Speakers vent frustration over Virginia’s mental health system

A town hall meeting on proposed reforms to the state’s mental health system turned into a forum for venting frustration Monday afternoon, the loudest applause going to a speaker who predicted that nothing was going to change.

“These are the same slides we saw 12 years ago,” said Bill Farrington, former president of the Virginia chapter of the National Alliance on Mental Illness. “You’ve got to have the numbers. I just see another meeting like this five years from now.”

Farrington’s comments followed presentations by the four “transition teams” appointed by the Virginia Department of Behavioral Health and Developmental Services. The town hall meeting was the first of four to be held around the state. More than 100 people attended Monday’s meeting, held at the Williamsburg Regional Library.

Others spoke emotionally about the difficulty in obtaining long-term inpatient care for family members; the lack of transitional care or supportive housing for those leaving hospitals; and the barrier imposed by the Health Insurance Portability and Accountability Act, known as HIPAA, to obtaining needed care for young adults in crisis.

“I’m retired military. I’ve cried and begged,” said one speaker, who didn’t want to give his name. “Surely HIPAA was about insurance companies not sharing information and wasn’t about keeping information from family,” he said. “Let’s make a change.”

Another of the dozen speakers who took advantage of the 30-minute public comment period noted that none of the teams even addressed access for Virginia’s foreign-born population — 15 percent, or approximately 950,000 people. She asked that the department focus on barriers to care presented by race, ethnicity and language.

The overlapping themes that emerged from presentations by leaders of the four teams — adult behavioral health, adult developmental services, children and adolescent behavioral health and justice-involved services — included the need to address the “fragmentation” of the system, reduce barriers to access, coordinate care, improve the training of providers, and maximize public funding streams.

The need for comprehensive substance abuse disorder services also emerged as a top priority across different populations.

The proposed reforms included:

* Creating “medical homes” at community services boards to provide primary medical care together with mental health care for those with a serious mental illness.

* Measuring recovery outcomes in “real life” terms, such as housing stability and employment, rather than hospitalizations.

* Exploring increasing Medicaid reimbursement for substance abuse treatment and allowing it for treatment of those under an emergency custody order or temporary detention order, as other states do.

* Providing Medicaid funding for peer support programs, as other states do.

* Implementing a “waiver” redesign to include needs-based supports for those with intellectual and developmental disabilities; almost 10,000 Virginians are on the waiting list for waivers with almost 5,000 designated as having an urgent need.

* Looking at the feasibility of using a single state contract for psychiatric medications in correctional settings, in order to provide them consistently.

* Educating criminal justice personnel in risk assessment in order to target services more effectively.

* Expanding the use of tele-psychiatry, particularly for in-home services for children, and for those in jail.

* Educating all health-care providers in screening for substance abuse disorders.

The agency’s commissioner, Debra Ferguson, said the proposed overhaul would be a two-year process with public comment bolstering the work of the four teams. She declined to answer questions.

Attendees were encouraged to submit comments in writing both on site and online at http://www.dbhds.virginia.gov where the full list of recommendations and upcoming town halls can be found. Public comment will be taken until May 31.

Salasky can be reached by phone at 757-247-4784.