THERE'S A TERM called "streeting" that refers to what happens to would-be patients who are turned away from hospitals for one reason or another. In Virginia, unfortunately, it is something that state mental facilities have been accused of doing.

A new report by G. Douglas Bevalacqua, the inspector general for the state Department of Behavioral Health and Developmental Services, says at least 200 mentally ill Virginians, people who were deemed a threat to themselves or others, were released back into the community from emergency rooms and other facilities because no appropriate psychiatric bed could be found for them.

This is not acceptable, from either a compassion or a public-safety viewpoint. As the OIG's report says, "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."

Mental health has long been a public-funding stepchild, and in difficult economic times, the squeeze worsens. Couple that with the expensive proposition of decentralizing Virginia's psychiatric care--moving it from large hospitals to community-based centers--and the challenge is greater still.

The debate continues over whether the state institutions' most troubled patients are suitable candidates for home- or community-based care. Nevertheless, the downsizing of the state institutions goes on in accordance with a settlement reached in a lawsuit by the U.S. Department of Justice, which cited the slow pace of Virginia decentralization efforts as well as poor treatment and unsafe conditions at "archaic" institutions. To help implement the settlement, the General Assembly earlier this year created a $30 million trust fund.

Still, a lack of funding persists. In Northern Virginia, downsizing and budget cuts severely reduced space at the onetime 123-bed Northern Virginia Mental Health Institute, so officials have discussed creating a regional emergency psychiatric center. But they know well that the local governments that would participate and fund such a facility are already living hand-to-mouth. And the $2 million scraped together for the project will hardly provide a long-term solution.

For these mentally ill and disabled Virginians and their families, the lack of beds for those who need immediate care creates a gut-wrenching situation. The commonwealth, a government that claims to be for all the people, must not neglect a group of its most vulnerable.





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