When Barriers to Discharge Aren’t “Extraordinary”

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NOTE:  The Virginia Department of Behavioral Health and Developmental Services (DBHDS) maintains an ongoing list of individuals in state psychiatric hospitals who are clinically ready to return home but cannot leave the hospital due to “extraordinary barriers” to discharge. dLCV is committed to keeping you informed about the status of the “Extraordinary Barriers to Discharge” list (EBL), as the existence of this list is an ongoing violation of these individuals’ legal and Constitutional rights to community-based care.

DBHDS reports that as of June 30, 2020, 216 individuals were on the Extraordinary Barriers to Discharge List (EBL).  Some of these individuals have been waiting for months, or even years, to return home.  The barriers they face are varied and often include a lack of the housing, services or supports they need to live independently in their home communities.  These barriers are often systemic, and demonstrate the Commonwealth’s long-standing unwillingness at all levels of responsibility to fully fund our public behavioral health and developmental services system.

Mr. J’s Case:  A Bungled Process

However, sometimes the barriers experienced by individuals on the EBL are not so extraordinary. Mr. J, an older adult with a history of mental illness and cognitive impairment, had been hospitalized at Eastern State Hospital (ESH) for nearly seven years when he and his family contacted dLCV for assistance with discharge planning. During dLCV’s advocacy, we discovered that despite being discharge-ready for nearly three years and ESH staff working with the family to find nursing home placement, Mr. J actually had not been evaluated to determine whether he required nursing home care. It wasn’t until Spring 2020 that ESH conducted an evaluation of Mr. J’s living skills and determined that he could be discharged to an assisted living facility. Once that was determined, Mr. J was finally discharged to a placement in the community.  Mr. J was on the EBL for over 1,000 days, requiring him to live in a state hospital far beyond his care needs and costing the Commonwealth more than $800,000 in avoidable hospitalization costs.

 A state psychiatric hospital is NOT a home.  The Commonwealth must do better on behalf of our fellow citizens!