NAMIGrading the States: A Report on America's Health Care System for Serious Mental Illness
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Grading the States 2006: Virginia - Narrative

In December 2005, Governor Mark Warner left office proposing a $460 million investment in the state's mental health system. That amount represented almost half of the state's $1 billion budget surplus.

Through the Virginia Department of Mental Health, Mental Retardation and Substance Abuse Services (DMHMRSAS), $290 million would be used to replace four outdated state facilities, two psychiatric hospitals, and two training centers for individuals with developmental disabilities. The remaining $170 million would go toward upgrades in the community system. The investment is long overdue.

"If we miss this window, it might be another decade before we have a chance to do what we're going to be proposing today," Warner declared. The work, however, relies on the readiness of the Virginia General Assembly and Warner's successor, Governor Tim Kaine, to ensure appropriations.

Beneath the excitement and hope that Warner's announcement has inspired lies the reality that Virginia's public system has suffered from years of deep cuts that fell disproportionately on the community system. Traditionally, Virginia has bucked national trends by putting more emphasis on state inpatient psychiatric facilities than on community services - and the neglect is beginning to show.

DMHMRSAS requires the commonwealth's 40 Community Service Boards (CSBs) to deliver community services, but in FY 2003 alone, $12.5 million was cut from their budgets, resulting in elimination or consolidation of services and staff. The strain on CSBs shows in significant ways, including long waiting lists for services. In 2004, by the commonwealth's own conservative estimates, the CSBs have a combined waiting list of approximately 3,000 adults.

Housing for individuals with serious mental illnesses is in very short supply, with an average wait time of 42 weeks for supervised residential services. There is only one supported housing program. Advocates report that Virginia relies primarily on group homes, but many have checkered pasts of abuses and neglect. Additionally, Virginia has some of the lowest reimbursement rates in the country for group homes.

DMHMRSAS has worked to implement evidence-based practices (EBPs) such as Assertive Community Treatment (ACT), supported employment, and integrated treatment for co-occurring disorders, but the budget crunch inevitably has affected progress. By DMHMRSAS's own admission, the use of EBPs is "very inconsistent statewide" and "the funding, licensing, and other infrastructure of the service system does not include incentives for providing EBPs."

Additionally, Virginia's ability to serve its growing population of ethnic and racial minorities has suffered because the state has shown no initiative on the issueof cultural competency. Virginia has not conducted a cultural competency assessment or developed a plan to meet the needs of minorities, who comprise nearly 30 percent of the state's total population.

Lack of short-term acute care beds for individuals in crisis is another major problem. In Northern Virginia, the commonwealth's most populous area, approximately 24 percent of the region's private bed capacity vanished in 2005 alone, due mostly to the closure of psychiatric wards at four different hospitals. Individuals in need of beds are transported downstate, resulting in trauma for the individual and diversion of local police officers, who must spend hours transporting people to areas as far away as Hampton Roads. 

State hospitals have posed a different set of issues. In the 1990s, four out of 10 were under investigation by the U.S, Department of Justice (DOJ) for egregious violations of the rights of patients. Part of the remedy included creation of an Independent Office of Inspector General to conduct unannounced inspections and audits of public facilities and services for mental illness and developmental disabilities. Improvements have been sufficient for closure of the cases. Conditions will improve if the legislature approves Warner's proposal to transform Eastern and Western State Hospitals into state-of-the art facilities.

In addition to the Warner proposal, other sources of hope exist:

  • Under Commissioner James Reinhard, M.D., advocates believe DMHMRSAS has embraced a more recovery-oriented focus for its programs and policies. Continued, effective leadership in this regard and the necessary financial resources are critical to the system's improvement.
  • DMHMRSAS has developed a comprehensive Workforce Development Plan and increased recruitment efforts for key occupations, along with establishing partnerships with educational institutions to offer additional training. It maintains a Workforce Development and Innovation Web site as a statewide resource. 
  • Some CSBs have partnered with local law enforcement to develop mental health courts and jail diversion programs. Fairfax County in Northern Virginia, the New River Valley in the state's rural southwest, and Virginia Beach in the southeast have developed especially strong programs. 

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