Virginia's problem with ‘streeting’ the mentally ill | Behavioral Healthcare Executive Skip to content Skip to navigation

Virginia's problem with ‘streeting’ the mentally ill

April 11, 2012
by Nick Zubko, Associate Editor
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Emergency rooms are busy places, which is probably why the expression "treat 'em, and street 'em" has made its way into the medical lexicon. But when it comes to treating patients with mental illness, “streeting” is becoming an increasingly serious problem. 

At least, that’s the case for many facilities in Virginia. According to an article in the Washington Times, the state is “grappling” with how to properly provide adequate care for individuals with severe mental illness. 

Defined as when a facility treats a patient in the ER or clinic without admitting them to the hospital, “streeting” typically occurs as a result of factors like limited staffing or capacity constraints. But the process leaves many patients with mental health conditions untreated.

The issue was originally introduced last year, with a report from the Office of the Inspector General for the state's department of behavioral health and developmental services. In a one-year period, the report found that 200 patients were turned away.

A subsequent report looked at how many people in need of “temporary detention order” were allowed to receive comprehensive evaluation to determine the proper level of care. According to the report, those orders were not executed for 72 people in a three-month period.

The state’s lack of licensed psychiatric beds is receiving most of the blame, but Inspector General G. Douglas Bevelacqua says Virginia needs to start doing a better job "given the potential consequences."

“Public safety and mental health overlap in this issue,” Bevelacqua said. “We need to get it right every time.”

Of course, the issue of “streeting” mental health patients is one that requires a lot more attention. So while the reports are startling, they also can serve to increase awareness.

But is Virginia really that unique? Or is this problem even more prevalent than the field would like to admit? Let us know.



I work in a jail as a health care provider and we are down and out broke budget with psych meds tht are ridiculous because the clients can't access primary care, or mental health care on the streets. If you are born with a mental illness, lets hope you also have a silver spoon. The Mental Health System is broken, I worked in it for 18 years and watched it sink down the tubes to a disempowered, underinformed, turn people away system that lacks hope, inspiration, or motivation to take charge and make things work again. My hope lies with Law Enforcement, Probation, Public Defenders, the courts, the policy makers and legilators.

Nick Zubko

Associate Editor

Nick Zubko


Nick Zubko is associate editor of Behavioral Healthcare.

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