Governor pledges $38 million in mental health aid

Posted at 10:54 AM, Dec 10, 2013
and last updated 2013-12-10 19:09:39-05

RICHMOND, Va. (WTVR) - Outgoing Virginia Gov. Bob McDonnell proposed a $38.3 million budget Tuesday for crisis mental health services over the next two years. While officials said the budget and other initiatives have been in the works for a while, the announcement comes less than a month after Democratic state Sen. Creigh Deeds was stabbed more than 10 times by his son, who then shot and killed himself.

Deeds' son, Gus, was reportedly getting a mental health evaluation one day prior to the incident, but he was released from treatment because the facility lacked enough psychiatric beds.

When the governor did not mention Deeds in his prepared remarks, CBS 6 reporter Joe St. George asked the governor whether he had spoken to the senator about mental health funding.

"I have spoken to Senator Deeds," the governor answered. "This is about fixing the system for all Virginians. Obviously it was a heart breaking situation that we experienced here recently.  Senator Deeds is a very good man, a public servant and obviously heartbroken about losing his son."

Click here to the video box below to watch the governor's full response.

For its part, Virginia robustly increased its mental health spending after the Virginia Tech massacre in 2007.

Mental health organizations contend most of that increase was reduced during the recession.

McDonnell said the Commonwealth needs to do more.

"Just looking over the last six-seven years, I think we just have a deeper obligation to try to...put resources into the system for everybody," he said.

The new funds will go towards crisis intervention and substance abuse disorders. McDonnell added that the commonwealth has dedicated even more money towards preventative measures involving mental health this year. All told, the amount comes close to $100 million, he said.

McDonnell, whose term ends in January, also proposed the creation of a task force that will make further recommendations for other initiatives.

His successor, Democratic Governor-elect Terry McAuliffe, praised McDonnell and pledged to uphold the new efforts.

"As governor I will work with the General Assembly to build upon the solid foundation Governor McDonnell laid today so that all Virginians can access the care and resources they need to live safe, healthy and productive lives here in the Commonwealth," he said in a statement.

The Governor’s budget provides the following funding for mental health efforts:

Mental Health Crisis Response Improvements

• Provide for Emergency Custody Order (ECO) extension – Negligible funding is needed to add an optional two hour extension that can be ordered by a magistrate only after clinical determination of need for TDO and only if a bed has not been found within the maximum ECO period to permit additional time to complete the bed search phase. Virginia’s current maximum ECO period is six hours.

• Provide for Temporary Detention Order (TDO) extension to 72 hours – $1,300,000 in FY 2015 and $1,600,000 in FY 2016 to provide for TDO extension that extends the TDO period from the current 48 hours to 72 hours (with a 24-hour minimum).

• Expand availability of secure crisis intervention team (CIT) assessment centers – $1,800,000 in FY 2015 and $3,600,000 in FY 2016 to allow a person to be held safely for evaluation and finding a bed without tying up law enforcement personnel. This funding would support six centers in FY2015 and 12 in FY2016.

• Maintain current adult capability at Eastern State Hospital (ESH) – $5,000,000 each year to maintain current adult capability at ESH. This will enable ESH to avoid a loss of bed capacity due to the reduction of Medicaid revenues related to the need to serve fewer geriatric patients.

• Expand adult bed capacity at ESH in FY 2015 – $2,200,000 each year to prevent loss of adult capacity by opening a vacant geriatric 20 bed unit to accommodate adult civil and forensic patients in the catchment area.

• Ensure operational supports for new Western State Hospital (WSH) facility – $670,000 in FY 2015 and $690,000 in FY 2016 to provide operational supports for the new WSH facility.

Behavioral Health Treatment and Support Services

• Expand mental health outpatient services – $3,500,000 in FY 2015 and $4,000,000 in FY 2016 for mental health services for older teens and young adults transitioning from school, college, or early in their adulthood when most serious mental illnesses first make their onset, and engagement in treatment is imperative. This item was recommended by the Governor’s Task Force on School and Campus Safety.

• Expand Program Assertive Community Treatment (PACT) programs – $950,000 in FY 2015 and $1,900,000 in FY 2016 to provide intensive clinical outreach and support to persons with serious and persistent mental illness to reduce crises and hospitalization. Virginia currently has 19 PACT programs.

• Expand telepsychiarty capacity – $1,100,000 in FY 2015 and $620,000 in FY 2016 for new telecommunication equipment to allow community services boards to conduct clinical evaluations offsite and more rapidly.

• Peer Support Recovery – $550,000 in FY 2015 and $1,000,000 in FY 2016 to provide support to people with behavioral health needs by people who are themselves in recovery from such problems and are trained as peer providers.

• Substance Abuse Community Recovery Program – $300,000 each year for the community recovery program which combats substance use disorders through employment and long-term recovery.

The Task Force’s responsibilities shall include the following:

• Recommend refinements and clarifications of protocols and procedures for community services boards, state hospital, law enforcements and receiving hospitals.

• Review for possible expansion of the programs and services that assure prompt response to individuals in mental health crises and their families such as emergency services teams, law enforcement crisis intervention teams (CIT), secure assessment centers, mobile crisis teams, crisis stabilization centers and mental health first aid.

• Examine possible extensions or adjustments to the emergency custody order and the temporary detention order period.

• Explore technological resources and capabilities, equipment, training and procedures to maximize the use of telepsychiatry.

• Examine the cooperation that exists between the courts, law enforcement and mental health systems in communities that have incorporated crisis intervention teams and cross systems mapping.

• Assess the availability of psychiatric beds in Virginia, the assessment process hospitals use to select which patients are appropriate for those beds, and to explore whether psychiatric bed registries and/or census management teams improve the process for locating beds.

• Review for possible expansion those services that will provide ongoing support for individuals with mental illness and reduce the frequency and intensity of mental health crises. These services may include rapid, consistent access to outpatient treatment and psychiatric services, as well as critical supportive services such as wrap-around stabilizing services, peer support services, programs of assertive community treatment, housing, employment and case management.

• Recommend legislative and budget proposals that will enable implementation of the above.

• Recommend how families and friends of a loved one facing a mental health crisis can be taught to improve the environment and safety of an individual in crisis.

• Examine workforce development activities and recommend any improvements to ensure an adequate mental health workforce.

The Task Force shall be co-chaired by the Secretary of Health and Human Resources and the Secretary of Public Safety.

Membership shall include the following individuals or representatives:

• The Attorney General of Virginia or his representative

• Chief Justice of the Supreme Court of Virginia or her representative

• Commissioner of the Department of Behavioral Health and Developmental Services

• Commissioner of the Department of Social Services

• Superintendent of the Virginia State Police

• At least three community services board emergency services directors

• At least three law enforcement officers, including at least one sheriff

• At least two executive directors of community services boards

• At least two magistrates

• At least two private hospital emergency department physicians

• At least two psychiatrists

• At least one representative of a state mental health facility

• At least two representatives from Virginia’s private hospital system

• At least two individuals receiving mental health services

• At least two family members of individuals receiving services

• Two members of the House of Delegates and the Senate of Virginia

Virginia's National Alliance on Mental Illness Director Mira Signer welcomed the increase in funding, but said her organization has yet to endorse the move to allow custody and detention orders to be extended, fearing violations of civil liberties.

"It's going to be an interesting conversation to have," Signer told St. George.

But will any of these changes have prevented the Deeds tragedy?

"Clearly workforce is still an issue," Secretary of Health Bill Hazel said.

One of the main critiques of the Deeds incident, as published reports indicate, is that Deeds' son was allowed to leave a hospital after an Emergency Custody Order because there were not enough beds - even though nearby hospitals say its beds were available.

Hazel said that an automated, internet based bed system schedule to go live next month, may not solve the issue of locating beds for patients completely - because of the inability of some locations to provide updated information.

"It is only as good as the data that is put in by the facility," Hazel said.