Signs of hope on mental health 10 years after Tech tragedy
Daily Press - 4/16/2017
April 16--A decade after a young man who slipped through the cracks of Virginia's mental health system shot and killed 32 students and staff at Virginia Tech, the General Assembly this year put itself on the hook to begin taking -- and paying for -- some first steps to fix an overwhelmed network of hospitals and community mental health agencies.
Seung-Hui Cho's teachers had worried about his odd, threatening behavior in classes and the violence in his writings for nearly a year and a half before his shooting rampage; female students had complained about stalking and bizarre instant messages that brought him to the attention of university police; and an apparent suicide threat led to a hospital stay and court-ordered outpatient treatment. But the university's counseling center let his case drop.
He was able to buy handguns and large amounts of ammunition even though the court-ordered treatment should have barred him from being able to.
Then-Gov. Tim Kaine and the General Assembly moved quickly to tighten laws on court-ordered mental health treatment, particularly focusing on follow-up, as well as on reporting such treatment to the Virginia State Police so gun sellers can get accurate background check reports. State officials focused on beefing up threat assessment teams at universities.
And the General Assembly approved a 22 percent increase in funding for community mental health services -- the local community services boards -- in the next two-year state budget. But it didn't last.
"What Virginia tends to do -- I think a lot of other states do, too -- when we have a tragedy or a crisis, we try to react to the crisis," said Jack Barber, the longtime director of Western State Hospital who now leads the state's Department of Behavioral Health and Developmental Services.
The legislature cut spending by 11 percent in its first post-Great Recession budget revision. As community mental health agencies strained to stretch limited funds to cover a growing need -- a need they'd been falling short on even after the post-Virginia Tech increase in funding -- more and more of their resources went to the most severely ill, people who were already in crisis. And they still couldn't reach them all.
One young man who wasn't reached despite his parents' urgent efforts, Gus Deeds, committed suicide after attacking his father, state Sen. Creigh Deeds, D-Warm Springs. That tragedy sparked a new round of reforms, focused on crisis services. The reforms required state hospitals to admit Virginians ordered for mental health evaluation under a temporary detention order, established a new automated registry of available mental health beds and set tougher standards for mental health workers assigned to emergency services.
This year, Deeds, joined by state Sen. Emmett Hanger, R-Mount Solon, co-chairman of the Senate Finance Committee, and Del. Peter Farrell, R-Henrico, pushed for the next step -- requiring community services boards to assess and evaluate people on the same day they first seek mental health help.
It also requires the boards to provide primary care screening and monitoring services and dictates a series of core services the boards will have to provide by 2021, including outpatient mental health and psychiatric rehabilitation services. The first covers diagnosis, counseling, medication management, services for jail inmates and the intense, daily visits by members of a specialized team of psychiatrists, nurses and social workers meant to keep the most severely ill from having to be hospitalized. The second covers programs meant to help people with mental illness with the social, job and family support they need to live independently.
The General Assembly approved that step, and Gov. Terry McAuliffe signed the legislation even though it means adding $65 million on top of an already approved $250 million-a-year budget for community mental health services.
The next big test comes in January 2020, when the legislature is supposed to add enough money to cover the new requirements for the following two fiscal years -- an estimated total of $278 million.
"I'm feeling more optimistic," Deeds said. "What's so hard is we know there are still people falling through the cracks."
And there's still work to be done, he said.
"To have it in the code means we're going to have to do it; we're going to have to close the deal," he said. "We have to be talking about a long-term fix."
Deeds said the General Assembly joint subcommittee on the future of the mental health system, set up after his son's death and which he leads, plans what he called a "deep dive into the data" and and hard look at the structure of the system to make sure the state stays on track. That means the final cost of the legislature's commitment to provide same-day assessments, primary care screening and the core services could end up being lower than currently forecast -- or higher.
"The General Assembly is saying, 'We're keeping a klieg light on this,'" said Joe Flores, Virginia's deputy secretary of Health and Human Resources, who worked for more than a decade for the state Senate Finance Committee, wrestling with mental health policy and funding issues.
"It puts the onus on the administration and the General Assembly to fund this," he said. "We're on the hook."
One huge challenge, Barber said, will be timing.
Most states devote about three-quarters of their mental health funds to community services. Virginia splits its spending about 50-50 between community care and its nine state hospitals, he said. Michigan, with 40 percent more territory and a million more residents than Virginia, has five state hospitals. California, 300 miles longer end to end than Virginia, with 4.5 times as many people, also has just five state hospitals.
The problem is that many of the people now in Virginia hospitals are there because there is no place for them in the community, Barber said. The community help they'd need to keep from bouncing back into the hospital simply isn't there. Putting it in place costs money.
Before it can cut the cost of running hospitals and operate them more like the kind of acute care facility that mental health professionals and civil liberties advocates say is ideal, Virginia needs to invest in setting up community services, Barber said. And it needs to think about the range of services it offers to make sure they are really meeting needs.
"We're going to need a bridge," he said. "That's what we're working on now."
Mira Signer, executive director of the National Alliance on Mental Illness-Virginia, said that while money is an issue, it's not the only thing the state needs to work on.
Even though she was discouraged by the Great Recession cuts to mental health funding, she noted that in recent years governors and legislators have agreed to spend $18 million to boost emergency services, $10 million to bolster the state's supportive housing, $10 million for services to people in jail, nearly $9 million for the teams that make daily checks on the most seriously ill, and nearly $9 million for children's services.
"I do feel pretty good," she said. "I think that they, the administrations and GA, got serious."
The new Code of Virginia language on community services "has the potential to be transformational," she said. "The challenge is to fund it so that it is not just ink on paper. The framework is there for the first time in a long time."
Deeds said that when he and the other lawmakers were hammering out details of the new code language -- a group that included House Appropriations Committee Chairman Chris Jones, R-Suffolk -- he was struck by how serious the legislature's intent was to fix the mental health system, even at a time when the state's finances are stressed.
"Chris was just very supportive and helpful," he said.
The time for lasting change, he said, has come.
"I've looked at all the studies and all the recommendations over the years," Deeds said. "Now I believe the political will is there."
Ress can be reached by phone at 757-247-4535.
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