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Psychiatric Society of Virginia American Academy of Pediatrics, Virginia Chapter American College of Emergency Physicians, Virginia Chapter

Joint Statement on Governor Kaine’s Proposed Closure of Child/Adolescent Psychiatric Units at Commonwealth Center for Children and Adolescents and Southwestern Mental Health Institute

The Psychiatric Society of Virginia (PSV), American Academy of Pediatrics-Virginia Chapter (AAP-VA) and the American College of Emergency Physicians-Virginia Chapter (VACEP) opposes the closure of the Child/Adolescent Psychiatric Units at Commonwealth Center for Children and Adolescents (CCCA) and Southwestern Mental Health Institute (SW MHI) as currently proposed in Governor Kaine’s December 2008 Deficit Reduction Strategies.
The physician community appreciates the extraordinary challenges facing Virginia during this difficult economic cycle. We understand the Kaine Administration wishes to achieve savings through the closure of these facilities and to move patients served by these facilities into private sector programs closer to home communities. We agree that community-based care in the least restrictive environment is virtually always preferred for persons with psychiatric illness and substance addiction.
However, Virginia’s physicians have grave concerns about how the proposed closures will impact access to inpatient and long-term psychiatric care for Virginia’s most severely afflicted children and adolescents. Philosophically, the closures could advance the goal of more community-based care and a continued shift from the reliance on public-sector service. Practically, we fear that such abrupt action will exacerbate existing problems that make it difficult to locate inpatient beds and admit patients who often have psychiatric and co-occurring other medical issues, behavioral problems, violent, safety concerns, or development disabilities. CCCA and SWMHI often serve as the safety net of last resort for Virginia’s other mental health facilities and providers, without them, psychiatrists, primary care physicians, CSBs, hospital emergency departments, law enforcement, and families will all be additionally burdened.
PSV, AAP-VA and VACEP pledge to work the Governor Kaine, the Department of Mental Health Mental Retardation & Substance Abuse Services, the General Assembly and any other stakeholders to explore alternatives to closure or closure implementation strategies that will address the following:
• Assessment of and demonstration that private sector providers are available to absorb the population that these facilities serve; regional and financial factors must be considered.
• Commitment from Executive and Legislative policy makers to demand changes in the private insurance market that inequitably and inadequately cover psychiatric care, compared to other medical conditions, thus increasing demand on public sector resources.
• Mechanisms that maintains the safety provided by CCCA and SWMHI through mandated acceptance of this patient population in exchange for any funds related to the closure and sale of facilities.
• Adoption of aggressive and attractive incentives for private sector creation and expansion of child/adolescent psychiatric beds and services. Currently, both public and private sector reimbursement for psychiatric service is inadequate to encourage investment in facilities from a broad range of providers. Remove application barriers and establish grants or other financial incentives for psychiatric bed projects.
• Closure of these facilities will further weaken psychiatric and mental workforce education and training opportunities. It is widely known that professional psychiatric workforce is inadequate and is significantly worse for child psychiatry. Virginia must support and seek funding for psychiatric-primary care collaborative projects, child psychiatric residencies, and telepsychiatry projects.
PSV, AAP-VA and VACEP urge policymakers and stakeholders to address these issues. With measured and proper implementation, it is possible to make changes to mental health care delivery that will result in improved patient care and positive fiscal impact.