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Budget addresses mental health reform Creigh Deeds column: State budget addresses mental health reform - but the work goes on

Richmond Times-Dispatch - 7/1/2018


The joint subcommittee has less than two years to complete our work, but many tough questions remain.

By Creigh DeedS

In February 2014 Susan Schaar, the clerk of the Senate of Virginia, shared with me a column from The Roanoke Times written by former senator and judge Dudley J. "Buzz" Emick. At the time, his words stung because the implication was that I needed to ask for more than what I was seeking during the 2014 General Assembly session. Time always provides some perspective.

Four and a half years ago I had only a basic understanding of our mental health laws and did not know enough of the intricacies of the system to even ask the right questions. Therefore, creation of a joint subcommittee to focus on the core problems became my top priority. After four years of work, I hope we have made a difference. With the implementation of STEP-VA, an acronym for mental health system transformation, we are expanding the services that community services boards (CSBs) must provide to the public, and supporting that effort with additional resources. We have made progress on issues such as alternative transportation and telemental health. We continue to explore the confounding nexus between the criminal justice and mental health systems to get more people into treatment.

The pinnacle thus far, however, is the adoption of the 2018-2020 biennial state budget. The budget includes money to further implement STEP-VA - including $11.8 million to expand same-day access to the remaining CSBs, $11.1 million to implement primary care screenings, and $15 million for outpatient services. Beyond those priorities, we also invested an additional $7 million for alternative transportation, $6.9 million for discharge assistance planning for individuals at our state facilities who are ready to return to their communities, $7.1 million for permanent supportive housing, and $3.2 million for jail discharge planning. The list goes on. In total, the budget provides an additional $84.1 million in community-based mental health spending. Coupled with the expansion of Medicaid, the budget recently signed by the governor holds so much promise for individuals struggling with mental illness and their loved ones.

Oftentimes I compare the work of mental health reform to eating an elephant. Despite every bite taken, a massive amount of work remains. The joint subcommittee has less than two years to complete our work, but many tough questions remain.

How do we continue this commitment in phasing in the requirements of STEP-VA and increasing the uniformity of available services throughout the commonwealth? Does our system promote serving people in the least restrictive environment possible and strike the right balance between spending on inpatient and community services, both public and private? Are the financial relationships between the state and the CSBs aligned to promote community services? How do we address the current pressure on state beds without losing our focus on community services? Permanent supportive housing is the best way to provide stability to those who struggle with mental illness, but identifying the necessary resources to meet the demand is challenging. How else can we incent the growth of supportive housing? Of course, the services are meaningless if we do not have the providers. What can we do to address existing workforce challenges? How do we increase the number of people looking to enter the mental health field? How do we secure sustainable and consistent state funding with intense competition for limited financial resources?

This list of questions is not exclusive or exhaustive, and answers will not be easy to identify. In Virginia, we have 40 very diverse CSBs, nine hospitals for adults, and one for children. Virginians with mental illness and their families deserve a system that works for them. A system that does not discriminate based on where one lives. And a system that is efficient and accountable. I am hopeful that our work would meet the late Judge Emick's charge to "be expansive."

The work goes on.

R. Creigh Deeds represents the 25th District in the Senate of Virginia. Contact him at


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