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Future of Mental Health System Awaits Legislative Session

Written by Bruce Cruser

Bruce Cruser has been Executive Director of Mental Health Virginia since 2016, bringing a background in social work and community corrections, and many years of leadership experience in local and state government.

December 15, 2023

Patient safety is a concern…” – JLARC Study on Virginia’s psychiatric hospitals, December 2023

We know we have a crisis… Our system is overwhelmed.” – Governor’s remarks about Virginia’s mental health system, 12/14/2023

Virginia’s mental health system should be a major priority when the General Assembly begins its annual session on January 10th. Earlier this week, the Joint Audit and Legislative Review Commission (JLARC) issued the results of their study on the Virginia’s state psychiatric hospitals. For those new to the topic, it is eye opening.

JLARC issued 32 recommendations for the General Assembly and the Executive branch to improve conditions and the system as a whole, from clarifying who the state hospitals are best equipped to serve, to requiring private hospitals to open their admissions to more people in a mental health crisis.  Virginia’s State Psychiatric Hospitals

Of most urgent concern is the 30% staff turnover due to unsafe working conditions and uncompetitive pay, with particular concern about the Commonwealth Center for Children and Adolescents (CCCA), the state’s only state psychiatric hospital for children.

JLARC recommends closing the CCCA because of its high rate of physical safety incidents,” … highest rate of patient self-harm, the highest number and percentage of substantiated human rights complaints, the highest use of physical restraint against patients, the highest staff turnover, nearly the highest staff vacancy rate, and the greatest dependence on expensive contract staff.” An unannounced inspection by a national accrediting agency determined the hospital to be “… an immediate threat to the health and safety of patients…”. Most other states contract with community hospitals and residential programs closer to patients’ homes to better meet the needs of children.

Governor Youngkin is proposing major funding increases to continue expanding the crisis continuum of care launched a year ago through a 3-year plan, the “Right Help, Right Now” initiative. This effort has helped triple the number of publicly funded emergency mobile crisis teams, which bring crisis response services to the individual, and can often resolve the immediate crisis through local resources instead of hospitalization. The new funding would make major investments in youth mental health by increasing school based mental health services, telehealth services, and increasing the pool of mental health professionals.

Although we are encouraged by both recent and proposed budget increases, Virginia is so far behind in meeting mental health needs that it will take continued, major investments to address the systemic problems. The legislature must step up and not be seduced by one-time fixes. A crisis of decades in the making, Virginia’s failure to support the mental health of its citizens will take intentional, sustained, system wide transformation to bring lasting improvement.

MHAV will be monitoring mental health related legislation and sharing information about some of the priority budget and policy issues.

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