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May 23, 2019

Mental Health Awareness Month: Virginia’s Progress and Opportunities in Behavioral Health

May is Mental Health Awareness Month, which affords us the opportunity to take stock of recent significant investments the state has made and look at the ongoing work that still needs to be done in order to improve quality and access to behavioral health services in Virginia. Though the month specifically names mental health, behavioral health is a more inclusive terms that encompasses mental health services and supports such as substance abuse treatment.  

Virginia is 40th in the nation in mental health access to care. While we’ve made progress, there is still much that needs to be accomplished so that everyone in every community across the state has access to behavioral health services.

Virginia Investments in Behavioral Health

This past year, state policymakers have made the following behavioral health investments:

  • A 21 percent increase of Medicaid reimbursement for licensed mental health professionals. This move is expected to encourage more mental health providers to accept Medicaid, further increasing access to services for people in Virginia with low incomes.
  • Additional funding for emergency opioid kits which will expand access and availability of Naloxone, which is used to reverse the effects of an opioid overdose.
  • Investment in crisis services at Community Service Boards and the Behavioral Health Authority (CSBs/BHA) in Virginia to continue implementation of the System Transformation, Excellence and Performance in Virginia (STEP-VA) program. This funding will advance the start date of crisis services provided by these facilities by two years, from July 2021 to July 2019.
  • Increased funding for additional staffing at state mental health facilities. This is an important step in building staff capacity at state hospitals that have routinely struggled to keep up with demand.
  • An additional $5.1 million in permanent supportive housing investments for people with a severe mental illness. This is expected to pay for about 400 more units, in addition to funding nearly 900 units that had already been allocated prior to this year’s budget negotiations. There is currently a backlog of individuals in institutions who are ready to move into a community setting with supports. The Virginia Department of Behavioral Health and Developmental Services (DBHDS) states there is a need for 5,000 permanent housing units throughout the state.
  • Funding for the planning, design, and construction of a new hospital to replace the aging Central State Hospital which serves as a mental health facility.
  • A $7 million agreement by Virginia’s DBHDS with a private transportation company was recently announced in order to alleviate the stress and possible trauma involved in having people needing hospitalization, transported by law enforcement.

Areas of Continued Need

Going forward, Virginia still needs to make progress in the following areas:

  • A further increase in funding for permanent supportive housing. As previously mentioned, investments do not meet the current need. Housing support is vital for some individuals with serious mental health concerns in order to be successful in their transition out of institutionalized care. An estimated $47 million investment is needed in order to meet the 3,700 unit gap across the state.
  • Consider the mental health needs of immigrants and refugees. Recent reports have highlighted the physical and emotional trauma that occurs for children and adults during their journey to the United States, as well as upon their arrival due to policies such as family separation. Immigrant and refugee parents of young children may have difficulty accessing mental health supports due to barriers such as cost, a lack of insurance options, concerns about eligibility and immigration status, and lack of culturally competent services (providers who are responsive to a client’s social, cultural, and linguistic needs), according to the Migration Policy Institute.

    Ensuring more health practitioners are trained in trauma-informed care and are aware of the heightened risk of exposure to trauma with immigrant and refugee communities would be an important step toward addressing this need. Statewide systems should be in place to help immigrant families navigate to relevant services with attention to culturally competent care. Increased diversity of mental health professionals in the state would help bolster linguistic and cultural competence.

  • Increase funding for the Virginia Mental Health Access Program (VMAP). This program helps educate primary care providers on screening, diagnosing, treating, and monitoring mental health concerns, thereby increasing the capacity for mental health services. This program also funds telehealth consultations with psychiatrists, psychologists, and social workers, which can help more people to gain access to services.
  • Build access to mental health supports in rural Virginia. There continues to be limited options for mental health treatment in some rural parts of Virginia. Many localities in Southwest and Southside Virginia are designated as having a high need of mental health providers in relation to their population. Telehealth initiatives such as VMAP could help improve access to care. Investing in workforce development for mental health professions could also be crucial to increasing the capacity to meet mental health needs in these localities.
  • Virginia needs to do more to increase the number of mental health professionals in the state. Loan forgiveness, cash incentives, higher pay, and a focus on worker safety have been proposed as possible solutions to meet the behavioral health needs of the state. A task force has been formed by Gov. Northam in order to consider initiatives to boost the number of mental health providers in Virginia.
Map: Mental Health Professionals Wanted -- The majority of localities in Virginia are designated as Mental Health Professional Shortage Areas, meaning there is a shortage of providers for the entire population within a defined geographic area.

Virginia is continues to move forward with the STEP-VA process and is actually ahead of schedule on some of its initiatives such as launching crisis and outpatient behavioral and mental health services through the state’s 40 CSB/BHA locations. Continuing to adopt recommendations from the Joint Subcommittee Studying Mental Health Services in the Commonwealth in the 21st Century – also known as the Deed’s commission – will help more families managing behavioral health issues connect to resources and supports. Recent steps should be applauded, but Virginia has more work to do in order to meet the behavioral health needs of all the people who call Virginia home.

Health Care

Freddy Mejia

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