With a mental health system in crisis, lawmakers inch toward stabilization

In its changes to the state budget, the 2019 General Assembly inched closer to stabilizing  Virginia’s struggling mental health system.

The effort is in part driven by the ongoing crisis within the state’s psychiatric hospitals, which have seen an unprecedented uptick in admissions, resulting in dangerous overcrowding.

On Tuesday, eight of the state’s 10 psychiatric facilities were operating at 95 percent capacity or above, according to data from the Department of Behavioral Health and Developmental Services. Hospitals are considered safest for patients and staff when operating at no more than 85 percent capacity.

Advocates and concerned lawmakers have pushed for a multifaceted approach to address the problems: increase resources to the hospitals to help current staff cope with the high numbers and simultaneously fund community services to prevent people from ending up in the mental hospital in the first place.

The 2018 biennium budget pumped $84.1 million into community-based mental health services, according to Sen. Creigh Deeds, D-Bath, who chairs the Joint Subcommittee to Study Mental Health Services in the Twenty-First Century, known as the Deeds Commission.

“We’ve made strides, for sure, over the last several years, but we still have a ways to go,” said Rhonda Thissen, executive director of the National Alliance of Mental Illness of Virginia. “Virginia still has a public mental health system that is overly weighted toward funding for hospitalization and crisis, and not community services, as compared to other states.”

This session, lawmakers added $5 million for permanent supportive housing, a model that allows residents to choose their own stable housing while receiving supportive services. That money could pay for about 400 more units, in addition to funding for around 900 units that has already been allocated to the behavioral health department for fiscal year 2020.

More units could make a big difference for the high hospital census, Thissen said, because it would help address the extraordinary barriers to discharge list — those people who have been medically cleared to leave the hospital but remain there because they have nowhere else to go.

“For 75 percent of the people on the extraordinary barriers to discharge list, the barrier in the community for them is housing,” Thissen said. “There’s a continuum from the hospital into the community, and this funding to create additional units is going to really help to relieve some of the pressure in that continuum.”

DBHDS has cited a need for 5,000 permanent supportive housing units.

To help relieve the immediate crisis within state psychiatric hospitals, the General Assembly has set money aside to increase staff, including $7.2 million in their negotiated budget for additional nurses and psychiatrists.

“Hospital staffing is an often-overlooked issue just in the same way that people in the state hospitals are overlooked because they’re out of sight, out of mind,” said Bruce Cruser, executive director of Mental Health America of Virginia. “How can people get the care they need when you have vacant positions because staff are burned out with high turnover? So that’s huge.”

The budget also includes language directing DBHDS to form a work group to study the census problem and create an action plan to relieve the pressure.

“That work is so important in helping us get out of this crisis mode,” Cruser said.

To further address workforce issues, the legislature devoted $2.6 million from the state’s general fund — to be combined with $4.5 million in federal funds — to increase Medicaid reimbursement for psychiatric services by 21 percent.

Additionally, the legislature passed measures to address mental health challenges for children in particular, like helping to improve the integration of mental health services into primary care and allowing school counselors to spend more time counseling students rather than administrative activities.

Another successes for mental health advocates was the passage of legislation sponsored by Del. Rob Bell, R-Albermarle, which requires the Board of Corrections to create standards for behavioral health treatment in jails.

“The momentum needs to continue,” Cruser said. “As a whole, the legislature certainly is better informed and more supportive of increasing funding and services than they were many years ago. But my fear is that they will feel, ‘We’ve already dealt with that,’ and not continue to support it.”