Two main obstacles are in the way: a lack of vision and money.
RICHMOND – Virginia’s mental health system needs structural reform. But in order to make that happen, first you need an “overarching vision”, said Sen. Creigh Deeds (D-Charlottesville). You also need to figure out how to pay for it.
The issue is a personal one for Deeds, who lost his son to suicide. When Gus Deeds suffered a mental health crisis in 2013, his father tried to get him into a facility for treatment. Six hours later, officials released Gus, claiming they couldn’t find an open bed. He then went home and within 24 hours, Gus stabbed his father multiple times before killing himself. Afterward, officials from three medical centers within a two-hour radius of the Deeds’ home said nobody called, despite the fact they had open beds. It’s just one example of the critical need to reform the state’s mental healthcare system.
Creigh Deeds spoke during Monday’s meeting of the Virginia General Assembly’s Joint Subcommittee on Mental Health Services in the 21st Century. He and other speakers outlined the challenges involved, both with reform and funding any changes.
The latter mandate is much more difficult to fulfill. The pandemic and subsequent economic downturn in Virginia led to significant budget cuts. Well-intended programs to reform the system simply don’t have enough money to operate effectively.
These shortages also come in the context of more Virginians than ever reaching out for mental health support. According to Bruce Cruser, the executive director of Mental Health America of Virginia, the organization has seen a 500% increase in folks taking mental health screenings. More than 10,000 people utilized the online screening tool since September 2020. Those from marginalized groups took the screening at higher rates. Seventy-one percent were women and 23% identified as members of the LGBTQ+ community.
At the same time, Virginia ranks near the bottom in terms of the readiness of its mental health workforce. This year, the Commonwealth is in 40th place.
Hospitals are Wrong-Sized
Monday’s meeting set the subcommittee’s priorities as it approaches the 2021 session of the General Assembly. On Dec. 16, Gov. Northam will release his budget proposals for next year, and on Dec. 21, the subcommittee will meet with the full joint subcommittee on mental health group.
Although many of the subcommittee’s efforts were stymied by budget shortfalls last year, Sen. Barker (D-Fairfax) emphasized that the group did make some progress. It secured $20 million to fund permanent supportive housing for those in mental health crisis and got about half of the funding it wanted for a hospital use census.
To that second point, several committee members pointed out that the key to sufficiently funding mental health services is to right-size the hospital system in Virginia. Right now, patients with both mental illness and dementia are being shuffled to state facilities where they aren’t accessing the appropriate care and are occupying a bed that could be put to better use.
Deeds said a census should be completed and the hospital system adjusted. Only then will the General Assembly be able to reallocate funds to assisted living and community services facilities where they’re desperately needed.
Next STEP is Money
Continuing to expand the STEP Virginia program, which aims to implement higher standards of care at assisted living facilities, will be an important part of this effort. Although as Barker pointed out, an improved assisted living facility is “great if you have the money to pay for it”—which many Virginians do not. He advocated for improving the public financing mechanism—an auxiliary grant program he called “woefully inadequate.”
Sen. Janet Howell (D-Reston) said with respect to STEP that the General Assembly should “stay on that track and just fund it as much as we can.” She caveated that legislators concerned with mental health will probably have to shift their focus somewhat in the wake of coronavirus, since prolonged isolation is causing spikes in youth depression and substance use disorders.
Marcus Alerts and Jail Diversion
Legislators discussed the importance of coordinating efforts across subcommittees and outside advocacy groups to ensure new programs are being implemented in the most effective way. The idea of diverting people in a mental health crisis away from the criminal justice system was raised several times during Monday’s meeting.
The most recent example of this problem is the case of Marcus-David Peters. Peters was a Essex County school teacher who was shot and killed by Richmond police on May 14, 2018. Peters’ car hit another vehicle near the intersection of N. Belvidere St. and W. Franklin St. that night. Peters hit two other vehicles before his car came to a stop in the center of the on-ramp for Interstate-95 North.
Clearly exhibiting signs of mental distress, Peters ran naked from the car and into traffic. He was hit by a vehicle and then laid in the right travel lane. At this point, the officer requested additional police units to come to the scene. At no point in any report does anyone mention a call for medical or mental assistance. The officer pulled out his taser while going to check on Peters, who at that point didn’t seem to realize anyone else was there. He was making snow angels on the side of the road.
As the officer came closer, Peters noticed he was there and started cursing. The Commonwealth Attorney’s report says Peters lunged towards the police officer. After a taser didn’t have any effect, the officer shot him.
As a result of the incident, the General Assembly created the Marcus Alert System during this fall’s special session. It aims to implement best practices for law enforcement officers responding to a behavioral health crisis.
Finding Alternatives to Jail
In a similar vein, several localities throughout Virginia have successfully piloted jail diversion programs. The goal of these programs is to keep people who face potential criminal charges because of behaviors resulting from mental illness out of jail. Instead, these people are diverted to behavioral healthcare facilities. Such a program exists in Barker’s own district, he said, and has proven its efficacy.
These programs promote compassion as well as cost-savings for localities, according to the National Alliance on Mental Illness. The cost of incarcerating someone in Fairfax County is $66,000/year, while the cost of treating their mental illness is less than $10,000/year.
Barker said the pilot programs have served their purpose, and the goal now should be full programmatic implementation across the state.
Finding the Providers
One final major roadblock to systemic reform is a lack of primary care physicians and psychiatrists in Virginia. Lots of people are interested in the mental health field, Barker said, but it’s difficult to retain those providers. Salaries in the field are low and facilities tend to be understaffed, meaning providers are overworked.
Del. Mark Sickles (D-Fairfax) said the root problem is the cost of medical school. New doctors in Virginia graduate with hundreds of thousands of dollars in student loan debt, he said. As a result, they’re incentivized to pursue more lucrative specialties. “We need to consider intervening in this debt problem,” he said. Barker pointed out that the state already funds 25 residencies in primary care and psychiatric medicine. Debt relief is also available after a certain term of service in an underserved community, he said. That’s especially true in rural areas.
Barker acknowledged that more could be done, however, to shore up specialties that need it most—provided the General Assembly can find the money.