Eastern State Hospital in Williamsburg is the largest of nine state-run psychiatric hospitals. Lawmakers have increased funding to community mental health services over the past several years in an effort to reduce admissions to state hospitals. (Photo courtesy of DBHDS)
Virginia ranks number 12 in the nation of most challenging states to access mental healthcare in a new Forbes Advisor analysis, and a Gallup survey from earlier in the year found that about 38% of Americans think mental health isn’t treated as well as physical health issues.
However, much of the data Forbes used in its analysis was from 2020 or 2021, and in recent years Virginia’s legislature has passed several laws bolstering access to care.
Virginia is in the second year of a three-year plan called Right Help, Right Now — which entails budget proposals and goals from Gov. Glenn Youngkin and legislative actions by state lawmakers.
For instance, when the national mental health emergency hotline transitioned to the easier-to-remember 988 system, Virginia legislation funded expanded call centers and listed deployment of mobile crisis units and community care teams as part of their responsibilities. Use of 988 has been on the rise in Virginia.
This week, Youngkin announced several million in grants to community service boards around the state that will be used to help with crisis response.
“Governor Youngkin is committed to building on ongoing efforts to develop innovative solutions that address the challenges within our behavioral health care system and ensure that Virginians in crisis receive the appropriate care and support they need,” said Youngkin spokesman Christian Martinez.
Some building on those efforts occurred this past legislative session when the governor signed bipartisan bills to require insurance coverage for mental health services provided through mobile crisis units, crisis receiving centers and crisis stabilization units.
Among the hallmarks of the 2024 session was Irvo’s Law, which allows families members or guardians to be present to provide support and decision-making when someone in a mental health crisis is being considered for temporary detention orders. The legislation stemmed from the 2023 death of Irvo Otineo, who was killed while restrained by sheriff’s deputies and workers in a state-run psychiatric hospital. His mother, Carolina Ouko, had been denied the ability to see him.
“Our families are part of our mental health and we need them beside us in those tough times,” Ouko said earlier this year as Youngkin signed the law named for her son.
Previous law to stem from mental health related tragedies is the Marcus Alert, named for Marcus-David Peters, who was killed by police in 2018. The alert, which has so far only been implemented by a handful of localities in Virginia, creates coordination between 911 and regional call centers to triage best response from law enforcement and trained clinicians when handling mental health situations.
A recent Behavioral Health Commission presentation noted that arrests of people in mental health crises have a “devastating impact” on people in crisis and “stress local and state resources.” Despite Virginia having a prevalence of crisis intervention-trained law enforcement officers, the report stated that crisis response should include or be led by clinicians.
Instances where someone assaults an officer who responds to their crisis are more common the longer people are held waiting in hospital emergency rooms under temporary detention orders, BHC policy analyst Claire Pickard Mairead told lawmakers at the meeting.
Mairead’s presentation noted how law enforcement leaders and research literature found that CIT has improved officers’ confidence in handling mental health crises, but there is little evidence of such officers being able to reduce arrests of people in crisis or injuries that might arise to the affected individuals or the officer if interactions turn forceful. The study did find that officers in Virginia expressed interest in CIT “refreshers.”
Legislation from 2020 directed the Department of Criminal Justice Services to develop a CIT training program that includes recertification and advanced training. Those new standards await approval from Youngkin’s office. From there, they can be open to public comment and go through final regulatory stages, the report read.
There is a desire for co-responder models, the report stated, as “effective ways to include clinicians when safety risks exist.” However, lack of funding and mental health workforce shortages have limited implementation.
And while lawmakers continue to explore how to improve mental health crisis response and law enforcement’s role in those, Sen. Creigh Deeds, D-Charlottesville, said “our focus needs to be on keeping people out of crisis.”
After losing his son, Gus, to a mental health crisis a decade ago, Deeds has been a leader in reforming mental health access in the state and chairs the Behavioral Health Commission, which conducts studies and explores legislative proposals each year.
On future goals, Deeds said that continued support for community service boards — a public health resource — can help, but that the state should explore how private sectors can become more robust too.
“We also have to be looking at the private sector providers to find out what kind of barriers we have to building the workforce, and what kind of barriers are out there that prevent effective mental health care in every part of the commonwealth,” Deeds added
To help address some of the workforce shortages, Sen. Tara Durant, R-Stafford, carried a bill that will help create pathways for people with community college degrees to enter mental health professions as technicians and technician assistants. Del. Rodney Willett, D-Henrico, introduced legislation that can make it easier for people with master’s degrees in psychology to practice independently.
Harrison Hayes, the director of the Virginia Health Workforce Development Authority, also pointed to a program funded by the state government and the Virginia Health Care Foundation that’s aimed at helping accelerate the licensure of social workers and counselors.
Despite Virginia’s various efforts to better fund mental health resources in recent years, Deeds said there’s still more work to do.
“The reality is, we’ve chronically underfunded mental health over such a long period of time,” he said. “It’s going to take a lot of years to get this right.”
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