VCC Summer-Fall 2021

V irginia C apitol C onnections , S ummer /F all 2021 17 Will Surplus Offer Solutions? By BONNIE ATWOOD “Back-to-School” just isn’t what it used to be. For as far back as anybody can remember, it has revolved around new shoes, new lunchboxes, fresh notebooks, and jumbo boxes of crayons. Unfortunately, today it means, shots, masks, distancing, and endless wars of the grown-ups. On the “good news” side, Virginia’s state surplus is in surplus to the tune of $2.6 billion (with a B!) dollars. Yes, it sounds like a lot of money, but for education alone, we’ve got a lot of backlog to make up for.We’re coming out of a tragic year when our children were held back in in-person learning, social skills, too many cases of lack in technology, and perhaps worse, a severe exposure to stress and fear. The one-time surplus is specified as a short-term investment. It can be used for repairs, for example, but not for the continuing expenses of new schools. Closely related to education is the housing crisis. As family finances were drained due to the pandemic, some potential eviction notices were withheld. But small landlords have bills, too, and the trouble trickled along until a halt to eviction had to be put back on the table. “Fund Our Schools,” a large coalition of primarily education groups is asking for investment in the Virginia Housing Trust Fund, as well as environmental initiatives. Significant funding is required to be put in a “rainy day” fund, and constituents debate about how hard it is raining as we speak. As always, the tax code is under re-inspection, as some call it “upside-down,” according to the Commonwealth Institute, with people making $17,000 a year in the same bracket as millionaires. Decisions on spending are always hard. That’s why we elect those people who we think are especially good at it. But they need to hear from us. Schools? Housing? Environment? You elected the best and the brightest. Tell them what you think. Bonnie Atwood is a lobbyist, writer, and editor. You can reach her at BonAtwood@verizon.net . Virginia’s Mental Health System: Where We Are; HowWe Got Here; and Where We Need to Go By ANNA MENDEZ In July, the Commissioner of the Department of Behavioral Health and Developmental Services froze admissions to five of Virginia’s eight state psychiatric hospitals. Even prior to the pandemic the census at the state hospitals had been at or above 100 percent. Coupled with the workforce shortages triggered by COVID, causing some facilities to operate at 50 percent staffing, admitting new patients became untenable. Patients and staff could not be kept safe and the right to receive care could not be met. While the admissions freeze was unprecedented, it was not surprising. Commissioner Alison Land had been regularly briefing the Deed’s Commission on the growing crisis. In addition to her reports leading up to the freeze, Virginia’s mental health care policy experts have anticipated a system meltdown for sometime, COVID-19 simply accelerated it. The system collapse was inevitable becauseVirginia has historically done two things simultaneously: dangerously underfunding public mental health care while directing the majority of what it does spend on inpatient psychiatric care. Despite being the tenth wealthiest state in the country, Virginia ranks 30th in per capita public health care spending. There are many reasons for this lack of investment, including lingering prejudice and discrimination against people with mental illness rooted in assumptions that mental illness is a character defect or moral failing. But the leading cause is purely economic: Virginia’s antiquated tax structure, much of which is 100 years old, does not generate revenue adequate to meet the needs of the Commonwealth. What minimal revenues Virginia does direct to mental health care are disproportionately spent on inpatient care, maintaining the third highest number of beds on a per-capita basis among the 50 states. Virginia spends 75 cents of every public mental health dollar on hospital beds and only 25 cents on community-based services shown to prevent hospitalization. This spending structure is the opposite of the rest of the nation. Overinvestment in hospital beds does not prevent mental health crises; rather it creates a perverse positive feedback loop that results in overreliance on inpatient care. Evidence shows that with the appropriate supports most persons with significant mental illness can avoid hospital-based care. Currently, these supports do not exist in Virginia in a quantity great enough, or quality high enough, to effectively prevent hospitalization. The notion that the majority of mental health crises that lead to hospitalization or incarceration are unpredictable is false. The nature of mental illnesses are such that rarely does a person go from being well to being incarcerated or hospitalized overnight. There are generally many opportunities for interventions along the trajectory to crisis but Virginia has not yet invested in the robust establishment of these community based services and supports. In addition to inadequate public mental health care spending, and a relative overinvestment in psychiatric hospital beds, two other variables deserve some credit for the current crisis. One is Virginia’s behavioral health workforce shortage. Increased funding, for increased salaries, will help address retention, but structural solutions that encourage people to enter the field are also necessary. The second is the declining number of patients experiencing a Temporary Detention Order (TDO) admitted to private hospitals. The fewer TDO patients accepted by 888-729-7428 • shavoffice@shav.org • shav.org See Virginia’s Mental Health System, continued on page 19 V