Sen. Jennifer McClellan: The cost of mental health failures in Virginia is way too high

Richmond Times-Dispatch

With the establishment of the first public institution dedicated to the mentally ill in Williamsburg in the 1776, mental health services have been a core responsibility of the Commonwealth of Virginia. Since then, Virginia’s mental health system has evolved from one focused primarily on institutionalization towards a single, integrated system of care, with increased emphasis on the establishment of community services and more effective and efficient use of state facilities.

Today, Virginia’s “public mental health, intellectual disability and substance abuse services system” is comprised of 16 state facilities and 40 locally run community services boards (CSBs) that “serve children and adults who have or are at risk of mental illness, serious emotional disturbance, intellectual disabilities, or substance abuse disorders.” State facilities are only one of several resources in an overall continuum of care that also include the CSBs, local psychiatric hospitals, hospital emergency departments, law enforcement, and the court system.

This evolution, however, has been slow; it typically occurs in bursts of activity, including studies by experts and bold calls for action by executive leadership once the community has been confronted with a tragedy that highlights gaps in the system. I outlined this 246-year struggle to meet the mental health needs of Virginians in a 2014 article for the Richmond Public Interest Law Review, published shortly after the passage of SJ 47 establishing the Joint Subcommittee to Study Mental Health Services in the 21st Century.

 

Chaired by Sen. Creigh Deeds, who witnessed first-hand the failures of our mental health system in November 2013, the Commission endorsed significant proposals to begin reshaping the CSBs and redefining the list of mandated services they are required to provide through a phased approach.

First, SB 1005 (Sen. Hanger) and HB 1549 (Del. Farrell) expand the list of core services the CSBs and behavioral health authorities must provide. Both versions require same-day access to mental health screening services. The Senate version also requires outpatient primary-care screening and monitoring services for physical health indicators and health risks, and follow-up services for individuals identified as being in need of assistance with overcoming barriers to accessing primary health services.

The Senate bill also requires additional core services to be phased in by 2021. While the governor’s introduced budget included funding for the full array of services cited by the Senate bill, the House budget only funds for same-day screening services. While it may take years to fund the full list of core services recommended by the Deeds Commission, it is important to establish our future vision for the mental health system in Virginia.

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The Deeds Commission also recommended mandated screening requirements within regional and local jails in order to determine which incarcerated individuals need mental health services (HB 1783 and SB 940). This particular initiative was funded in the governor’s proposed budget. However, the House bill did not pass, and the fate of the Senate bill is uncertain due to competing budget priorities. Indeed, both the House and Senate budgets eliminated the funding for these screenings and assessments.

In response to the tragic deaths of Natasha McKenna and Jamycheal Mitchell, the Deeds Commission proposed HB 1782 (R. Bell) specifying the authority of the Board of Corrections to review jail deaths. This proposal was developed with input from regional jails and local sheriffs, and the governor included funding for such investigations. However, the bill failed in the House, and both the House and Senate budgets cut this funding in order to fund law enforcement pay raises.

Fortunately, the House and Senate budgets recognized the need to invest in supportive housing, a critical component often overlooked when addressing mental health needs. Even so, the House provided $3 million less than the Senate.

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As evident in the incremental funding approach necessitated by this year’s budget shortfall, the important work of the Deeds Commission is not over. As a result, the House and Senate have passed legislation to extend the Commission an additional two years.

Two hundred and forty one years ago, Virginia led the nation in recognizing that providing services to those Virginians with mental health issues is a core function of our government. Yet, we have yet to perfect that system, with tragic results. Senator Deeds is committed to ensuring the current reform efforts do not long languish or fizzle out as so many have done, only to be revived in the wake of tragedy. The cost of failure is too high.

 
 

Jennifer McClellan, a Richmond Democrat, represents the 9th District in the Virginia Senate. Contact her at district09@senate.virginia.gov.